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 Dublinthe model does not clearly acknowledge that the presence of barriers and theabsence of facilitators contribute in any way to the difficulties that a person witha disability experiences. The social model of disability is thus only partiallyadopted and is never clearly acknowledged or operationalised.In 1993, the World Health Organization began revising the ICIDH, seeking theassistance of disability groups from around the world, including DisabledPeoples International, along with professional groups such as the AmericanPsychological Association and the American Occupational Therapy Association.Two drafts were produced and critiqued and in 2001 the final version, called theInternational Classification of Functioning, Disability and Health (ICF) waspublished. This classified functioning at both the level of body/body part, wholeperson, and whole person within a social context, thus incorporating holism oruniversalism as its guiding principle (Bickenbach et al, 1999). The main changewas that the instrument acknowledged that the environment has an interactionaleffect on people, which may assist or hinder their participation in life activities,and that this may be more instrumental in a person’s inability to participate thanthe limitations associated strictly with their physical, mental, or emotional state(Lollar and Crews, 2003).2.5.3. Society’s attitudes to women with disabilityAccording to Tilley (1998), many of the challenges encountered by women withdisabilities when accessing health care are located in prejudicial social attitudesand discriminatory and exclusionary practices of individuals, organisations andinstitutions. In particular, ‘The attitudes of medical professionals towardsdisabled women as child bearers have often been based on myth rather thanfact’ (Kallianes and Rubenfeld, 1997: pg 208). These women may experiencemultiple layers of discrimination, exclusion and inequalities in access to, anduse of, mainstream healthcare services (Combat Poverty Agency, 1995). Allwomen experience challenges when accessing health care, but for women withdisabilities the challenges are often disproportionate and inequitable (Lawtherset al, 2003). Health inequities are said to be those differences that areunnecessary, avoidable, unfair and unjust (Whitehead, 1992). Such inequities21
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinevolve from a complexity of factors including the segregation of women withdisabilities, attitudinal barriers, physical barriers and the unmet needs foradvocacy (Pillinger, 2004). No single challenge can be considered ascompromising a women’s access to health care, rather the challenges are anaccumulation of several factors (Scheer et al, 2003). These challenges preventwomen from accessing health care when required and only serve to isolate andalienate women with disabilities (Grabois et al, 1999) and lead to them feelingas though they have failed as wives and mothers (Mitton et al, 2007). Whilethese challenges may be relatively insignificant for women without a disability,for women with disabilities who need more interaction with, and have anincreased need for, appropriate and accessible health care services, thechallenges are very significant (Parish and Huh, 2006) and equate to anadditional disadvantage in women’s health and well being (Iezzoni, 2003).2.5.4. Reproductive controlMany authors have argued that for women with physical disabilities the politicsof eugenics has had a long-standing influence on repression of reproductionand the parenting role (Finger, 1992; Waxman, 1993; Kallianes and Rubenfeld,1997). In addition, health care professionals and broader society exertedpaternalistic control (Waxman, 1993; Kallianes and Rubenfeld, 1997; Bau,1999) over such women’s reproductive and mothering rights, consequentlymany disabled women’s identities were unseen and unquestioned(Zitzelsberger, 2005).Often, women with physical disabilities are presumed to be unable to cope withpregnancy, birth and motherhood and are counselled not to become pregnant(Tilley, 1998; NDA, 2007). Tait (1986) notes how women with disabilities aregenerally economically less privileged and socially more defenceless, and howthese women continue to be deprived of the ability to reproduce by forcedsterilisation, often by means of a hysterectomy. Data on the frequency ofsterilisation among women with a disability are sparse. A large-scale studyundertaken by Nosek et al (2001) compared the reproductive health of women22
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