“There is something like a barrier”: Disability stigma, structural discrimination and middle-class persons with disability in Ghana

Abstract Discrimination against persons with disability is not just a relational phenomenon. It has a structural dimension that is equally oppressive. Structural discrimination can occur even in places and instances where individual discrimination may not be present. Structural discrimination is not always easily noticeable and thus cannot be legislated against easily. This study explored the lived experiences of structural discrimination as experienced by 16 middle-class persons with disability in Ghana. The participants shared experiences of simultaneous acceptance and limited access or in some cases rejection in educational institutions, places of work, religious spaces and the service industry. These experiences of structural discrimination happen because the social class positions of middle-class persons with disability qualify them to enter mainstream social, economic and political spaces but the stigma which their impairments elicit compromises their identities in these spaces, making their full integration into mainstream activities challenging. Corporeal differences ought not to be used as basis for denying access to resources and opportunities. Societies have to consciously work to identify structures that oppress persons with disability and inhibit their integration into mainstream activities. There is the need for the creation of an inclusive society that actively pursues the dismantling of exclusionary structures and normative systems within society.


PUBLIC INTEREST STATEMENT
Discriminatory experiences that persons with disability have do not only come from their relational encounters or the actions of individuals, but also from the structures and normative systems of institutions such as schools, religious groups, places of work and the service industry. An analysis of the stigmatising lived experiences of middle-class persons with disability in Ghana reveals that middle-class persons with disability experience simultaneous acceptance and denials in these social spaces despite the existence of laws that are meant to prohibit discriminatory behaviour. These contradictory outcomes inhibit the ability of middle-class persons with disability to fully access the opportunities and resources that their middle-class statuses would otherwise confer on them. There is the need for a conscious effort to be made in ensuring that normative systems and structures that exclude persons with disability are eliminated to allow for the inclusion of persons with disability in mainstream activities in the society.

Introduction
This study examines the lived experiences of structural discrimination that middle-class persons with disability in Ghana have. Persons with disability are among the least privileged people in societies everywhere (Athanasou, 2014;Erickson et al., 2014;Foster & Wass, 2012;Grech & Soldatic, 2016;Gudlavalleti, 2018;Hughes, 2013;Mitra et al., 2013). The stigma and discrimination that they encounter usually ensure that they either remain in lower socio-economic classes or have great difficulty escaping the oppression that the disability identity elicits. Persons with disability are, however, not a homogenous category of people. They can be differentiated on the basis of several social identities and the social statuses they occupy (Nario-Redmond, 2010;Pal, 2011;Priestley, 2005;Vernon, 1999). As a result of this heterogeneity, their lived experiences of disability stigma are a function of their impairments and personal traits such as age (Salmon, 2013), gender (Addlakha, 2008;Naami, 2015;Nepveux, 2006), race (Block et al., 2001;Fuller-Thompson et al., 2009;Kelley-Moore & Ferraro, 2004), ethnicity (Ali et al., 2014;McDonald et al., 2007) and type of impairment (Maroto & Pettinicchio, 2014;Pal, 2011;Tøssebro, 2004). These multiple identities have implications for how persons with disability experience "disability".
When the intersection between social class and disability is examined, it is perceptible that middle-class persons with disability have experiences that are quite different from the experiences of persons with disability in the lower social classes (Minkler et al., 2006;Powell, 2003;Vernon, 1999). Class privilege confers several advantages that are not available to lower-class persons with disability on middle-class persons with disability. At the same time, the presence of the impairment exposes middle-class persons with disability to stigmatising and discriminatory experiences. The combined effect of having an impairment and being lower-class is different from the combined effect of having an impairment and being middle-class. In the case of the former, there are two stigmatising conditions of poverty and disability. In the latter, there is one-the disability. It must be noted that class privilege of middle-class persons with disability does not make them less likely to be stigmatised, as compared to lower-class persons with disability. It does not mean that they are free from or have weakened forms of disability stigma. Rather, it means that their experiences of disability stigma are different (Grischow, 2015;Maroto & Pettinicchio, 2014;Powell, 2003). Their middle-class status rather places them in different social spaces where they encounter different forms of disability stigma, oppression and discrimination.
It has been argued by Kleinman and Hall-Clifford (2009), Link and Phelan (2001), and Shaw et al. (2012) that studies on disability stigma have often had an individualistic focus, emphasised the internalisation of stigma, how stigma influences and defines individual behaviour and how individuals who have impairments are required to make adjustments in order to fit in the society or group. As a consequence, the structural dimension of disability stigma experiences is subtly overlooked in favour of micro-level analysis of social interaction. While there is nothing wrong with micro-level analysis of disability stigma, the seemingly continuous limited consideration of the structural dimension is not ideal. The structural dimension of the social condition of being middle-class and having impairments, along with the nuances of the lived experiences of disability stigma have not been theorised adequately. Minkler et al. (2006), Powers et al. (2002), Pettinicchio (2015), andMcCarthy (2003) and have sought to bridge this gap but their studies were conducted in the developed world. Studies on social class and disability have also tended to be skewed towards persons with disability who have economic constrictions, are socially excluded and are politically marginalised (Abidi & Sharma, 2014;Hughes, 2013;Kassah, 1998;Mitra et al., 2013;Naami & Mikey-Iddrisu, 2013;Pal, 2011;Yeo & Moore, 2003). Not much is, therefore, known in the developing world about how middle-class persons with disability experience disability as a result of their dual identities of being privileged by their social class and disadvantaged by their impairments at the same time. Beyond these, not much is known about how structural discrimination manifests within developing countries such as Ghana. Since this study was conducted in Ghana, the context of disability relations in Ghana is presented to place the study in perspective and to provide a background for the interrogation of the lived experiences of structural discrimination that middle-class persons with disability have as a result of disability stigma.

Disability in Ghana
Conceptualisations of disability in Ghana are heavily influenced by traditional and religious beliefs, often leading to the institutionalisation of negative stereotypes which limit the full social participation of persons with disability severely (Kassah, 2008;Nukunya, 2016). Prejudice and discrimination are common experiences that persons with disability in Ghana have. These sometimes result in the use of pejorative labels to call and describe persons with disability (Agbenyega, 2003;Avoke, 2002;) as well as difficulties in finding and keeping jobs and economic opportunities (Acheampong et al., 2016;Kassah, 1998;Naami, 2014Naami, , 2015. As a result, persons with disability have a lower employment rate compared with non-disabled people. When they find employment, they are more likely to be in the informal sector rather than the formal sector where long term job security and employee benefits are guaranteed (Mensah et al., 2008;Naami, 2015). The difficulties in finding employment are also compounded by an inaccessible built environment , lack of access to loans and credit facilities (Naami, 2014) as well as stigmatising comments and complaints against persons with disability that are made by clients and customers of businesses that employ persons with disability (Slikker, 2009).
Persons with disability in Ghana largely have limited access to formal education (Mensah et al., 2008;Mfoafo-M'Carthy et al., 2020;Opoku et al., 2019). In recent years, however, a number of reforms have made formal education more accessible to persons with disability and enhanced their employability. These include colleges of education introducing special needs training courses, a number of universities in Ghana introducing undergraduate and postgraduate programmes meant to train teachers for special needs schools, the establishment of both private and public special needs schools and the creation of vocational training and rehabilitation centres across the country (Ametepee & Anastasiou, 2015;Opoku et al., 2019;Slikker, 2009). The challenge, however, is that several of these institutions, perhaps apart from the universities and the private institutions, are functioning well below their capacities and expectations. The institutions have become largely ineffective due to their use of obsolete training methods and equipment, the lack of trained staff, inadequate and inaccessible infrastructure and limited financial resources (Ackah-Jr & Danso, 2019;Agbenyega, 2007;Naami, 2014;Slikker, 2009). Other challenges that persons with disability have in accessing education in Ghana include overcrowding in schools (Avoke, 2001), poverty (Kassah, 2008), parental decisions to hide children with disabilities (Opoku et al., 2015) and a weak implementation of inclusive education by the state (Fefoame, 2009;Mensah et al., 2008). It becomes apparent, therefore, that persons with disability in Ghana have limited availability and sometimes lack of opportunities in obtaining formal education (Agbenyega, 2007;Avoke, 2001;. Persons with disability also have challenges in accessing healthcare (Naami & Hayashi, 2011;Picton, 2011), moving within the built environment (Ackah-Jr & Danso, 2019; Tchiakpe et al., 2018;Tudzi et al., 2017;Yarfi et al., 2017) and political participation (Sackey, 2015). All these challenges in persons with disability's access to employment, healthcare, education and the built environment exist despite the passing of the Persons with Disability Act 2006 (Act 715) which was meant to protect the rights of persons with disability and eliminate the discrimination and exclusion they experience and facilitate their full social participation (Anthony, 2011;Kassah, 2008;Ocran, 2019).

Structural discrimination
The successful enactment of disability stigma and its attendant discrimination occur through three social processes. These are individual discrimination, structural discrimination and self-stigma (Baffoe, 2013;Burris, 2002;Dirth & Branscombe, 2017;Link & Phelan, 2001). Individual discrimination occurs when a person, particularly a non-disabled person, behaves contemptuously towards a person with disability, in ways that limit the aspirations or participation of the person with disability in mainstream societal activities. Self-stigma occurs when a person with disability internalises the negative attitudes that society shows towards disability and consequently engages in self-blame, leading to a low self-esteem. These two processes are borne out of the complexities of relational dynamics as people contest for power, privilege and opportunity within social interaction.
Structural discrimination occurs at a different level. It is the expression of collective sentiments of a social unit rather than the manifestation of individual action (Corrigan et al., 2004;Dirth & Branscombe, 2017). It exists within social networks and also as accumulated disadvantages and limitations over time (Link & Phelan, 2001). In structural discrimination, stigmatised individuals such as persons with disability may be excluded from social networks and informal relationships that are constituted around professional successes and other social achievements (Burris, 2002). It is possible to find situations where no individual openly shows contempt towards the individual who carries the stigmatised attribute. This is because structural discrimination can and does manifest independently of individuals' attitudes and awareness (Burns, 2011). However, the cumulative effect of the stigma and its discriminatory outcomes become institutionalised over time and oppress stigmatised individuals. Similarly, structural discrimination occurs when public spaces are not functionally accessible to persons with disability. The inaccessibility could be as a result of physical barriers or normative systems that oppose the acceptance and inclusion of persons with disability (Link & Phelan, 2001).
Structural discrimination can also result in negative outcomes that may be unrelated to the stigmatised attribute when it reinforces stereotypes that give rise to forms of individual discrimination (Link & Phelan, 2001). The significant thing about structural discrimination is that, it occurs subtly within groups and institutions which are meant to be neutral in fact. Sometimes, it may not even be easily noticeable and thus, cannot be legislated against easily (Burris, 2002;Corrigan et al., 2004;Dirth & Branscombe, 2017). This is because the determinants of structural discrimination are deeply embedded in the social norms and value systems of groups and societies.

Defining social class
"Social Class" is used in the Weberian sense in this study to mean groups of individuals who have similar "life chances" with regards to their levels of education, occupation, lifestyles and their abilities to acquire particular kinds of goods and services. Consistent with the Weberian position, therefore, "Middle-class" in this study refers to "non-manual workers who enjoy a wide range of advantages over manual workers but subordinate to people whose wealth means they do not have to work" (Bruce & Yearly, 2006, p. 96). In this regard, the middle-class persons with disability include persons with disability who may be skilled professionals, public workers and entrepreneurs who have high incomes, a lot of prestige in society and a great of control over their livelihood (Leinonen et al., 2012;Vitt, 2007).

Research design
This hermeneutic phenomenological study presents the results of an examination of the structural discrimination experienced by middle-class persons with disability as a result of disability stigma. The choice of the qualitative approach was informed by the researcher's quest to have real people share real stories about their lived experiences (Bryman, 2016;Creswell, 2013;Heidegger, 1962). As in all phenomenological studies, a concept or a phenomenon of interest is identified and assessed for ways in which it is experienced by study participants. The phenomenon of interest in this study is the structural discrimination experienced by middle-class persons with disability as a result of disability stigma.

Data collection and analysis
Data was gathered from 16 middle-class persons with disability who have sensory and/or physical impairments. The participants, made up of 11 males and five females, were purposively selected. Six participants had physical impairments, three had hearing impairment, two had visual impairment, one had partial speech impairment, one had kyphosis, one had achondroplasia and two had both physical impairments and partial visual impairment. Also, the ages of the participants and age at onset of impairment were taken into consideration during the sampling process. Four participants acquired their impairments in their adulthood. They were already middle-class at the time of acquisition of their impairments. Twelve participants acquired their impairments as children or were born with the impairments. Six out of this 12 were born to middle-class families. Four were born into lower-class families that gave them support as they grew. That support has played an immense role in their social mobility as they have transitioned from being lower-class persons with disability to becoming middle-class persons with disability. Two out of the 12 were born to lower-class families that offered very little support to them. They have since become middle-class as a result of their own efforts in their adulthood.
A semi-structured interview guide was used to collect data from the participants. All the participants agreed to the interviews being recorded. All the interviews were transcribed soon after they had ended. Analysis of data was done concurrently with data collection. The analytic framework used in this study was the Interpretative Phenomenological Analysis (Larkin et al., 2006;Smith & Osborn, 2015). The researcher listened to the interviews and read the transcripts multiple times to gain a deeper understanding of the experiences that had been shared by the participants. Codes were attached to sections of the transcripts that contained experiences that were relevant to this study. Codes that indicated parallels and variances in the participants' lived experiences of structural discrimination were organised into distinct themes.

Ethics
The study was approved by the Ethics Committee for the Humanities, University of Ghana, Legon (ECH 053/15-16). Participants were informed about the focus of the research and what their roles in the study were. All the participants signed consent forms to confirm their participation in the study. A braille version of the consent document was given to the participants who had visual impairment. Of the two participants who had visual impairment, consent was obtained orally from one and the second asked his niece to sign on his behalf. The participants were, however, informed that they could withdraw from the study at any point in time without consequence, if they so wished. Assurances of confidentiality and anonymity of responses were also given to the participants. For this reason, the names that appear in this article are pseudonyms. The participants were not exposed to any threat of physical harm during the interview process. The dignity and selfesteem of the participants were preserved in the course of study in general and in the conduct of the interviews in particular.

Results
The analysis of structural discrimination as experienced by middle-class persons with disability in their social spaces is presented in this study. These social spaces include educational institutions, places of work, religious spaces and the service industry.

Educational institutions
For persons with disability who are born with their impairments or acquire them as children, the options available for formal education are sometimes significantly constrained by their impairments. One of the ways in which this becomes manifest is in the programmes and course options that are made available to them. They do not always have the opportunity to select from the full range of programmes and courses available to non-disabled students at their level. This was the experience of the participants who acquired their impairments as children and attended special needs schools. Timothy has hearing impairment and indicated that he would have wanted to read General Science (natural & physical sciences) in Senior Secondary (High) School, but the programmes on offer in his special needs school were General Arts (social sciences & humanities) and Vocational Skills (sewing, textiles & catering). This made him choose General Arts because his preferred option of General Science was not available in the special needs school. He admits that this has significantly altered his academic and career aspirations. Another participant expressed her frustration with the situation by highlighting the non-availability of adequate resources and accessible support systems needed to make formal education fully accessible to persons with disability: Why can't we be accountants? Why can't we be nurses? Why can't we be in other professions? It's all because of the communication barrier. Institutions find it difficult to pay interpreters. Example, in the universities, if a deaf person wants to learn accounting, one interpreter, another person wants to learn psychology, another interpreter, and the institution will say there is no money to pay the interpreters, so the institutions will force them, 'all of you, do this', to save money [. . .] if the institutions use some small money to pay them, they feel they are wasting money. (Mary, hearing impairment) Another form of structural discrimination in educational institutions is the separation of persons with disability from non-disabled people. Residential special needs schools, especially for persons with hearing and visual impairment, have the propensity of producing and reinforcing the exclusion of persons with disability from full social participation. This separation of persons with disability from non-disabled persons in schools creates difficulties for persons with disability when they seek integration into mainstream activities. One participant observes: When it happens like that, you always have your mates being visually impaired persons or persons with disabilities. So when you need help, the visually impaired person, he is not getting a job so [. . .] it's like we've been isolated. We are a kind of people. It's like they are a kind of people. The other society sees us as a different kind of people. So there is something like a barrier. If there is inclusive education, we will all see ourselves as one people. (Thomas, visual impairment) The inaccessibility of the built environment is also conspicuous in educational institutions. Some of the new large buildings constructed after the passage of the Persons with Disability Act 2006 (Act 715) in especially the universities in Ghana have ramps and access routes for persons with disability. However, this does not apply to all the new buildings. A participant who was a graduate student in a public university shared his frustration: The university [. . .] went to put up a modern structure. There is no ramp. Sometimes, when you look at these things you say ah! So who thinks about you? Who really cares about you? If you go against all these things to acquire a certificate and still people want to undermine that certificate, it is very annoying. (Charles, physical impairment) According to experiences shared by the participants, the inaccessibility of the built environment is not limited to only the universities. There are a number of Senior High Schools whose built environment and infrastructure are not accessible to persons with disability. Several educational institutions have open drains, poor road markings, too many stairs, few and poorly constructed ramps, absence of elevators, malfunctioning street lighting and untarred roads that make wheelchair usage problematic. Some of the schools they attended did not have regular supply of water. They were thus compelled to walk long distances to fetch water. The challenge of a student who has physical impairment and having to carry water for a long distance is apparent. For a female participant, her experience was that there were times she fell down and poured her bucket of water away. She sometimes went on that trip twice, when non-disabled students only had to do that once.

Places of work
Some employers recruit middle-class persons with disability and assign largely minimal tasks to them. Some employers and organisational managers appear to be reluctant in providing the appropriate support systems that will facilitate optimum productivity of persons with disability. They do this because they are often uncertain about the functional competence of persons with disability and what they deem to be the high cost of making such support available. This situation does not allow middle-class persons with disability the ease to work, as was the case of a participant who had hearing impairment and who was offered a position by an organisation he had spent some time working with as a trainee: I didn't have an interpreter and other supportive devices that I use to work. So they were trying to give me anything to do but I realised that it wasn't my capability, because I was skilful elsewhere and what they wanted me to do wasn't what I wanted to do and also, I didn't have a sign language interpreter to ease my communication so I thought it wise that if there was an opportunity here, I move to this place because here, I can get communication opportunities. They were interested in keeping me there but they were not interested in providing the facilities that would allow me to work. So I explained to them that that was why I was leaving. (Timothy, hearing impairment) Timothy saw the organisation's move to offer him a position at all cost as an act of patronage because the offer, to him, was not given because they found him to be resourceful, but rather, as a sympathetic means of accommodating him and "helping" a person with disability. This lack of institutional support in employment, which contradicts provisions in the Persons with Disability Act (2006), also manifests in the failure of organisations to make basic arrangements for persons with disability to work efficiently, even when these persons with disability are in charge of specialised units: One funny thing is I don't think that some of my colleagues in the department I find myself [in] kind of adequately comprehend the essence of our unit which is assistive technology. I am in my third year now and I have still not had an office set up adequately for me. (John, visual impairment) In similar circumstances, opportunities that are available to everyone else are seemingly denied middle-class persons with disability. A participant who works as a journalist in a large organisation shared experiences about how she has never been made to go for a "foreign assignment", i.e., covering foreign trips of especially the President of the country, his vice or a government delegation. Being sent on "foreign assignment" is prestigious and is considered a sign of advancement in one's career. The absence of these opportunities can be considered discriminatory, given that the participant's experience, qualification and competence matches her colleagues' evenly, with her impairment essentially being the only element of variation: I think that, though they might have not told me but sometimes there are certain assignments that they thought (Afia) should do it but she can't do it because of her disability. I've never gone on scheduled foreign assignments which of course they think it will be a lot of hard work. You have to rub shoulders with the international journalists here and there. That is the only point I can say they have discriminated against me. (Afia, physical impairment)

Religious spaces
Five out of the 15 participants who were Christians reported that they were satisfied with their involvement in their churches' activities. Two participants out these five occupy positions in their churches. One receives regular home visits from her church's clergy and leadership. Two participants who have hearing impairment indicated that they have sign language interpreters at church and that allows them to participate in church activities. In addition to these five, three other participants reported that they are not active in church. Their limited involvement in church is, according to them, not as a result of their impairments. One participant indicated that she stays away from certain church activities in order not to draw "unnecessary" attention and scrutiny to herself and her impairment. The remaining six participants reported a number of experiences which made them feel stigmatised and discriminated against.
The manifestation of structural discrimination in the religious space points to a simple reality for persons with disability, that is, they are welcome to the space but their impairments render them unworthy for full acceptance and integration. So, this becomes a situation where persons with disability are partially accepted and partially rejected. One participant believes that he was deliberately and regularly overlooked even though his friends were almost always called to perform important functions in church: The church wouldn't give you a role to play and involve you in activities like reading the bible and other things. You wouldn't get the chance to do those things until you take the initiative or you ask your friend that when they ask you to read the bible, let me read instead. I had that kind of drive to do and that was keeping me going. (Jeremy, Physical impairment) For others, the conduct of some church officers brought their impairments to the fore. In the case of one participant who has visual impairment and had been a regular member of his church for a long time, he was reminded of how his impairment made him a potential nuisance to other congregants, for which reason he was asked to accept seating positions on the fringes of the chapel: [I] called the ushers and I asked the person to make me sit somewhere. So, the person held my hands [. . .] then I went with this usher and she put me just at the back of the church. And there were lot of empty spaces in front of us so I asked her that, look take me a bit forward so that it wouldn't be like I have been isolated because many people had not come to church yet, so me alone sitting [on] one bench, at the back was not good. She said no I should sit there because when people are getting up I will worry them. (Thomas, visual impairment) The non-existence of specific protocols to accommodate persons with disability and their needs exposes them to stigmatising conduct from other members of their congregations. Some religious groups are aware of the fact that some persons with disability are in their fold, yet they do little to meet their needs and include them in the organisations' activities. these groups are happy to have persons with disability as members but do not actively pursue actions that will make these persons with disability comfortable in the group, as was recounted by one participant: I remember some time ago, we had an interpreter when I was baptising my daughter. That was the last time I had an interpreter. Always, when I go to church, there is no interpreter. The church doesn't have any interpreter. In the deaf school, the Church has an interpreter but outside the church, no interpreter. It means the pastor's sermon and the songs do not benefit me . . . my wife too, she doesn't benefit . . . we just go and sit, we close and we go home. We meet friends, we smile, we greet them, and then we go home, that's all we do . . . some time ago, in 2009, I wrote a notice about that issue. I told the church to provide interpreters for the deaf people in the church. Up to date, I have not heard anything about that. The church has put the letter somewhere. Maybe the deaf people in the church don't show themselves but they are there in the church. They don't benefit. Now they have all left because there are no sign language interpreters. (Timothy, hearing impairment) For this participant and his wife, church is nothing more than a social event, a gathering of friends. Their impairments and the non-availability of sign language interpretation means that they do not get to participate in the activities of the church beyond what they see. They do not gain from the spiritual and cathartic effects of being in church. The fact that the church provided an interpreter at a special service when his daughter was being baptised is an indication that the church leadership know that they are there.
The failure of some religious groups to recognise the personhood of persons with disability results in the religious space becoming a place for the expression of oppressive traditional beliefs. For some participants, the religious space is where they are sometimes reminded of how different they are and also told about the spiritual origins of their impairments. Religious beliefs sit at the core of the negative disability stereotypes that orient disability relations. These beliefs manifested when one participant was invited to a church service: My husband heard that some church, [they] were doing a revival. They were [performing] miracles. He invited me to go just for prayers but not because of my [hearing impairment] but when we went there, the pastor asked me a question and I said I'm hearing impaired and the pastor was like you there, the devil, come! Your mother and your sister have blocked your mouth, a lot of things. Then I said no, no. Then he said you wait here, and I told him I'm sorry, I have my own church. I can't waste time waiting for you so I'm going. If God himself wants me to hear, why not wait for him? I'm just a perfect human being. (Mary, hearing impairment) Beyond these, the physical structures of various religious groups are sometimes inaccessible to especially persons with physical impairment. Some buildings do not have ramps to allow for ease of access. The ramps in some structures are also not properly constructed. They are either too steep or covered with very smooth tiles, both of which inhibit mobility and can also expose wheelchair users to accidents. Some of the features in the buildings limit the extent to which persons with disability can fully participate in activities of the church, as was expressed by two participants: Look at the mansions they are putting up as cathedrals. When I say it, they laugh. It is just a façade. At the entrance, you see a ramp. You manage to get in and then the floor is not levelled. It is partitioned. As for the platform it is a no, no for you. It means that you can't be a leader. They have limited you. So the question is so even Jesus or God doesn't take handicapped people? When I say it they say 'eeigh'. We were putting up our structure. I fought my pastor so long. He didn't understand until a friend came from the UK. In conversation and I was asking him yes . . . I'm telling my pastor that we need a ramp here. He doesn't seem to understand. We spoke ahhh and they did something there, pretence, a sham. (Afia, physical impairment) I can't go to church now because of the stairs and when people are going for collection you will be sitting down so either you stay outside the church premises or . . . that is another challenge I am facing currently but so I will try and adjust . . . maybe I will sit in front or at the back, where I may not disturb other people. (Michael, physical impairment & partial visual impairment) The failure and sometimes reluctance of some religious groups to create an enabling environment for persons with disability to be able to participate in the affairs of the group forces persons with disability to make adjustments to themselves in order to be part of the group, as was expressed by Michael when in fact, it is the church that needs to make changes to accommodate persons with disability.

The service industry
The behaviour of some service providers add to the structural discrimination that middle-classpersons with disability face. As middle-class persons, they sometimes aspire to acquire services which are associated with their social class position. However, since persons with disability are usually stereotyped as poor people, middle-class persons with disability encounter situations where their impairments are used to construct a master status for them as poor and undeserving people and on that basis, they are questioned about their claim for that service.
A participant who had hearing impairment reported that he went to the Driver and Vehicle Licensing Authority (DVLA) to acquire a Drivers' License. An officer at the Authority told him that he was ineligible for the Drivers' License because he had hearing impairment. The participant prompted the official that Section 27 of the Persons With Disability Act, 2006 (Act 715) reads "A person with hearing disability may own a driving license upon passing a driving test and satisfying conditions prescribed by the Driver and Vehicle Licensing Authority" (Republic of Ghana, 2006). The official responded that he would confer with his superiors and get back in touch with him. The participant told me that he had waited for quite some time but the response was yet to come. Thus, the law grants persons with hearing impairment the right to obtain a Drivers' License but the DVLA has not re-calibrated itself to grant that. While they are yet to do so, persons with hearing impairment are denied their right to drive. Some banking halls are not accessible to especially people with physical impairments who use wheelchairs. The usual design of banking halls is to have an elevated counter that is at the height of the midsection of the body of a standing person of average height. It is rare to find banking halls with specially designated areas where wheelchairs users can access. A participant shared his experiences from various banks: When you go to every counter, the counter is high above us. They don't have a place that is at our level while we are in the wheelchair. They want us to hang and sign our documents. They don't make provisions for us, say a different section for us. Some of the banks don't have it. You just go to a few banks and find out for yourself. You will see that their counters are all high. Those in the wheelchair would have to turn their necks. The people who are to serve you at the counter are seated and the counter is above them. Whenever I get there, I tell them, please, you would have to get up to attend to me. I will let you stand on your feet to serve me, because I won't see you if you sit. Non-disabled people will be on their feet so they can see you when you are seated but I can't. (Jeremy, physical impairment) Other users of the bank do not have to draw attention to their bodies in ways that persons with disability are made to do. That is stigmatising because persons with disability are compelled by the structures of the banking hall to speak about their own "functional limitations" even when there is no need for that. The set-up of these banking halls is done without consideration for the needs of persons with disability. The banks or those in charge of the construction have little expectation about persons with disability being "rich" enough to possess bank accounts, as informed by the negative stereotypes about disability. They do not also have the awareness to create an enabling environment that does not exclude persons with disability.
Another participant who uses a wheelchair shared experiences about how access routes were non-existent when she wanted to use them in an office she had gone to. In one instance, she refused to allow people to carry her over a doorway and insisted that the designated door be opened for her to go through. In another situation, officers at a transport terminal offered to "manoeuvre" her around an elevation when she went there: I went to the Metro Mass place and it's just a small ramp that they need for you to enter and I had to be manoeuvred and I said this doesn't take much. A bag of cement is all you need so I will come back and I will expect to see a ramp. Little, little things that will make a difference so that one doesn't feel like oh, I'm different or I'm a bother, straight forward things. If we are thinking people, we put them in place without somebody even coming to tell us. (Ewura, physical impairment & partial visual impairment)

Discussion
By virtue of their social class position, middle-class persons with disability are often involved in mainstream social, economic and political activities. Their interactions with people within social networks, organisations and institutions are, thus, subject to institutional regulations, administrative processes as well as the social norms and value systems of their societies. However, disability stigma, which is a very potent form of social control, is often embedded into the structure of these institutions (Burris, 2006;McLaughlin, 2021;Nario-Redmond, 2020) and manifests as structural discrimination. This structural discrimination undermines the desire and ability of persons with disability to participate in activities of society, making it difficult and sometimes impossible for middle-class persons with disability to be fully integrated into all aspects of society. The institutional regulations, administrative procedures and the nuances of social relations are sometimes exclusionary, even if it is unintended by the institutions and their processes or invisible to non-disabled people through whom these discriminatory tendencies mostly manifest (Dirth & Branscombe, 2017;Moloney et al. 2019;Watermeyer & Swartz, 2006). In some ways, middle-class persons with disability are welcomed and are given certain opportunities by virtue of their social class position. In other ways, they are denied access to several other opportunities because of their impairments, in ways that creates contradictory positions of acceptance and rejection for middleclass persons with disability. This culminates in a lack of attention for persons with disability in general and for middle-class persons with disability in particular, the neglect of their needs, their marginalisation and exclusion, their oppression as well as the abuse they experience in all aspects of social interaction within institutions and social networks, the evidence of which has been presented in this study.
While it is not uncommon for some institutions to appear to be all-embracing and accommodating to persons with disability and their needs, the reality is that evidence of structural discrimination abounds within these same institutions, be it schools, places of work, religious congregations or the service industry. The non-availability of certain programmes and courses in special needs schools means that persons with disability may have access to formal education but through no fault of theirs or any particular individual, their options are limited by how the schools are set up. Consistent with the position of Hehir (2002), the programmes and options available in special needs schools, often considered inferior to mainstream schools, differ from what exists in mainstream schools. The teaching of certain vocational skills, though useful, is thus training for low-skilled and low-income jobs. The non-availability of the full range of programme and subject options is often explained as being occasioned by the cost involved in doing so, given that special needs schools are often poorly resourced. Segregated education in itself, as has been noted by Kassah et al. (2018), Lamptey et al. (2015) and Shelton et al. (2010), perpetuates exclusion and marginalisation of persons with disability. This is because segregated education makes it more difficult for persons with disability to be accepted into mainstream societal activities. They are kept in "protected" spaces and only "emerge" at the end of their studies when negative disability stereotypes have already been entrenched (Cooney et al., 2006). As Kassah et al. (2018) and Schur et al. (2003) note, segregated education reduces the social capital of persons with disability and can also lead to diminished social skills and political participation. These happen because special needs schools are often set up as a response to people's impairments, rather than they being established to meet their total educational needs. Formal education, then, becomes a means of reinforcing disability stereotypes and social exclusion in addition to perpetuating the social differentiation that exists between persons with disability and non-disabled people. In Ghana, however, special needs schools are sometimes the only realistic option that persons with disability in pursuit of formal education can access.
Persons with disability have limited opportunities for employment (Athanasou, 2014;Chhabra, 2021;Maritz & Laferriere, 2016;Sevak et al., 2015). When they are employed successfully, the discrimination at their places of work restricts them (Bonaccio et al. 2020Fevre et al., 2013Foster & Wass, 2012;Hogan, 1998;Morgan, 2021) and sometimes compels them to quit their positions. This, as noted by Hogan (1998), amounts to "punishment" to them for possessing "compromised" bodies. The constricting experiences shared by the participants are similar to findings of Fevre et al. (2013) that co-workers of persons with disability sometimes fail to provide the necessary support needed by persons with disability in their lines of duty. When this happens, persons with disability are unable to work to the best of their abilities. they are incapacitated and disabled not by their impairments, but by the reluctance of their organisations and colleagues to create an enabling environment that will allow them to thrive. In the long run, being stifled at work means that opportunities to progress in their careers and rise into management positions are limited (Erickson et al., 2014;Fevre et al., 2013;Schur et al., 2009). These limitations are created and maintained by negative stereotypes, the imagery of weakness by which impairments are represented and idealist constructions of how the "perfect" worker ought to look like (Foster, 2018;Foster & Wass, 2012;Jammaers et al., 2016). The disability remains the master status regardless of the qualities one has ((Mik-Meyer, 2016).
The level of scrutiny that stigmatised persons such as persons with disability encounter rises in periods of economic downturn when opportunities are generally limited (Shelton et al., 2010). The stereotypical thought is usually that, non-disabled people ought to be considered before persons with disability because the former are perceived to be more agile and "stronger" than the latter. This "othering" of persons with disability affects all aspects of the lives of persons with disability (Brzykcy & Boehm, 2022Foster & Wass, 2012Horton & Tucker, 2014;Jammaers et al., 2016;Mik-Meyer, 2020;Mpofu & Harley, 2006). With Ghana being a developing country with an economy that creates opportunities for marginalised people slowly, the threat of structural discrimination always looms large over persons with disability. It is important to note that experiences of structural discrimination at the work place, as reported by eight out of the 16 participants do not depend on the type of impairment one has, but rather on one's location. If persons with disability find themselves in places of work where they are surrounded by progressive people, these experiences would most likely not occur. However, work place environments that have dogmatic people are almost certainly hostile.
Religion plays a cardinal role in the foundation of social norms and value systems in Ghana (Anthony, 2011;Mfoafo-M'Carthy et al., 2020;Nukunya, 2016) and also plays a major role in the formation of negative disability stereotypes in Ghana (Bayat, 2015;Ocran, 2019;Slikker, 2009). Consequently, impairments are often considered as evidence of supernatural activity such as punishments from deities, malevolent spirits and ancestral spirits for the sins of persons who have the impairments or those committed by their family relations (Agbenyega, 2003;Avoke, 2002;Bayat, 2015;Kassah, 1998;Slikker, 2009. Impairments are sometimes believed to occur as a result of curses that are pronounced on individuals or their families (Naami, 2014). Impairments are, therefore, seen in a negative light as social contaminants. The religious space is conceptualised as a sacred place that does not countenance social contaminants such as "bodily flaws". It is, therefore, not surprising that sites of religious congregation are places where instances structural discrimination against persons with disability were experienced by some of the participants.
The restrictions, condescension, patronage and mistreatment that the participants reported inhibits the capacities and aspirations of persons with disability to establish and develop relationships that have the potential of empowering them and making them feel secure in those social spaces (Loja et al., 2013;Shaw et al., 2012;Zola, 2005). When the design and construction of the built environment are exclusionary, in situations described by Imrie (1996) as "design apartheid", the needs of non-disabled people are prioritised over the needs of persons with disability. As a result, in a number of schools, places of work, transport terminals, banks, hospitals and places of worship, the accessibility needs of persons with disability such as passages with appropriate dimensions, toilet fittings installed at appropriate heights and tables are often disregarded.

Conclusion
This paper highlights the stigmatising experiences of middle-class persons with disability as a distinct category of persons with disability. This study also shows the significance of socio-cultural differences and contextual factors in the experiences of persons with disability. This is because normative systems may amplify or mitigate stigmatising experiences. Even though the study was conducted in Ghana, the findings reveal that the experiences of persons with disability in Ghana are in many ways similar to the experiences of persons with disability in other places. Middle-class persons with disability experience contradictions of simultaneous acceptance and rejections in different social spaces. While these experiences cannot always be foretold, they are founded on constructions of what the ideal body ought to look like and how it ought to function. They are also influenced by normative systems of various societies within which persons with disability live. The similarity of these experiences means that the actions needed to correct these normative systems and the stigmatising social order ought to be discussed at the structural, institutional and the relational levels of social organisation within different societies. At the end of the day, societies and institutions ought to question how people's identities as persons with disability tend to override their middle-class status and other social identity markers to become the master status that determines relational outcomes. This should not be allowed to persist. There is a lot of ignorance about the functional abilities of persons with disability in general and middle-class persons with disability in particular. Middle-class persons with disability are middle-class persons. They have impairments that cannot and should not be ignored because the impairments are part of their personal and social identities. Ignoring the impairments can easily lead to a situation where persons with disability will be expected to behave like non-disabled persons in order to fit in. This will in itself lead to forms of structural discrimination because the institutional regulations, administrative processes and social norms which guide the conduct of people within these social systems are sometimes exclusionary. The impairments of persons with disability should never be the basis for their social rejection and exclusion. Their impairments should never be the reason why they are treated with condescension, regardless of whatever society they may be living or working in. As middle-class persons, they have taste and preference for materials and services that non-disabled middle-class persons seek or aspire to enjoy. They seek and pursue opportunities that non-disabled persons also seek. Their impairments, however, get in the way of society's conceptualisations of how they ought to live their lives in ways consistent with their social class status. This is because their impairments compromise their social identities and undermine their acceptability in some of the social spaces they operate in. In addition to having to deal with relational manifestations of stigmatising experiences, middle-class persons with disability have to contend with institutionalised neglect, patronage and paternalism in ways that marginalise, exclude and dehumanise them, in addition to reducing their social worth. For these reasons, there is, therefore, an urgent need for an "inclusive world building", explained by Garland-Thomson (2017, p. 52) as the need to "integrate people with disabilities into the public world by creating an accessible, barrier free material environment". Social diversity founded on bodily differences ought not to become basis for differential access to opportunity and resources. It is important for societies and organisations within them to recognise the fact that while stigma emerging from interpersonal interactions can be overcome with legislation and policy interventions albeit with some difficulty, structural discrimination requires a more concerted effort of social change that goes to the roots of social norms and value systems governing social institutions. Disabling built environments have to be transformed into progressive and accommodating spaces. Institutional reforms are needed to reorient social action for social inclusion. Education is needed to drive attitude change within social networks. Law enforcement is needed to bring all of these together in addition to grounding the changes into normative systems for posterity. It will be impossible to eliminate disability stigma in general and structural discrimination in particular if institutional remedies and social reforms are not actualised. These emancipatory changes are required in every country, community and institution.