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 Dublin3.2. Defining ‘access to services’The Commission on the Status of People with Disabilities (1996) argued thatpeople with disabilities have a fundamental right to a health service which isaccessible, equitable, individual centred and responsive to their particular need.Furthermore, positive health outcomes and social gain for women withdisabilities are dependent on accessible and appropriate health care and theprovision of adequate health information to woman during pregnancy, childbirthand early motherhood.Access is a multidimensional concept with 5 distinctive dimensions,incorporating both the potential to obtain and the actual receipt of health care(Aday and Andersen, 1984). It encompasses more than just access to thephysical environment; it also includes access to health information and effectivecommunication between health professionals and women. Women withdisabilities report insufficient access to health care services (Fouts et al, 2000).They encounter substantial challenges, which impact significantly on their abilityto access care. These challenges are varied and can be categorised asphysical, attitudinal, communicational, informational and financial (Thierry,1998). The term access has multiple meanings and a precise definition isdifficult to find. The Oxford Dictionary describes the term as ‘the action of goingor coming to or into; coming into the presence of, or into contact with; approach,entrance and the habit or power of getting near or into contact with; entrance,admittance, admission’ (Oxford Dictionary, 2008). Words synonymous with theterm include ‘coming to or towards and approaching’. Terms such as access,availability and acceptability are often used interchangeably.Many researchers (Aday, 1975; Penchansky and Thomas, 1981; Parish andHuh, 2006) attempt to define, refine and interpret the concept which hasresulted in the development of many different interpretations. Suchinterpretations range from the potential to obtain available resources andservices to ensuring equal use of services for equal need. The use and relativityof the services forms the basis of Aday’s (1975) definition. The author contends51
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinthat a ‘lack of access occurs when there is a need for the services but theseservices are not being utilised’ (Aday, 1975:pg. 221). However, Penchanskyand Thomas (1981) extend the definition further and suggest that access is ameasure of the degree of ‘fit’ between the characteristics and expectations ofthe person and characteristics of the health care services. Parish and Huhconclude that it is the ‘timely utilisation of services to achieve the best possiblehealth’ (Parish and Huh, 2006:pg. 7). A commonality in all definitions is that theconcept is dependent on the person’s ability and willingness to enter into thehealth care services (Penchansky and Thomas, 1981).Penchansky and Thomas (1981) suggested how the concept has 5 reasonableand distinctive dimensions which are interrelated and not easily separated. Thedimensions are:• Availability, which refers to the relationship between the extent and typeof services available to address women’s needs;• Accessibility, referring to the relationship between the location of thewomen and the location of the services;• Accommodation, which is the relationship between the service providersand the organisation of resources to accommodate women;• Affordability, referring to the women’s ability to afford the services;• Acceptability, which refers to the relationship established between healthservices providers and the women.Challenges encountered in any of these 5 component dimensions will impactsignificantly on women in 3 distinctive ways – a decrease in the utilisation ofservices, dissatisfaction with the services and care received and an inequality inservice provision (Penchansky and Thomas, 1981). Availability and affordabilityhave much the same challenges for able-bodied women as for those who aredisabled, with the exception that many disabled women are unemployed andtherefore are less likely to be able to access private care. The challenges andbarriers experienced by women with physical disabilities when accessing health52
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