Women with Disabilities: Barriers and Facilitators to Accessing ...

WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinthat the policy reduces the availability of alternative models of care and theproximity of services to women as some women are required to travel up to 80kms to the nearest maternity unit (Sheeran, 2007). The organisation andmodels of care are not uniform or standard among these hospitals. In additionto the 2 midwifery-led units, 4 out of the 19 hospitals offer community basedservices, for example, Domino and Community Midwives schemes. Theseschemes afford a woman who is classified as having a ‘low risk’ pregnancy theopportunity to access care in the community or in her own home. Depending onthe model of care on offer the woman may also give birth at home. Somehospitals provide an alternative model called the ‘early transfer home’service/scheme where mothers and babies are discharged from the hospital 6hours after the birth and a team of midwives provide midwifery care for thesubsequent 5 days in the woman’s own home. To be eligible for this schemethe mother and baby must have had an uncomplicated birth and immediatepostnatal period.3.3.2. TransportDriving independently may not be an option for some women with a physical (orsensory) impairment so they are reliant on public transport, taxis or otherindividuals when travelling to and from health care facilities (Anderson andKitchin, 2000; Lawthers et al, 2003; Prilleltensky, 2003; Scheer et al, 2003).Depending on the woman’s geographic location and the availability of suitablyadapted public transport, access to health care facilities and participation inother community activities may be severely curtailed. In the United States, it isestimated that 1 in 4 women with disabilities have no access to appropriatetransportation (Nosek, 1992; Goodman, 1994). Inadequate transport to andfrom the health care facilities can pose significant challenges for women tryingto get to appointments and to access reproductive care. Even when publictransport is available Smeltzer et al (2007) report how, in the United States, it isexpensive, undependable and inadequately equipped to accommodate orsecure women with a wheelchair (Smeltzer et al, 2007). Long waiting times forsuitably adapted transport to arrive is the norm and can be problematic when54