What is the scale and scope of the intersecting discrimination faced by women affected by leprosy?

Lessons from Bangladesh: a quantitative study

Most people working in the field of leprosy could tell you that women affected by leprosy face intersecting forms of discrimination, but we rarely have an opportunity to see that quantified. The Leprosy Mission's team in Bangladesh has done exactly that so they could provide input to a report by the UN's CRPD Committee.

Their insights came through a quantitative study of 150 women and girls with leprosy-related disabilities, giving all of us a window on what this intersecting discrimination looks like in numbers and what the consequences are. The study has generated profound findings into the lives of the respondents, which statistically demonstrate various forms of discrimination.

It is a window into Bangladesh, but also an insight for women worldwide.

The findings show that a combination of inequalities have enabled the functional exclusion of the respondents within their communities.

Additionally, the results demonstrate a rational understanding amongst respondents that government assistance, legal protections and equal access to healthcare is unattainable for women with leprosy related disabilities. This enables further exclusion from everyday life, as women do not attempt to seek guidance or support from systems which should rightfully protect them.

This article breaks down the data findings into three key inequalities that enable discrimination: the cycle of poverty, access to healthcare, and government failings in implementation of necessary or quality services, policies, and programmes.

Photo Credits - Ruth Towell

The Cycle of Poverty

The cycle of poverty or cycle of deprivation refers to the perpetual nature of poverty-related disadvantages, which creates a trap of low income, poor health, and limited opportunities. This was identified within the study through a variety of economic disadvantages, including access to the labour market, access to education, and a lack of information or communication about social assistance.

‘Have you been denied accommodation – such as ramps or assistance – at work, school, or other public places?’.

52.7% of respondents answered ‘N/A - I don’t enter these places’, indicating a rational understanding or anticipation that respondents will face physical access barriers in their attempt to enter such places. This enables the functional exclusion of women and girls from fundamental parts of life such as participating in education or the labour market.

‘If you are a teenager or young women, have you faced barriers to attending school?’

22% of respondents answered that they never had the opportunity to go to school, and 8% said they face active discrimination or accessibility issues whilst at school. This points to the functional exclusion of girls within the education system, limiting their ability to attain the necessary education required of many roles within the labour market. This result evidences the cycle of poverty in action, one disadvantage enabling further disadvantages that will persist along the life course.

‘Do you have secure access to housing or land ownership, or are you deprived of it?’

58% of respondents answered that they live with friends or family and do not have any personal accommodation. Economic barriers have contributed to the systematic denial of necessary economic security required to own a home or land. Women therefore become vulnerable to eviction, ostracism, displacement, dependency, and may even lead to feelings of being a burden. This also evidences the functional exclusion of women with leprosy–related disabilities in participating fully within their community's and wider society.

‘Have you been able to find employment opportunities despite your disability?’

Most respondents answered ‘N/A’ and 35.3% of respondents answered, ‘I didn't try because of stigma or inability’. Collectively, these answers suggest the rational understanding that there are no opportunities within the job market for the respondents. Respondents' access to job opportunities is greatly limited and suggests a wider issue of discrimination within the job market for those with disabilities.

Overall, the answers provided demonstrate a bleak picture of respondents' access to financial or economic inclusion within Bangladesh. They are consistently sidelined from accessing opportunities and have subsequently disengaged in seeking education or employment. This directly fuels the cycle of deprivation and therefore furthers discrimination within Bangladesh against women and girls affected by leprosy-related disabilities.

Photo Credits - Ruth Towell

Limited access to healthcare

Limited healthcare access, both physical and perceived, was identified as a major issue in respondents survey answers. The data collected clearly points to a variety of barriers that have and continue to prevent women from accessing essential healthcare.

‘Have you ever faced any barriers in accessing Sexual Reproductive Healthcare (SRH)?’

34% responded that they haven't attempted to access such services, suggesting a rational understanding that their SRH needs will not be provided for by current healthcare systems.

A combined 50% of respondents reported that they faced direct deprivation, significant stigma or don't attempt to access such services. Discrimination within healthcare services, especially considering the sensitivity of such healthcare needs, is detrimental to respondents self-confidence and bodily autonomy.

‘Are healthcare facilities in your area designed to support women with limited mobility?’

A combined 82% of respondents answered that healthcare facilities are not accessible, suggesting insufficient support, no support or a lack of knowledge about support.

Accessible healthcare is the exception, not the rule.

Monika Biswas

Photo Credits - Ruth Towell

These responses provide “irrefutable quantitative evidence that the inaccessibility of healthcare facilities is not a minor inconvenience but a severe form of systemic discrimination, directly contravening the principles of reasonable accommodation and equal access for persons with disabilities.” Therefore, access to healthcare provisions in Bangladesh are unequal and require dramatic change.

Goverment failings

The third issue identified in respondent answers suggests government failings in the provision or implementation of high-quality services, policies, programmes or initiatives. Additionally, a lack of trust or willingness to engage with the legal system in Bangladesh when faced with discrimination was identified as a major issue for respondents.

‘How has the combination of poverty and leprosy-related disability affected your access to basic services and opportunities?’

A combined 56.6% of respondents answered that they are severely limited or somewhat limited in their access to basic services and opportunities. This further evidences the systematic failure of governments to provide a meaningful safety net to those who face disability and economic hardship. Respondents evidently are not receiving adequate or appropriate treatment from the government, allowing the cycle of poverty to persist without question or redress.

‘Are there any programmes in your area that help girls with disabilities continue their education?’

A combined 78% of respondents indicated that these programmes are not available, or that they are not aware of any. Such responses suggest a lack of service delivery provided by government bodies and barriers in outreach related to current initiatives.

A lack of targeted educational programmes is not a minor oversight but a primary driver of the high dropout rates and illiteracy that perpetuate the cycle of poverty and discrimination for women and girls with leprosy-related disabilities.

Monika Biswas

‘As a woman with a leprosy related disability, do you receive any form of social security or government assistance?’

31.1% of participants stated that they were not aware of any, which suggests government failing in distributing adequate information around social assistance and the beneficiaries right to access such provisions. 20% of respondents said they received benefits but that they are irregular or inadequate in supporting them and their needs. This undermines the purpose of social security. When paring social security failings with women’s limited access to the labour market identified in previous responses, the cycle of poverty and exclusion continues to permeate in the respondents’ livelihoods.

Photo Credits - Ruth Towell

‘Have you sought legal help or compensation for discrimination or violence?’

Most respondents answered that they did not seek legal help when faced with discrimination. Ultimately, this response suggests that the greatest issue with intersecting discrimination is the positioning of women with leprosy-related disabilities as entirely other, ostracising them to such an extent that seeking legal help when crimes are committed against them is not a conceivable option. The rational understanding that nothing will be done enables further discrimination, allowing the cycle of exclusion to persist. In addition, eight respondents answered that they tried to seek legal help after discrimination had occurred but were discouraged by stigma or obstacles. Being denied the fundamental right to legal assistance is a truly concerning fact.

Government bodies in Bangladesh are critically failing women with leprosy-related disabilities; from no social assistance or educational programmes at all, to a lack of information about how to access them. The quality of social assistance which some have received is not adequate. Discrimination is then intensified by disheartening failings within the legal system, allowing the cycle of exclusion to continue.

Photo Credits - Ruth Towell

What can be done now?

Despite the current difficult situation presented by respondents’ answers, there is always room for positive change. Women with leprosy-related disabilities have identified one crucial legislative change they believe could make the greatest difference within their lives.

‘If you could recommend one change in Bangladesh’s laws and policies to better support women with leprosy-related disabilities, what would it be?’

62.7% of participants shared that formal recognition of leprosy patients as persons with disabilities is a foundational priority to ensure they receive adequate social assistance. Acknowledging this recognition at state level would enable women to claim their rightful disability allowances, demand reasonable accommodations for their needs and gain access to targeted healthcare and livelihood programmes.

This is not a mere preference, it is a clear-eyed diagnosis of the root cause of marginalisation… without this formal status, they remain invisible to legal and social protection frameworks.

Monika Biswas

This research was conducted by Monika Biswas alongside her team at TLM Bangladesh: Musfiq Rahman and Sujit Moulik. Article by Celia Mason.

Practical changes that would make a difference
Amending Legal Frameworks	Including leprosy-specific provisions in the 2013 Act to recognise unique impairments such as claw hand, and ulcers. In addition, mandate reasonable accommodations as a protected right.
Gender-Disaggregated Budgeting	Mandate dedicated funding for women with leprosy-related disabilities in National Leprosy Programme and Ministry of Women and Children Affairs programmes to address intersectional barriers.
Strengthen Data Collection	Systematically collect disaggregated data on gender, socio-economic status, ethnicity, and leprosy-specific disabilities to inform targeted policies.
Expand NGO Partnerships	Formalise collaborations between National Leprosy Programme, Ministry of Women and Children Affairs, and community-led groups (e.g. SHGs, ALO) to enhance awareness, service delivery, and advocacy.
Faith Leader Sensitisation	Scale up training for religious and community leaders to combat stigma, building on successful models like Nilphamari’s imam-led sessions.
Simplify Access to Benefits	Providing in-person support for rural and illiterate women to navigate online disability card applications and social protection schemes.
Targeted Livelihood Programs	Develop leprosy-friendly microcredit and skill training programmes, as suggested in Chuadanga, to address economic exclusion.
Healthcare Inclusion	Integrate leprosy-specific Sexual and Reproductive Health Rights and maternal care training for providers and ensure accessible facilities (e.g., ramps, female-friendly spaces).