Being a person with special needs in North Macedonia is a daily challenge. The healthcare system, infrastructure, and social mentality often fail to provide the necessary support for these individuals, leaving them and their families to face a harsh reality. To truly understand this, all it takes is spending a little time at the CFKD (Care for Disabled Kids) day center. This day center is a warm nest of care, education, and socialization for 14 individuals aged between 13 and 55. Despite having different diagnoses, due to the inability to form separate groups, they spend most of their time together.
“Age difference isn’t a significant factor in their relationships. Most have formed various types of connections with one another, whether close or distant. For these individuals, verbal communication isn’t always primary, so their relationships are based on different forms of communication through which they express opinions, agreements and disagreements, emotions,” says Aleksandra Nestoroska, a psychologist at the center.
If being a person with special needs is difficult, being a woman in this category is even more complicated. In a society still dominated by patriarchal norms, women with disabilities face double discrimination: both as people with disabilities and as women. This means that for many of them, opportunities to get an education, find employment, or live independently are nearly impossible.
“I believe the difficulty of caregiving largely depends on the degree of the person’s disability, but I can also confirm that the very nature of the female gender presents an additional challenge in caregiving,” Aleksandra explains.
The Challenges of a Girl with Down Syndrome: When Your Body Becomes Another Obstacle
Now, imagine being a girl with Down syndrome, autism, or another diagnosis. In addition to the daily struggles with learning, social integration, and medical care, you face another issue every month: menstruation. For most girls and women, menstruation is a tiring and sometimes painful process, but for a girl with special needs, this natural cycle becomes a real challenge.
“Often, these individuals are unable to maintain personal hygiene on their own and require assistance or supervision. There are different levels of understanding menstruation as a biological feature—ranging from the ability to comprehend the phenomenon and care for oneself or accept help, to a complete intellectual inability to understand it or maintain hygiene independently. Furthermore, everyone reacts differently to the symptoms of menstruation and PMS—such as pain, emotional irritability, and similar issues,” Aleksandra emphasizes.
In North Macedonia, even girls without disabilities struggle to afford menstrual products due to high prices and lack of access to menstrual education. For a girl with special needs, the situation is even more problematic, as she might not understand how to use menstrual products or may have difficulty changing them regularly. In such cases, the presence of a parent or caregiver is essential—not only to provide the hygiene products financially, but also to assist throughout the entire process.
“Yes, this is the reality for these individuals and their families. It doesn’t affect only the person with a disability, but also everyone involved in their care. Intellectual and physical disabilities do not exempt these people from the biological nature of the female body. I think the general public hasn’t even considered this topic as a fact and reality for women with disabilities and those who care for them,” Aleksandra says.
Why Is Greater Support So Important?
The state must take steps to ensure that people with special needs—especially women and girls—are not left on the margins of society. Educational programs on menstruation and hygiene are necessary for all girls, regardless of their abilities. Moreover, there should be support centers where girls with Down syndrome and women with disabilities can receive appropriate healthcare and social care.
It is not fair for a girl with special needs to face a double challenge—not only due to her condition, but also because of the lack of support from society and the state. It is time for society to change its approach and treat them as individuals with equal rights, not as a burden to be hidden or neglected.
According to the 2021 Census, the number of women with special needs in North Macedonia is higher than that of men. A total of 52,203 women in the country live with some form of disability—whether mobility, vision, hearing, communication, or other impairments—compared to 42,209 men with disabilities.