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 DublinAlakus etal (2007)BuultjensandLiamputtong (2007)Montgomery et al(2006)AustraliaAustraliaCanadawomen withpostpartumdepression mayencounterExploreclinicians’ andservice users’view on currentservices andgaps in servicesprovided toparents withmental healthdifficulties whohave childrenunder 5 yearsTo explorewomen’sexperience ofpostpartumdepression(PPD)Describemothers withserious mentalillnessexperience ofmotheringFocused groupworkshopsInterviewsInterviewscare to new mothers,with problemsincluding PPD34 cliniciansrecruited frommental healthservices. Number ofservice users notidentified10 women admittedto a mother andbaby unit20 mothers recruitedthrough a mentalhealth serviceFear of shaming the family and desire tomaintain family harmony. Lack of spousalsupport and validation of need to seek helpLack of interagency collaboration andcommunication between services, lack ofaccessible support groups for parents withyoung children. Health care professionalsnot aware of services available and unableto provide this information to service usersLack of knowledge about infant mentalhealth issues among professionals workingin adult mental health service. Lack ofawareness among maternal and childhealth that a woman may have a mentalhealth difficulty. Fear of loss of custodyWomen perceived that the support offeredwas more focused on the baby rather thanmother’s needs Shame was a barrier forsome women accessing care. Women didnot receive education about PPD and werenot aware of services available or thatmother and baby units existed.Women used strategies to hide their illness,to protect children from discrimination.Women prioritised children’s needs overtheir own. Medication only ‘masked’symptoms. Feared hospitalisation asincreased risk of custody loss. Health careprofessionals perceived as having limitedunderstanding of their distress andprovided little focused assistance around181
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY, CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinAndersonet al(2006)Edge(2006)Edge andRogers(2005)Daviesand Allen(2005)U.S.A.U.K.U.K.Explore reasonlow incomemothers withmental healthdifficulties donot accessmental healthservicesExplorewomen’sexperiences andmeanings ofperinataldepressionExplorewomen’sexperiences andinteractions withhealth careprofessionalsEthnographicinterviewsIn-depthindividualinterviewsSemistructuredinterviews127 mothers withmental healthdifficulties whosought treatment fortheir children atcommunity mentalhealth services.12 Black Caribbeanwomen experiencingpostpartumdepression (PPD)with babies between6-12 months,recruited fromcommunity healthcentres and ateaching hospital11 mothers with arange of mentalhealth difficultiesrecruited thoughcommunity mentalhealth teamparentingPrioritising children’s needs over own. Fearof custody loss. No health insurance. Lackof transportation and affordable childcare.Perception that health professionals did notunderstand their life circumstances andproblemsRejecting the label of depression as it isassociated with perceived less competenceand personal weakness. Fear ofdiscriminatory and coercive treatments.Fear of being only offered anti-depressantdrugs resulting in addiction and seriousmental illness. Fear of children being takeninto care. Cultural imperatives to denypsychological distress not discussproblems outside the home. Unavailabilityof counsellors from own culturalbackground.Health care professional attitudes/failure todiagnose. Long waiting lists.Women feel under ‘surveillance’ fromprofessionals. Women engage in‘impression management’ strategies inclinical encounters for fear of judgmentsbeing made about their motheringcapability. Health care professionalsdiscount women’s expertise as mothers182
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University of DublinTrinity College
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