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 Dublindisabilities have the right to become parents, while a similar number (87%) ofrespondents agreed that people with sensory impairments should have childrenif they chose to (NDA, 2007).The introduction of legislation, policy and many other initiatives may all havecontributed to the change of attitude evident in the second survey. Theinitiatives include the implementation of the National Disability Authority Act(Government of Ireland, 1999), the Equal Status Act (Government of Ireland,2000); the European Year for People with Disabilities (Council of Europe, 2003);the Special Education Needs Act (Government of Ireland, 2004), Disability Act(Government of Ireland, 2005) and more recently, the National DisabilityStrategy (Department of Justice, Equality and Law Reform, 2004). Although it isimportant to acknowledge the change in attitudes between the 2 surveys,periodic monitoring of attitudes over time is useful in order to differentiate thetransient fluctuations in attitudes from ongoing positive trends that may occur atthe time any survey is completed.3.6. Facilitators to overcome accessibility challenges forwomen with physical disabilities3.6.1. General facilitating factorsThe environmental challenges that exist for people with disabilities are solvable(Moore, 1997; Veltman et al, 2001) and all health care facilities should be madephysically and socially accessible. The following suggestions may alleviate themany challenges encountered by women with disabilities in accessing theservices. Policies and guidelines that promote access for women withdisabilities should be devised, implemented and audited on a regular basis,involving women with disabilities in the development phase and auditing phases(Nzegwu, 2004). Consideration should be given to creating a specialist role tocater for the needs of women with disabilities, for example, a disability advisor(Brown, 2001). A robust complaints mechanism should be established to enablefeedback from women to be heard and acted upon (Nzegwu, 2004).69
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublin3.6.2. Factors regarding location of servicesWomen should receive health care as near to their home as possible (Instituteof Obstetricians and Gynaecologists Subgroup, 2006). Community basedmodels of midwifery care, for example, Domino schemes, should be developedin all maternity units (Institute of Obstetricians and Gynaecologists Subgroup,2006), which will enhance continuity of care and choice for women (WomenWith Disabilities Australia (WWDA), 2004; HSE, 2005) and facilitate women withdisabilities, in particular, to choose their preferred model of care. All womenshould be provided with information about these services (WHC, 2004). Serviceproviders should be more creative and flexible in the provision of care (Crow,2003; RCN, 2007), to accommodate women with disabilities in a location nearto their homes.3.6.3. Facilitating transport to servicesReliable and accessible public transport to and from the provider’s facilities isessential (Scheer et al, 2003). Failing that, women with disabilities should beprovided with subsidised private transport as required.3.6.4. Facilitating improvements in the physical environmentStructural and architectural barriers that prevent women with disabilities fromaccessing health care facilities and services should be identified and remedied.Modification of the built environment should occur and should be guided by thebuilding legislation that addresses the issue of accessibility (Department ofEnvironment and Local Government, 1997, 2000; NDA, 2002a). Remedialmeasures include the provision of a disabled parking bay close to the entranceand clearly signposted, change of the physical environment to ensure freedomof access, ramps externally and internally, wider exterior and interior doors, andwider corridors with access to all areas. All amenities should be within reachand the receptionist desk should be at appropriate level to facilitate exchange ofinformation in a private and respectful manner (Jones and Tamari, 1997;Schopp et al, 2002; McKay-Moffat, 2007). A simple wheelchair tiltingmanoeuvre may avoid the need to transfer woman to tables for antenatal70
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