The impact of unemployment on women with physical disabilities in Tamale, Ghana

Unemployment rates among persons with disabilities are high, with women being at greater risk due to the interaction of gender and disability. Although studies portray the inequality, oppression, and exclusion women with disabilities encounter, little research is available on the impact of unemployment on women with physical disabilities. This qualitative study explores the daily experiences of unemployed women with physical disabilities in Tamale, Ghana. Phenomenology and focus group research approaches guided this study, since so little is known about how unemployment impacts the lives of women with physical disabilities. Purposive and snowball sampling were used to recruit 10 women with physical disabilities for in-depth interviews. Purposive sampling was also used to recruit 14 representatives from the government and civil society organizations for two multiorganizational focus groups

THE IMPACT OF UNEMPLOYMENT ON WOMEN WITH PHYSICAL DISABILITIES IN TAMALE, GHANA by Augustina Naami A dissertation submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Doctor of Philosophy College of Social Work The University of Utah December 2010 Copyright © Augustina Naami 2010 All Rights Reserved The University of Utah Graduate School STATEMENT OF DISSERTATION APPROVAL The dissertation of Augustina Naami has been approved by the following supervisory committee members: Henry Lawrence Liese , Chair 09/30/2010 Date Approved Reiko Hayashi , Member 09/30/2010 Date Approved Caren Jean Frost , Member 09/30/2010 Date Approved Joannah Ellen Bettmann , Member 09/30/2010 Date Approved Cathy Elizabeth Chambless , Member 09/30/2010 Date Approved and by Jannah Mather , Chair of the Department of Social Work and by Charles A. Wight, Dean of The Graduate School. ABSTRACT Unemployment rates among persons with disabilities are high, with women being at greater risk due to the interaction of gender and disability. Although studies portray the inequality, oppression, and exclusion women with disabilities encounter, little research is available on the impact of unemployment on women with physical disabilities. This qualitative study explores the daily experiences of unemployed women with physical disabilities in Tamale, Ghana. Phenomenology and focus group research approaches guided this study, since so little is known about how unemployment impacts the lives of women with physical disabilities. Purposive and snowball sampling were used to recruit 10 women with physical disabilities for in-depth interviews. Purposive sampling was also used to recruit 14 representatives from the government and civil society organizations for two multi-organizational focus groups. Study findings are classified under two broad findings: poverty and inadequate social participation. Poverty stems from inadequate income due to unemployment and disability. Poverty impacts on the family and social relations of unemployed women with physical disabilities, their mobility, and recreational activities. Poverty also affects their ability to provide for basic necessities of life, and in the absence of welfare programs to lessen the effects of poverty, the majority are compelled to engage in begging and other iv menial jobs for survival. Inadequate social participation, on the other hand, results from the unemployment of women with physical disabilities and their nonparticipation in social support groups, as they cannot afford to pay approved membership dues and transport fare to and from meetings. Inadequate social participation has a bearing on the information unemployed women with physical disabilities receive, which further excludes them from mainstream society. Policy recommendations include awareness creation about the capabilities of women with physical disabilities; effective collaboration with other stakeholders to facilitate the advancement of women with physical disabilities; educating employers about tax benefits for employing persons with disabilities in general; training women with physical disabilities for new and challenging employment opportunities such as managerial roles; and affirmative action policies to ensure the education and employment of women with disabilities in general, as well as microfinance for their small scale businesses. I dedicate this dissertation to my parents and siblings for their invaluable support. TABLE OF CONTENTS ABSTRACT ……………………………………………………………………. iii ACKNOWLEDGMENTS …………………………………………………….. x Chapters 1. INTRODUCTION………………..………………………………… 1 The Ghanaian Context ….....………………………………………… 2 Overview of the Northern Region .…………………………………… 3 Persons with Disabilities …………………………………………….. 5 Globally ……………………………………………………… 5 Ghana ………………………………………………………… 6 Women with Disabilities . …………………………………………….. 10 Globally ……………………………………………………… 10 Ghana ………………………………………………………… 11 Purpose of Study ………………………………………………… 12 Significance of the Research ………………………………………… 13 Conclusion ………………………………………………………… 14 2. LITERATURE REVIEW……………………………………………… 16 Introduction…………………………………………………………… 16 Global Situation of the Unemployment of Women……………………. 17 Overview of the Unemployment of Women with Disabilities………… 18 The Interface of Gender, Disabilities, and Other Vulnerabilities……... 21 Women in Ghana ……………………………………………… 25 Women with Disabilities in Ghana……………………………. 28 Gender, Sexuality, and Identity……………………………….. 30 Social Support………………………………………………… 31 Feminist and Disability Movements and Women with Disabilities……………………………………………………. 33 Theoretical Perspectives of the Unemployment of Women with Disabilities………………………………………………………. 37 Social Model of Disability………………………………….. 38 vii Feminist Theory………………………………………………. 41 Conclusion……………………………………………………………. 43 Research Questions…………………………………………………… 44 3. METHODS…………………………………………………………… 46 Introduction…………………………………………………………… 46 Research Design………………………………………………………. 47 Rationale for the Use of Qualitative Research………………… 47 Phenomenological Research Approach……………………….. 48 Focus Groups…………………………………………………... 50 Research Paradigms…………………………………………………… 52 Research Participants………………………………………………….. 53 Individual Participants ………………………………………… 53 Focus Group Participants …………………………………….. 54 Ethical Considerations………………………………………… 54 Data Collection and Sources of Data………………………………...... 55 Procedure……………………………………………………… 56 Data Analysis and Interpretation……………………………………… 58 Analysis of Phenomenological Interviews……………………. 58 Focus Group Analysis………………………………………… 59 Use of Self in Research……………………………………………..... 60 Criteria for Ensuring Credibility and Trustworthiness of the Study.. .. 61 Conclusion…………………………………………………………… 62 4. RESULTS……………………………………………………………. 63 Introduction………………………………………………………… 63 Participants' Demographic Information……………………………. 64 Daily Living Experiences of Unemployed Women with Physical Disabilities in Tamale……………………………………………….. 64 Mobility…………………………………………………….. 65 Family Relations……………………………………………. 69 Social Participation…………………………………………. 73 Lack of Economic Participation……………………………. 78 Experiences with Employment………………………….... 82 Living Experiences of Unemployed Women with Physical Disabilities…………………………………………… 84 Managing to Survive: How Women with Physical Disabilities Manage to get Money for their Daily Living………………….. 87 Feelings about Life…………………………………………… 89 Perceptions of Stakeholders about the Impact of Unemployment on Women with Physical Disabilities in Tamale………………… 90 Family Relations…………………………………………… 90 Managing to Survive……………………………………... 93 Issues Associated with the Unemployment of Women with Physical viii Disabilities in Tamale……………………………………………….. 94 Attitudinal Issues…………………………………………… 94 Rehabilitation Issues………………………………………... 102 Other Issues………………………………………………… 107 Recommendations to Reduce the Impact of Unemployment and Chronic Unemployment Among Women with Physical Disabilities.. 110 Attitudinal Change………………………………………….. 110 Making Rehabilitation Centers More Effective…………….. 114 General Recommendations…………………………………. 118 Conclusion…………………………………………………………... 131 5. DISCUSSION ………………………………………………………. 135 Introduction…………………………………………………………. 135 Summary of Findings……………………………………………….. 135 Barriers to the Employment of Women with Physical Disabilities………………………………………… 136 The Impact of Unemployment on Women with Physical Disabilities………………………………………… 138 Findings Compared with the Social Model of Disability (SMD)…… 148 Implications…………………………………………………………. 150 Policy……………………………………………………….. 150 Practice……………………………………………………... 156 Future Research…………………………………………….. 157 Strengths and Limitations of the Study…………………………….. 158 Strengths …………………………………………………… 158 Limitations ………………………………………………… 159 Conclusion…………………………………………………………. 160 APPENDICES A. GHANA MAP……………………………………………………… 163 B. FOCUS GROUP RECRUITMENT LETTER……………………… 165 C. INDIVIDUAL INTERVIEW GUIDE ……….................................. 167 D. FOCUS GROUP INTERVIEW GUIDE……………………………. 171 E. CONSENT COVER LETTER FOR INDIVIDUAL INTERVIEWS ……………………………………………………… 173 F. INDIVIDUAL INTERVIEW GUIDE TRANSLATED IN DABGANLI…………………………………………………….. 176 G. CONSENT COVER LETTER FOR FOCUS GROUPS …………… 181 ix REFERENCES ……………………………………………………………… 184 ACKNOWLEDGMENTS I would like to acknowledge the Lord God Almighty for supplying all my needs throughout this journey, especially, physical strength and divine guidance. I could never have reached this far without Him. I would also like to acknowledge the dean of the College of Social Work, Jannah Mather, for her financial support. I am grateful to my dissertation committee and the faculty of the University of Utah College of Social Work. I was privileged to work with a good committee who selflessly supported and guided me through this journey. I owe my sincere gratitude to my committee chair and mentor, Dr. Hank Liese. Dr. Liese was a remarkable support not only for my dissertation but also in the whole doctoral program. Right from the day I arrived in the USA, Dr. Liese made sure that virtually nothing served as an obstacle in achieving my sole objective of obtaining a Ph.D. I am also grateful to Dr. Reiko Hayashi, who supported me to gain deeper insights into disability issues. I am equally appreciative to the rest of my committee members, Dr. Caren Frost, Dr. Joanna Bettmann, and Dr. Cathy Chambless, for their insightful and thought-provoking feedback. I am thankful to the women who participated in this study for willingly sharing their stories. Their honesty and trust was overwhelming. I am also grateful to the organizations who participated in the focus groups for eagerly sharing their perspectives xi about the impact of unemployment on women with physical disabilities in Tamale, Ghana. I am indebted to my family for their endless support and motivation since childhood. Their emotional support, motivation, and encouragement mean a lot to me. I could not have done this without their help. And to my two daughters, Claudia and Augustina, I thank them for their love and understanding. Last, I must mention my deep sense of appreciation to my American Mother, Dr. Carrie Wicks, and my personal mentors, Dr. Brenda MaGadney-Douglass and Dr. Emmanuel Boakye Chamba, for their prayers and inspiration. CHAPTER 1 INTRODUCTION Persons with disabilities are the world's largest minority group and they are estimated to include about 10% of the global population (United Nations Enable [UNE], 2008a). Social, architectural, transportation, institutional, and information barriers continue to prevent them from having access to available resources and opportunities to maximize their potential. For women with disabilities, the situation is worse, as a result of the interaction of gender and disability (The Disabled Women's Network [DAWN], 2007). For women with disabilities from Ghana, the situation could be more complicated, given the intersection of disability, gender, poverty, cultural beliefs and practices, negative perceptions about their capabilities, and geographic area. This chapter presents background information about the research setting, the Ghanaian context, as well as an overview of the Northern Region where the study was conducted. The situation of persons with disabilities and that of women with disabilities globally and in Ghana are presented in the chapter. The chapter concludes with a discussion on the purpose of the study and study rationale. 2 The Ghanaian Context Located in Western Africa, Ghana is bordered to the south by the Atlantic Ocean and to the north by Cote d'Ivoire, Togo, and Burkina Faso. Ghana, which was colonized by the British, gained independence in 1957. It is 239,460 square km in area with a population of approximately 23.4 million whose median age is 20 years and life expectancy is 59. There are about eight major ethnic groups and over 100 spoken languages in Ghana, but English is the official language (Central Intelligent Agency [CIA], 2008a). Poverty trends based on various studies estimate about 40% of Ghanaians to be poor and unable to access health facilities and get adequate shelter, clothing, and education. Approximately 27% out of the 40% are classified as "extremely poor," incapable of meeting their basic human needs, such as food. They are also likely to suffer from intergenerational poverty (Ghana Statistical Services [GSS], 2008b). Poverty in Ghana is defined both in terms of income and human development indicators. Ghana's Gross Domestic Product (GDP) per capita is estimated at US$1,400 and a GDP growth rate of 6.4% (CIA, 2008a). The Human Development Index is 0.532, which resulted in Ghana's rank of 135 out of 177 countries (United Nations Development Program [UNDP], 2008). By United Nations standards, therefore, Ghana is a least developed country. And the rating reflects Ghana's poor performance in meeting the health, sanitation, education, employment, and nutritional needs of its citizens. Both the National Health Insurance Scheme (NHIS) and safety net programs in Ghana established respectively in 2005 and 2008 are still at their teething stage and hence experiencing many difficulties. A majority 3 of Ghanaians cannot afford to pay the NHIS premium of GH¢ 7.2 (US$7), despite efforts of some administrators to collect the premium in installments (Ghana News Agency [GNA], 2008a). Moreover, in spite of the importance of good access to health facilities, only about 57.6% of Ghanaians have good access to health facilities. Comparatively, urban dwellers have better access to health facilities than Ghanaians living in rural areas, where poverty is said to be more concentrated (GSS, 2008a). Inadequate health facilities and bad road networks exacerbate the plight of rural dwellers in accessing health care. There is no doubt that education plays an important and dynamic role in a nation's development and yet, only 50% of Ghanaians 15 years old and over are literate. Of this number, 65.8% are males and 42.3% are females (GSS, 2008a). The unemployment rate in Ghana is estimated at 20% (CIA, 2008b) and 13.6% of Ghanaians are underemployed (GSS, 2008a). Consequently, about 12.8% of Ghanaian households have problems meeting their basic food needs (GSS, 2008a). Overview of the Northern Region The capital of the Northern Region, one of the 10 administrative regions in Ghana, is Tamale (see Appendix A). The Northern Region stretches over an area of about 70,383 square kilometers. It is the biggest region in Ghana and has 20 districts. The region shares boundaries to the north with the Brong Ahafo, the Upper East, and the Upper West Regions, and the Volta Region to the south. It also shares boundaries with two countries, the Republic of Togo to the east and Ivory Cost to the west. The 2000 population census estimated the population of the Tamale Metropolis at 293,881, comprised of 146,979 (50.1%) males and 146,902 (49.9%) females. More than 85% of the people in the Northern 4 Region live in rural areas, compared with the national average of 68%, and only 27% of rural dwellers have good access to health facilities (GSS, 2008a). While the northern sector recorded the lowest literacy rates in Ghana, the Northern Region recorded the lowest (22.6%) compared to the Upper East (23.0%) and Upper West (24.4%) Regions. Furthermore, while the national female literacy rate is estimated at 42.3%, it is only 15% in the Northern Region (GSS, 2008a). In the southern sector, agriculture for export, mining, industries, and urban commerce provide steady incomes year-round to the people. However, in the Northern Region, though 90% of the resident population is engaged in small-scale agriculture (mostly in crops such as maize, guinea corn, rice, cowpea, and yam), a hostile agro-climatic environment has presented few opportunities for high returns from farming. Additionally, what little produce is generated in the Northern Region encounters marketing difficulty as middlemen from the south do not give access for the produce to reach the southern markets. Farmers are therefore compelled to sell their produce at cheaper prices, thereby exacerbating poverty in the Northern Region (GSS, 2008c). Private sector involvement in the Northern Region is minimal. There are only a few smaller industries owned by native Ghanaians. These industries have not been able to expand to absorb the pool of the unemployed due to their inability to raise resources. All major industries are concentrated in the south, compounding the problem of unemployment and poverty in the northern region (GSS, 2008c). This situation persists, and the disparity between the southern and northern sectors continues to widen. Accordingly, in 2007, the government of Ghana allocated GH¢2,500 (US$2,600) to establish the Northern Ghana Development Fund (GNA, 2008b). The 5 government is also putting together a long-term development strategy that seeks to address the problem of that faces the northern region. The government seeks to encourage the private sector to invest in the region by exploring the region's competitive advantage in food production and by adding value to agro-processing. This might improve socio-economic lives of the people in the Northern Region. But the region has yet to experience the positive impact of the government's interventions. Persons with Disabilities Globally Persons with disabilities are the world's largest minority group and they are estimated to include about 10% of the global population (United Nations Enable [UNE], 2008a). Social, architectural, transportation, institutional, and information barriers continue to prevent individuals with disabilities from having access to available resources and opportunities to maximize their potentials. It is estimated that about 90% of children with disabilities of school going age in the third world countries are not in schools, the global literacy rate for adults with disabilities is 3%, and for women with disabilities only 1% (UNE, 2008a). Furthermore, the unemployment rate for persons with disabilities in developing countries is between 80 to 90%. Unemployment rates are between 50 and 70% for persons with disabilities in the industrialized countries (UNE, 2008b). This unemployment rate is high compared to the United States' national unemployment rate of 5.7% (Bureau of Labor Statistics, 2009) and the United Kingdom's 5.4 % (CIA, 2008c). 6 Additionally, several countries do not have accessible transport systems. In Ghana, there is no single accessible transportation system to ease the mobility of persons with disabilities. The majority of countries also lack free medical care and welfare benefits for persons with disabilities (Action on Disability and Development [ADD], 2007). Consequently, as Elwan (1999) notes, persons with disabilities account for 15 to 20% of the world's poorest and are among the poorest of the poor. Ghana The population of persons with disabilities in Ghana is approximately 10% (55.1% female and 44.9% male) of the country's total population of 23.4 million (Ministry of Employment and Social Welfare [MESW], 2000). The term "disability" in Ghana refers to people with physical, intellectual, or sensory impairment and mental illness. The causes of disability in Ghana are many and varied. Some occur through road accidents, amputation, and other diseases such as leprosy, measles, and polio. For many years, persons with disabilities have been regarded as less productive and have not been given the maximum opportunity to demonstrate their capabilities (MESW, 2000). Persons with disabilities in Ghana struggle with poverty and disablism in the Ghanaian society. Low societal expectations of their capabilities combined with architectural barriers, lack of access to transportation, lack of information, inadequate education and educational facilities, inadequate medical systems, negative cultural beliefs and practices, and few social welfare benefits propel persons with disabilities into poverty. Additionally, due to the stigma attached to disability, many disabled Ghanaians are 7 rejected by their families and survive on the street by engaging in petty trading and begging (MESW, 2000). Negative attributes of disability in Ghana derive from three underlying cultural beliefs. The first view connects physical wholeness and beauty on the one hand to cultural phenomena on the other. The second associates bodily wholeness with economic independence, while the third notion links disability to an invisible metaphysical order of things (Quayson, 2007). Ghanaians generally view impairment as a curse from God, gods, and ancestors for some sins committed by persons with disabilities or members of their families at some point in their lives (Agbenyega, 2002, 2008; Avoke, 2002; Kassah, 2008). These negative attributes conferred on disability have had undesirable consequences on persons with disabilities in terms of their education, employment, access to health care, and social life. Due to lack of access to formal education, a majority of persons with disabilities are trained at the Vocational Rehabilitation Centers (VRC), which are geared towards self-employment (MESW, 2000). The centers are being run with government subvention. It is expected that any persons with disabilities who wanted to be trained should have access to these training centers at no cost to them. Trainees live on campuses of the centers, which operate on the semester system. The projected training period is 2 years. According to the MESW, persons with disabilities who completed VRC training were provided with working tools, materials, and seed capital to start their own businesses. However, this assistance was terminated in 1992 due to lack of government funding. Globalization, which according to Stiglitze (2000) is self-regulatory and capable of ensuring efficient resource allocation, has eliminated traditional economic systems that 8 have employed persons with disabilities and allowed them to work at their own pace. The new system is characterized by competition, but persons with disabilities are seen as slow, incompetent, and always needing supervision, a perceived inherent cost that entrepreneurs would want to avoid. This has been compounded by a mass migration of the youth (both nondisabled and disabled persons) from the rural areas to urban centers, creating stiff competition for jobs that are virtually nonexistent. In 2005, in its quest to address the poverty situation of persons with disabilities in Ghana, the government directed every local government to allocate up to 5% of its share of resources from the government (district assembly common fund) to persons with disabilities to better their situation. This was heartwarming news for persons with disabilities, who experience difficulties in accessing mainstream funds/activities/programs due to attitudinal, informational, structural, and architectural barriers. "Ring fencing" programs, such as the 5% common fund, are easier for persons with disabilities to access since they know the programs are earmarked for them. A study by Naami (2006a) showed that the majority of local governments were not aware of this directive. Other local governments claimed they had given out all their allocated resources, while in reality only a few persons with disabilities received support from the funds. Still other local governments shunned persons with disabilities when they came to their offices to request the funds. By the third quarter of 2006, only 3 of the 34 local governments in Northern Ghana had allocated a total of GH¢ 57,251 (US$6,089) of the common fund to support persons with disabilities. In 2007, the government specified that 2% of the common fund be allocated for persons with disabilities. This is a step in the right direction, but the problem is whether district assemblies will comply with the new 9 directive. To further buttress this finding, many disability groups in Ghana recently complained about their inability to access the common fund (Joy Online News, 2009; Public Agenda, 2009). For example, one disability group leader from the Volta region notes, "This situation is not just peculiar to the Ho Municipality, but cuts across almost all the assemblies where the Chief Executives and the assembly members divert the funds meant for the PWDs into other developmental projects" (Public Agenda, 2009, ¶4). In 2006, in an attempt to minimize the issue of unemployment and poverty in the country, the government launched the National Youth Employment Program (NYEP). The NYEP seeks to empower the youth to contribute to the socioeconomic development of the country (Government of Ghana, 2006). The program has six modules (Youth-in- Agriculture; Waste and Sanitation; Auxiliary Health Assistants; Rural Education; Information and Communication Technology (ICT) paid internships; Industrial Attachments and Long Vacation Jobs). Though the NYEP has started creating jobs, the program is incompatible with the employment of persons with disabilities. For instance, most persons with disabilities cannot work in the Agricultural, Waste Management, and Sanitation modules as these modules are more labor-intensive. The ICT paid internships, Auxiliary Health Assistants, and Industrial Attachments and Long Vacation Jobs modules have also not been beneficial to persons with disabilities due to lack of or inadequate education and attitudinal barriers, primary obstacles to the employment of persons with disabilities in Ghana (MESW, 2000). Regarding the Education module, the majority of persons with disabilities in that sector are only craft instructors (teachers of arts and crafts, e.g., weaving doormats); barriers to education continue to deprive them of a good education and the professional development needed to qualify for the module. The NYEP 10 unfortunately has not resulted in employment for persons with disabilities. A National Health Insurance Scheme launched in 2005 is a poverty reduction strategy that might reduce excessive poverty and enhance the overall quality of life for Ghanaians. The National Health Insurance Scheme (NHIS), as discussed previously, is at its teething stage. It does not make enough provisions for persons with disabilities to access quality health care, a majority of whom find it difficult to pay the basic premium. The NHIS recognizes the need to make provisions for the poor and the vulnerable in society (including persons with disabilities) by creating an exempt category. However, according to the World Bank (2008), "Although the purpose of the NHIS is to provide a pro-poor alternative to the cash-and-carry system, there are still problems with identifying and registering indigents who are: (i) ‘exempt' from coverage" (p. 13). The term indigent in the NHIS policy is ambiguous, leaving the NHIS staff with a great deal of discretion as to whom they consider to be an indigent. Consequently, many persons with disabilities are left out of the exempt category and are unable to access the NHIS and enjoy its benefits. Compounding their plight are the negative perceptions that society holds about persons with disabilities. Women with Disabilities Globally Gender and disability interacts to create multiple vulnerabilities for women with disabilities. Those from developing countries experience discrimination on account of gender, disability, and geographic region (The Disabled Women's Network [DAWN], 11 2007). The multiple oppressions women with disabilities face support each other, creating inequalities for men and women with disabilities. Consequently, there is inequality in opportunities for women and men with disabilities (DAWN, 2007). For instance, the years of education of men with disabilities (22.7%) is more, compared to women (15.7%). Women with disabilities are less likely to have jobs, compared with men (Elwan, 1999), and women with disabilities experience unequal opportunities on the job, such as pay for equal work (UNE, 2008c). Ghana Ghanaians see persons with disabilities as a generic group; it does not matter whether they are men or women. Persons with disabilities are stereotyped with their disabilities and hence treated as such. However, people normally forget that, even within the disability community, there are both men and women. The needs of men and women in general (whether able-bodied or disabled) differ. According to Naami (2006b), women with disabilities are discriminated against more and live in more disadvantaged conditions than their male counterparts. Compared to their male counterparts, they are more disadvantaged in their opportunities, economical resources at their disposal, and the information they receive. The majority of women with disabilities are excluded from health care, education, and employment opportunities, thus making worse their poverty conditions. Some cultural beliefs and practices in Ghana also exist and perpetuate the inequality between men and women (Coalition on Women's Manifesto for Ghana [CWMG], 2004). The CWMG emphasizes that the gender inequalities in Ghanaian 12 society result in violations of the basic human rights of women with disabilities in all facets of life. One would expect that the disability movement would be sensitive to the plight of women with disabilities and consider their concerns and needs. However, issues and needs of women with disabilities are not a part of the main agendas of the disability movement in Ghana. These issues are sidelined in what is termed the "Women's Wing"; women's groups within the movement are responsible for organizing and advocating for the rights of women and children with disabilities. These groups have not been given the necessary attention they deserve and are virtually inactive and nonperforming. From the preceding discussion, it is clear that the plight of women with disabilities in Tamale is worse based not only on disability, but also gender, poverty, cultural beliefs and practices, negative perceptions about their capabilities, and geographic area. The overall impact of these issues is multiple vulnerabilities and exclusion for women with disabilities in Tamale in all facets of life, including employment. Thus, it is imperative to investigate the impact of unemployment1 on their day-to-day lives amidst these vulnerabilities. Purpose of Study A pilot study was conducted in Salt Lake City, Utah to determine the impact of unemployment on women with physical disabilities. The qualitative interviews with 5 women indicate that the following experiences of women with physical disabilities were the direct result of their exclusion from the labor market: (1) loneliness, (2) dependency, 1 Unemployment refers to the situation where women with disabilities are willing to work and are looking for jobs (paid or self-employment) but cannot find jobs. 13 (3) "living the struggle," (4) "not having fun," (5) inadequate income, and (6) "having unfulfilled dreams." Evidence from the pilot study suggests the impact of unemployment could be worse for women with physical disabilities from minority groups and geographic regions where safety-net programs (e.g., Social Security Income) are non-existent. The pilot study also suggests the need to investigate stakeholders' perceptions about the impact of unemployment on women with physical disabilities and what can be done to ameliorate the situation. The results of this study are discussed in more detailed in Chapter 5. This study explored the impact of unemployment on women with physical disabilities in Tamale, Ghana. The study used qualitative research methods, specifically, phenomenology and focus groups approaches. It used the social model of disability and feminist theory as the theoretical framework to understand the day-to-day experiences of unemployed women with physical disabilities. The study explored which findings are related to key principles of the social model of disability theory and which ones question it. Significance of the Research Women with disabilities have diverse training and experience that can add diversity to the workforce (UNE, 2008b). According to the UNE, diverse work groups develop better solutions to business challenges, build business reputation, and help businesses to get to more customers. The unemployment of women with disabilities impedes the diversity they could bring to workplaces. 14 Employment provides not only income but also opportunities for social participation; it increases psychological well-being and overall satisfaction, as well as the self-dignity and self-esteem of persons with disabilities. Employment is particularly important for persons with disabilities, especially women, since women with disabilities are among the more vulnerable and marginalized of society (Boylan, 1991; Lonsdale, 1990). Little research is available on the impact of unemployment on persons with disabilities. In fact, almost no research is available on the impact of unemployment on women with disabilities. What research does exist will be explored in Chapter 2. In Ghana, there is virtually no research concerning persons with disabilities in general. Thus, this dissertation will not only contribute to the literature on disability issues in Ghana, but will also specifically contribute to the literature on women with disabilities for both social work and disability studies. Conclusion This chapter discussed the Ghanaian context and gave an overview of the Northern Region, where the research will be conducted. The global and Ghanaian situations of persons with disabilities and women with disabilities were also discussed. The next chapter reviews the literature relating to the unemployment of women with disabilities, the interface of all the vulnerabilities confronting them, and how that impacts on their unemployment. The theoretical perspective of the study is also discussed. Chapter 3 focuses on study methods, including the study design, research paradigm, the use of self in research, participant selection, data collection and procedures, and 15 trustworthiness notes. Chapter 4 presents results of the data analysis. The final chapter discusses the study's findings and their implications for policy, practice, and future research. CHAPTER 2 LITERATURE REVIEW Introduction This chapter reviews the literature relating to the unemployment of women with disabilities. It also explores the interface of disability, gender, and other vulnerabilities and the effects that the interaction of these vulnerabilities generates in the lives of women with disabilities. The theoretical perspective of the unemployment of women with disabilities as well as the research questions posed for the study are also presented. In order to develop a general understanding of the impact of gender on employment, the general employment situation for women will briefly be explored. It is important to note that there is not much literature specifically addressing the unemployment of women with disabilities; that alone shows the marginalization of women with disabilties and their issues and needs. Thus, I will draw largely from existing literature on the unemployment of persons with disabilities. I will show that, due to the interaction of gender and disability, and the unpleasant consequences they produce, the employment situation for women with disabilities is problematic. 17 Global Situation of the Employment of Women Many countries in the world have passed laws directed towards equal treatment of men and women in the labor market, however, employment disparities are persistent, even in industrialized countries. In general, women are less valued in the world of work as shown by lack of equity in participation, pay, the kind of jobs they have, and the positions they hold. Studies conducted across the globe using both micro (Blau & Kahn, 2003) and macro data (Azmat, Guell, & Manning, 2006; Shelton, 1992; United Nations Economic Commission for Europe [UNECE], 2008) have converging findings regarding gender employment disparities. For instance, Blau and Kahn (2003) investigated the gender pay gap in 22 countries across the globe. The data were extracted from the International Social Survey Program between 1985 and 1994 and include countries such as the United States, Britain, Canada, Japan, Germany, The Netherlands, and Russia. The gender pay gap averaged between 14 and 84%. The study outcome reveals the following gender pay gaps: United States (40%), Britain (37%), Japan (85%), and Slovenia (14%). Apart from women being underrepresented in the world of employment, studies have shown they are also underrepresented in official and managerial positions while they are overrepresented as sales, clerical, and service workers. The UNECE (2008) found that, except for the United States and Lithuania, where the proportion of women among legislators, managers, and senior officials was rather high (54 and 47%, respectively), the rest of Europe and North America has a clear majority of men among legislators, managers, and senior officials. Trends in Europe and North America also show that women are less likely to be employers or self-employed, and no country within 18 the UNECE has attained a 50% proportion of women among these groups (UNECE, 2008). Despite the awareness of employment disparities and the need for equal pay for equal work, gender disparities in employment persist, with women being disadvantaged. Inadequate human capital, a low participation rate in the labor force, and discrimination are attributed to the predicament of women in the labor force (Azmat et al., 2006; Shelton, 1992; UNECE, 2008). Women with disabilities have the same social, economic, and other conditions as all other women. What makes the situation of women with disabilities different is the presence of a disability. Disability and gender interact to create more vulnerabilities for women with disabilities compared with able-bodied women and men with disabilities. This issue will be explored in detail in the following sections. Overview of the Unemployment of Women with Disabilities Women with disabilities experience several drawbacks due to gender and disability. Those from developing countries experience more vulnerabilities as they are discriminated against by gender, disability, and geographic region. The various forms of oppression women with disabilities face reinforce each other, resulting in unequal opportunities for women and men with disabilities (Emmett & Alant, 2006). According to Randolph and Andresen (2004), women with disabilities in the United States are at higher risk of being unemployed than men with disabilities, regardless of the disability type. Randolph and Andresen found that the unemployment rates for women with disabilities (55.1%) was much higher than their male counterparts 19 (45.3%), men without disabilities (11.7%), and women without disabilities (25.1%). Similarly, Smith (2007), who investigated the effect of disability and gender on unemployment rates, concludes that women with disabilities continue to experience consistently higher rates of unemployment compared to all other populations. For all years examined (1995-2002), rates of unemployment remained relatively consistent for persons with disabilities in general. Race, age, marital status, educational level, and income, which were all covariates, remain constant across the time period, leaving disability and gender as the only predictors of unemployment. However, the unemployment rates for women with disabilities remained fairly constant across time, compared with women without disabilities and men with disabilities. The average unemployment rate was estimated at 55.2% for women with disabilities compared to 44.8% for men with disabilities and 30.3% for women without disabilities (Smith, 2007). As is the case with women without disabilities, women with disabilities are underrepresented in official and managerial positions, while they are overrepresented in secretarial and service sectors (Lonsdale, 1990; U.S. Equal Employment and Opportunity Commission [EEOC], 2000). Many women with disabilities are employed in the service sector compared to men with disabilities. It is estimated that, in the United States, 1.8 million women with disabilities are employed in the service sector. This number represents 18.7% of women working in that category. For men with disabilities, only 1.1 million work in the service sector, representing15.3% of men employed in that sector (EEOC, 2000). Women with disabilities are not only less likely to be employed, but they also earn less than their male counterparts. While men with disabilities are almost twice as 20 likely to have jobs compared to women with disabilities (Elwan, 1999; Jans & Stoddard, 1999), working women with disabilities also encounter inequality at their workplaces, including pay for equal work (UNE, 2008c). For instance, Elwan notes that women with disabilities in full-time jobs earned only 56% as much as men with disabilities. In developing countries, the situation could be worse, but there is a dearth of literature to estimate the scope and trends of unemployment among women with disabilities. However, The Disabled Women's Network (DAWN, 2007) argues that the unemployment rate for women with disabilities in developing countries is almost 100%. The statistics presented above must be viewed with caution. Although most of the studies used national data bases with large sample sizes, they are not without limitations. Hence, care must be taken in generalizing the findings. Most of the studies in the United States concentrated on national datasets such as the Behavioral Risk Factor Surveillance Survey (BRFSS). These datasets focus only on the civilian population, leaving out persons with disabilities in institutions, hence minimizing the scope of the problem. In addition, according to Randolph and Andresen (2004), the BRFSS data do not distingushed between full-time and part-time employment. Therefore, it is not clear whether more women with disabilities are temporarily employed or not compared to men with disabilities and other populations. Most of the literature is based on Western and industralized countries such as the United States. Therefore, care must be taking in generalizing findings to developing countries as differences in geographic regions might result in various differences among the regions. 21 The Interface of Gender, Disability, and Other Vulnerabilities Available literature emphasizes that women with disabilities face double jeopardy in terms of oppresion because they are women and have a disability. Minority women with disabilities and those from the developing world experience a triple jeopardy, i.e., they are discriminated against because they are women, have a disability, and are from a minority group or from a developing country (DAWN, 2007; Emmett & Alant, 2006; Lonsdale, 1990; Prilletensky, 1996; Randolph & Andresen, 2004; Smith, 2007; William & Rogovsky, 1992). Studies have shown that women with disabilities face simultaneous oppression in all facets of life (DAWN, 2007; Elwan, 1991; Emmett & Alant, 2006; Randolph & Andresen, 2004; Smith, 2007; William & Rogovsky, 1992). For example, only 15.7% of women in the U.S. have 13 years or more of schooling, compared to 22.7% for men with disabilitites (Elwan, 1991). Women with disabilities receive fewer health services compared to their male counterparts. For example, in her qualitative study on the vulnerabilties of women with disabilities in Nepal, Dhungana (2006) discovered that about twice as many men with disabilities receive health services and other necessary mobility appliances compared to their female counterparts. Women with disabilities experience a high prevalence of various abuses, compared to their male counterparts (DAWN, 2007: Dhungana, 2006; Harris & Enfield, 2003; UNE, 2008a). Althoug women with disabilities frequently consult health care professionals for a host of reasons other than problems associated with their disabilities, two qualitative studies on medical care, gender, and disability (Lonsdale, 1990; Thomas, 2001) found that health care professionals often have difficulty 22 looking beyond the disabilities of female patients, often turning the necessary visits into traumatic experiences and at times the provision of inappropriate services (Lonsdale, 1990). For example, some of the women reported that some doctors get confused between their illnesses and disabilities and rather seek to cure them of their disabilities instead of concentrating on the illnesses; resulting in some of the women undergoing unecessary surgical proceedings. A review of the literature reveals inequalities in relation to vocational rehabilitation (VR) services women and men with disabilities receive; women with disabilities receive fewer VR services than their male counterparts. Vocational rehabilitation is one of the major existing interventions providing employment skills for persons with disabilities in general. VR programs are fundamental aspect of services planned to facilitate the effective participation of persons with disabilities in the community, as well as their economic development (Kosciulek, 2004). In spite of the importance of VR programs in job creation, receipients of the services have limited access to available jobs. Several studies in the United States have assessed the effectiveness of VR programs, nationally or by states, with employment as the main outcome variable (see for example Butterworth, Schalock, & Gilmore, 1998; Capella, 2001, 2003; Gibbs, 1990; Platt, 1995; Walls, Misra, & Majumder, 2002). Capella (2001) discovered that, of the consumers whose cases closed after they had received VR services for fiscal year 1997, only 61% were able to find jobs. Similarly, after examining trends across the years in one of the largest rehabilitation program, Walls et al. (2002) suggest the need to reconsider VR program strategies to ensure effective 23 actions that will benefit people with disabilities. The authors imply that current VR programs do not produce favorable employment outcomes for persons with disabilities. Even though vocational rehabilitation has not resulted in the expected employment outcome for persons with disabilities, research has shown that women with disabilities are worse off because they receive fewer VR services. For example, in 1996 in the United States, out of the total of more than 1.2 million people VR programs served, only 589,472 (43%) were women (Jan & Stoddard, 1999). Similarly, the VR program in Ghana has yet to realize the expected employment outcome for persons with disabilities in general. The VR programs (weaving, tailoring, dressmaking, shoemaking, and cooking) are not highly demanded in the modern market economy, which is very much service-oriented. For example, in 2000, the composition of the Gross Domestic Product (GDP) showed that the service sector had the largest share (38%), followed closely by agriculture (37%), and then industry (25%) (CIA, 2008). VR program services fall under the industry category, which has a smaller share of GDP. Boylan (1991, p. 27) defines VR services provided in developing countries as "second hand" services. These services are seem to be more restrictive and less beneficial because they disregard the potential of individuals with disabilities. The program neither provides employable skills to enable persons with disabilities to access jobs nor challenges them to maximize their potential. In addition, intermittent closures of VR centers due to inadequate funding and the delay of government financial support prolong training of participants. Insufficient funding also results in poor working conditions and low motivation for the center staff. Government funding is crucial for the success of VR programs (Boylan, 1991). Thus, the 24 cumulative effect of the problems of VR programs is that trainees are poorly prepared for the job market due to the poor quality of training they are given. As a result, persons with disabilities often get frustrated with the situation and prefer not to go for any training whatsoever. In an article entitled "Beggars with a Choice," it is noted that persons with disabilities are refusing to participate in VR programs because they claim that "similar training programs have yielded no positive results. We will not waste our time training again" (Ghana News Agency [GNA], 2004 ¶ 3). Research has shown that poor VR outcome, lack of access to the labor market, and poverty have caused many Ghanaians with disabilities to resort to begging on the streets in Ghana for survival (Appiagyie, 2006; Kassah, 2008). The situation could be worse for women with disabilities due to the interaction of gender, disability, culture, and other vulnerabilities they encounter in the Ghanaian society and the unfavorable consequences these interactions produce. This will be discussed in more detail in the next section. The seriousness of the isolation of women with disabilities from VR services, especially those from rural areas in developing countries, is emphasized by Boylan (1991). According to Boylan, none of the 55 successful VR programs in Africa, at the time of her study, had involved women with disabilities. Reasons given for this neglect are that "…the organisers did not think there were any disabled women in the areas, that the schemes were not relevant or that to include disabled women would present additional problems" (p. 28). Again, inequalities exist in relation to welfare and community assistance given to women and men with disabilities around the world. For example, in the United States in 25 1995, while women with disabilities received only 25.6% of social security benefits, men with disabilities received 30.6 % (Jan & Stoddard, 1999). In Nepal, Dhungana (2006) found that men with disabilities get better family and community support than their female counterparts. She notes that men with disabilities are encouraged to get involved in family and community activities but the women are discouraged from such activities. Women in Ghana This section discusses the general situation of Ghanaian women. Understanding this perspective might help us understand the condition of women with disabilities in Ghana as there is dearth of literature concerning women with disabilities in Ghana. Ghana has a rich culture and traditional values. This is exhibited in communal values such as respect for the elderly and diversity, as well as the sense of belonging to a community where the problem of one community member becomes the problem of the whole community (CWMG, 2004). Communities thus guard their members against any behaviors that might bring dishonor to the whole community. Communal values are also demonstrated in the festivals celebrated in Ghana. Festivals are mostly community/tribal-based and serve as dedication and thanksgiving to the gods. Festivals provide the opportunity for community members, those living within and outside the community, to get together. Although they still honor the gods, Ghanaian festivals today are also used as platforms to raise funds for community development projects such as schools, clinics, and community libraries. Examples of festivals and the people who celebrate them are as follows: homowo festival, Ga people of Accra; hogbetsotso, Ewe people of Anlo; and Damba, Northern and Upper Regions. 26 Another aspect of the rich Ghanaian culture is the belief in the extended family. The extended family include not only husband, wife, and children but parents, uncles, siblings, cousins, grand and great-grand relatives. Children are very much treasured in the family, irrespective of how they are conceived, i.e., whether within or outside of wedlock or the family. Much of the responsibility for family members rests on other family members due to the extended family belief system. Poverty and other socioeconomic conditions in contemporary times make it difficult for many families to assist those in need. It is estimated that about 40% of Ghanaians are poor, i.e., having incomes below the poverty line and hence struggle to meet basic human needs (GSS, 2009). Despite these communal Ghanaian cultural beliefs and practices, various forms of other cultural beliefs and practices in Ghana discriminate against women in general and perpetuate the situation for women with disabilities. Women are expected to marry and have children earlier than their male counterparts and are often blamed for marital failures and the absence of children in marriage (CWMG, 2004). While cultural practices disallow women from expressing their sexual desires even to their husbands, polygamy is allowed and widely practiced in some communities in Ghana, resulting in some men having multiple sexual partners. Polygamous marriages not only contribute to women's inability to negotiate for safer sex but also result in little attention from their husbands and bearing the burden of caring for self and children (CWMG, 2004). Women's inability to negotiate for safer sex also stems from the practice where women are expected to submit to men in general and their husbands in particular, irrespective of decisions at stake. Decision-making in marriage is solely a man's responsibility, as he is considered the head of the house. The situation is not different at 27 the societal level. Women are excluded from decision-making processes at all levels, including crucial matters that concern them, and some religious doctrines reinforce women's submission to men (CWMG, 2004). For example, in the mosques, women always sit behind the men. This same discriminatory seating is found in mosques in the Middle East and other countries around the world where Islam is practiced. And in some churches, women sit separately from men. Women's submission and lack of participation in decision-making originate from the way Ghanaians are socialized (CWMG, 2004). For example, girls are socialized to perform more household chores while boys do more masculine type of household work. Like their counterparts in other parts of the world (Dhungana, 2006), Ghanaian women are mostly associated with roles such as nurturing, mothering, wifey, and sexual partners. These perceptions about women limit their participation in the labor market (CWMG, 2004). The roles women play in the society, most times, are not paid for, tedious and lengthy. Instances are where rural women usually travel long distants in search for water and fuel, as well as doing manual laundry. They also travel long distances in search of food and cook daily since many of them do not own refrigerators. However, women's socio-economic contributions usually go unrecognized, as society considers those roles as appropriate for women. Their limited participation in the labor force results in their limited power and influence in decision-making both at home and in the community (CWMG, 2004). The perceptions about women discussed presently, affect the way institutions treat them in terms of employment and remuneration. On the other hand, it is deemed appropriate for men to work outside of the home as professionals. Men tend to control all the systems in the country including the economic, 28 political, legal, and cultural (CWMG, 2004). Though these practices are changing, many communities in Ghana still observe them. Women with Disabilities in Ghana Discriminatory practices against women in Ghana discussed previously may have more unfavorable implications for women with disabilities due to negative perceptions and prejudices relating to disabilities. Women with disabilities in Ghana, as their counterparts across the globe, are regarded as asexual. A situation that precludes them from perfoming the roles assigned to women in the society-wifey, mothering, and sexual partner (Lonsdale, 1990; Traustadottir, 1990). DAWN (2007) emphasizes that women with disabilities from the developing world experience a triple jeopardy: they are discriminated against because they are women, have a disability, and are from the developing world. But again, the lack of literature about women with disabilities in Ghana makes it difficult to determine the extent of the effect that the interaction of gender, disability, and cultural practices in Ghana have on women with disabilities. However, as noted in Chapter 1, Naami (2006b) found that women with disabilities in Ghana experience more discrimination and live in more disadvantaged conditions than their male counterparts. In some cases in Ghana, women with disabilities do not have control over their lives. They suffer exploitation and abusive practices (Naami 2006b; CWMG, 2004), a situation Lonsdale (1990) also found in her study. Although Lonsdale's qualitative study of 22 women with physical and sensory disabilities of different ages, races, and socioeconomic conditions did not specify how many experienced abuse, it gives insight into the abusive practices women with disabilities experience. These practices include rape, incest, sexual molestation, and the 29 intrusiveness of health and other professionals who feel they do not need permission to touch and manipulate bodies of women with disabilities. Similarly, Dhungana (2006) found that, in Nepal, husbands of those women with disabilities who are married often abuse them physically. The Coalition on Women's Manifesto for Ghana (CWMG, 2004) provides an overview of the situation of women with disabilities in Ghana. According to the Coalition on Women's Manifesto for Ghana, "Gender inequalities in the Ghanaian society result in even greater suffering and discrimination for disabled women" (p. 59). The CWMG emphasizes that women with disabilities in Ghana have limited access to education, health care, decision-making, and employment opportunities, thus aggravating their conditions of poverty (CWMG, 2004). Dhungana's qualitative study demonstrates how the patriarchal system in Nepalese society results in the stigmatization and marginalization of women with physical disabilities. From her interviews with 30 women with physical disabilities, Dhungana found disparities in education, employment, income, health care services, information received, and family and community support between men and women with disabilities. Of the 30 women interviewed, 13 had no education at all, 10 had a high school education, and only two obtained a bachelor's degree. Further, about twice as many men with disabilities received health services and necessary mobility appliances compared to their female counterparts. 30 Gender, Sexuality, and Identity A review of the literature brings to light the uncertainty that women with disabilities have about their identity. Though women with disabilities are just like all other women, the question is: does society see them that way? Society mainly considers women in general as having roles such as mothering, wifey, and sexual partner; however, society sees women with disabilities as incapable of performing the traditional roles assigned to women. Society considers the functional limitations of women with disabilities as impediments to performing traditional women's roles (Boylan, 1991; Lonsdale, 1990; Traustadottir, 1990). Labeling women with disabilities as asexual has considerable implications on their lives, including their sexuality, marriage, and mothering (Lonsdale, 1990; Traustadottir, 1990). For instance, Dhungana (2006) establishes the hesitation of men to marry women with disabilities because they believe women with disabilities cannot perform the traditional women's role. Moreover, husbands of those women who are married make every effort to disallow them from having babies because they believe women with disabilities cannot be good mothers. Studies have shown that parents of adolescent women with disabilities discourage their children from establishing intimate relationships and their sexual identities because the women are afraid that their children's dreams cannot be fulfilled (Boylan, 1991; Dhungana, 2006; Lonsdale, 1990). This perception limits the access of women with disabilities to sexuality education (Boylan, 1991; Lonsdale, 1990). Another difficulty that women with disabilities encounter in regard to their sexuality is how to meet potential partners. This is a barrier for women with disabilities in 31 their quest to develop their sexual identity (Boylan, 1991; Lonsdale, 1990). It is more difficult for them to find partners compared to their male counterparts (Boylan, 1991), and due to the stigma attached to disability, some men fear to develop relationships with women with disabilities (Boylan, 1991; Dhungana, 2006). Closely related to this issue of sexuality is society's idea of the perfect woman. A woman's body is linked to her self-image and women learn this at a very young age (Lonsdale, 1990). Women then become conscious of their body and their physical appearance, which are the yardstick society uses to judge who a woman really is. The perfect woman is perceived as someone with an attractive physical appearance (Lonsdale, 1990). Consider then a woman with some form of physical impairment; this social norm does not hold for her, which will impact her sexuality and marriage. For example, Boylan (1991) emphasizes that women with disabilities are less likely to marry compared to their male counterparts. This further drives women with disabilities into social isolation, and those who do marry experience considerable pressure to not let their disabilities interfere with the ability to perform traditional women's roles (Boylan, 1991; Lonsdale, 1990). The question is whether feminists and disability movements place the needs and issues of women with disabilites on their agendas for advocacy. Social Support Social support is defined as social relationships capable of providing individuals with tangible support or feelings of a sense of belonging to a loving or caring person or group (Hobfoll & Stokes, 1988). Social support includes emotional support, informational assistance, comfort, intimacy, tangible support, and physical affection 32 (Cohen, Mermelstein, Kamarck, & Hoberman, 1985; House & Kahn, 1985; Wallston, Alagna, & DeVellis, 1983). The importance of social support in the rehabilitation process is acknowledged in the literature (Belgrave & Walker, 1991; Cohen, & Syme, 1985; Jackson, Meade, Ellenbogen, & Barrett, 2006). Due to its significance in the rehabilitation process, it is recommended that social support be included in every rehabilitation effort (Belgrave & Walker, 1991; Cohen, & Syme, 1985; Jackson et al., 2006). The significance of social support is recognized in the area of community integration of persons with disabilities. For example, Hee-Young's (2005) study aimed at developing a model of factors relating to successful social reintegration of persons with spinal cord injury in South Korea. The author concludes by recommending the inclusion of social support, especially, family and community support, in social integration intervention for persons with spinal cord injuries. Although the literature is inconsistent about which types of social support predict employment outcomes for persons with disabilities, the literature notes the importance of social support in predicting employment outcomes for persons with disabilities. This phenomenon is identified among minority groups, especially Black persons with disabilities (Belgrave & Walker, 1991; Wilson, 1988) and African Americans with spinal cord injuries (Jackson et al., 2006). The association of social support, good physical and mental health, and general well-being is well documented in the literature (Barrera et al., 1981; Cohen, & Syme, 1985; Dadich, 2006; Hale, Hannum, & Espelage, 2005; Heller & Rook, 2001). For example, Hale, Hannum and Espelage (2005), who investigated the importance of social 33 support on college students' physical health, found that the sense of belonging and connection to others predicts good physical health. Similarly, Dadich (2006) investigated the impact of self-help support groups on young men recovering from a mental illness and found that social support networks improve the mental health of this population. Although the literature is not explicit about the importance of social support for women with physical disabilities who are unemployed, it can be deduced from the preceding discussion that social support is important for unemployed women with physical disabilities, especially those in Ghana, given that welfare programs are nonexistent in Ghana. Feminist and Disability Movements and Women with Disabilities Although there is inadequate empirical evidence to demonstrate the scope of the problem, available literature reveals that the disability rights movement and women's movement do not include issues of women with disabilities on their agendas (Deegan & Brooks, 1985; Lonsdale, 1990; Rubin, 1997; Traustadottir, 1990). Deegan and Brooks (1985) argue that the disability movements are dominated by men who focus their attention mainly on male concerns and hence give little attention to such women's issues as sexuality, relationships, and motherhood. This is validated in the case of Ghana. In Ghana, there are three major national Organizations of Persons with Disabilities (OPWDs) and an umbrella body for the OPWDs. They are: (1) the Ghana National Association of the Deaf (GNAD); (2) the Ghana National Association of the Blind (GAB); (3) the Ghana Society for the Physically Disabled (GSPD) ; and (4) the Ghana Federation of the Disabled (GFD), which is the 34 umbrella body of OPWDs. These organizations (except the GFD) have "women's wings" and branches all over the country. Women's wings are women's groups within the movements that are supposed to organize women and children with disabilities and advocate for their issues and rights. Issues and needs of women with disabilities are not part of the main agendas or plans of the OPWDs. These issues are relegated to the women's wings. However, the women's wings have not been given the necessary attention they deserve and are virtually inactive (Naami, 2006b). Women with disabilities have limited access to decision-making and full participation in activities of the disability movement. In addition, operating as women's wings in the different disability groupings does not give women with disabilities the opportunity for collaborative efforts; they do not have a common platform on which to address their issues and needs. Because they have been marginalized (within and outside the disability movement) for a long time, women with disabilities have become acquiescent, with an inferiority complex that impedes their full participation within the movement and in society as a whole (Naami, 2006b). The feminist movement, on the other hand, is criticized for considering women as a homogenous group, thus not taking into account disability and other vulnerabilities that further impact on women's lives. Women's experiences differ by race, ethnicity, class, sexual oreintation, and geographic background (Lather, 1991). For example, the experiences of women from Ghana (a developing country) differ from those of women in the United States (a developed country). Also, experiences of women with disabilities, who are doubly discriminated against on account of gender, disability and other vulnerabilities (e.g., attitudinal, architectural, transportation), will differ from those 35 without disabilities, even when they live within the same geographic region. In whatever way gender is constructed, it is important to recognize that disability and other vulnerabilities can complicate the problems that women face, particularly minority women. Another dimension of the exclusion of women with disabilties from the women's movement is the fact that meetings and conferences are often held in inaccessible places (Rubin, 1997; Traustadottir, 1990) and accommodations such as brail, taped meeting materials, and sign language interpretation are not provided at meetings (Rubin, 1997). The interaction of gender and disability is summarized and represented in Figure1. Figure 1 summarizes oppressions women with disabilities encounter in society. Gender inequality in our societies is an age-old tradition. The outer circle in Figure 1 represents society and its partriachal dogma, which oppresses women in general. The feminist movement started in the 17th century to advocate for the inclusion of women in mainstream society. However, as discussed earlier, the women's movement considers women a generic group and by so doing tends to ignore the issues and needs of women with disabilities (Deegan & Brooks, 1985; Lather, 1991; Lonsdale, 1990; Rubin, 1997; Traustadottir, 1990). This scenario is represented in the second circle. The disability movement exists to advocate for the inclusion of persons with disabilities in mainstream society as social, architectural, transportation, institutional, and information barriers continue to prevent them from having full access to available resources and opportunities to maximize their potential. However, the disability movement, just like the feminist movement, is criticized for not including issues of women with disabilities in their main agenda (Deegan & Brook, 1985; Lonsdale, 1990; Rubin, 1997; Traustadottir, 1990). The third circle captures this situation. 36 Society, and the feminist and disability movements, all tend to marginalize women with disabilities. As illustrated in Figure 1, women with disabilities are embedded within the disability and the women's movements as well as within society, none of which adequately include the needs and issues of women with disabilities. Different forms of oppression exist within each of the circles to perpetuate the situation of women with disabilities. For example, women with disabilities are regarded as asexual in society and hence are considered incapable of performing the traditional roles assigned to women (Lonsdale, 1990). This belief, coupled with the stigma attached to disability, has various negative consequences on the lives of women with disabilities in all spheres of life. It is important to note that the interaction of gender and disability is more than just an addition to the impact of oppression on the lives of women with disabilities. Gender, disability, and other factors (e.g., culture, geographic region, minority status) interact simultaneously to produce many and varied effects, all of which can have negative consequences for women with disabilities as discussed in the preceding section. To be visible and have their needs and issues addressed, women with disabilities have to overcome oppression and marginalization within the disability and women's movements and society in general. They have to challenge all these structures that exist to create and maintain disability- and gender-based discrimination and other forms of oppression. From the forgoing discussion, it is obvious that disability and gender operate to perpetuate the vulnerabilities of women with disabilities in both the developed and developing worlds. In the developed countries, there exist disability and other safety net programs to support persons with disabilties, including women, but in developing 37 countries (e.g., Ghana), these supports are nonexistent, exacerbating the situation of women with disabilities. The review of the literature elucidates the many forms of oppression women with disabilities encounter and their unpleasant consequences, which in turn perpetuate the unemployment situation of women with disabilities. The literature was explicit about the consistency of employment disparity between men and women with disabilities, with women experiencing higher rates of unemployment. Women with disabilities are not only less likely to be employed, they also earn less than their male counterparts and are underrepresented in managerial and other top official positions. Even though several studies portray the inequality, oppression, and exclusion that women with disabilities face in their daily lives, little research is available on the impact of unemployment on persons with disabilities in general. In fact, almost no research is available on the impact of unemployment on women with physical disabilities. In order to better understand this perspective, qualitative research is necessary. This study will explore the impact of unemployment on women with physical disabilities in Tamale, Ghana. Ways in which social oppression and exclusion of women with disabilities perpetuate their unemployment will be discussed with the help of narratives and descriptions provided by study participants. Theoretical Perspectives of the Unemployment of Women with Disabilities Two theoretical perspectives, the social model of disability and feminist theory, will guide this study. 38 Social Model of Disability The social model of disability acknowledges that a person with a disability might have functional limitations caused by physical, mental, or sensory impairment. However, instead of individualizing disability, the model places much emphasis on society as the cause of the problems that persons with disabilities encounter (Altman, 2001; Barnes, 1992; Finkelstein, 1980; Linton, 1998; Oliver, 1990; Union of the Physically Impaired Against Segregation [UPIAS], 1976). The social model of disability was pioneered by the Union of the Physically Impaired Against Segregation, an activist movement in Britain. The model was later formalized by Vic Finkelstein (1980) and Mike Oliver (1990). The main premise of the model is that society organizes itself in ways that exclude persons with disabilities in its activities (Barnes, 1992; Finkelstein, 1980; Oliver, 1990; UPIAS, 1976). Finkelstein's (1980) account of the social model of disability is based on a materialist framework and posits that the level of economic development in a particular society determines the exclusion or inclusion of persons with disabilities in mainstream development. Finkelstein asserts that there were three phases of economic development. In Phase One, persons with disabilities were not excluded from production processes and the rest of society. Although persons with disabilities participated in production processes, they formed part of the mainstream of oppressed groups. In Phase Two, Finkelstein argues that the rise of industrialization resulted in the exclusion of many persons with disabilities from the production process because they had to compete with others in the market economy. In this phase, persons with disabilities were regarded as a social problem since they could not be mainstreamed into society; rather, they were 39 segregated from mainstream society into institutions. In the final phase, Finkelstein posits that the invention and utilization of new technology (e.g., mobility aids) and effective collaboration between persons with disabilities and professionals will result in the reintegration of persons with disabilities into mainstream society. Disability in this phase is seen exclusively as a social restriction. Finkelstein's account of the social model of disability was criticized for a number of reasons. The first criticisim is based on historical inaccuracies. He was criticized for basing his Phase Two of the model, which discusses the industrial revolution, on an article written in 1894. This claim is inconsistent with the industrial revolution, which started in the 1750s (Oliver, 1986). In addition, Finkelstein's historical indication of when the segregation of persons with disabilities started is noted to be inaccurate. Based on available information, segregated treatment of persons with disabilities occurred around the Phase One period, not Phase Two as Finkelstein hypothesized (Oliver, 1986). Finkelstein's argument that persons with disabilities were treated kindly in Phase One has also been disputed from a historic perspective for lack of evidence (Oliver, 1986). The final critcism centers on Finkelstein's assumption that technological utilization would result in the independence of persons with disabilities and their integration into mainstream society. Oliver (1986) argues that Finkelstein's account did not clearly articulate how improved technology would advance the attitude of people towards persons with disabilities. These criticisms notwithstanding, Tregaskis (2002) emphasizes the merit in Finkelstein's model: It has been widely acknowledged as a seminal analysis, particularly in terms of its emphasis on disability as a social construction, and in seeing the big issues as lying within the relationship between the individual and society…these had to be 40 seen within a wider social context in which people with impairments are oppressed. (p. 460) Drawing on the work of Finkelstein (1980) and UPIAS (1976), Oliver (1990) frames disability as a social construction. He argues that the underlying principle upon which societies function is the distributive principle, i.e., goods and services produced in the society are distributed to the population as a whole because everyone in the society works. However, since not everyone in the society is willing or able to work, this group of people is classified as being in need of society's help. Disability therefore is perceived as a structural boundary category, lying between work-based and needs-based distributive systems. Persons with disabilities are perceived as being among the deserving poor, hence eligibile for safety net programs. Persons with disabilities in a capitalist system are therefore structurally defined as dependent (Oliver, 1990). Oliver argues that this kind of system is employed as a way to oppress and stigmatize persons with disabilities. Oliver's work has been criticized mainly for claiming capitalist economics as the cause of disability (Tregaskis, 2002). The social model presupposes that, beyond the functional limitations of persons with disabilities, certain barriers (e.g., structural, physical, architectural, transportation, social, information) exist to prevent this population from participating in mainstream society. Thus, disability is seen as a form of social oppression and exclusion Corker (1999). She argues that removing the structural barriers, noted to hinder the full participation of persons with disabilities in society, has not resulted in equal opportunities for women and other minority ethnic groups. Social model theorists later expanded the model to include analysis of a cultural perspective that might create and maintain the social exclusion of persons with disabilities. Shakespeare (1994) argues that "…a theoretical explanation which neglects 41 the disabling role of society, which ignores socio-cultural structures, is a mere fantasy. However, I would equally suggest that a mono-linear explanation, reducing everything to economic factors, is misguided" (p. 289). He asserts that persons with disabilities are discriminated against economically as well as by prejudice. Prejudice is exhibited in both interpersonal and cultural relationships that distinguish between the "self" and the "other," and it is evident in the stigmatizing language used and the negative imagery of persons with disabilities in the media and the literature. Cultural practices, therefore, according to Shakespeare, play a role in the exclusion of persons with disabilities. Although scholars in the disability field (e.g., Corker, 1999) have argued for the expansion of the model to account for the gender perspective of disability, there is not much literature to explain this perspective. There is still a need to include feminist perspectives on the exclusion and oppression of women to analyze the gender dimension of the impact of unemployment on women with physical disabilities. Feminist Theory The feminist movement started in the 60s and 70s. Though there are different perspectives of feminism (e.g., liberal, radical, socialist), feminist theory in general is rooted in the belief that women are oppressed simply due to their gender. The oppression is based on the dominant ideology of the patriarchal system, which privileges male power over women (Olessen, 1994; Robbins, Chatterjee, & Canda, 1998). The patriarchal system is dominated by men in the economic, political, legal, and social spheres. 42 Feminist theory posits that the patriarchal system creates and maintains boundaries and obstacles for women. This in turn results in unequal opportunities for men and women in all spheres of life (Olessen, 1994; Robbins et al., 1998). One way patriarchy results in the oppression of women is the creation and sustenance of the patriarchal dominance dogma by assigning different gender roles to men and women (Robbins et al., 1998). It is generally accepted practice that the roles women play in the society are those of mothering and nurturing while men are seen to play the role of professionals (Olessen, 1994). With regard to the unemployment of women with disabilities, feminist theory would conclude that women with disabilities experience unemployment because they are women. Although feminist movements have been criticized for failing to give a voice to women with disabilities and to include their concerns within the feminist agenda (Deegan & Brooks, 1985; Lather, 1991; Lonsdale, 1990; Rubin, 1997; Traustadottir, 1990), the feminist perspective can be used to analyze the gender dimensions of the unemployment of women with disabilities as the approach recognizes the social oppression that derives from sexism. The two theoretical perspectives discussed here are essential in exploring the relationships among disability, gender, and unemployment. The social model of disability help focus our minds on the need for change in society and the physical environment. Analysis through the social model of disability also has policy implications for it targets broader systemic issues (Shakespeare, 1994) behind the unemployment of women with disabilities. However, it is important to note that drawing from the principles of the social model of disability itself is not enough because the model does not adequately explain the 43 gendered nature of the unemployment of women with disabilities. Applying the social model of disability and feminist theory together will result in better understanding of the employment situation of women with disabilities. Conclusion From the discussion thus far, it is clear that the situation of women with disabilities in Tamale, Ghana, is complicated, given the intersection of disability, gender, poverty, cultural beliefs and practices, negative perceptions about their capabilities, and geographic area. The overall impact of these issues could create multiple vulnerabilities and exclusion for women with disabilities in Tamale in all facets of life, including employment. Additionally, low societal expectations about the capabilities of women with disabilities, combined with architectural barriers, limited access to transportation, low educational attainment, lack of information, inadequate medical systems, and few social welfare benefits, could compound their condition. Thus, the need to investigate the impact of unemployment on the day-to-day lives of women with physical disabilities amidst these vulnerabilities cannot be overemphasized. It is equally important to investigate what measures participants recommend as necessary to reduce the impact of unemployment and chronic unemployment among women with physical disabilties. 44 Research Questions The proposed study will consist of interviewing women with physical disabilities who are unemployed to understand the impact of unemployment on their lives. Stakeholders will also be interviewed to understand their opinions about the impact of unemployment on the lives of women with physical disabilities and what they consider could be possible solutions to the problem. The research questions are intentionally broad so as to capture the depth of the problem and to gather data in their fullness. The three research questions this study poses are the following: 1. What are the experiences of women with physical disabilities in Tamale relating to employment and unemployment in their social, economic, health, psychological, and legal contexts? 2. What do stakeholders in disability in Tamale consider to be the impact of unemployment on women with physical disabilities in Tamale? 3. What do both women with physical disabilities and stakeholders in Tamale recommend as ways to reduce the impact of unemployment as well as chronic unemployment among women with physical disabilities? The next chapter presents the research methods that will be used to answer these questions. 45 Figure 1. Diagrammatic Representation of the Vulnerabilities of Women with Disabilities Society Women's Movement Disability Movement Women with Disabilities CHAPTER 3 METHODS Introduction This chapter includes a discussion of the following major areas: (a) research design, (b) research paradigms, (c) research participants, (d) data collection and sources of data, (e) data analysis and interpretation, (f) use of self in research, and (g) criteria for ensuring credibility and trustworthiness of the study. The first section of the chapter, research design, provides a description and rationale for choosing qualitative research; specifically, it speaks to the selection of phenomenological and focus group approaches for the study. The research paradigms section will discuss the basic paradigms, constructivist and critical theory, guiding the study and the rationale for selecting them. The research participants section will address the participant sample and recruitment process as well as ethical considerations. The data collection and sources of data section addresses the study's data sources and procedures. The data analysis and interpretation section gives a detailed description of the data analysis and interpretation processes the research will use once data are collected. Under the use of self in research section, the researcher's background and position will be discussed. The final section of this chapter discusses criteria for ensuring credibility and trustworthiness of the study. 47 Research Design This section provides a description and rationale for choosing qualitative research; specifically, it speaks to the selection of phenomenological and focus group approaches for the study. The study was exploratory in nature. These methods were used to facilitate the understanding of the day-to-day experiences of unemployed women with physical disabilities in their personal, social, economic, political, and legal contexts. Rationale for the Use of Qualitative Research This study used a qualitative research approach. Qualitative research, according to Marshall and Rossman (1999), "is a broad approach to the study of social phenomena…and grounded in the lived experiences of people" (p. 2). Chapter 2 revealed the magnitude of the various forms of oppression that exist in society and the unpleasant consequences their interaction creates to perpetuate the unemployment situation for women with disabilities. Even though quantitative research methods portray the inequality, oppression, and exclusion that women with disabilities face in their daily lives, little research is available about the impact of unemployment on persons with disabilities in general. In fact, almost no research is available on the impact of unemployment on women with physical disabilities. For example, how do women with physical disabilities experience unemployment in their daily lives--economically, socially, and politically? To better understand this perspective, qualitative research was necessary. A qualitative study was used to facilitate the understanding of the perspectives of women with physical disabilities regarding the impact of unemployment in their lives and 48 the meaning they attach to this phenomenon. Deeper understanding of this phenomenon was captured through face-to-face interactions with women with physical disabilities in their social context (Marshall & Rossman, 1999). Phenomenological and focus group approaches were the two qualitative research methods selected as appropriate for this study. Phenomenological Research Approach Phenomenology "is the study of lived experiences and the ways we understand those experiences to develop a worldview. It rests on an assumption that there is a structure and essence to shared experiences that can be narrated" (Marshall & Rossman, 1999, p. 112). Phenomenology studies the participants' perspective of their worlds. It gives a detailed description of the content and structure of the participant's consciousness to understand and to explain his/her lived experiences and the essential meanings attached to those experiences (Kvale, 1996). Phenomenology "focuses on the deep, lived meanings that events have for individuals, assuming that these meanings guide actions and interactions" (Marshall & Rossman, 1999, p. 113). The purpose of the phenomenological approach is to describe and explicate the meaning and essence of a phenomenon that several individuals share (Kvale, 1996; Marshall & Rossman, 1999). This approach requires the researcher to give a full description of her background experiences that might impact on the study. Setting aside or bracketing the researcher's preconceptions enables her to better understand the essence of the phenomenon as experienced by the participants. This stage of the inquiry, according to Patton (1990) is referred to as epoche. 49 The researcher then identifies the essence of the phenomenon being studied. This phase of the inquiry process is called phenomenological reduction (Patton, 1990). Phenomenological reduction can be viewed as "an attempt to place the common sense and scientific foreknowledge within parentheses in order to arrive at an unprejudiced description of the essence of the phenomena" (Kvale, 1996, p. 54). This stage of the inquiry is important as it requires the researcher to identify the essence of the phenomenon being studied by setting aside his/her presuppositions and judgments. The approach requires the inquirer to cluster data collected around themes describing the phenomenon and exploring all emergent viewpoints and possible meanings of the phenomenon to make conclusions about the meaning of the phenomenon (Creswell, 1998). This is the final stage of the phenomenological approach. It is termed structural synthesis (Creswell, 1998). Structural synthesis is an important stage of the inquiry as it enables the researcher to make conclusions about the essence of a phenomenon from data collected. Why the Phenomenological Approach? Since so little is known about how unemployment impacts the lives of women with physical disabilities, phenomenology was the first approach selected for the current study. The phenomenological approach helped explicate the meaning and essence of unemployment among women with physical disabilities from their viewpoint, fostering our understanding about the daily experiences of unemployed women with physical disabilities. Phenomenology also facilitated our understanding of how the impact of unemployment and chronic unemployment among women with physical disabilities can 50 be minimized and/or alleviated. This approach requires the researcher to give a full description of his/her background experiences that could influence the study. Thus, an unprejudiced description of the essence of the impact of unemployment among women with physical disabilities and what could be done to change the situation is a possibility using this approach. Focus Groups A focus group is a qualitative research technique usually facilitated by the researcher or a moderator. The facilitator helps create a permissive environment and focused questions to foster discussion and the sharing of diverse points of view to help understand the research topic (Kruger & Casey, 2000; Marshall & Rossman, 1999). Focus groups are group interviews which generally consist of "7 to 10 people (although they range from as small as 4 to as large as 12) who…have been selected because they share certain characteristics relevant to the study's questions" (Marshall & Rossman, 1999, p. 114). Stewart and Shamdasani (1990) outlined seven typical uses of focus groups. They are to: (1) obtain general background information about a topic; (2) generate research hypotheses for further research; (3) stimulate new ideas and creative concepts; (4) diagnose potential problems with a new product, service, or program; (5) generate impressions about a program or service; (6) study a phenomenon of interest and facilitate the design of questionnaire and survey instruments for further research; and (7) interpret previously obtained quantitative results. Focus groups are noted to be difficult to maintain, compared to individual interviews, due to the differences in background of members and group dynamics (e.g., 51 some participants dominating discussions). I was sensitive to and handled group dynamics with caution during discussions. The analysis and interpretation of data from focus groups can also be difficult (Marshall & Rossman, 1999; Stewart & Shamdasani, 1990). Despite these disadvantages, focus groups have several advantages over other research methods. They have greater ability to generate interaction among participants to explore a research topic; they provide an opportunity to collect rich data from a range of people with diverse experiences and opinions about a topic of interest; they are comparatively easy and quicker to conduct and relatively cheaper than individual interviews; and the results can be easily understood (Marshall & Rossman, 1999; Morgan, 1988; Stewart & Shamdasani, 1990). Why Focus Groups? Since so little is known about how unemployment impacts the lives of women with physical disabilities, the use of focus groups was indicated. The focus group interviews sought to understand stakeholders' perceptions about the impact of unemployment on women with physical disabilities and what could be done to ameliorate the situation. Two focus groups of stakeholders working in the disability area from the government and civil society organizations in Ghana were considered for this study. Their different perspectives about the topic were compared and contrasted to better understand the phenomenon studied. 52 Research Paradigms A research paradigm is a set of basic beliefs that a researcher holds concerning the nature of the world (Linclon & Guba, 1985). Two research paradigms, constructivist and critical theory, guided this study and informed the selection of the research approaches. Constructivists believe that reality is constructed; it is socially and contextually specific and locally based (Linclon & Guba, 1985, 1994a, 1994b). A constructivist researcher, therefore, seeks to develop an understanding of meanings people make out of their experiences. Little is known about the impact of unemployment on women with physical disabilities; thus, the constructivist research paradigm attempted to help us understand the meanings women with physical disabilities in Tamale make out of their experiences with unemployment. Critical theorists, on the other hand, believe that reality is historical and shaped by social, political, cultural, economic, ethnic, racial, and gender values and crystallizes over time to become a status quo reality, accepted as natural and immutable (Guba & Lincoln, 1994a). Inquiry aims at exposing the injustices and inequities that exist in society due to the dominance of unequal power relationships and social structures (Guba & Lincoln, 1994a). Critical theory was necessary for this research as the study focused on a population, women with physical disabilities, demonstrated to be oppressed and marginalized in all facets of life due to the negative consequences that the interaction of gender and disability produce (DAWN, 2007; Elwan, 1991; Emmett & Alant, 2006; Randolph & Andresen, 2004; Smith, 2007; William & Rogovsky, 1992). Both critical theory and constructivist paradigms view ways of knowing as transactional and subjective, through the interaction between the inquirer and participants 53 (Guba & Lincoln, 1994a). This research was designed to involve a methodology that fostered interaction with women with physical disabilities in Tamale regarding their experiences with unemployment and hence generated knowledge about the impact of unemployment among these women. The constructivist and critical theory paradigms were both appropriate frameworks for developing a more descriptive worldview regarding the impact of unemployment on women with physical disabilities. Both paradigms furthered my understanding of the research topic. Additionally, since critical theory aims at social change, it helped to inform this study about the appropriate social action to pursue to lessen the impact of unemployment and chronic unemployment among women with physical disabilities (Guba & Lincoln, 1994a). Research Participants Individual Participants Ten women with physical disabilities between 20 and 45 years of age, unemployed and living in Tamale, Ghana, were interviewed in person for this study. Seven participants were members of the Ghana Society of the Physically Disabled (GSPD) and were recruited through purposive sampling. As Patton (2002, p. 230) notes, "The logic and power of purposive sampling lie in the selection of information-rich cases for the study in depth." Studying information-rich cases fosters "in-sight and in-depth understanding" (Patton, 2002, p. 230) of the phenomenon being studied. Participants were recruited from GSPD because the organization is familiar to me and easily accessible. Additionally, the organization focuses on issues of persons with physical disabilities, including women, the target population for the study. 54 To recruit the participants, I asked one of the leaders of GSPD to review existing records of the agency about women with physical disabilities for eligible participants. The eligible participants then contacted me (by telephone) for participation in the study. I also used snowball sampling to recruit 3 participants by asking participants from GSPD to refer me to other women with physical disabilities with whom they were acquainted, who were unemployed and not members of GSPD. Five non-GSPD members called me by phone, but only 3 were eligible for the study. Only those women who volunteered to participate in the study were interviewed. Focus Group Participants Two focus groups of stakeholders working in the disability area from government and civil society organizations (nongovernmental, faith, and community-based organizations and organizations of persons with disabilities) in Tamale were considered for this study. Six representatives from government organizations were interviewed in the first focus group and 8 representatives from civil society organizations in the second. To recruit stakeholders, a letter containing information about the study was given to appropriate agency personnel (see Appendix B). Interested stakeholders contacted the Principal Investigator by phone for participation. Ethical Considerations The study followed the ethical standards for human subject research provided by the Institutional Review Board (IRB) of the University of Utah. Participants were told that participation in the research was voluntary. Participants were also informed about the confidentiality of the study. They were told that information received from them 55 would be kept confidential and no one else would have access to the study data except the principal investigator. While in Ghana, data were stored in a secured office at the Ghana Society of the Physically Disabled. When I returned to the United States, data were stored in a secured office at the College of Social Work at the University of Utah, and only aggregate results of the study were shared and discussed in the research proceedings. All study participants were adults and hence, there was minimum risk for participation in the study. This information was shared with participants in a written informed consent in English that was read to them before the interviews. To maintain confidentiality, pseudonyms are used in all transcripts and research reports. All audiotapes and other identifying information will be destroyed after the dissertation is completed and articles are published using the data. Data Collection and Sources of Data Data for this study were collected from two main sources: in-depth interviews and focus group interviews. An interview guide consisting of open- and close-ended questions was developed for the in-depth interviews. The guide included a demographic section (e.g., age, marital status, number of children, education, type of disability, income level) and specific questions about the experiences of women with physical disabilities with unemployment in their personal, social, economic, political, health, psychological, and legal contexts (see Appendix C). The interviews were semistructured, which allowed participants to speak on areas of particular relevance to them. Interviews ranged from 1-2 hours each. Participants were interviewed until saturation was reached. All interviews were audiotaped, with participants' permission. 56 A separate interview guide was used for interviewing stakeholder groups. The focus group interview guide covered the same content and topics as the individual interview guide. This interview guide included questions on demographics (e.g., age, marital status, education, number of years in the current job) and perceptions about the experiences of unemployed women with physical disabilities in the social, economic, political, health, psychological, and legal contexts (see Appendix D). The interviews were semistructured, which allowed participants to speak on areas of particular relevance to them. The focus group interviews lasted 90 minutes each. Both interviews were audiotaped with participants' permission. As the principal investigator, I kept a journal that recorded field observations and issues arising from the field not captured on the audiotapes. These notes, together with the recorded interviews, were reviewed at the close of each interview. Issues arising from the reviews enabled me to develop strategies to fill in gaps in subsequent interviews. I also recorded the dynamics of the research context in the journal, which ensured awareness of self and helped control biases that could have been introduced into the study. Procedure Phenomenological Interviews Participants were informed about the purpose of the study. They were told that participation was voluntary. After they volunteered to participate in the research, the consent cover letter (see Appendix E) was read to each of them before the interviews. Participants were interviewed with an interview guide that contained both open- and 57 close-ended questions to elicit their daily experiences with unemployment. Study participants had little or no formal education; hence, the interview guide was translated in Dagbanli (see Appendix F), the local language spoken in Tamale. Eight interviews were conducted in Dagbanli with the help of a translator hired to assist in conducting the interviews. Translation and interpretation services were sought from the Ghana Institute of Linguistic, Literacy, and Bible Translation (GILBT) for the purpose of facilitating the interviews and back translation into English. These services were requested since I do not speak Dagbanli. Participants were given 15 Ghanaian cedis for participating in the research. Four volunteers from the individual participants reviewed and discussed the initial themes and gave me their feedback. Focus Group Interviews The focus group discussions with stakeholders were conducted in English. Participants were informed about the purpose of the study and about their voluntary participation. After they volunteered to participate in the research, the consent cover letter (see Appendix G) was read to them before the discussions. Stakeholders were not compensated for participating in the research. Both focus group interviews were audiotaped with participants' permission. Summarized preliminary analysis was personally delivered to all focus group participants for their feedback. I then contacted them by phone for their feedback. 58 Data Analysis and Interpretation Analysis of Phenomenological Interviews Analysis began with the first contact with respondents and remained fluid throughout the process. I reviewed each individual audiotape interview several times before transcription. I transcribed all audiotapes verbatim. The eight Dagbanli interviews were also transcribed into English by the interpreter. The data analyses were done by hand; that is, I did not use any computer software or program for the analysis. The transcripts were written in the form of narratives. The audiotapes became reference material to which the transcripts and journal could be compared. I read the qualitative data several times before the analysis. In the analysis, line-by-line coding was used for 5 of the 10 interviews. Initially, memos and diagrams were developed to conceptualize the data from the initial open codes of the five interviews to identify themes. Those five interviews were chosen because of the extent to which they were representative of participants' respective set and their richness to enable me to include as much variation as possible into the analysis. The selection of the five interviews was based on age, disability type, family relationship, marital status, and membership in GSPD. Four individual participants were reconvened to review and discuss the initial themes. Their feedback was incorporated into the analysis. Memos were developed to help the analysis. The analysis explored all emergent different viewpoints and all possible meanings of the phenomenon to make conclusions about the essence of the impact of unemployment on women with physical disabilities (Creswell, 1998). 59 Focus Group Analysis Data from the two focus groups were analyzed separately in order to differentiate the responses of the two categories of participants: (1) stakeholders from government organizations and (2) stakeholders from civil society organizations. The focus group data analysis was also done by hand. I reviewed audiotapes multiple times before transcription. The audiotapes were transcribed verbatim. The two focus group analyses were done separately. The analyses were done question-by-question, using the focus group interview guide as an outline. I read through the responses to each question on the interview guide several times to identify themes that shed light on the topic. These themes were put under their respective questions. After that, I read through the summaries of the two focus groups to identify themes that cut across questions and focus groups. Summarized preliminary analysis was personally delivered to all focus group participants for their feedback. I then contacted them by phone for their feedback, which was incorporated in the analysis. Themes emerging from both focus groups and individual interviews were then compared and contrasted to find common themes and to make conclusions about the impact of unemployment on women with physical disabilities. The social model of disability and feminist theory, discussed in the previous chapter, were used to evaluate and interpret themes emerging from the data. Emerging themes were compared with the two theoretical frameworks to determine which ones help inform or question them. 60 Use of Self in Research The phenomenological research approach requires the researcher to give a full description of her background experiences that might impact on the study. I am a woman with a physical disability and have been experiencing discrimination on account of gender and disability. My interest in disability issues began when I was in college. It was obvious that there were only a few persons with disabilities on campus. So I wondered where the rest were, since persons with disabilities are estimated to comprise 10% of the Ghanaian population of 23 million (MESW, 2000). The university environment had many access barriers. There were uneven steps and no ramps or elevators on campus. Government financial support for persons with disabilities in the college was limited. Further, the leaders of the disability group on campus were relatively inactive and did little advocacy for students with disabilities. My undergraduate degree was in economics because I thought I could not do any work that required working outside of an office. However, my passion for advocating for the rights of persons with disabilities grew while in college. After my college education, I worked with persons with disabilities for 4 years, taking them from the streets, giving them formal education and vocational training, and supporting them to establish their own businesses. After 4 years of working in an environment that teaches persons with disabilities how to become self-sufficient, I thought it was time to marry the practical skills that I had obtained with appropriate knowledge and theory. Thus, I pursued a master's degree in social work at the University of Chicago. After completing my master's degree program, I worked with women with disabilities for 3 years, building their capacity to advocate for their human rights as well as their socioeconomic and 61 political development. This background has given me insight into some of the issues women with physical disabilities encounter in their daily lives. Finally, as a social worker, I have the passion to advocate for vulnerable populations, especially women with disabilities. All these perspectives that influenced my choice of the study topic, research questions, and methodology might influence the data collection and analysis. However, to understand and interpret the real experiences of women with physical disabilities with unemployment, it was imperative to be aware of my own personal and professional experiences and bracket them (Kvale, 1996) so they do not contaminate data and study outcome. This process facilitated an unprejudiced description of the experiences of women with physical disabilities with unemployment with the women's voices being active. Criteria for Ensuring Credibility and Trustworthiness of the Study I put in place measures to ensure the credibility and trustworthiness of the study as Lincoln and Guba (1985) suggest. According to Lincoln and Guba, credibility of a study deals with the truthfulness of the outcome. To ensure the credibility of this study, I used member checking criteria. Four participants from the individual interviews were brought together to give their feedback after initial thematic analysis of data. In addition, summarized preliminary analysis was personally delivered to all focus group participants for their feedback. I then contacted them by phone for their feedback. Member checking, according to Lincoln and Guba, is crucial to establish the credibility of a study. I also used multiple data collection methods (in-depth interviews, focus groups, and a journal) 62 to deepen understanding of the phenomenon. Two theoretical perspectives were used to evaluate and interpret data from the study. In addition, I kept a reflexive journal throughout the study process to bracket my preconceptions and judgment at every stage of the process from the experiences of participants, thus ensuring a more accurate interpretation and understanding of the phenomenon studied (Kvale, 1996). Conclusion This chapter discussed the research design, paradigms, and study participants. Data collection methods, sources of data, and data analysis were also discussed. The use of self in research and criteria for ensuring credibility and trustworthiness of the study were presented. The next chapter presents study results. CHAPTER 4 RESULTS "Being unemployed is not a good thing because all the time I will be thinking and I always have sleepless nights" (Zara). "If you are not working you don't feel happy, you feel left out" (Mavis). Introduction This chapter discusses results of the study. The following major areas will be presented: (a) participants demographic information, (b) daily living experiences of unemployed women with physical disabilities in Tamale, (c) perceptions of stakeholders about the impact of unemployment on women with physical disabilities in Tamale, (d) issues associated with the unemployment of women with physical disabilities in Tamale, and (e) recommendations to reduce the impact of unemployment and chronic unemployment among women with physical disabilities. The first section of the chapter reports participants' demographic information. The next section provides description of the daily living experiences of unemployed women with physical disabilities in Tamale as narrated by them. The third recounts the perceptions of disability stakeholders from the government and civil society 64 organizations regarding the impact of unemployment on women with physical disabilities in Tamale. The fourth section reviews issues associated with the unemployment of women with physical disabilities in Tamale as seen by both the unemployed women themselves and disability stakeholders. The chapter's final section reports the recommendations both unemployed women with physical disabilities and stakeholders in Tamale made to reduce the impact of unemployment as well as chronic unemployment among women with physical disabilities. Participants' Demographic Information There were 24 participants in this study, 6 stakeholders from government, 8 stakeholders from civil society organizations, and 10 unemployed women with physical disabilities. Summaries of the demographic information of participants are given in Tables 1-3. Daily Living Experiences of Unemployed Women with Physical Disabilities in Tamale This section presents a description of the daily living experiences of unemployed women with physical disabilities in Tamale. Specifically, the following themes are discussed: mobility, family relations, social participation, lack of economic participation, experience with employment, daily living experiences, managing to survive, and feelings about life. It is important to note that the impairments of the women interviewed did not greatly limit their ability to perform roles as women, mothers, and wives. The apparent difficulty of the majority regards lifting heavy things. For example, those who lived in 65 houses with no running water had difficulties fetching and carrying water from one place to another. Although some of them carry water with their tricycles, others rely on their children and family members for help. Others sometimes pay for these services. Mobility Mobility is no doubt an important issue impacting the daily lives of unemployed women with physical disabilities. However, participants bemoaned the difficulty going in and out of their homes due to lack of proper mobility aids as well as inaccessible public transportation and architectural barriers. Mobility Aids Tricycles, calipers (i.e., braces), and crutches were identified as mobility aids important in the daily lives of women with physical disabilities. These mobility aids, participants claimed, offer invaluable help in terms of improving their mobility since many vehicles in Ghana are inaccessible. Tricycles Approximately 50% of participants reported having tricycles that were given them by benevolent people, mostly Catholic priests and nuns. The tricycles are their major source of mobility as accessible transportation is nonexistent in Ghana. However, in view of their economic situation, participants lamented having difficulties acquiring new tricycles and/or repairing older ones. Often they claimed they depend on the mercies of benevolent people to repair their tricycles. Ninash gave an example of the difficulties 66 unemployed women with disabilities experience with their tricycles when they break down: The other thing I can think of is that I am having problems with my tricycle. Sometimes when I come out and the tricycle breaks down, I don't know what to do; I don't know where to go unless people help me to repair it, because I don't have the money to pay for the repairs. Calipers and Crutches About 60% of participants reported using braces and crutches that were mostly sponsored by Catholic priests and nuns. However, as with the tricycles, participants said they cannot repair or replace their braces and crutches when they break down due to their economic situation. Ayi's narration exemplifies this situation: No, because sometimes I want to repair my calipers when they are broken but my parents don't have [referring to money] and I don't have either so I don't know what to do. The repairs normally take place in the capital which is far from Tamale. Father Martin helped me to get my caliper and crutches and the repairs. Even as I can't do these smaller things, how can I do the other things I want to do like getting a kiosk and a place to sit and do my work? The importance of mobility aids for persons with disabilities cannot be overemphasized. In the United States and other developed countries, the government provides for the mobility aids of persons with disabilities. However, in Ghana, persons with disabilities do not receive assistance to purchase or repair their mobility aids, further impacting on their economic situation. Vehicles Participants indicated the importance of transportation in everyone's life. They noted transportation enhances business activities. The need for accessible transportation 67 to facilitate their businesses cannot be overemphasized. However, participants stated none of the public vehicles is accessible, which is problematic. Anytime they travel, they struggle to get in and out of vehicles, making it difficult for them to travel to places within and outside Tamale. Gina gave an example of this condition: Because now if I want to travel, someone has to help me to get in the bus, otherwise I can't travel. Sometimes, it is even difficult to get the ticket …. Because I can't stand in the queue. I have to pay someone to help me. One day I was going to Wenchi and when I got to Techiman, there is a bus I couldn't get in. Two people had to help me get in. One held my head and the other my legs……I didn't feel good at all about that and if the government helps us this way, we will be very happy. Inaccessible vehicles could further limit the mobility of persons with disabilities and most likely their ability to work. Sidewalks Participants noted that most sidewalks in Tamale present challenges. The few that exist are often blocked by vehicles, motor bicycles, and other road users, rendering them inaccessible. Participants also said they encounter challenges using zebra crossings. Often, vehicles do not stop for them to cross the road. Awo's narrative described this situation: There are some places you cannot go with the tricycle. You have to leave it and walk or crawl if you have no calipers and crutches…sometimes you come to a place, a car will block you and you can't even pass by because there is not enough space and they will not give you space to pass. And sometimes when you get to the zebra crossing, instead of their stopping, like in Accra and other places, here it is not done. Participants claimed they are compelled to use main roads due to the challenges they encounter on sidewalks. However, using main roads is associated with several risks, including running into reckless drivers, motor and bicycle riders, occasional accidents, 68 and harassment from other road users. In spite of the dangers they come across using major roads, participants said they are compelled to use them, because they must provide for themselves and their children. Gina described this situation in her narrative: The road itself has problems. When riding on them, we have a lot of difficulties. Sometimes people will be using the motor bicycles and bicycle riders will be crossing in front of you or even pushing your chair away but you can't say anything because if you do, they will insult you. One day, my friend and I were going home. Her son was sitting on her lap and then a bicycle rider ran into her tricycle. She and her baby both fell out of the tricycle. The child hit his head against the street and hurt himself. The rider didn't even help them. He rather insulted the woman and said "you disabled people when you get up you will not sit at one place. You will be going up and down town disturbing us." Someone else came to help my friend and the son. We always cry when we are out in town because when you are out there, people can insult you for nothing but you can't say anything but I can't sit in the house, who will take care of me? I can't get something to supplement what my husband will give me so I have to go out every day. Sidewalks are a necessity not only for persons with disabilities but for other pedestrians as well. The challenges sidewalks present for persons with disabilities in Tamale further affects their mobility. Buildings The majority of respondents lamented the difficulty they experience accessing buildings and other facilities. They mentioned it is extremely difficult for them to use inaccessible hospital buildings when they are sick due to their physical condition. They claimed most times the hospital elevators break down, compelling them to climb a flight of stairs, a difficult task for some persons with physical disability to perform when they are sick. Other participants said inaccessible buildings hinder access to government officials to advocate for their needs. They stated that by the time they reached the top of 69 the high rise buildings, the officials would have seen them would disappear because they do not want to talk with them. A vivid example was given by Gina: Sometimes when I get to a building I can't get in. By the time I try to get in the building the people [referring to government officials], they will see me come and they can run away and leave me. Worn out mobility aids, inaccessible transportation, and architectural barriers-- inaccessible sidewalks and buildings--hinder the mobility of women with physical disabilities in Tamale and impinge on their employment. Family Relations Participants have mixed experiences with their families. Though some families care for their members with disabilities, family members are unable to help much due to poverty, which is well-documented in the Northern region. Other families, however, do not care for their relatives with disabilities although they could afford to do so. Participants also lamented their inability to take up their social responsibilities due to unemployment. Specifically, this section discusses relationship with parents and other relatives, intimate relationships, and relationship with children. Relationship with Parents and Other Relatives The majority of participants in this study reported having good relationships with their relatives and relying on their families for their basic needs. They claimed receiving support in diverse ways from their families, including food, emotional, and material support. However, participants indicated they do not receive enough monetary support from family members due to poverty, which characterizes the Northern region. They 70 remarked their family members, many of whom are subsistence farmers, do not earn sufficient money to provide for their financial needs. Zara stated: We have a good relationship. They are helping me because they know they are the only people I have and hence the need to help me. But they don't provide me with all my needs. Not all of them because they don't have money. While some participants mentioned they have good relationship with their families and receive diverse support from them as discussed above, others narrated negative experiences with their families. Despite the Ghanaian belief in supporting needy family members, some participants claimed their families, both close and extended, do not pay attention to their needs even when they personally request help. Oftentimes they seek help from outside their families. Others said, occasionally, some family members show interest to assist them but their spouses convince them not to help. Two good examples of this situation were given by Ninash and Awo, respectively: I live in my father's house with my siblings. My relationship with them is not good at all. If I need food and ask them, they won't give me. I have to go outside and ask for food…When my dad was living it was much better but now that my dad is dead my siblings don't care about me…Eh, no one helps me when I am in need. No one in the house helps me except outsiders. They don't even give me emotional support…I don't even ask because if I do, they will not pay attention to me. And I am afraid they will insult or become angry with me when I ask. I do not stay with them. I live with my grandmom and my uncles and their wives and children in a different town. And when my uncles want to give me something, their wives tell them they shouldn't so I don't get anything from them. But I don't have any problem with my uncles, grandmother, my parents, and siblings. While the majority of the participants in discussing their family relationships were concerned about the support they did or did not receive from family members, others lamented their inability to support needy family members, especially their parents and siblings. According to them, their current economic condition has strained their family 71 relationships as they are unable to help family members in times of need. A situation they stressed worries them. Gina gave an example: My paren