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 Dublindelays help-seeking actions and prolongs their illness. In addition, women fearbeing judged ‘a bad mother’ and, in particular, are afraid that they will losecustody of their child. Because of this, they do not trust health care providersand feel that they are continually having to prove themselves to the authorities.Other barriers stem from a reluctance to take medication, fearing that it willcause addiction, affect the fetus or baby while breast-feeding, or impair theirability to care for their children. Finally, these women tend to be from lowincome families and costs of childcare and transport may prevent them fromaccessing health care services.Few facilitators to improve access to services were mentioned in the literature,but those that were included the provision of childcare facilities, education ofhealth professionals, the introduction of support groups and the provision ofdesignated perinatal multidisciplinary teams in the community. Bettercommunication and continuity of care from health professionals could assist indeveloping more trust with their clients. Family meetings are recommended toassist in developing understanding and acceptance among relatives, andcounselling services are more acceptable to most women than drugs.This chapter has demonstrated clearly that there are many deficiencies in thecare provided for women with mental health difficulties in pregnancy, childbirthand early motherhood. More research on what measures would provideeffective support would be valuable.113
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinChapter Six: Women with intellectual disability: barriersto accessing services and professional help duringpregnancy, childbirth and early motherhood6.1. IntroductionThe literature concerning women with intellectual disabilities and theirexperiences of pregnancy, childbirth and early motherhood was not extensive.Initial sections of this chapter will present the barriers for these women toaccessing services, as identified from 25 published research papers (Appendix6, Table 8). No appreciable amount of literature was found on any of thebarriers except acceptability of services. It is not known, but it is unlikely thatthere are specific services available for women who have intellectual disabilitiesand are pregnant. The final section describes facilitators that were noted in only1 paper (Appendix 6, Table 9).6.2. Barriers to acceptability of services for women withintellectual disabilities6.2.1. Society’s attitudes to women with intellectual disabilitiesbecoming pregnantStehlik (2001) traces the history of the development of negative attitudestowards the sexual and reproductive capability of women with intellectualdisabilities. These negative attitudes, she argues, continue today, withprevention of conception as the ultimate aim, through the employment ofinvoluntary sterilisation and non-consensual contraception. Priestly (2000)argues that the infantilisation of women with intellectual disability allowed theirreproductive health to be ignored, with no impetus to carry out breastexaminations and cervical smear testing or to maintain menstrual care. Theexistence of these disparities has only in recent years come to light and is nowbecoming a focus of care (Ditchfield and Burns, 2004; Rodgers and Lipscombe,2005; Rodgers et al, 2006). A review of the literature on the sexual health ofwomen with intellectual disabilities reveals little research into their pregnancy or114
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