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 Dublindarkened room the woman cannot focus on the educator’s lips, so lip-reading isimpossible. The use of videos with no subtitles is inappropriate and theprovision of leaflets may be inappropriate due to the difficulty some women mayhave with comprehension (Kelsall, 1992). Background noise and chatter can beirritating and distracting and a woman may find it difficult to concentrate on lipreading.If strategies such as group discussions are used, women with ahearing impairment may feel excluded and may choose not to participate in thediscussion because of their inability to lip-read other women in the audience,their own limited diction or simply because they do not understand what is beingdiscussed. This isolates and marginalises women with hearing impairment evenfurther.4.6.2. Ineffective communication between health professionals andwomen with hearing impairment4.6.2.1. IntroductionEffective communication is a fundamental challenge for women with disabilitiesespecially those with a hearing impairment (Clark, 2002; Royal National Institutefor the Deaf (RNID), 2004; NDA, 2007). Deaf women can encounter enormouschallenges and discriminatory practices when accessing health care (Iezzoni etal, 2004; Steinberg, 2006) but linguistic challenge is the most significant onerequiring redress (Harris and Bamford, 2001). It is estimated that 50% ofwomen with hearing impairment experience difficulty when communicating withhealth professionals (Ubido et al, 2002). Communicational and linguisticdifficulties can occur both at a personal level, as women interface with healthprofessionals, and at an institutional level (Steinberg, 2006). Iezzoni et al (2004)found that health professionals fail to comprehend the uniqueness of the deafculture and its associated linguistic identity. These challenges have the potentialto exclude and marginalise women who are deaf from society.A lack of awareness and knowledge amongst health professionals of how toapproach and communicate with deaf women manifests itself as a generalunwillingness to communicate. Although it is deemed an important component79
WOMEN WITH DISABILITIES: BARRIERS AND FACILITATORS TO ACCESSING SERVICES DURING PREGNANCY,CHILDBIRTH AND EARLY MOTHERHOODSchool of Nursing and Midwifery, Trinity College Dublinof good care that maternity care professionals communicate adequately withwomen with sensory impairments (Royal College of Anaesthetists et al, 2007),health professionals often become impatient and intolerant (Kelsall, 1992; Ubidoet al, 2002; Iezzoni et al, 2004; D’Eath et al, 2005; O’Hearn, 2006) wheninteracting with women who are deaf. These behaviours compound the issuemore and the interaction and exchange of information becomes difficult. Ifwomen are not afforded the opportunity to meet with the same individual ateach visit, the quality of communication is compromised. Women feel they haveto explain their deafness each time (Kelsall, 1992; Ubido et al, 2002) andbecome frustrated at having repeatedly to develop mechanisms to facilitatecommunication. In addition, the extra time and privacy needed to facilitateeffective communication is not always considered or accommodated (Fraser,1999) in health care institutions.When women attended for an appointment unaccompanied, only 1 in 10 fullyunderstood what the health professionals were saying (Ubido et al, 2002). Manywomen do not acknowledge that they do not understand or comprehend what isbeing said and are inclined to nod and smile at health professionals rather thanask for something to be repeated (Fraser, 1999). Women feel embarrassed(Ubido et al, 2002; Iezzoni et al, 2004) and are concerned that if they ask healthprofessionals to repeat information over and over this may be misconstrued asa cognitive impairment and their ability to become a parent will be questioned(Fraser, 1999).4.6.2.2. Using sign languageDeaf women are not satisfied with the communication strategies adopted byhealth professionals (O’Hearn, 2006). Women would prefer health professionalsto use several different methods of communication (Iezzoni et al, 2004;O’Hearn, 2006), which would help to increase clarity and facilitateunderstanding (O’Hearn, 2006). A study of 23 deaf women, in the United Statesfound that most of the women used American Sign Language as their primarymode of communication but many would endorse the use of some methods of80
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