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 Dublinequipment can also be a source of discomfort and its use can be a dauntingand traumatic experience for some women, especially those with a physicaldisability, and their experience may deter these women from seeking furthercare (Goodman, 1994; Welner, 1999).3.3.3.5. Lack of assistance with physical environmentAn inaccessible environment coupled with a lack of accessible baby equipmentand inflexible hospital guidelines, procedure, policies or protocols impact onwomen’s ability to care for their babies in a confident and independent manner.McFarlene found that health professionals are often unable or fail to suggestcreative and practical solutions to overcome the challenges encountered withan inaccessible environment and equipment (McFarlene, 2004). They fail toprovide alternative equipment solutions, or to refer the women to appropriateservices from where adapted/modified equipment may be purchased (Lipsonand Rogers, 2000).Access to high quality personal care attendants could facilitate independence inwomen with disabilities (Lawthers et al, 2003); however, some women in theUnited States experience difficulty in finding suitably trained and experiencedpersonal care attendants. Limited numbers of competent attendants impact onthe women’s autonomy and ability to be independent and render the individualdependent on formal and informal support structures such as partner, theirchildren and extended family (D’Eath et al, 2005).3.4. Barriers preventing accommodation of women withphysical disabilities3.4.1. Access to health informationPossessing information engenders a sense of autonomy and control and is acentral tenet of the decision making process; Clark (2002:pg 10) suggests that itis in fact ‘the fourth right of citizenship’. Insufficient access to informationexcludes women from the process of informed decision making and impacts59
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinsignificantly on their choice. Moreover, it impinges on the doctrine of informedconsent where women must understand all risks and benefits associated withprocedures and care (Grabois, 2001; D’Eath et al, 2005). Not having adequateexplanation especially about invasive, intimate procedures renders womenmore vulnerable and when the procedures are conducted they may feelundignified, humiliated and degraded.The information needs of women with disabilities are varied and dependent onthe type of disability or impairment experienced (McKay-Moffat, 2007). Womenwith disabilities, however, do experience difficulties in receiving quality healthinformation (Nosek, 1992; Harris and Bamford, 2001; Commission forHealthcare Audit and Inspection, 2008) and Campion (1997) and the RoyalCollege of Nursing (RCN) (2002) found serious deficits in the provision ofinformation in relation to pregnancy, childbirth and disability in the U.K.. Whenprovided, the information tends to be irrelevant, inadequate, unhelpful(Goodman, 1994; Commission for Healthcare Audit and Inspection, 2008) andcontradictory (Thomas and Curtis, 1997). Women are forced to obtaininformation from other sources, e.g. support groups/networks and voluntaryagencies while many parenting skills are developed through experientiallearning (Thomas and Curtis, 1997).3.4.2. Antenatal education classes for women with disabilitiesThe learning needs of expectant women with physical disabilities varyconsiderably more than for women without disabilities and contemporarymodels of antenatal education have been described as inappropriate (Conine etal, 1986; Blackford et al, 2000). The evidence suggests that the needs ofwomen with disabilities are not being met when attending antenatal classes(Conine et al, 1986; Blackford et al, 2000; Commission for Healthcare Audit andInspection, 2008). Some women reported that class facilitators do not advocatefor women with disabilities (Blackford et al, 2000) and described them as coldand uncaring (Westbrook and Chinnery, 1995). Westbrook and Chinnery (1995)found that many facilitators lack knowledge in relation to disability and60
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