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 Dublinmaternity services, therefore, is to be doubly disadvantaged. The barriers andfacilitators experienced by women with a disability when accessing the healthand maternity services during pregnancy, childbirth and early motherhood werenoted under the 5 headings of: availability, accessibility, accommodation,affordability and acceptability.7.1.2. Barriers to accessing services for women with disabilities7.1.2.1. Availability of services for women with disabilitiesIn general, services were available in most countries for women with physicaldisabilities or sensory impairments, but whether the care was appropriate andaccessible was questionable. There were, however, poor links betweenmaternity and mental health services (Currid, 2004; Commission for HealthcareAudit and Inspection, 2008), and it was difficult to discover if any suitableservices were available for women with intellectual disabilities.7.1.2.2. Accessibility of services for women with disabilitiesAccessibility of services, in the main, related to the location and models of care,difficulties in transport and moving around the physical environment. For womenwith sensory impairment there was an identified need to improve access tobuildings and services (Nzegwu, 2004), with emphasis on the difficulties ofcompleting registration forms, locating a seat in the waiting area, and realisingwhen to go into the examination room (Ubido et al, 2002). In some instancesphysical, architectural and communication barriers were so prominent that theavailability of particular services were at a sub-optimal level (Miller and Finnerty,1996; Fiduccia, 1997; Grabois, 2001; D’Eath et al, 2005). Women with mentalhealth difficulties needed particular encouragement to overcome the possiblelack of motivation to attend clinics (Zittel-Palamara et al, 2008) or even, rarely,special assistance if they denied the pregnancy totally (Apfel and Handel, 1993;Nicholson et al, 1998a).119
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin7.1.2.3. Accommodation of women with disabilitiesBarriers to accommodation centred mainly on the lack of provision of suitabledisability-specific health information for women (Conine et al, 1986; Carty et al,1993). In particular, women with sensory impairments needed informationprovided in alternative formats (Jones et al, 2007), and all women requiredinformation on the existence of mental difficulties in pregnancy and thepostnatal period, and of services available to them (Buultjens and Liamputtong,2007). There were difficulties with communication, caused by physical malpositioningof reception desks and staff (McKay-Moffat, 2007), and a lack ofappreciation of the needs of women with sensory impairments. Interpersonalskills, aids and services were typically deemed inappropriate by women withdisabilities, irrespective of their type of disability. This impacted on the issue ofinformed consent (McEvoy et al, 1983; Mowbray et al, 1995a; Grabois, 2001),resulted in a deficit of information for expectant and/or new parents andcontributed to impaired autonomy, decreased self-confidence, self-esteem andself-worth (Thomas, 1997; Tilley, 1998; Walter et al, 2001; Prilleltensky, 2003).Maternity care professionals had little knowledge about the effects of physicaldisabilities on pregnancy (Westbrook and Chinnery, 1995; Smeltzer et al, 2007)and the capability of women with all types of disability to parent. In addition,their lack of knowledge of the effects that mental health difficulties had onpregnancy, childbirth and early motherhood (Wiley et al, 2004) led to poorscreening practices and inappropriate care (Robinson, 2007).120
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