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 Dublinsocial issues may result in women minimising or denying their distress.Although an important source of psychological support, the propensity to drawon informal sources of support may have implications for women from othercultures, affecting their willingness to seek help from professionals forpsychological problems.Teng et al (2007) interviewed 16 health care workers in Canada, regarding theirexperiences of providing care to recent immigrant women with postpartumdepression. Participants in this study were of the view that cultural conflictsacted as major barriers. The lack of cultural recognition, especially within non-Western cultures, of postpartum depression as a ‘medical problem’ requiringintervention, the stigma and shame associated with a ‘label’ of mental illness,and the cultural imperative that family issues are not discussed outside thehome, may result in many women denying their distress, for fear of beingalienated or bringing shame on themselves and their family. In addition, a lackof spousal support and validation of the need to seek help was also viewed as abarrier.5.7. Barriers to acceptability of services for women with mentalhealth difficulties: Fear of being judged a ‘bad’ mother5.7.1. Society’s views of mothers with mental health difficultiesMontgomery (2005) asserts that women with mental health difficulties areviewed as the wrong women giving birth in the wrong circumstances.Consequently, a significant barrier to women disclosing their distress is a fear ofbeing judged as a ‘bad’ or ‘poor’ mother; this fear has been found to underminewomen’s willingness to disclose to friends, families and professionals, which inturn leads to self-exclusion, withdrawal, decreased social networks, andreducing emotional support (Edhborg et al, 2005; Edwards and Timmons, 2005;Davies and Allen, 2007; Jesse et al, 2008).Women who have experienced a mental health difficulty before pregnancyreport being victims of stigma and negative societal attitudes from friends,101
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinfamily and health professionals, even before they get pregnant. They are awarethat the very idea of them displaying the normal desire to bear children isperceived as selfish, with an automatic assumption that they will not be ‘stableenough to function as a mother’ (Perkins, 2003:pg. 157). Consequently, thesewomen automatically encounter the medical discourse of ‘relapse risk’ fromboth family and professionals. Women are strongly advised that a worsening orrelapse of ‘illness’ must be avoided at all costs and are continuously advised notto get pregnant, for fear of a recurrence of their illness (Nicholson et al, 1998a),with others being made to feel that getting pregnant and remaining healthy ismerely a ‘pipe dream’ (Perkins, 2003:pg. 157). Once pregnant, women reportexperiencing reactions including disapproval, ambivalence and anger (Blanch etal, 1994; Mowbray et al, 1995a). Consequently, the fear of negative reactionsacts as a powerful barrier to these women seeking help and support, and mayresult in women delaying accessing prenatal care.5.7.2. Family’s views of mothers with mental health difficultiesFamily members can be a powerful source of support to women, or a source oftension and conflict. Women report that family members who do not understandtheir mental health difficulties are angry, resentful and blame them for problemsthat arise with children. In some cases family members, cast the mother in a‘sick role’, undermining the women’s efforts to parent or recover, by makingdecisions about children without consulting or considering the mother’s wishes(Nicholson et al, 1998c). The long term consequence of this behaviourfrequently result in women internalising societal and family assumptions aboutincapability and incompetence (Fox, 2004; Schen, 2005). As a consequence,mothers are less likely to seek help when needed from family and reportdifficulty trusting their own assessments of their children’s needs, their ability tomeet them and the confidence to advocate for themselves or their children(Mowbray et al, 1995a; Nicholson et al, 1998b). In addition, if women wereadmitted to in-patient units, these were seen as inappropriate places forchildren to visit, due to the lack of facilities for children, such as family roomsseparate from wards (Nicholson et al, 1998a; Diaz-Canjela and Johnson, 2004).102
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