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 Dublinhow health professionals after the birth of her daughter, tried to discourage thepractice of rooming-in, 4 citing her incapacity to see the baby’s cot and baby asthe reason to separate mother and baby at such a critical time. Kent recalledpainful encounters in which health professionals questioned and challenged thecompetence of a blind woman to mother, nurture and care for her baby.Comments were often patronising and derogatory and she felt that healthprofessionals and others were judging her parenting skills. The authoracknowledges how many a new mother lives with ‘performance pressure’ (Kent,2002:pg. 85), but a visual impairment only serves to heighten the pressure asmothers constantly struggle to prove that they can successfully fulfil therequirements of their mothering role (Conley-Jung and Olkin, 2001; Kent, 2002).4.5 Barriers to accessibility of services for women with ahearing impairmentDeaf and hard of hearing women have widely different experiences of the socialworld when compared to hearing women and even women with otherdisabilities, so accessibility to, and provision of, health care services shouldrecognise and respect these differences. According to Steinberg, women whoare deaf engage with health care services in 2 ways, as ‘individuals and as amember of a minority group’ (Steinberg, 2006:pg. 2530) and are likely to besubjected to layers of different and compounding inequalities. The experiencesof women who are deaf when accessing health care are under-researched andservices are under-developed, although some studies (Harris and Bamford,2001; Steinberg et al, 2002; Ubido et al, 2002; Valios, 2004; Tingle andDunmore, 2005; Steinberg, 2006) have highlighted the challenges encounteredby women when accessing health care.The most common channel of communication used by health care facilities isineffective for women with hearing impairment. Ringing the hospital or speakingto a health professional is an impossible task for these women. Making hospital4 Rooming-in is the (usually recommended) practice of leaving babies in their cots beside theirmothers all day and night, while in the maternity unit. The benefits are said to be increasedbonding between mother and baby although the resultant need to wake during the night to feedthe baby may be seen by some women as a disadvantage.77
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinappointments over the telephone is difficult for women so many have to go intothe clinic in person or ask somebody else to make the appointment. This can bea cumbersome task if women are reliant on public transport. Kelsall (1992)found that alternative methods of communication are rarely explored. In additionto the challenges encountered in making appointments, the majority of womenwho are deaf have difficulty gaining access to health care facilities that operatean intercom system (House of Commons Health Committee, 2003). Waiting forappointments is, for many, a source of frustration and embarrassment (Ubido etal, 2002). The lack of a visual call system in waiting areas means that thosewith hearing impairment may not be aware of when their name has been called,so they either miss their cue or rely on others to tell them when it is their turn,which relegates them to a dependent role. If women lip read they may not seeor recognise their name being verbalised because health professionals may‘over-mouth’ and shout and, especially when verbalised with impatience, itbecomes difficult for women who are deaf to understand what is being said.This may lead to frustration and anxiety which further impedes the woman’sability to lip-read or sign effectively (Kelsall, 1992; Iezzoni et al, 2004). As aresult women are more inclined to avoid health services and not attend forappointments, rather than deal with the embarrassment and frustration thatdevelop from such challenges (Iezzoni et al, 2004; O’Hearn, 2006; Steinberg,2006).4.6 Barriers preventing accommodation of women with ahearing impairment4.6.1. Access to health information and antenatal education classesThere is a severe deficit in the provision of formal health information for womenwho are deaf (Josiah, 2004). Antenatal classes may be sources of frustrationand confusion for these women. Signed antenatal classes are uncommon, sothis excludes a large majority of women who use sign language as their primarymode of communication. For women who lip-read, class facilitators may posechallenges by not positioning themselves in good light, words may be unclearand rushed, slide presentations may be difficult to read and if used in a78
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