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 DublinClark (2002) U.K.Conine et al(1986)D’Eath et al(2005)CanadaIrelandTo exploreaccessibility ofhealth informationprovided by NHS topeople withdisabilities.To examine theavailability ofpreventativematernal healthcare and theprovision ofchildbirth educationservices to womenwith a physicaldisability inVancouverTo explore theexperiences ofpeople withdisabilities inaccessingmainstream healthservices.Quantitative.Review keyinformationbooklets andleaflets.Quantitative.Self reportedsurvey.Qualitativedescriptive,exploratory.Unstructuredinterviews.130 people witha physical andsensorydisability.20 agencies inVancouver thatprovidechildbirtheducationservices forwomen with aphysicaldisability.32 participants,12 women, 15men withdisability, 5relatives/advocates. 4women withdisabilities(physical andhearing) withexperience ofmaternityservicesPeople with disabilities do not receive healthinformation in appropriate formats.Childbirth education for women with a physicaldisability is limited; women are usually referredelsewhere. Challenges encountered withphysical accessibility. Educators do notconsider provision of classes for this populationas part of their function. Educators lackknowledge about the impact pregnancy willhave on disability. Not willing to embraceconcept of normality and mainstreaming of thispopulation.People with disabilities experience a multitudeof inequalities in accessing and utilising thehealth services. Services are fragmented anduncoordinated, inequalities not addressed byinstitutions, principles of equity, fairness andperson centeredness are not operationalised,and the person’s autonomy is impaired by lackof support mechanisms. Communication,physical and attitudinal challenges werefrequently encountered and unaddressed.163
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY, CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinGrabois etal (1999)Grue &Tafjord-Laerum(2002)Jackson &Wadley(1999)Lipson &Rogers(2000)U.S.A.NorwayU.S.A.U.S.A.To determine ifprimary carephysicians andaccess to theiroffices are incompliance withU.S.A. DisabilitiesAct (1990)To explore themotheringexperiences ofmothers with aphysical disability.To determinereproductiveconditions, potentialcomplications andbehaviours inwomen post spinalcord injury.To develop agreaterunderstanding ofwomen’sexperiences of andtheir satisfactionwith the health careservices utilisedduring pregnancy,QuantitativeCrosssectionalsurvey.Self-reportedquestionnaireQualitativedescriptive,exploratory.Semistructuredinterviews.Quantitative.Questionnaire.Qualitative.Semistructuredinterviews.220 physicians(GPs, internistsobstetricians).62 responded.Response rate= 28%.30 women witha physicaldisability agedbetween 28-49years472 women,one year postspinal cordinjury.12 women withmobility limitedphysicaldisability.18% of physicians could not provide a serviceto people with disabilities and were noncompliantwith disability legislation. Barrierswere identified in relation to physical access,inaccessible equipment and inappropriatereferral of people. Practices werediscriminatory.Becoming a mother afforded women a sense ofnormality, focus was on mothering notdisability. Women had to overcome societalattitudes that perceived them as different to thenorm. Perceived as dependent recipients ofcare rather than autonomous carers. Fear thattheir children will be taken into custody.Reproductive health concerns of women withspinal cord injury. Sexual experiences andcomplications associated with the injury arediscussed. Challenges in access toreproductive health care were encountered.Women’s experiences shaped by 3 factors –specific disability, resources, personality andapproach to pregnancy. Health professionalshad little experience and lacked awarenessand knowledge of pregnancy and disability. Noreferral to allied professionals. Birth experiencewas medicalised and technology usedfrequently. Postpartum health professionalswere insensitive, communication was164
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