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 Dublinpregnancy and fail to consider the special needs of women with physicaldisabilities. Some facilitators consider that the provision of antenatal educationclasses for women with disabilities is not part of their role and function (Conineet al, 1986) and have indicated how the provision of adaptive programmes forwomen with disabilities is time-consuming and disruptive to normal progress(Conine et al, 1986). In a recent survey of the 152 trusts providing maternityservices in England, pre-pregnancy advice clinics were available for womenwith a physical disability in only 19% (Commission for Healthcare Audit andInspection, 2008).Conine et al (1986) found that many of the environments where antenatalclasses are held are inaccessible; doors, walkways and bathroom facilities aregenerally inappropriate and directional guides indicating the location ofappropriate facilities are non-existent. There is a lack of sufficient information inappropriate formats which could help to facilitate a state of independence(Blackford et al, 2000) and facilitators do not discuss adaptive techniques thatcould help women with disabilities in their parenting skills. Lipson and Rogers(2000) and McKeever (2003) found that facilitators did not routinely providealternative equipment or refer the women to appropriate services from whereadapted/modified equipment may be purchased.Teaching and learning resources used by class facilitators are more suited towomen without a disability and are inappropriate for women with a physical (orsensory) impairment. The stigma of having a disability impacts on women’ssense of self and self-confidence. Consequently women may lack theconfidence to discuss their particular concerns and issues with class facilitators.This often results in many women not accessing and availing of antenataleducation classes or, when they do, women are unwilling to voice concerns orsimply ask a question because the educator and other women with no disabilityin the class cannot relate to or associate with their anxieties or fears. Womentherefore feel excluded from the class (Westbrook and Chinnery, 1995).61
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin3.4.3. Ineffective communication between health professionals andwomen with disabilitiesSome health professionals communicate with women with disabilities in apatronising (D’Eath et al, 2005) or authoritarian (Westbrook and Chinnery,1995) manner. Campion (1997) reports that the language used by many healthprofessionals reflects their prejudicial attitudes and ignorance and may leavewomen feeling fearful, uncomfortable and degraded. Even the physicalpositioning of health professionals in clinic areas reduces good communication,for instance, due to lack of eye to eye contact between a wheelchair user andthose standing near them (McKay-Moffat, 2007).3.5. Barriers to acceptability of services for women withphysical disabilities3.5.1. Attitudinal challenges from health professionalsInappropriate attitudes, behaviours and a lack of awareness (Nosek, 1992;House of Commons Health Committee, 2003; RCN, 2007) are the mostsignificant subtle challenges encountered by women with disabilities whenaccessing health care during pregnancy, childbirth and early motherhood andare the most difficult to address and overcome (Schopp et al, 2002). Womenwith a disability will have very diverse backgrounds and different experiencesand the disability will impact differently on the lives of each individual. Whenhealth professionals are unable to recognise and embrace this diversity it has aprofound impact on the development of attitudes and whether or not womenaccess the health care services (Kallianes and Rubenfeld, 1997; Shakespeare,2000).3.5.2. Staff attitudes and behaviours towards women with disabilities3.5.2.1. Attitudes and behaviours regarding sexualityThe many myths and misconceptions surrounding women with disabilities haveresulted in the construction of negative prejudicial attitudes towards them, andhostility, sympathy and pity are common associated emotions (DeLoach, 1994).62
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