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 Dublin‘developmental disability’ and ‘intellectual disability’ (Schalock et al, 2007;Wehmeyer et al, 2008). The American Association on Mental Retardationchanged its name on 1 st January 2007 to the American Association onIntellectual and Developmental Disabilities (AAIDD) (AAIDD, 2008).In the past century and a half, additional social policy labels have applied to thisgroup of people. These included terms such as 'developmentally disabled','feeble-minded’, ‘idiot’, ‘imbecile’, ‘mental defective’, ‘mentally retarded’ and‘vagabond’. (United Kingdom Parliament, 1913; Stainton, 1992; Trent, 1994;Cocks et al, 1996; Walmsley, 1997; 2000; Walsh and Gash, 2004; Grant et al,2005). Gates et al (2007) adds ‘moral defective’ and ‘uneducable’ to this list.The label utilised and what it means has varied over time and legislativeboundaries. From the literature, it would appear that, as social policy shiftedover the last century from care based on the bio-medical model, emphasisingsegregation and institutionalisation, to a social and rights based approach, theterms existing at the time became outdated and changed. Furthermore,negative overtones have developed around many of the labels that werepreviously used and so these have become unacceptable (ERHA, 2002; Gates,et al, 2007). Thus, for example, the previous medical and legal classifications‘idiot’ and ‘imbecile’ (United Kingdom Parliament, 1913) are now generallyconsidered to be insulting and undignified terms.2.7.2.2. Defining characteristics and diagnostic criteriaWhile the label and meaning(s) attached to this heterogeneous group of peoplemay vary over time and between societies, the general consensus in thepublished literature is that a number of commonalities exist (Gates et al, 2007;MacKenzie, 2007) and the following recurring themes have emerged (WHO,1992 and 1993; Jenkinson, 1996; American Psychiatric Association, 2000;Scottish Executive, 2000; Department of Health, 2001; Welsh Office, 2001;ERHA, 2002; New Zealand Ministry of Health, 2003; Department of Health and41
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinSocial Services and Public Safety Northern Ireland, 2005; Salvador-Carulla,2008):- There is a below-average level of intellectual functioning(intelligence quotient of less than 70);- There is a significant deficit in everyday living skills;- The onset occurs before the age of 18 years.In relation to diagnostic criteria and classifications of intellectual disability, theDiagnostic and Statistical Manual of Mental Disorders (DMSIV) TR Edition(American Psychiatric Association, 2000) and the International StatisticalClassification of Disease and Related Health Problems 10 th Version. (ICD 10)(WHO, 1992) are the most commonly used.The Disability Act (Government of Ireland, 2005) uses the term ‘intellectualdisabilities’, but does not define it. The Criminal Law (Sexual Offences) Act(Government of Ireland, 1993) uses the term ‘mental handicap’, but it also is notdefined. However, Section 5(5) of the Act (‘Protection of mentally impairedpersons’), does define the term ‘mentally impaired’, a heading which a smallproportion of people with an intellectual disability may at times come under. Inthis section "mentally impaired" is defined as “suffering from a disorder of themind, whether through mental handicap or mental illness, which is of such anature or degree as to render a person incapable of living an independent life orof guarding against serious exploitation.” (Government of Ireland, 1993:pg. 5(5))There is one legal definition of intellectual disability in United Kingdom, found inthe Mental Health Act (United Kingdom Parliament, 1983). However, this onlydefines people with intellectual disabilities (mental or severe mental impairment)who exhibit aggressive or seriously irresponsible behaviour (a minority of theintellectual disability population). According to Gates et al (2007), this is the firsttime in the United Kingdom that intellectual disability and mental ill health havebeen defined as separate legal entities.42
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