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 Dublinand imposition of the biomedical solutions in the treatment and prevention ofrelapse may increase women’s reluctance to access services and/or encouragethem to disengage from services prematurely.5.10. Barriers to affordability of services for women with mentalhealth difficultiesFor mothers with low income and inadequate transportation, an inability to paytravel costs and childcare can be another barrier and added stress (Anderson etal, 2006). Difficult getting transport to and from appointments and not being ableto afford a babysitter was also highlighted in Teng et al’s (2007) study onimmigrant mothers. The lack of crèche facilities and the inappropriateness ofsome mental health environments for children were seen as major barriers toengaging with services as women were unable to bring their children to theirconsultation ( Nicholson et al, 1998a; Diaz-Canjela and Johnson, 2004). Thesebarriers are exacerbated among mothers with severe mental health difficulties,as they are, typically, not just in receipt of low income, but in addition areparenting alone. Lack of health insurance has also been cited as a barrier toaccessing services (Sobey, 2002). Thus the financial burden of accessingsupport cannot be underestimated, especially for low income, unwaged orrecently immigrant women. A recent study in England found that 70% of the 152trusts surveyed said they would provide home antenatal or postnatal visits forwomen with mental health needs (Commission for Healthcare Audit andInspection, 2008), which would be very helpful.5.11. Facilitators to overcome availability challenges for womenwith mental health difficultiesOnly 10 published papers presented facilitators to access, in addition tohighlighting numerous barriers. The literature provided very little in the way ofsuggestions to improve the availability of services, except possibly theexhortation to close the gap between policy, aspiration and service provisionand to provide training and education of health professionals (Shakespeare etal, 2003), which might improve communication between professionals inmaternity services and those in mental health care. The introduction of109
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublintelesupport or web-based support groups (Ugarriza, 2002) might also increasethe care provided in the community, albeit through lay involvement rather thanthrough health service funded initiatives. The suggestion of providingdesignated perinatal multidisciplinary teams in the community (Oluwatayo andFriedman, 2005) would make a significant difference to women suffering mentalhealth difficulties in pregnancy or the postnatal period. Assistance frompsychologists and social workers (Zittel-Palamara et al, 2008) would also assistwomen with postpartum depression.For women who experience postnatal mental health difficulties, rapid access toappropriate specialist services and treatment is recommended to lessen theirdistress and the possible negative impact on their babies (Royal College ofPsychiatrists, 2002). The report of the Confidential Enquiries into MaternalDeaths (Lewis, 2007) identified the need for women to be cared for in specialistmother and baby psychiatric units and not separated from their baby. However,specialist mother and baby units are few and far between in the United Kingdom(Robinson, 2005) and nonexistent in Ireland (NWCI and NDA, 2005).Consequently, women are admitted to mixed sex, acute psychiatric units thatare ill equipped to meet their or their babies’, special needs.5.12. Facilitators to overcome accessibility challenges forwomen with mental health difficultiesVery little work has been carried out to identify facilitators in this area and, giventhe negative effects of a mental health condition; it is hard for many of thesewomen to motivate themselves to access services, especially if they arefragmented or nonexistent. The development of greater trust between healthprofessionals and the women presenting at services is, however, one optionthat is likely to facilitate increased attendance (Jesse et al, 2008)..5.13. Facilitators to improve accommodation of women withmental health difficultiesThe main suggestions provided by the literature were to provide education forwomen about postnatal illness and the services available to them (Buultjens110
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