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 Dublin7.1.2.4. Affordability of services for women with disabilitiesWomen with mental health difficulties were identified as having barriers in thearea of affordability (Anderson et al, 2006), as many are from low incomefamilies and the costs of childcare and transport may also prevent them fromaccessing health care services.7.1.2.5. Acceptability of services for women with disabilitiesHealth professionals’ lack of knowledge and negative attitudes led to barriers inacceptability, as women did not feel respected or supported (Steinberg, 2006;Commission for Healthcare Audit and Inspection, 2008) and healthprofessionals failed to recognise and appreciate their needs. Evidence from theliterature reveals how healthcare workers primarily viewed all mothers with adisability as being dependent recipients of care and services. Women perceivedthat their right, ability and capacity to parent were constantly met withscepticism (Harris and Bamford, 2001; Prilleltensky, 2003, 2004) and womenreported that they felt continually scrutinised, particularly those with anintellectual disability or enduring mental health difficulties (Prilleltensky, 2003;Grue and Tafjord-Laerum, 2002). Women with mental health difficultiesappeared to have the most obstacles to surmount, including overcoming areluctance to admit to their illness, due to the stigmatisation of mental healthdisorders, and the fear of being judged a ‘bad mother’ (Edhborg et al, 2005;Davies and Allen, 2007). The fear of losing custody of their child led, in manyinstances, to lack of trust in health care providers (Montgomery et al, 2006;Jesse et al, 2008) and the feeling that they were continually having to provethemselves to the authorities. Struggling to be accepted as ordinary and to beconsidered within the concept of normality, mothers felt vulnerable (Conley-Jung and Olkin, 2001; Llewellyn et al, 2003) and went to great lengths topresent themselves as managing the transition to parenthood competently.Women with intellectual disabilities encountered society’s negative attitudes tothem becoming pregnant and caring for their children also (Cuskelly and Bride,2004; Drummond, 2006), with a resulting lack of support networks for them121
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinduring pregnancy, childbirth and early motherhood (Aunos et al, 2008). Childrenof mothers with intellectual disabilities or mental health difficulties were oftentaken into custody, despite a lack of evidence of harm to them. Following suchremoval, parents were often unrepresented in the court proceedings and formalcourt interventions were not activated to help parents regain custody (Swainand Cameron, 2003).7.1.3. Facilitators to improve access to services for women withdisabilitiesFacilitators to access that were identified for women with all disabilities includedimproved physical access to all care areas, the provision of sensitive antenataleducation classes (Conine et al, 1986; Carty et al, 1993) and education ofhealth professionals to improve their knowledge of, and attitudes towards,women with disability (Baker et al, 1997; Smeltzer, 2007). Specific disabilityawareness and training for health professionals, particularly in speakingcorrectly for lip-readers (RCN, 2007), and in the use of basic sign language isrecommended in the literature. The use of telephone amplifiers and/or pictorialsignage, audible, visual and tactile systems in waiting rooms and informationprovided in an appropriate language and format were all noted to be useful inimproving accessibility to services (Clark, 2002; Nzegwu, 2004). It was alsofound that the employment of sign language interpreters in appropriatelanguages is useful for women with sensory loss who are from ethnic minoritygroups (Pierce, 2003).For women with mental health difficulties, improved communication betweenprofessionals in maternity services and those in mental health care was seen asdesirable (Shakespeare et al, 2003), with emphasis on the provision of morecounselling services instead of drugs (Edge and Rogers, 2005; Edge, 2006).The key Irish study of the experiences of people with disabilities of the healthservices, commissioned by the National Disability Authority (D’Eath et al, 2005),reported some positive experiences particularly in relation to care provided byGeneral Practitioners. People with mental health difficulties, however, did notexperience the same degree of partnership approaches and inclusive practices122
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