RE-EXAMINING HEALTHCARE BARRIERS THROUGH THE AFFIRMATIVE MODEL: SOCIAL EXCLUSION OF WOMEN WITH DISABILITIES IN KOHAT DIVISION, PAKISTAN

Abstract

This study examines how healthcare accessibility and responsiveness (independent variable), interpreted through the Affirmative Model of Disability, shape the extent of social exclusion experienced by women with disabilities (dependent variable) in the Kohat Division of Khyber Pakhtunkhwa, Pakistan. A cross-sectional design was employed with a proportionally allocated sample of 370 respondents across three districts of Kohat Division. Methodological rigor was ensured through collaboration with district Social Welfare Offices at said districts for participant identification and the engagement of senior oral instructors to support communication with hearing and vocally impaired participants. Women with physical, auditory, verbal, and stature-related impairments were included, while individuals with intellectual disabilities were excluded due to concerns regarding response reliability. Cronbach’s Alpha produced a coefficient of 0.87, confirming strong internal consistency. Chi-Square (χ²) statistics assessed bivariate associations, and Kendall’s Tau-b (T^b) tested non-spurious relationships. Findings indicated a significant association between healthcare barriers and social exclusion (χ² = 13.073, p = 0.000; Tb = 0.188), demonstrating that inadequate healthcare services, discriminatory attitudes, and structural inaccessibility intensify exclusionary experiences. Results further suggest that healthcare inequities exert a particularly pronounced effect on older women with disabilities. Viewed through the Affirmative Model, the study affirms that exclusion stems not from impairment itself but from systemic, attitudinal, and institutional shortcomings. The study recommends disability-inclusive healthcare reforms, institutional strengthening, and socially affirmative practices to reduce the entrenched exclusion faced by women with disabilities.