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 Dublin3.3.3.2. Internal architectureInternally waiting areas and rooms pose physical challenges with inaccessiblebathroom facilities, inadequate space and narrow corridors posing difficulties forwomen with disabilities especially when trying to manoeuvre in a wheelchair.Reception desks are at an inappropriate height or level to facilitate eye to eyecontact (McKay-Moffat, 2007) and the exchange of personal and sensitiveinformation with receptionists, who are often perceived as gatekeepers to theservices. Space restriction limits any freedom of movement and limits thewomen’s possibility to move around the built environment, which essentiallyrestricts them to one particular area.Some health care units in Ireland have been described as substandard, withsignificant infrastructural deficits (Institute of Obstetricians and GynaecologistsSubgroup, 2006). In some units the infrastructure and the configuration of thebuildings are so constrained that it impedes the delivery of optimal services.Inadequate facilities and insufficient consultant, midwifery and nursing stafflevels (Institute of Obstetricians and Gynaecologists Subgroup, 2006) causeclinical risk management issues and the capacity constraints have led toovercrowded, unsafe environments, which impact on the access and the qualityof service delivery for all women (Health Service Executive, 2005). Healthservices are only rendered accessible by the informal actions of relatives andfriends who compensate for the ‘deficiencies, inefficiencies and injustices’(D’Eath et al, 2005:pg. 4) of the services. Service inadequacies may thus bemasked where friends or relatives compensate for gaps. Access to basicfacilities e.g. toilet and bathing facilities can be problematic (McFarlene, 2004)and some women, in consequence, are upset and feel marginalised by thefailure to meet these basic needs.3.3.3.3. Inadequate collaboration of servicesWomen with disabilities frequently encounter fragmented and uncoordinatedservices (Commission on the Status of People with Disabilities, 1996;57
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College DublinDepartment of Health, 1996; Baker et al, 1997; Thomas and Curtis, 1997).Services that are fragmented and uncoordinated are insensitive to individualneeds and service provision is often compromised (Thomas and Curtis, 1997;D’Eath et al, 2005). Health professionals in maternity services may work inisolation from other professions or staff involved in the care of the women with adisability; there is little collaboration with other professionals to assist them tobecome knowledgeable about the disability, and a referral to allied healthprofessionals, for example, physiotherapists or occupational therapists, is anuncommon occurrence (Lipson and Rogers, 2000; McGuinness, 2006).Consequently, health professionals do not offer effective, individualised andculturally sensitive care or proactive help and guidance (Tingle and Dunmore,2005).3.3.3.4. Lack of suitable equipmentIt is also difficult for women with disabilities to use equipment that is fixed andnot readily adjustable, for example, examination tables and impractical babycots, and many women rely on health professionals to help negotiate suchinaccessible equipment (Thomas and Curtis, 1997). However, these womenfrequently experience a lack of will, manpower and suitable equipment to helptransfer them safely in order that examinations can occur or in order that theycan interact with their baby. A recent study of 152 trusts 3 providing obstetric ormidwifery-led maternity services in England found that 83% of trusts reportedhaving height-adjustable couches available at some antenatal clinics and 90%said they would provide home visits for disabled women. However, only 22% ofdelivery units had flexible-height cots (Commission for Healthcare Audit andInspection, 2008).Inappropriate training of health professionals in correct manual handlingtechniques exacerbates the issue of safe transfer even more and exposeswomen to impractical and unsafe techniques (Grabois, 2001). Diagnostic3 Health service provision in England occurs within designated Trusts that divide the country intoa number of areas.58
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