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 Dublinsome physicians employ discriminatory actions (Grabois et al, 1999) bydeveloping an eligibility criterion that excludes women with a disability or byfailing to modify policies, practices or procedures that would ensure theinclusion of women with disability and facilitate access to their services.3.5.4.2. Lack of knowledge in health care professionals resulting ininappropriate careHealth professionals rarely consider pregnancy and disability together. Womenare often defined in terms of their disability and their disability overshadowstheir pregnancy and new role as a mother (Lipson and Rogers, 2000; Clark,2002; Prilleltensky, 2003). This may not be the experience of all women, forsome the opposite may occur; health professionals may fail to acknowledge thephysical disability and may not discuss the possible additional and uniqueneeds the women may have (McKay-Moffat and Cunningham, 2006). Anunfamiliarity with the woman’s disability impacts on the provision of appropriatecare (Fiduccia, 2000). Welner (1999) found that the casual attitude of somehealth professionals towards complications that may occur can instil a lack ofconfidence and facilitate a state of discomfort between health professionals andthe woman. Many health professionals make a conscious effort to avoiddiscussing the reproductive concerns and issues of women with disabilitiesbecause they are overwhelmed by their workload and unable to manageadditional problems (Welner, 1999).3.5.4.3. Lack of knowledge in health care professionals resulting inincreased medicalisation of birthAs described above, women with disabilities who need to access health andmaternity services must negotiate between their own self-identity as a healthywoman and the medical perception of disability. Women with physicaldisabilities have identified how decisions in relation to mode of delivery usuallyoccur without consultation with them or assessment and consideration of theirability to deliver vaginally, despite their wish to do so (Lipson and Rogers, 2000;Smeltzer, 2007). Instrumental or operative birth is commonly advocated by67
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinhealth professionals (Lipson and Rogers, 2000; McFarlene, 2004). Physiciansunfamiliar with caring for women with physical disabilities base their decisionson rigid protocols devised primarily for the larger population of women withoutdisabilities, so the woman’s birth choices may not be respected (Lipson andRogers, 2000).3.5.4.4. Lack of knowledge in health care professionals resulting in poorpostnatal careBias and insensitive care also extends to the postnatal period. Healthprofessionals lack knowledge about the necessity to refer women to alliedhealth professionals, support services and networks. Women describe a lack ofspecialised and adapted instruction, for example, no referral to adaptive aids ortechniques that might assist with breast-feeding and instruction on parentingskills not being specific or tailored for women with physical disabilities (Lipsonand Rogers, 2000). Some health professionals focus predominantly on thephysical disability and fail to consider the woman as competent (Thomas, 2001;McGuinness, 2006) and capable of becoming a parent.3.5.5. Recent improvement in societal attitudesData from the first ever national survey exploring public attitudes to disability,commissioned in 2001 by the National Disability Authority presents aninteresting picture of how disability is perceived and accepted in the Irishcontext. The study revealed how an individual’s personal experience ofdisability impacts significantly on the establishment of their attitude towardpeople with disabilities (NDA, 2002). Five years later the survey was repeatedand the relationship between attitudes and personal experience was identifiedonce again. Evidence from this second survey suggests that people’s attitudestowards disability are improving (NDA, 2007) but society still has a long way togo before inequalities and the social exclusion of people with disabilities are tobe adequately addressed. Responding to a question on whether people withdisabilities should or should not have children, the majority of respondents(84%) drawn from the general population agreed that people with physical68
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