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 Dublinappointment times are inflexible. The service is generally infrequent and thedistance of health care facilities from designated bus stops may be such thatwomen still need to negotiate many other challenges in the environment beforereaching the health care facility.For women who use private transport but are unable to drive themselves, apartner, family member, friend, or personal assistant is needed to ensureappointments are kept. Here extensive advance planning is required and oftenappointments need to be scheduled around the driver’s availability. However,accommodation of these requirements and flexibility in the scheduling ofappointments is not a consideration experienced by women. Appointments aregenerally arranged around physician’s and/or consultant’s schedules and it canbe difficult to obtain an appointment outside the scheduled hours (Clark, 2002).Waiting times for appointments are generally reported as too long (O’Doherty,2006) and women’s complex needs, which warrant assistance and extra time(Schopp et al, 2002; Women’s Health Council (WHC), 2004) are rarelyconsidered or accommodated when interacting and interfacing with healthprofessionals (WHC, 2004).3.3.3. Physical environment3.3.3.1. Access to buildingsThe design of the built environment can be another critical determinant ofaccessibility and impacts significantly on the social inclusion and participation ofwomen. For some women physical accessibility to the building is often the firstand most obvious challenge encountered (House of Commons HealthCommittee, 2003; Thierry, 2006) and can be one of the most challengingaspects to obtaining care (Schopp et al, 2002). Access to the built environmentis legislated for in the Disability Act (Government of Ireland, 2005) and Part M ofthe Building Regulations (Department of Environment and Local Government,1997, 2000). The Disability Act (Government of Ireland, 2005) and the EqualStatus Act (Government of Ireland, 2000) require that all service providers‘where practicable and appropriate’ (Disability Act (Government of Ireland,55
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin2005:pg. 27)), make reasonable accommodation for all people with disabilities.Women with disabilities require information about accessible services andresources but information on the number and location of accessible health carefacilities and physician’s practices is not readily available (Clark, 2002; Pierce,2003).Evidence suggests that a substantial proportion of health care facilities andphysician’s offices are inaccessible to women with a physical or sensorydisability (Campion, 1997; Welner, 1997; Grabois et al, 1999; DeJong et al,2002; Smeltzer et al, 2007). It is estimated that 2 out of 5 women withdisabilities experience difficulty getting into and around the built environment ofphysicians' offices (Goodman, 1994) while a fifth of women in both the UnitedKingdom and the United States report that due to architectural barriers, healthcare facilities are unable to accommodate them during childbirth (Goodman,1994; Nosek, 1996). Other obstacles that render health care facilities,physician’s offices and clinics inaccessible include the physical location offacilities, offices and clinics, non availability of designated parking bays and thetopography of pavements and curbs (Thomas and Curtis, 1997). For somewomen the stress and physical energy generated from trying to gain access isso intense that some would ‘delay appointment making’ (Scheer et al, 2003:pg.227) rather than try to negotiate access to an inaccessible environment(Goodman, 1994; Nosek et al, 1995; Scheer et al, 2003). This is compoundedeven further as health professionals are often unaware of the problems thatinaccessible offices and clinics present (Smeltzer et al, 2007). Physicalchallenges which impede access convey the impression to women that they areunwanted, unwelcome and are a burden on health care providers (Kaplan,2006).56
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