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 DublinCaribbean women (Edge and Rogers, 2005), suggesting that there are racialdisparities in barriers. Women in these studies were of the view that simplytelling women that information is confidential is not sufficient, health careprofessionals need to build rapport with women, by demonstrating care andempathy. The need to provide culturally sensitive counselling, by utilisingcounsellors for different racial backgrounds, and acknowledging the centrality ofspiritual support in some women’s lives was also emphasised.5.9. Barriers to acceptability of services for women with mentalhealth difficulties: Conflict and fears over taking medication5.9.1. Fear of addictionFor many women who experience mental distress, prescribed medication in theform of anti-depressants and or anti-psychotics form part of their treatmentregime. The fear of being prescribed medication was a significant barrier toaccessing services for the Black Caribbean women in Edge (2006) and Edgeand Rogers’s (2005) study. Women believed that if they attended a GP, antidepressantmedication would be the only treatment offered, leading to adownward spiral of addiction, increased medication and eventually a seriousmental illness. This fear stemmed from previous negative experiences withhealth care professionals and perceptions that black people are discriminatedagainst and subjected to unequal and inappropriate treatments by healthprofessionals. Evidence from research in other areas of mental health suggeststhat that these fears are well founded. It is estimated that women are twice aslikely to be prescribed psychotropic drugs as men, and less likely to be referredfor specialist mental health care (WHC, 2005). In addition, black people aremore likely than white people to be hospitalised through compulsory order, to betreated in a more coercive manner, and to receive higher levels of physicalinterventions, such as electro-convulsive therapy and drugs (Pilgrim andRodgers, 1999).5.9.2. Fear of effect of medications on the fetus or babyMany psychotropic drugs, such as mood stabilisers can be a teratogenic risk tothe fetus. The NICE (2007) guidelines emphasise the need to discuss with107
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinwomen the risks associated with becoming pregnant while on medication andthe risk associated with stopping medication abruptly or in a controlled manner.Despite this the evidence suggests that women are not informed about theirmedications and often struggle alone with the dilemma of stopping medicationand risking their own mental health, or continuing the medication and worryingabout exposing the fetus or baby to harmful effects (Thomas, 1997; Chernomaset al, 2000). Einearson et al (2001), in their Canadian study, found that of the 36women involved, 34 (94%) had discontinued psychiatric medication abruptly forfear of birth defects and harming their baby. As a consequence, many of thewomen suffered both physical and psychological adverse effects, includingsuicidal thoughts. In the majority of cases the women stopped their medicationon the advice of a doctor (family physician or psychiatrist), who in their haste toensure a ‘drug free pregnancy’ may not have considered fully theconsequences of their actions. Conflict over taking anti-depressant medicationand breast-feeding was also an issue for women, postnatally. Women reportedfearing transmitting the medication to the baby during breast-feeding or fearingthat medication would disrupt the breast-feeding experience (Ugarriza, 2002).Consequently, some of the women in Ugarriza’s (2002:pg. 232) study stoppedtaking medication because they did not want to ‘fail’ at breast-feeding,perceiving themselves to have already failed the test for being a ‘good mother’.5.9.3. Fears of impaired ability to care for their childrenWomen also expressed concern about having to be maintained on medicationto prevent relapse. The women in Montgomery et al’s (2006) study spoke of themedication as simply ‘masking’ symptoms, without having any appreciableeffect on their ‘suffering’. Women in 2 other studies (Chernomas et al, 2000;Diaz-Canjela and Johnson, 2004) described how the medication slowed themdown, reduced their concentration and impaired their ability to look after theirchildren. Fatigue also prevented them from attending to their own appearanceand personal grooming. Consequently, some women made decisions to forgomedication that was slowing them down so that they could parent andbreastfeed (Nicholson et al, 1998c; Brunette and Dean, 2002). Althoughmedication may be necessary in the acute phase of illness, the over-reliance on108
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