Women with Disabilities: Barriers and Facilitators to Accessing ...

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WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinExecutive Summary1. IntroductionThis review was commissioned by the National Disability Authority (NDA), in ajoint initiative with the National Women’s Council of Ireland (NWCI), to provideinformation on the challenges facing women with disabilities in accessing healthservices during pregnancy, childbirth and early motherhood, both in Ireland andinternationally. The review is one of 3 documents meeting the objectives of anational study commissioned by the NDA. The second report (Begley et al,2009) presents a comprehensive review of Irish and international social policiesrelating to disability and childbirth. The third document (Begley et al, 2010)presents the results of a nation-wide study exploring the strengths andweaknesses of publicly-funded Irish health services provided to women withdisabilities in relation to pregnancy, childbirth, and early motherhood.2. BackgroundOver the past 2 decades, childbirth in Ireland has become more medicalised,and women with disabilities may therefore be at risk of being viewed through amedical lens solely because of their particular disability. A review of the salientinternational literature relating to the care of women with all types of disabilitiesshowed a history of discrimination. Evidence from the literature suggests thatsociety has undervalued women with disabilities, has exerted control over theirsexual and reproductive lives and, in many cases, has exacerbated theirdifficulties. Mothers with intellectual disabilities or mental health difficulties, inparticular, are often separated from their children, whether or not there is anyevidence of potential harm or neglect.ix
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin3. Purpose of reviewThe purpose of this review was to identify and analyse Irish and internationalliterature on the challenges facing women with disabilities in accessing healthservices during pregnancy, childbirth and early motherhood. Because the remitof the literature review was to look at the challenges facing women in thissituation, there may appear to be a rather negative slant to the report. This isneither intentional nor accurate and, indeed, some positive factors are reportedunder the heading of ‘facilitators’ to access.4. Outline of reviewTo provide a background and context for the review, a search for literature onhistorical developments in the care of women with disabilities, their sexualityand reproductive rights, and the effect of disabilities on pregnancy wasconducted. In addition, and to cover the main focus of this review, literature onthe challenges faced by women with disabilities in accessing services duringpregnancy, childbirth and early motherhood was sought and presented underthe headings of ‘barriers’ and ‘facilitators’ to access.A total of 161 papers on women with physical disabilities were sourced, 114 ofwhich were relevant; 18 papers (14 of which were relevant) on women withhearing impairment, 9 (6 of which were relevant) on women who had a visualimpairment, 3 papers on ethnicity and disability, 97 on women with mentalhealth difficulties and 52 on women with intellectual disability. The reviewincluded both qualitative and quantitative research papers from 1950 to 2008.Data from countries comparable to Ireland were included and all literature froman Irish context was used.A total of only 87 research papers relating to barriers and facilitators toaccessing services during pregnancy, childbirth and early motherhood wereidentified for women with all disabilities, although some papers discussed morethan one disability. These papers were reviewed and analysed under 5x
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