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 Liamputtong, 2007) and to provide support groups for mothers (Ugarriza,2002; Diaz-Caneja and Johnson, 2004). Certainly, meeting other women withsimilar experiences was found to be a positive experience in one small study inthe United Kingdom (Edwards and Timmons, 2005).5.14. Facilitators to improve acceptability of services forwomen with mental health difficultiesThis was the largest section, with the most barriers described, yet there is littleliterature presenting suggestions of how to facilitate an improvement inacceptability of services for these women. Many of the barriers stemmed fromsociety’s and the families’ attitudes to mental health, which would be hard tochange. Family meetings (Diaz-Caneja and Johnson, 2004) may assist indeveloping understanding and acceptance among relatives, which may in turnhelp women to come to terms with their situation.Training and education of health professionals (Shakespeare et al, 2003) mayhelp to change attitudes and foster greater trust between health professionalsand women attending their services (Jesse et al, 2008). Continuity of care(Heneghan et al, 2004) has also been shown to increase the trust felt by womenand is recommended.In the few studies located that asked women what type of help and support theywould benefit from, all were looking for supportive partnerships withprofessionals. Women wanted to be treated with respect, and have theirstrength acknowledged. The need for professionals to see mothers as not justan ‘illness’, but as people living and surviving often in difficult and challengingpersonal and social circumstances, was emphasised. Women expressed adesire for more family meetings, help in communicating with their children,especially about their mental illness. In addition parenting skills training,occasional respite services, and early intervention with ongoing support werehighlighted. The value of peer support was recognised by women whorequested opportunities to meet other mothers in a group context to shareexperiences, and activities for children to meet other children in similar111
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinsituations (Nicholson and Henry, 2003; Diaz-Canjela and Johnson, 2004). Inaddition, there is some suggestion that counselling services are moreacceptable to most women than drugs, and non-national women prefer to haveaccess to counsellors from their own cultural background (Edge and Rogers,2005; Edge, 2006).5.15. Facilitators to improve affordability of services for womenwith mental health difficultiesAgain, there were few suggestions put forward, but one paper recommendedproviding childcare facilities at clinics (Ugarriza, 2004) to decrease the cost ofattending for visits, which might increase attendance. Providing practical helpwith mothering (Diaz-Caneja and Johnson, 2004) would also be beneficial.5.16. SummaryWomen with mental health difficulties appear to suffer far more barriers toaccessing services than do women with other disabilities. This may be solelybecause the experiences of women with mental health difficulties are betterdocumented; however, the availability of appropriate care is certainly less andthere are poor links between maternity and mental health services. Due to thewomen’s mental state, they may lack motivation to attend clinics or they mayeven, rarely, deny the pregnancy totally, which can lead to postnatal emotionalproblems.Many women are ignorant of the existence of antenatal mental health difficultiesand have only a slight knowledge of postnatal mental disorders. They lackknowledge of the services available to them and, due to their illness, may bereluctant to seek help. As screening practices in maternity settings are uniformlypoor, and maternity care professionals are not very knowledgeable aboutmental health issues, many women will not have a timely diagnosis and referralmade.Even when diagnosed, many women are afraid to admit to their illness, due tosociety’s, and their family’s, stigmatisation of mental health disorders. This112
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