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Ahmad SAIH, Holtrop J, van den Eijnden MJM, Jonkman NH, van Pampus MG, van den Heuvel OA, Broekman BFP, Schonewille NN. Family planning decision-making in relation to psychiatric disorders in women: a qualitative focus group study. Reprod Health 2024; 21:96. [PMID: 38956660 PMCID: PMC11221133 DOI: 10.1186/s12978-024-01836-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 06/24/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND Recent studies revealed an elevated likelihood of unintended pregnancies among women with psychiatric disorders compared to their counterparts without such vulnerability. Despite the importance of understanding family planning decision-making in this group, qualitative inquiries are lacking. This study explored family planning decisions among women with psychiatric disorders. METHODS Utilizing a qualitative approach, three focus group discussions were conducted with purposive sampling: women with a history of unintended pregnancies (N = 3), women without children (N = 5), and women with a history of intended pregnancies (N = 9), all of whom had self-reported psychiatric disorders. Using thematic framework analysis, we investigated the themes "Shadow of the past," reflecting past experiences, and "Shadow of the future," reflecting future imaginaries, building upon the existing "Narrative Framework." RESULTS The Narrative Framework formed the foundation for understanding family planning among women with psychiatric disorders. The retrospective dimension of focus group discussions provided opportunities for reflective narratives on sensitive topics, revealing emotions of regret, grief and relief. Childhood trauma, adverse events, and inadequate parenting enriched the "Shadow of the past". The "Shadow of the present" was identified as a novel theme, addressing awareness of psychiatric disorders and emotions toward psychiatric stability. Social influences, stigma, and concerns about transmitting psychiatric disorders shaped future imaginaries in the shadow of the future. CONCLUSIONS This study enlightens how family planning decision-making in women with psychiatric disorders might be complex, as marked by the enduring impact of past experiences and societal influences in this sample. These nuanced insights underscore the necessity for tailored support for women with psychiatric disorders.
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Affiliation(s)
- Shahenda A I H Ahmad
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Jorina Holtrop
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | | | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Maria G van Pampus
- Department of Gynecology and Obstetrics, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Odile A van den Heuvel
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
- Department of Anatomy and Neuroscience, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
- Compulsivity, Impulsivity and Attention Program, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Birit F P Broekman
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
- Amsterdam Public Health, Mental Health Program, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Noralie N Schonewille
- Department of Psychiatry and Medical Psychology, OLVG, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
- Department of Psychiatry, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
- Amsterdam Public Health, Mental Health Program, Amsterdam UMC, Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
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Asim M, Hameed W, Sohail MM, Saleem S, Hayward M, Turan JM. Barriers and facilitators to perinatal care of women with disabilities in lower- and middle-income countries: a study protocol for scoping review of qualitative studies. BMJ Open 2024; 14:e079605. [PMID: 38926146 PMCID: PMC11216051 DOI: 10.1136/bmjopen-2023-079605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 06/02/2024] [Indexed: 06/28/2024] Open
Abstract
BACKGROUND The Sustainable Development Goals have put emphasis on equitable healthcare access for marginalised groups and communities. The number of women with disabilities (WWD) to marry and have children is rapidly increasing in low- and middle-income countries (LMICs). However, these women experience multifaceted challenges to seeking perinatal care in LMICs. The objective of this scoping review is to document key facilitators and barriers to seeking perinatal care by WWD. We also will propose strategies for inclusive perinatal healthcare services for women with disabilities in LMICs. METHODS We will conduct a scoping review of peer-reviewed and grey literature (published reports) of qualitative and mixed-methods studies on facilitators and barriers to seeking perinatal care for women with functional disabilities from 2010 to 2023 in LMICs. An electronic search will be conducted on Medline/PubMed, Scopus and Google Scholar databases. Two researchers will independently assess whether studies meet the eligibility criteria for inclusion based on the title, abstract and a full-text review. ETHICS AND DISSEMINATION This scoping review is based on published literature and does not require ethics approval. Findings will be published in peer-reviewed journals and presented at conferences related to reproductive health, disability and inclusive health forums.
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Affiliation(s)
- Muhammad Asim
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Waqas Hameed
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Malik Muhammad Sohail
- Center for Religion, Science and Social Wellbeing, Department of Sociology, University of Chakwal, Chakwal, Punjab, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Mark Hayward
- Population Research Center, The University of Texas at Austin, Austin, Texas, USA
- Department of Sociology, The University of Texas at Austin, Austin, Texas, USA
| | - Janet M Turan
- Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Morais FRC, Moreira MCN, Costa LMDL. Women with disabilities and their motherhood: scoping review. CIENCIA & SAUDE COLETIVA 2024; 29:e09202023. [PMID: 38747771 DOI: 10.1590/1413-81232024295.09202023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 07/07/2023] [Indexed: 05/25/2024] Open
Abstract
This review aims to disclose the gaps and needs for acknowledging the rights to experience motherhood of women with disabilities. To do so, we map how much is known about these women's experience with motherhood, shedding light on their sexual and reproductive rights. The present work followed the scoping review by the Joanna Briggs Institute (JBI). This research is structured by elaborating the question, identifying the relevant studies, selecting the studies, extracting the data, sorting, summarizing, and creating reports based on the results. Results: we found 1050 articles, of which 53 were selected for the analysis. considering the different themes, we generated three axes: (1) infantilization, dehumanization, and discredit in the experience of motherhood; (2) obstetric ableism - an expression of violence in obstetrics; (3) reproductive justice - politicize motherhood and care. The study showed the urgent need to regard women with disabilities as people having the right to make sexual and reproductive health choices. Health professionals need permanent education to acknowledge and guarantee such a need as interweaving relationships to reach decision-making and autonomy.
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Affiliation(s)
- Fernanda Rodrigues Chaves Morais
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
| | - Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz. Av. Rui Barbosa 716, Flamengo. 22250-020 Rio de Janeiro RJ Brasil.
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Merits M, Lubi K, Tammes M. Experiences of women with impaired physical mobility during pregnancy, childbirth and postpartum: A case study. Eur J Midwifery 2023; 7:26. [PMID: 37808525 PMCID: PMC10552004 DOI: 10.18332/ejm/170433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 07/23/2023] [Accepted: 08/23/2023] [Indexed: 10/10/2023] Open
Abstract
INTRODUCTION The research deals with a little-studied topic in Estonia: the experiences of women with impaired physical mobility (IPM) during pregnancy, childbirth, and in the postpartum period. Women with IPM, a vulnerable group, have a higher risk of complications and a higher probability of missing out on comprehensive maternity care. METHODS The method of the present research is qualitative. It is a case study of three women with IPM with whom semi-structured interviews were conducted. RESULTS It was found that women with IPM encountered several obstacles and problems during pregnancy, childbirth, and the postpartum period; despite this, women's experiences with maternity care were mostly positive. Furthermore, there are several areas for improvement to ensure more comprehensive maternity care. Women with IPM need more support and help, and midwives are expected to have additional knowledge regarding the specifics or limitations resulting from mobility impairments. CONCLUSIONS In the future, the topic needs greater attention and improvement in the Estonian context to ensure more comprehensive maternity care for women with IPM. It is important to provide midwives the knowledge and skills to assist women with IPM during pregnancy, childbirth, and the postpartum period.
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Affiliation(s)
- Marika Merits
- Midwifery Department, Health Education Centre, Tallinn Health Care College, Tallinn, Estonia
| | - Kadi Lubi
- Department of Health Technologies, School of Information Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Meelike Tammes
- Midwifery Department, Health Education Centre, Tallinn Health Care College, Tallinn, Estonia
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Hameed W, Asim M, Saleem S, Avan BI. Inequalities in utilisation of essential antenatal services for women with disabilities in Pakistan: analysis of a cross-sectional demographic and health survey of Pakistan 2017-2018. BMJ Open 2023; 13:e074262. [PMID: 37487675 PMCID: PMC10373668 DOI: 10.1136/bmjopen-2023-074262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
OBJECTIVES Although the number of disabled women entering motherhood is growing, there is little quantitative evidence about the utilisation of essential antenatal care (ANC) services by women with disabilities. We examined inequalities in the use of essential ANC services between women with and without disabilities. DESIGN, SETTING AND ANALYSIS A secondary analysis of cross-sectional data from recent Demographic and Health Survey of Pakistan 2017-2018 was performed using logistic regression. PARTICIPANTS A total weighted sample of 6791 ever-married women (age 15-49) who had a live birth in the 5 years before the survey were included. OUTCOME MEASURES Utilisation of ANC: (A) antenatal coverage: (1) received ANC and (2) completed four or more ANC visits and (B) utilisation of essential components of ANC. RESULTS The percentage of women who were at risk of disability and those living with disability in one or more domains was 11.5% and 2.6%, respectively. The coverage of ANC did not differ by disability status. With utilisation of essential ANC components, consumption of iron was lower (adjusted OR, aOR=0.6; p<0.05), while advice on exclusive breast feeding (aOR=1.6; p<0.05) and urine test (aOR=1.7; p<0.05) was higher among women with disabilities as compared with their counterparts. Similarly, the odds of receiving advice on maintaining a balanced diet was higher (aOR=1.3; p<0.05) among women at risk of any disability as opposed to their counterparts. Differences were also found for these same indicators in subgroup analysis by wealth status (poor/non-poor) and place of residence (urban-rural). CONCLUSION Our study did not find glaring inequalities in the utilisation of ANC services between women with disabilities and non-disabled women. This was true for urban versus rural residence and among the poor versus non-poor women. Some measures, however, should be made to improve medication compliance among women with disabilities.
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Affiliation(s)
- Waqas Hameed
- Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Muhammad Asim
- Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
- Population Research Center, University of Texas at Austin, Austin, Texas, USA
| | - Sarah Saleem
- Community Health Sciences, The Aga Khan University, Karachi, Sindh, Pakistan
| | - Bilal Iqbal Avan
- Department of Population Health, London School of Hygiene & Tropical Medicine, London, UK
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Tang MB, Kung PT, Chiu LT, Tsai WC. Comparison of the use of prenatal care services and the risk of preterm birth between pregnant women with disabilities and those without disabilities: A nationwide cohort study. Front Public Health 2023; 11:1090051. [PMID: 36778582 PMCID: PMC9911428 DOI: 10.3389/fpubh.2023.1090051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 01/09/2023] [Indexed: 01/28/2023] Open
Abstract
Objective The difficulties faced by pregnant women with disabilities in accessing health care may make them less likely to receive prenatal care. The aims of this study were to compare the number of prenatal services and the risk of preterm birth between pregnant women with and without disabilities. Methods A total of 2999 pregnant women aged ≥20 years with birth records in 2011-2014 in Taiwan were enrolled. Data were obtained from the Registration File for Physical and Mental Disabilities and the National Health Insurance Research Database. A 1:4 matching between pregnant women with disabilities and those without disabilities was performed. The logistic regression analysis with generalized estimating equations was used to analyze. Results The median of prenatal care services used by pregnant women with disabilities was 9.00 (interquartile range, IQR: 2.00). Pregnant women with disabilities used fewer services than those without disabilities (median, 10.00; IQR: 1.00). The disabled group (8.44%) had a significantly higher proportion of preterm births than did the non-disabled group (5.40%). The disabled group was at a 1.30 times higher risk of preterm births than was the non-disabled group. Conclusions Pregnant women with disabilities used significantly fewer prenatal care services and had a significantly higher risk of preterm birth than pregnant women without disabilities.
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Affiliation(s)
- Meng-Bin Tang
- Department of Public Health, Graduate Institute of Public Health, China Medical University, Taichung, Taiwan,Department of Health Services Administration, China Medical University, Taichung, Taiwan,Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan
| | - Pei-Tseng Kung
- Department of Healthcare Administration, Asia University, Taichung, Taiwan,Department of Medical Research, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Li-Ting Chiu
- Department of Health Services Administration, China Medical University, Taichung, Taiwan
| | - Wen-Chen Tsai
- Department of Health Services Administration, China Medical University, Taichung, Taiwan,*Correspondence: Wen-Chen Tsai ✉
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Maternal healthcare for women with physical disabilities in Northern Vietnam: perspectives of healthcare providers. Disabil Health J 2023; 16:101439. [PMID: 36739186 DOI: 10.1016/j.dhjo.2023.101439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 12/28/2022] [Accepted: 01/04/2023] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pregnancy among women with physical disabilities is common around the world; however, there are limited qualitative studies that explore the perspectives of healthcare providers toward pregnant women with disabilities outside of the Global North. OBJECTIVE This article explores perspectives and experiences of maternal healthcare providers in the delivery of services to women with physical disabilities in Northern Vietnam. METHODS Semi-structured interviews were conducted with 14 healthcare providers who worked in public and/or private healthcare North Vietnamese facilities where maternal services were provided. Data were thematically analyzed. RESULTS The participants included six males and eight females. Ten were obstetricians/gynecologists, one was a doctor specializing in obstetric imaging diagnosis, three were midwives, and one was a midwife/assistant doctor. Four themes were identified. In the first theme, providers attached provisos to the right to motherhood including the view that the women were limited to one child and should undergo prenatal screenings for fetal abnormalities. In the second theme, the providers reported that disability was not incorporated into their education; this led to half of them lacking confidence in providing appropriate maternal healthcare services for women with physical disabilities. The third theme found that although women with physical disabilities were considered as a priority group, decisions around who was seen before others or provided with fee discount/exemption were left in the hands of staff. The fourth theme identified that some providers overlooked their needs for physical accessibility and independence. CONCLUSION This study shows that maternal healthcare providers in Vietnam discounted the needs of women with physical disabilities. The needs of women with disabilities should be included in the training of maternal healthcare providers in Vietnam.
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Colaceci S, Apuzzo L, Solfizi M, Trivelli G, Di Tora S, Dellafiore F, Iodice M, Giusti A, Zambri F, Marchetti F. 'They put the baby on me; the life I felt growing inside me was finally taking shape'. Lived experiences of women with vision impairments during pregnancy and motherhood: A phenomenological qualitative study. Midwifery 2023; 116:103535. [PMID: 36347146 DOI: 10.1016/j.midw.2022.103535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 08/22/2022] [Accepted: 10/28/2022] [Indexed: 11/06/2022]
Affiliation(s)
- Sofia Colaceci
- Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy.
| | - Luigi Apuzzo
- Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Martina Solfizi
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Gessica Trivelli
- Departmental faculty of Medicine and Surgery, Saint Camillus International University of Rome and Medical Sciences (UniCamillus), Rome, Italy
| | - Sofia Di Tora
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federica Dellafiore
- Department of Public Health, Experimental and Forensic Medicine, Section of Hygiene, University of Pavia, Pavia, Italy
| | - Maddalena Iodice
- Local Health Authority ASL Roma 4, Carlo Chenis Hospice, Civitavecchia, Rome, Italy
| | - Angela Giusti
- National Centre for diseases Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy
| | - Francesca Zambri
- National Centre for diseases Prevention and Health Promotion - Italian National Institute of Health, Rome, Italy
| | - Francesca Marchetti
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Pastor‐Bédard N, Pituch E, Lamata E, Grondin M, Bottari C. Parenting with a physical disability: A scoping review of assessment methods. Aust Occup Ther J 2022; 70:257-300. [PMID: 36285693 DOI: 10.1111/1440-1630.12845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 09/16/2022] [Accepted: 09/20/2022] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Daily childcare can be challenging for parents with a physical disability who have young children. Occupational therapists are valuable facilitators to family participation. However, occupational therapists have reported significant gaps in knowledge when documenting the parenting role of parents with a physical disability in occupational therapy practice. This study explored and described the parenting assessment methods used with parents with a physical disability in the scientific literature. METHODS A scoping review was conducted, and search results were reviewed by two separate reviewers. The search strategy was applied to five databases (Embase, CINAHL, MEDLINE, HaPI, PsycInfo). Numerical and thematic analyses were conducted. RESULTS Four thousand one hundred fifty articles were screened, and 73 relevant scientific articles were included. Seventy-six assessment methods were identified, including 20 assessment instruments with few reported population-specific psychometric studies. Most assessments were conducted via interviews (n = 45), followed by questionnaires (n = 27), and only six were performance based. Parenting practices and experience were the two dimensions most assessed, with little attention given to parenting responsibility. Mothers with multiple sclerosis, spinal cord injury, rheumatoid arthritis, and cerebral palsy were the most assessed. CONCLUSION Further research is needed to develop specific, multidimensional, and validated parenting assessments for all parents with a physical disability, including performance-based assessments. Formal assessments should be conducted by professionals, including occupational therapists, who have the necessary training.
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Affiliation(s)
- Nadielda Pastor‐Bédard
- School of Rehabilitation, Faculty of Medicine Université de Montréal Montreal Quebec Canada
- CIUSSS du Centre‐Sud‐de‐l'Île‐de‐Montréal Montreal Quebec Canada
| | - Evelina Pituch
- School of Rehabilitation, Faculty of Medicine Université de Montréal Montreal Quebec Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal Montreal Quebec Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre‐Sud‐de‐l'Île‐de‐Montréal Montreal Quebec Canada
| | - Estelle Lamata
- School of Rehabilitation, Faculty of Medicine Université de Montréal Montreal Quebec Canada
- Ergo 2000 Sherbrooke Sherbrooke Canada
| | - Myrian Grondin
- Marguerite‐d'Youville Library Université de Montréal Quebec Canada
- Urbanisation Culture Société Library, Institut national de la recherche scientifique Montréal Quebec Canada
| | - Carolina Bottari
- School of Rehabilitation, Faculty of Medicine Université de Montréal Montreal Quebec Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal Montreal Quebec Canada
- Institut universitaire sur la réadaptation en déficience physique de Montréal du CIUSSS du Centre‐Sud‐de‐l'Île‐de‐Montréal Montreal Quebec Canada
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Re-owning Motherhood in Metacognitive Reflection and Insight Therapy (MERIT) with A Woman Diagnosed with Schizophrenia: Lessons from A Case Study. JOURNAL OF CONTEMPORARY PSYCHOTHERAPY 2022. [DOI: 10.1007/s10879-022-09565-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Khanna A, Smith LD, Parish SL, Mitra M. Pregnancy recommendations from women with intellectual and developmental disabilities to their peers. Disabil Health J 2022; 15:101343. [PMID: 35739053 DOI: 10.1016/j.dhjo.2022.101343] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND As recent as the mid-twentieth century, eugenics practices on women with intellectual and developmental disabilities were commonplace. Deinstitutionalization has led to an increasing proportion of women with intellectual and developmental disabilities living in the community and becoming pregnant. Previous research has reported barriers to maternal health care (i.e., perceived provider stigma, inadequate communication, stress surrounding child protective services involvement, and financial strain). Research shows that this population is at increased risk of adverse outcomes including preterm delivery, low birth weight babies, and maternal mortality. OBJECTIVE/HYPOTHESIS This study aimed to explore recommendations from mothers with intellectual and developmental disabilities for other women to potentially improve pregnancy experiences for this population. METHODS We conducted semi-structured individual interviews among 16 women with intellectual and developmental disabilities. Data were coded using a content analysis process and iteratively analyzed using inductive and deductive techniques to determine emergent themes. RESULTS Participants offered recommendations for navigating pregnancy to their peers who are pregnant, or thinking about becoming pregnant. Themes included: (1) planning for birth; (2) advocating at the point-of-care; (3) seeking supports and services; (4) interacting with child protective services; (5) communicating with providers; and (6) exhibiting resilience. CONCLUSION Our study highlights recommendations for improving pregnancy experiences of women with intellectual and developmental disabilities. Informed by the lived pregnancy experiences of our participants, these recommendations can inform clinician training, new guidelines, and services to support and improve pregnancy experiences for women with intellectual and developmental disabilities.
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Affiliation(s)
- Aishwarya Khanna
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA; Center for Healthcare Organization and Implementation Research (CHOIR), Bedford VA Healthcare System, 200 Spring Rd, Bedford, MA, 01730, USA
| | - Lauren D Smith
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA.
| | - Susan L Parish
- College of Health Professions, Virginia Commonwealth University, 907 Floyd Ave, Richmond, VA, 23284, USA
| | - Monika Mitra
- The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University, 415 South Street, Waltham, MA, 02453, USA
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Kazembe A, Simwaka A, Dougherty K, Petross C, Kafulafula U, Chakhame B, Chodzaza E, Chisuse I, Kamanga M, Sun C, George M. Experiences of women with physical disabilities accessing prenatal care in low- and middle-income countries. Public Health Nurs 2022; 39:1156-1166. [PMID: 35512242 DOI: 10.1111/phn.13087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/15/2022] [Accepted: 04/16/2022] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Women with physical disabilities experience barriers to accessing patient-centered and accommodative care during the prenatal and childbirth periods. While there is a growing body of work in high-income countries to address these needs, there is little research detailing specific challenges in low- and middle-income countries (LMICs) where a woman's' burden- and need-is greatest. METHODS We conducted an integrative review to synthesize the experiences of women with physical disabilities accessing prenatal care and childbirth services in LMICs. Five databases were searched for systematic reviews, retrospective cohort studies, cross-sectional studies, narrative literature reviews, as well as other evidence types. We used Ediom's EvidenceEngine™, a machine-assisted search engine that uses artificial intelligence to conduct this search using pertinent keywords to identify original research published between January 2009 - September 2018. These results were augmented by hand searching of reference lists. Forty articles were identified using this method and 11 retained after duplicates were removed and inclusion and exclusion criteria applied. RESULTS Four types of experiences are described in these 11 studies: (1) limited physical and material resources; (2) health care worker knowledge, attitudes, and skills; (3) pregnant people's knowledge; and (4) public stigma and ignorance. DISCUSSION People with physical disabilities face specific challenges during pregnancy and childbirth. Importantly, these findings offer targets for enhanced clinical training for nurses, midwives, traditional birth attendants and public health workers, as well as opportunities for the improved delivery of prenatal care and childbirth services to these vulnerable women.
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Affiliation(s)
- Abigail Kazembe
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Andrew Simwaka
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Kylie Dougherty
- Columbia University School of Nursing, New York, New York, USA
| | - Chisomo Petross
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Bertha Chakhame
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | | | - Isabella Chisuse
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Martha Kamanga
- Kamuzu College of Nursing, University of Malawi, Lilongwe, Malawi
| | - Carolyn Sun
- Hunter College School of Nursing, New York, New York, USA
| | - Maureen George
- Columbia University School of Nursing, New York, New York, USA
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Smith LD, Valentine A, Moore Simas TA, Parish SL, Levy A, Mitra M. Clinician-reported barriers to providing perinatal care to women with intellectual and developmental disabilities. JOURNAL OF INTELLECTUAL & DEVELOPMENTAL DISABILITY 2022; 48:12-22. [PMID: 36969147 PMCID: PMC10036077 DOI: 10.3109/13668250.2022.2086110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Background Research suggests that women with intellectual and developmental disabilities are at increased risk for adverse pregnancy outcomes. Further, they report unmet perinatal care needs. This qualitative study examined clinician perspectives on barriers to providing perinatal care to women with intellectual and developmental disabilities. Method We conducted semi-structured interviews and one focus group with US obstetric care clinicians (n=17). We used a content analysis approach to code data and analyse them for larger themes and relationships. Results The majority of participants were white, non-Hispanic, and female. Participants reported barriers providing care to pregnant women with intellectual and developmental disabilities across individual (e.g., communication challenges), practice (e.g., identification of disability status), and system levels (e.g., lack of clinician training). Conclusions Clinician training and evidence-based guidelines for perinatal care of women with intellectual and developmental disabilities as well as services and supports during pregnancy are needed.
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Affiliation(s)
- Lauren D. Smith
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Anne Valentine
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Tiffany A. Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School, UMass Memorial Medical Center, Worcester , MA, USA
| | - Susan L. Parish
- College of Health Professions, Virginia Commonwealth University, Richmond, VA, USA
| | - Alanna Levy
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
| | - Monika Mitra
- Lurie Institute for Disability Policy, Heller School for Social Policy and Management, Brandeis University, Waltham, MA, USA
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Barriers to and facilitators of effective communication in perinatal care: a qualitative study of the experiences of birthing people with sensory, intellectual, and/or developmental disabilities. BMC Pregnancy Childbirth 2022; 22:364. [PMID: 35473673 PMCID: PMC9044670 DOI: 10.1186/s12884-022-04691-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/18/2022] [Indexed: 11/17/2022] Open
Abstract
Background Effective provider-patient communication is a key element of quality health care, including perinatal care. What constitutes “effective communication” in perinatal care may vary according to the population seeking care, such as women with intellectual and developmental disabilities (IDD) and sensory disabilities. Research broadly indicates that communication issues are among the barriers to perinatal care experienced by women with disabilities. However, few studies have explicitly explored their communication experiences in this context. The purpose of this study was to understand the communication experiences of birthing people with IDD and/or sensory disabilities in perinatal care. Methods We conducted semi-structured interviews with 17 people with IDD (e.g., autism, cognitive delay) and/or sensory disabilities (e.g., d/Deaf, blind) in Ontario, Canada, who had recently given birth, to explore barriers to and facilitators of effective communication in perinatal care. A combination of deductive and inductive thematic analysis guided data analysis. Results We found that birthing people with IDD and/or sensory disabilities encountered multiple barriers to effective communication in perinatal care, namely, lack of policies and guidelines, lack of provider experience, lack of provider effort, as well as ableism and provider assumptions. Facilitators included knowledgeable, aware, and supportive providers; access to communication aids and services; tailoring information to patients’ disability-related communication needs; empathic communication; and, communication among providers. Conclusion Unmet communication needs may contribute to negative health and social outcomes for birthing people with disabilities and their newborns. Accessibility policy implementation and practice change are needed to meet the communication needs of people with IDD and/or sensory disabilities in perinatal care to ensure positive experiences and outcomes.
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Pregnancy, Motherhood and Partner Support in Visually Impaired Women: A Qualitative Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074308. [PMID: 35409989 PMCID: PMC8998677 DOI: 10.3390/ijerph19074308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Revised: 03/31/2022] [Accepted: 04/02/2022] [Indexed: 12/10/2022]
Abstract
Background: This qualitative study aimed to explore the experiences of women with vision impairments regarding the meaning of motherhood and their mothering-related issues and priorities. Methods: In-depth individual, semi-structured interviews were conducted between July and December 2020 with a group of visually impaired mothers residing in Italy. The interviews explored experiences related to pregnancy, childbirth, and motherhood; support received from partners, family, and friends; ways of interacting and communicating with the child; and the participants’ sense of personal self-efficacy and self-awareness. Results: Fifteen women participated in this study, ten with a congenital visual impairment and five with an acquired disability. The mean age of the sample was 49 years. The qualitative content analysis of the transcripts of the interviews pointed out four main themes or categories: (1) pregnancy and motherhood experiences, (2) family and social support, (3) relationship and communication with the child, and (4) self-efficacy and self-awareness. Conclusions: This study underlined that mothers with visual impairments show a strong desire to be recognized and accepted as women and mothers by their social environment. Adequate social and family support is associated with a better sense of personal self-efficacy and greater confidence in one’s skills as a mother.
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Hankó C, Pohárnok M, Lénárd K, Bíró B. Motherhood Experiences of Visually Impaired and Normally Sighted Women. HUMAN ARENAS 2022. [DOI: 10.1007/s42087-022-00276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AbstractThe present study explores the characteristics of visually impaired mothers’ personal identities as reflected in their individual representations of motherhood taking account of the impact of the specific social context on these representations. The sample included 20 visually impaired (VI) and 21 normally sighted (NS) mothers. In line with the narrative psychological approach to motherhood, each participant gave a narrative account of her related experiences in a semi-structured interview. The transcribed responses were subjected to a thematic analysis aimed at comparing the narratives of visually impaired and normally sighted mothers’ for thematic composition in order to identify shared and impairment specific themes of motherhood experiences. The motherhood experiences were sorted into eight thematic categories: Emotions; Continuity; Personal Development; Connectedness; Challenges; Partner; Roles and Principles; and Calling/Career. While in some categories VI and NS mothers showed similar patterns of experience, such as finding a new purpose in life and developing a new role in the family with the advent of pregnancy (Personal Development), in other categories motherhood experiences were thematized differently, such as VI mothers focused on challenges posed by day-to-day situations, NS mothers were rather concerned with their children’s future (Challenges). The study presents the shared and non-shared aspects of disabled and non-disabled women’s motherhood experiences with the primary aim of demonstrating the potential impact of the prevailing sociocultural norms, and attitudes considering visually impaired mothers on their motherhood experiences.
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Blair A, Cao J, Wilson A, Homer C. Access to, and experiences of, maternity care for women with physical disabilities: a scoping review. Midwifery 2022; 107:103273. [DOI: 10.1016/j.midw.2022.103273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 01/02/2023]
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Hanna E, Donetto S. The pregnancy experiences of amputee women: a qualitative exploration of online posts. J Reprod Infant Psychol 2021:1-11. [PMID: 34789041 DOI: 10.1080/02646838.2021.2004301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND This paper seeks to explore the pregnancy experiences of amputee women. Relatively little is known about pregnancy for amputees, but the wider literature on disability and pregnancy shows that the disabled pregnant body is often viewed as 'high risk'. The majority of amputations (90%) involve lower limb amputations; whilst our analytical interest was not limited to lower limb amputations, the sources we explored reflected the prevalence of lower limb amputees. METHODS Using online blogs and first-person accounts from 6 different sources (3 authors of blogs, 2 authors of websites and 1 author of an information page on a general amputation website), we thematically analyse amputee women's own narratives around their experiences of pregnancy. FINDINGS Four key themes were identified, which we describe as: The lack of information for the pregnant amputee; Managing risks; The embodied experience of suffering; and 'It's all worth it in the end'. Women amputees faced trade-offs between risks to self and the unborn child and reported physical discomforts due to pregnancy-related bodily changes impacting their prosthesis or residual limb. The challenges of pregnancy as an amputee were, however, all seen to be outweighed by the safe arrival of a healthy baby. CONCLUSIONS The lack of information on pregnancy for amputees may affect women's resilience to the adaptation challenges they face. Research should further explore the experiences of amputee mothers to ensure adequate information is available to them and their caring professionals, and that the needs of women with more challenging experiences are also addressed.
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Affiliation(s)
- Esmée Hanna
- Leicester School of Allied Health Sciences, De Montfort University Leicester, UK
| | - Sara Donetto
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care at King's College London, UK
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Khan M, Brown HK, Lunsky Y, Welsh K, Havercamp SM, Proulx L, Tarasoff LA. A Socio-Ecological Approach to Understanding the Perinatal Care Experiences of People with Intellectual and/or Developmental Disabilities in Ontario, Canada. Womens Health Issues 2021; 31:550-559. [PMID: 34556400 PMCID: PMC8595790 DOI: 10.1016/j.whi.2021.08.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Accessible and quality care during the perinatal period is critical for optimal maternal and neonatal health. Using the socio-ecological model, the purpose of this study was to explore barriers and facilitators that shape the perinatal care experiences of people with intellectual and/or developmental disabilities (IDD). METHODS Semi-structured interviews were conducted with 10 individuals with IDD in Ontario, Canada, who had given birth within the past 5 years. Interviews focused on care experiences before, during, and after pregnancy. Data were analyzed using a directed content analysis approach, and the socio-ecological model guided analysis. RESULTS Barriers at the societal (e.g., cultural norms of motherhood), policy/institutional (e.g., child protection policies and practices), interpersonal (e.g., inadequate formal and informal support), and intrapersonal levels (e.g., internalized stigma) contributed to participants having negative perinatal care experiences. Conversely, we identified facilitators on the interpersonal level (e.g., positive interactions with perinatal care providers and familial and social service supports) as positively shaping participants' perinatal care experiences. CONCLUSIONS Findings reveal that the perinatal care experiences of people with IDD are shaped by several interrelated factors that largely stem from societal-level barriers, such as dominant (stigmatizing) discourses of disability. To improve the perinatal care experiences of people with IDD, there is a need for interventions at multiple levels. These include the development of policies to support perinatal care for diverse populations and training care providers to enact policies at the institutional and interpersonal levels.
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Affiliation(s)
- Momina Khan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Hilary K Brown
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada.
| | - Yona Lunsky
- Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Kate Welsh
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | | | - Laurie Proulx
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada
| | - Lesley A Tarasoff
- Department of Health and Society, University of Toronto Scarborough, Toronto, Ontario, Canada; Azrieli Adult Neurodevelopmental Centre, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Nguyen TV, King J, Edwards N, Dunne MP. Whose decision? Caesarean section and women with physical disabilities in Northern Vietnam: A qualitative study. Midwifery 2021; 104:103175. [PMID: 34740027 DOI: 10.1016/j.midw.2021.103175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 09/12/2021] [Accepted: 10/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND Pregnant women with physical disabilities are more likely to have caesarean sections than are women without disabilities. For some women with disabilities, caesarean birth may not be clinically necessary, as they may lack autonomy in decision-making to a greater extent than is the case for other pregnant women. OBJECTIVE To explore the relative influence of health staff, family, friends, and the women themselves on key decisions about childbirth of women with physical disabilities in northern Vietnam. RESEARCH DESIGN/SETTING A qualitative approach using a phenomenological design was employed. Fifty-six in-depth interviews were conducted with women with physical disabilities who had given birth in the previous three years in two northern provinces in Vietnam (Hanoi and Thaibinh). Twenty-nine women participated in a first interview and 27 completed follow-up interviews several months later. Additionally, semi-structured interviews were conducted with 12 maternal healthcare providers. Interviews were transcribed and thematically analysed. RESULTS Twenty-eight of the 29 participants underwent caesarean sections. Two themes were identified: (1) The women reported that caesarean section was mandated by attending doctors "because of their disability". Consistently, the healthcare providers said caesarean section is essential for women with physical disabilities; and (2) The women said that their parents and peers supported caesarean birth. Very few women indicated that they could influence this decision, even though one-third said their personal preference was for vaginal birth. CONCLUSIONS Many women with physical disabilities are not given the opportunity to exercise informed choices around childbirth options. Women in Vietnam who live with physical disabilities should be empowered to make informed decisions about childbirth. It is recommended that professional guidelines and training are revised to properly engage women with physical disabilities in joint decision-making for the birth of their children.
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Affiliation(s)
- Thi Vinh Nguyen
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, 149 Victoria Park Road, Queensland 4059, Australia.
| | - Julie King
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, 149 Victoria Park Road, Queensland 4059, Australia
| | - Niki Edwards
- School of Public Health and Social Work, Faculty of Health, Queensland University of Technology, 149 Victoria Park Road, Queensland 4059, Australia
| | - Michael P Dunne
- Institute for Community Health Research, Hue University, Hue, 47000, Vietnam; Australian Centre for Health Law Research, Faculty of Business and Law, Queensland University of Technology, Brisbane, 4059, Australia
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Doody O, Bailey ME, Hennessy T. Nature and extent of intellectual disability nursing research in Ireland: a scoping review to inform health and health service research. BMJ Open 2021; 11:e051858. [PMID: 34615681 PMCID: PMC8496393 DOI: 10.1136/bmjopen-2021-051858] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES To capture the extent and nature of intellectual disability nursing publications in Ireland. DESIGN Scoping review using Arksey and O'Malley approach. DATA SOURCES Six databases (PsycINFO, CINAHL, Medline, Academic Search Complete, Scopus, Embase) were searched along with a web-based search of the eight academic institutions delivering intellectual disability nurse education in Ireland for publications indexed from the earliest available date to the 31 December 2020. ELIGIBILITY CRITERIA Publications by an academic, practitioner or student working in intellectual disability practice or education in Ireland relating to intellectual disability nursing, care or education. DATA EXTRACTION AND SYNTHESIS Data pertaining to type of paper/design, authors (academic/professional/student), year, collaboration (national/international), topic/content area and title were extracted from each paper. Data were analysed by two authors using Colorafi and Evans content analysis steps where data was tabulated, and a narrative synthesis undertaken. RESULTS The reporting of the review is in line with the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and PRISMA extension for Scoping Reviews Checklist. Database and web-based searching resulting 245 articles meeting the criteria for this review. Through content analysis the 245 articles were mapped onto six themes: supporting inclusion, future planning, aspects of health, interventions, education, professional development and research, and personal and professional accounts of caring. CONCLUSIONS This review highlights the extent and nature of intellectual disability publications by academic, practitioner or student working in intellectual disability nursing in Ireland together with opportunities for future growth and development. From the findings it is apparent that there is an ongoing need for intellectual disability nurses to define their role across the full trajectory of health provision and to make visible their role in person-family centred support, inclusion, and contributions in health education, health promotion and health management.
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Affiliation(s)
- Owen Doody
- Nursing and Midwifery, Health Research Institute, University of Limerick, Limerick, Ireland
| | - Maria E Bailey
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Therese Hennessy
- Nursing and Midwifery, University of Limerick, Limerick, Ireland
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O'Connor-Terry C, Harris J. Pregnancy decision-making in women with physical disabilities. Disabil Health J 2021; 15:101176. [PMID: 34353758 DOI: 10.1016/j.dhjo.2021.101176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 07/15/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Women with physical disabilities experience barriers to knowledge about pregnancy and adequate reproductive healthcare, which impedes decision-making processes and negatively impacts their pregnancy planning. OBJECTIVE The purpose of this study was to learn more about pregnancy decision-making in women with physical disabilities. METHODS We conducted a qualitative study utilizing semi-structured interviews with women with physical disabilities. We asked questions regarding pregnancy, parenting, reproductive health, relationships and interactions with the healthcare system. We utilized interview transcripts and notes to form a codebook regarding pregnancy and parenting decision-making, knowledge, and fears. We then organized codes into themes based on pre-existing literature regarding fertility and conceptualization of the self. RESULTS We completed and analyzed 16 interviews. Themes overall reflected the participants grappling with their own baseline assumptions that they were infertile, as well as managing similar assumptions from others. However, many of the participants recall an exact point where they began to contemplate the fact that having children was possible for them. Finally, disability-related parenting challenges are considered very early in pregnancy decision-making process. CONCLUSIONS Women with physical disabilities experience barriers to contemplating pregnancy including inadequate information on pregnancy and reproductive healthcare that affects their decision-making regarding pregnancy and parenting. All healthcare providers should talk to patients with disabilities about family planning and address possible barriers to contemplating pregnancy.
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Affiliation(s)
| | - John Harris
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA; Magee-Womens Research Institute, Pittsburgh, PA, USA
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Cox A, Parsons T, Watkin S, Gallagher A. Supporting the delivery of good maternity care for parents with learning disabilities. Midwifery 2021; 102:103073. [PMID: 34265502 DOI: 10.1016/j.midw.2021.103073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 02/19/2021] [Accepted: 06/17/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVE Despite directives to improve maternity care in general and to improve care for parents with learning disabilities, the maternity experience of parents with learning disabilities is often poor and lacking reasonable adjustments to care. The objective of this study was to develop resources - in collaboration with key stakeholders - to support the workforce in delivering good maternity care to parents with learning disabilities. DESIGN A two-phase mixed-methods study. PARTICIPANTS Phase 1: 16 key stakeholders (health and social care professionals, parents with learning disabilities and their informal supporters/carers) were interviewed to understand views of best practice and inform resource development. Phase 2: 20 healthcare professionals engaged with the resources and gave feedback via online survey or discussion group to further refine them. FINDINGS Thematic analysis of key stakeholder interviews indicated that good maternity care for parents with learning disabilities requires a positive and proactive approach to identifying need; reasonable adjustments to communication and providing information; and professionals working together to support and enable parents. KEY CONCLUSIONS Health and social care professionals identified barriers to the delivery of good maternity care for parents with learning disabilities, including how to identify whether a parent has learning disabilities. Professionals in maternity services require additional resources to ensure parents' needs are recognised and they are provided with personalised preparation for parenthood and sufficient support. IMPLICATIONS FOR PRACTICE The Together Toolkit and Maternity Passport were coproduced to support the workforce to deliver good maternity care to parents with learning disabilities, these resources are free and accessible for use [https://www.surrey.ac.uk/research-projects/together-project-supporting-delivery-goodpractice-maternity-services-parents-learning-disabilities]. Further evaluation will explore acceptability and perceived impact of these resources in maternity services.
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Affiliation(s)
- Anna Cox
- School of Health Sciences, University of Surrey, United Kingdom.
| | - Treena Parsons
- School of Health Sciences, University of Surrey, United Kingdom
| | | | - Ann Gallagher
- College of Medicine and Health, University of Exeter, United Kingdom
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Dommergues M, Candilis D, Becerra L, Thoueille E, Cohen D, Viaux-Savelon S. Childbirth and motherhood in women with motor disability due to a rare condition: an exploratory study. Orphanet J Rare Dis 2021; 16:176. [PMID: 33849607 PMCID: PMC8045243 DOI: 10.1186/s13023-021-01810-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/31/2021] [Indexed: 11/28/2022] Open
Abstract
Background Rare diseases may result in motor impairment, which in turn may affect parenthood. Our purpose was to evaluate perinatal outcomes, parenting needs, mother-infant interactions and infant development in a set of volunteer women with motor impairment due to a rare disease. In a parenting support institution, we recruited a consecutive series of 22 volunteer pregnant women or young mothers, recorded perinatal outcomes, and followed mother-infant interaction and relationship and infant development up to 14 months postpartum. Cases with intellectual or psychic disability were not included. Results There were 11 genetic diseases (2 Spinal Muscular Atrophy, 1 Charcot-Marie-Tooth, 1 autosomal dominants myopathy, 1 mitochondrial disease, 2 Elhers-Danlos, 1 Friedreich ataxia, 1 spinocerebellar ataxia, 1 tetrahydrobiopterine deficiency,1 Ectrodactyly), and 11 rare non-genetic conditions (2 spine tumors, 2 strokes, 1 juvenile chronic arthritis, 3 birth injuries, 1 inflammatory myopathy, 1 congenital amputation, and 1 traumatic amputation). These resulted in 10 impairments of four limbs, 4 impairments of both lower limbs, 7 unilateral impairments, and one distal tremor. Social deprivation Epices score, Cutrona social support scale, Edinburg Postnatal Depression scale, and Spielberger State/Trait Anxiety Inventory were unremarkable. Perinatal outcome: 4 gestational diabetes, 1 pre-eclampsia, 9 caesareans, 6 assisted and 7 spontaneous vaginal deliveries, 20 term live-births and 2 premature deliveries (35–36 weeks). Twelve women declared they were self-sufficient for daily activities; six declared they were self-sufficient to provide basic care to their baby. Distribution of the Brunet-Lezine child development score was normal. The parent-infant relationship global assessment scale (PIR-GAS) was well adapted in 2 cases, adapted in 8, perturbed in 7, significantly perturbed in 2, and distressed in 3 (mean 71.8; 95% CI 49.6–93.9). This was unrelated to any somatic or emotional characteristics of the participants. Coding interactive behavior revealed that infant engagement was lower and infant avoidance greater than in controls (p < 0.05). Conclusion Infant development was normal, but mother-infant interactions were altered in half of the participants independently from the degree of motor impairment, underscoring the need for parenting support, even for parents who are self-sufficient in daily activities.
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Affiliation(s)
- Marc Dommergues
- Department of Obstetrics and Gynecology, Hopital Pitié Salpêtrière APHP and Sorbonne Université, 83 Boulevard de l'Hopital, 75013, Paris, France.
| | | | - Ludivine Becerra
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - Edith Thoueille
- Service d'Aide à la Parentalité des Personnes en Situation de Handicap, Paris, France
| | - David Cohen
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
| | - Sylvie Viaux-Savelon
- Child Psychiatry, Hopital Pitié Salpêtrière APHP and Sorbonne Université, Paris, France
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Wos K, Baczała D. Parenting by mothers with intellectual disabilities in Poland: A photovoice study. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2021; 34:1452-1462. [PMID: 33823563 DOI: 10.1111/jar.12887] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND The diverse nature of parenting among people with intellectual disabilities can be affected by many factors, including stereotypes, experiencing social isolation, living in poverty, suffering from chronic diseases and limited access to health care. Because of these factors, people with intellectual disabilities are not readily viewed as potential parents by society. METHOD The research was conducted using the photovoice method, which analyses photographs taken by participants-seven mothers with intellectual disabilities (aged 22-43). RESULTS Thematic analysis yielded six main areas: pregnancy and childbirth, household duties-everyday life, caring for children, the importance of motherhood for a woman, parenting problems and difficulties, and types and forms of assistance. CONCLUSION Raising a child has become a life goal for the interviewed women. However, there were also difficulties in their lives, which have not been solved by formal and informal support. Individual support for mothers should include tailor-made sexual education, access to gynaecological care or long-term family support.
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Affiliation(s)
- Klaudia Wos
- Interdisciplinary Doctoral School of Social Sciences, Nicolaus Copernicus University in Toruń, Toruń, Poland
| | - Ditta Baczała
- Faculty of Philosophy and Social Sciences, Nicolaus Copernicus University in Toruń, Toruń, Poland
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Maternity care experiences of women with physical disabilities: A systematic review. Midwifery 2021; 96:102938. [PMID: 33636618 DOI: 10.1016/j.midw.2021.102938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 01/27/2021] [Accepted: 02/02/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Fifteen percent of the world's population has some form of disability, the most common form being a physical disability. Ten percent of women with disabilities are of childbearing age; however, because women with disabilities are often deemed less likely to have children, accessibility to maternity care is limited. Women with disabilities experience problems during pregnancy and childbirth due to physical barriers and barriers to information, problems with communication and the attitude of providers. A recent World Health Organization statement calls for more action, dialogue, research and advocacy on disrespectful treatment during childbirth. To give substance to this, an overview of the experiences of women with a physical disability is essential. Therefore, the aim of this systematic review is to identify and provide an overview of reported maternity care experiences of women with physical disabilities, including sensory disabilities. DESIGN This systematic review was conducted using a meta-aggregation approach for synthesis and the steps of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement. The search strategy focused on qualitative studies in the databases PubMed, Embase and CINAHL. The Critical Appraisal Skills Programme checklist was used to evaluate methodological quality, and a best-evidence synthesis was performed. FINDINGS Of the 4,486 studies screened, ten were included. The methodological quality of the studies ranged from high to moderate. The results indicated that women experience barriers related to accessibility of facilities, adapted equipment, lack of knowledge, and healthcare providers' dismissals of their concerns and unwillingness to assist. In contrast, support has a positive influence on women's experiences. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE There is evidence that women with physical disabilities continue to encounter barriers in accessing maternity care related to inaccessible care settings, lack of knowledge and the attitude of healthcare providers. Healthcare providers should be trained to be aware of women's special needs and to improve clinical practice.
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Matin BK, Williamson HJ, Karyani AK, Rezaei S, Soofi M, Soltani S. Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies. BMC WOMENS HEALTH 2021; 21:44. [PMID: 33516225 PMCID: PMC7847569 DOI: 10.1186/s12905-021-01189-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/21/2021] [Indexed: 01/15/2023]
Abstract
Background Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally. Methods We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities. Results Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare. Conclusions Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD’s access to health care.
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Affiliation(s)
- Behzad Karami Matin
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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van Buuren AL, O'rinn SE, Lipworth H, Church P, Berndl A. Reproductive health and pregnancy experiences of women with spina bifida: A qualitative study. J Pediatr Rehabil Med 2021; 14:643-654. [PMID: 34397434 DOI: 10.3233/prm-200776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Despite an increasing number of individuals with spina bifida reaching reproductive age, there has been a paucity of research into their reproductive health care needs. The objective of this study was to better understand the reproductive health experiences of self-identified women with spina bifida using qualitative methodology. METHODS A phenomenological study design was used to address this objective. Women with spina bifida identified their interest in participating in a semi-structured interview after completing an online reproductive health survey. Interviews were recorded and transcribed verbatim. Qualitative analysis followed a phenomenological approach using Dedoose software. RESULTS Twelve self-identified women with spina bifida participated. They described experiences in four domains: sexual education, pregnancy, labor and delivery, and postpartum. In addition, an intersecting domain of social justice and advocacy emerged. Numerous themes are described, including a lack of tailored sexual health information, impact of pregnancy on function, attitudes towards delivery method, and parenting challenges. CONCLUSION This study explored the continuum of reproductive health experiences of women with spina bifida. They face unique reproductive health challenges that provide an opportunity for health care providers to offer more holistic care.
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Affiliation(s)
- Asia L van Buuren
- UBC Department of Pediatrics, BC Children's Hospital, Vancouver, BC, Canada
| | | | | | - Paige Church
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Toronto Department of Pediatrics, Division of Neonatology, Toronto, ON, Canada
| | - Anne Berndl
- Sunnybrook Health Sciences Centre, Toronto, ON, Canada.,University of Toronto Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Toronto, ON, Canada
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Becker H, Andrews E, Walker LO, Phillips CS. Health and Well-Being among Women with Physical Disabilities After Childbirth: An Exploratory Study. Womens Health Issues 2020; 31:140-147. [PMID: 33272777 DOI: 10.1016/j.whi.2020.10.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 10/23/2020] [Accepted: 10/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Although research about pregnancy for women with disabilities has increased, their postpartum experience has received little attention. Studies generally focus on parenting, not on the health of the mothers themselves, despite recent studies underscoring the health risks they may face. Thus, our purpose was to examine postpartum health among women with physical disabilities, including how they maintain or improve their health. METHODS Semistructured interviews were conducted with eleven new mothers with physically disabling conditions. A qualitative descriptive approach was used to analyze the transcribed interviews and identify themes. RESULTS Nine women had delivered via cesarean section, and most had mobility impairments. Their average age was 35 years; 91% were college educated and 82% had a partner. Six overarching themes were identified: paying a price to have the baby, focus on the baby, supports-or a lack thereof, feelings of isolation, getting challenges under control/overcoming barriers, and not quite there yet/getting back to health promotion. CONCLUSIONS Despite their resilience in dealing with the challenges of caring for their babies within the context of their disabling conditions (including recovery from complications from the birth experience), these women clearly identified the need for additional resources and supports. They also recognized limitations to their own health that came along with their parenting responsibilities. Health care providers should be more attuned to the postpartum needs of women with physical disabilities, and policies should provide additional supports such as insurance coverage for home visits to help maximize women's health and well-being during this important life transition.
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Affiliation(s)
- Heather Becker
- The University of Texas at Austin, School of Nursing, Austin, Texas.
| | - Erin Andrews
- VA Texas Valley Coastal Bend HealthCare System, Austin, Texas
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Ganle JK, Apolot RR, Rugoho T, Sumankuuro J. 'They are my future': childbearing desires and motivations among women with disabilities in Ghana - implications for reproductive healthcare. Reprod Health 2020; 17:151. [PMID: 33023601 PMCID: PMC7539488 DOI: 10.1186/s12978-020-01000-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 09/29/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous research has highlighted widespread public mis/perceptions that portray women with disabilities (WWDs) as asexual, less likely to marry, and often not interested in childbearing. However, evidence from high-income settings shows that many WWDs are sexually active and do have or want to have children. Notwithstanding this, very few studies have focused on understanding childbearing desires and motivations among WWDs in low-income settings. This qualitative research explored childbearing desires and motivations among WWDs in Ghana. METHODS A cross-sectional qualitative study was conducted with WWDs aged 18-49 years in Northern Ghana. The distribution of participants by disability types were as follows: physical disability/impairment (n = 37); visual impairment (n = 11); speech and hearing impairment (n = 14); epilepsy (n = ten); and albinism (n = five). A pre-tested open-ended thematic topic guide was designed and used to conduct in-depth interviews. Interviews were tape-recorded and later transcribed for analysis. Transcripts were coded using QSR NVivo 11 software. Thematic content analysis techniques were used to analyse and present the data. RESULTS Nearly all the WWDs interviewed were sexually active, desiring to have children, and intended to have as many children as they could support. Strong desire to experience the joy of motherhood; fear of social insecurity; fear of old age economic insecurity; desire to challenge stigma and negative stereotypes about disability, sexuality and motherhood; and desire for self-actualisation, were key motivations for childbearing. CONCLUSION Our findings challenge existing negative public perceptions about the status of WWDs in relation to sexuality, childbearing and motherhood. More importantly, our findings suggest that if the Sustainable Development Goals related to universal access to sexual and reproductive healthcare are to be attained, WWDs must be targeted with quality sexual and reproductive healthcare information and services.
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Affiliation(s)
- John Kuumuori Ganle
- Department of Population, Family and Reproductive Health, School of Public Health, University of Ghana, Legon, P.O. Box LG 13, Accra, Ghana. .,Stellenbosch Institute for Advanced Study (STIAS), Wallenberg Research Centre at Stellenbosch University, Stellenbosch, 7600, South Africa.
| | - Rebecca Racheal Apolot
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Makerere University, Kampala, Uganda
| | - Tafadzwa Rugoho
- Department of Development Studies, Great Zimbabwe University, Masvingo, Zimbabwe
| | - Joshua Sumankuuro
- School of Community Health, Faculty of Science, Charles Sturt University, Bathurst, New South Wales, Australia
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Panuccio F, Berardi A, Marquez MA, Messina MP, Valente D, Tofani M, Galeoto G. Development of the Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) for evaluating and measuring the impact of physical disability on pregnancy and the management of motherhood: a pilot study. Disabil Rehabil 2020; 44:1474-1480. [PMID: 32748671 DOI: 10.1080/09638288.2020.1802520] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The aim of this study was to develop a questionnaire that allows researchers to investigate and measure the impact of physical disability on pregnancy and the management of motherhood. Such a questionnaire requires good internal consistency. METHODS The tool was developed following a study conducted in 2013 in the United States consisting of a semi-structured interview with open-ended questions. A team of three experts drafted and refined the questions, generating 31 retrospective, self-rated, and predefined questions (answered using a 5-point Likert scale). A statistical analysis of the instrument was also included, to assess its reliability and internal consistency. RESULTS The Pregnancy and Motherhood Evaluation Questionnaire (PMEQ) was prepared. It is a self-administered questionnaire consisting of an initial section and three subscales. In this phase of the study, 35 women with different pathologies leading to physical disability were recruited and completed the questionnaire. The PMEQ was found to have a good internal consistency. Cronbach's α was 0.812 (p > 0.05). CONCLUSION The PMEQ has proven to be a valid, reliable, and rapid administrative tool useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.IMPLICATION FOR REHABILITATIONThis study provides researchers and clinicians a new tool for the evaluation of motherhood and pregnancy in women with physical disabilities.The PMEQ has proven to be a valid, reliable, and rapid administrative tool (10 min) useful for investigating and measuring the impact of physical disability on the management of pregnancy and motherhood.It is a new tool useful in both clinical and research practice to underline the importance of carrying out preventive and woman-centered assistance interventions.This tool is useful for promoting the autonomous management of pregnancy and motherhood in women with physical disabilities, and improving these women's quality of life and sense of satisfaction and competence in managing maternal tasks.
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Affiliation(s)
| | - Anna Berardi
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
| | | | - Marisa Patrizia Messina
- Department of Gynecological-Obstetric Sciences and Urological Sciences, Sapienza University of Rome, Rome, Italy
| | - Donatella Valente
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy.,IRCSS Neuromed, Pozzilli, Italy
| | - Marco Tofani
- Neurorehabilitation Unit, Department of Neurosciences and Neurorehabilitation, Bambino Gesù Children's Hospital, IRCSS, Rome, Italy
| | - Giovanni Galeoto
- Department of Human Neurosciences, Sapienza University of Rome, Rome, Italy
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Nguyen TV, King J, Edwards N, Dunne MP. “Nothing suitable for us”: experiences of women with physical disabilities in accessing maternal healthcare services in Northern Vietnam. Disabil Rehabil 2020; 44:573-581. [DOI: 10.1080/09638288.2020.1773548] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Thi Vinh Nguyen
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Julie King
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Niki Edwards
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
| | - Michael P. Dunne
- Faculty of Health, School of Public Health and Social Work, Queensland University of Technology (QUT), Brisbane, Australia
- Institute for Community Health Research, Hue University, Hue, Viet Nam
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Acheampong AK, Aziato L, Marfo M, Amevor P. Breastfeeding and caring for children: a qualitative exploration of the experiences of mothers with physical impairments in Ghana. BMC Pregnancy Childbirth 2020; 20:331. [PMID: 32471372 PMCID: PMC7260762 DOI: 10.1186/s12884-020-03028-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Accepted: 05/22/2020] [Indexed: 11/10/2022] Open
Abstract
Background Breastfeeding and caring for children demand time, energy and effort. Mothers with physical impairments in Ghana require special needs to be able to achieve optimal motherhood as society demands. Globally, literature on breastfeeding and caring for children among mothers with physical disabilities is limited. Similarly, there is dearth of literature on the experiences of mothers with physical impairments in Ghana. Therefore, this study sought to add to literature by exploring the experiences of mothers with physical impairments with regards to breastfeeding and how they care for their children. Methods Qualitative descriptive exploratory design was used. Twelve mothers with physical impairments who had been purposively sampled gave informed consent before data was collected through in-depth one-on-one interviews. Data was recorded, transcribed and analyzed inductively using the content analysis technique. Results Mothers with physical impairments perceived breastfeeding as difficult and expensive due to issues relating to disruption of sleep, dysfunctional limbs and the need for breastfeeding mothers to eat nutritionally balanced meals. Participants felt prejudged and discriminated at different points in their daily encounters. Conclusion Mothers with physical impairments have challenges. Therefore, attitudinal change should be advocated in the Ghanaian society with respect to issues concerning people living with disabilities.
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Affiliation(s)
| | - Lydia Aziato
- Department of Adult Health, School of Nursing and Midwifery, University of Ghana, Legon, Accra, Ghana.
| | - Margaret Marfo
- School of Nursing, Wisconsin International University College-Ghana, Accra, Ghana
| | - Philomena Amevor
- School of Nursing, Wisconsin International University College-Ghana, Accra, Ghana
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König-Bachmann M, Zenzmaier C, Schildberger B. Health professionals' views on maternity care for women with physical disabilities: a qualitative study. BMC Health Serv Res 2019; 19:551. [PMID: 31387583 PMCID: PMC6685240 DOI: 10.1186/s12913-019-4380-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 07/30/2019] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND During pregnancy, childbirth and puerperium, women receive care from a range of health professionals, particularly midwives. To assess the current situation of maternity care for women with physical disabilities in Austria, this study investigated the perceptions and experiences of health professionals who have provided care for women with disabilities during pregnancy, childbirth and postpartum. METHODS The viewpoints of the participating health professionals were evaluated by means of semistructured interviews followed by an inductive qualitative content analysis of the interview transcripts, as proposed by Mayring. RESULTS Four main categories emerged from the inductive content analysis: (i) structural conditions and accessibility, (ii) interprofessional teamwork and cooperation, (iii) action competence, and (iv) diversity-sensitive attitudes. According to the participating health professionals, the structural conditions were frequently not suitable for providing targeted group-oriented care services. Additionally, a shortage of time and staff resources also limited the necessary flexibility of treatment measures in the care of mothers with physical disabilities. The importance of interprofessional teamwork for providing adequate care was highlighted. The health professionals regarded interprofessionalism as an instrument of quality assurance and team meetings as an elementary component of high-quality care. On the other hand, the interviewees perceived a lack of action competence that was attributed to a low number of cases and a corresponding lack of experience and routine. Regarding diversity-sensitive attitudes, it became apparent that the topic of mothers with physical disabilities in care posed challenges to health professionals that influenced their natural handling of the interactions. CONCLUSION The awareness of one's own attitudes towards diversity, in the perinatal context in particular, influences professional security and sovereignty as well as the quality of care of women with disabilities. There is a need for optimization in the support and care of women with physical disabilities during pregnancy, childbirth and puerperium.
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Affiliation(s)
| | | | - Barbara Schildberger
- University of Applied Sciences for Health Professions Upper Austria, Semmelweisstraße 34/D3, 4020, Linz, Austria.
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35
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Streur CS, Schafer CL, Garcia VP, Quint EH, Sandberg DE, Kalpakjian CZ, Wittmann DA. "He told me it would be extremely selfish of me to even consider [having kids]": The importance of reproductive health to women with spina bifida and the lack of support from their providers. Disabil Health J 2019; 13:100815. [PMID: 31239106 DOI: 10.1016/j.dhjo.2019.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Revised: 05/23/2019] [Accepted: 06/04/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND As more women with spina bifida (SB) enter their reproductive years, the number having children is significantly increasing. However, little is known about their understanding of their ability to get pregnant or their experiences in considering, planning, or interacting with providers during a pregnancy. OBJECTIVE We sought to determine what women have been told and understand about their reproductive health, their attitudes towards having children, and their experiences interacting with providers when seeking reproductive health care. METHODS In this exploratory study employing qualitative research methods and following Grounded Theory, interviews with women with SB 16 years or older were transcribed verbatim and analyzed by three coders. RESULTS Interviews of 25 women with SB ages 16-52 (median 26) revealed the following themes about their reproductive health perceptions and experiences: 1) poor understanding of reproductive health and potential, 2) interest in having a family, 3) facing provider's opposition to their reproductive goals, 4) going into pregnancy and delivery unprepared, 5) the importance of provider support for reproductive goals. Five women experienced an unintended pregnancy. CONCLUSIONS Although having children is important to most women with SB in this study, they report a poor understanding of their reproductive potential with several noting unintended pregnancies. They feel uninformed and unprepared during pregnancy and face discouragement from providers. Those experiencing supportive providers report a more positive experience. This demonstrates the urgent need to educate women with SB about their reproductive health and the providers who care for them how to support and counsel these women.
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Affiliation(s)
| | | | | | - Elisabeth H Quint
- Department of Obstetrics and Gynecology, University of Michigan, United States
| | - David E Sandberg
- Department of Pediatrics and Communicable Diseases, University of Michigan, United States
| | - Claire Z Kalpakjian
- Department of Physical Medicine and Rehabilitation, University of Michigan, United States
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Maternal Healthcare Experiences of and Challenges for Women with Physical Disabilities in Low and Middle-Income Countries: A Review of Qualitative Evidence. SEXUALITY AND DISABILITY 2019. [DOI: 10.1007/s11195-019-09564-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Gur A, Stein MA. Social worker attitudes toward parents with intellectual disabilities in Israel. Disabil Rehabil 2019; 42:1803-1813. [PMID: 30616429 DOI: 10.1080/09638288.2018.1537382] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: United Nations human rights treaties and domestic law require social workers to support the parenting rights of persons with intellectual disabilities. Social workers are also required to protect the health and well-being of those clients' children. This study explores the experiences, challenges, and complex attitudes of Israeli social workers regarding parenthood by their clients with intellectual disabilities.Methods: A qualitative method employed semi-structured interviews with twenty-one social workers. A thematic analysis identified major themes.Results: Social workers recognized the parental desires of clients with intellectual disabilities and acknowledged their role in supporting those individuals. Nevertheless, most of the social workers expressed negative perceptions regarding the right or capability of clients with intellectual disabilities to parent. Social workers thus felt the tension between their personal reservations and their professional duty to support these clients. Regardless of individual attitudes, social workers uniformly asserted that greater state and community support was needed to enable the parental capacity of their clients.Conclusions: In addition to increasing state and community support for parents with intellectual disabilities, additional training is needed for empowering social workers to act on behalf of these clients in Israel.Implications for RehabilitationSocial workers hold critical roles for parents with intellectual disabilities and are required to support their clients' parenting while ensuring the health and well-being of their children.Israeli social workers balance negative or ambivalent attitudes regarding the capability of parents with intellectual disabilities against a desire to honor their duty to support these clients.State and community support for parents with intellectual disabilities must be increased.Additional training is needed for empowering social workers to act on behalf of these clients in Israel.
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Affiliation(s)
- Ayelet Gur
- The Louis and Gabi Weisfeld School of Social Work, Bar Ilan University, Ramat Gan, Israel
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Potvin LA, Barnett BM, Brown HK, Cobigo V. "I Didn't Need People's Negative Thoughts": Women With Intellectual and Developmental Disabilities Reporting Attitudes Toward Their Pregnancy. Can J Nurs Res 2019; 51:154-167. [PMID: 30602298 DOI: 10.1177/0844562118819924] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Since the illegalization of involuntary sterilization of persons with intellectual and developmental disabilities, there has been an increase in childbearing in this population. However, women with intellectual and developmental disabilities continue to experience prejudicial attitudes toward their pregnancies. Objective To analyze the experiences of women with intellectual and developmental disabilities regarding their perceptions of support persons’ attitudes toward their pregnancies. Methods Three case studies derived from grounded theory research exploring perinatal social support received by women with intellectual and developmental disabilities. Using inductive content analysis, we further analyzed the perceptions of women with intellectual and developmental disabilities regarding support persons’ attitudes toward their pregnancies. Findings: The nature of interactions with support persons and women’s characteristics, such as help-seeking behaviors, disability, mental illness, and age, influenced support persons’ attitudes toward childbearing. Women preferred support from caregivers perceived as nonjudgmental and tended to restrict contact with persons perceived as prejudicial. However, some attitudes improved following positive interactions with the women. The relationship between support persons’ attitudes and the women’s help-seeking behaviors is thus complex. Conclusions Education of families and medical and social services practitioners and opportunities for positive contact should be further explored. Caseworkers of women with intellectual and developmental disabilities may have invaluable roles in facilitating positive interactions between women with intellectual and developmental disabilities and caregivers.
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Affiliation(s)
| | | | - Hilary K Brown
- 2 Women's College Research Institute, Women's College Hospital, Toronto, Canada.,3 Interdisciplinary Centre for Health and Society, University of Toronto Scarborough, Canada
| | - Virginie Cobigo
- 1 School of Psychology, University of Ottawa, Canada.,4 Centre for Research on Educational and Community Services, University of Ottawa, Canada.,5 Children's Hospital of Eastern Ontario Research Institute, Children's Hospital of Eastern Ontario, Ottawa, Canada
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Pregnancy in Disability: Community Perceptions and Personal Experiences in a Rural Setting in Ghana. J Pregnancy 2018; 2018:8096839. [PMID: 30643648 PMCID: PMC6311281 DOI: 10.1155/2018/8096839] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/24/2018] [Accepted: 11/28/2018] [Indexed: 11/23/2022] Open
Abstract
Background Persons with disabilities (PWDs) generally face strong discrimination and exclusion, especially with regard to their sexual and reproductive health. There is a prevailing social myth in Ghana that women with disabilities are asexual and cannot experience a positive motherhood experience. Although the World Health Organization recommends that research is conducted in this regard, community attitudes towards pregnant women living with disabilities remain largely unexplored. The purpose of this study was to explore community attitudes to pregnancy among women living with disabilities. Methodology The study design was a mixed method cross-sectional study involving quantitative face-to-face individual interviews with 400 randomly selected community members (both males and females) in three communities in the Adaklu District of Volta Region in Ghana. In addition, in-depth interviews were held with five female PWDs. Simple and multiple logistic regression analysis were used to examine the factors associated with perceptions towards pregnant PWDs. Results Majority of respondents agreed that pregnant women with disabilities should be kept in special institutions until delivery to prevent transmission of their disability to fetuses of pregnant women without disabilities. People also believed that pregnant PWDs are incapable of a safe motherhood experience. Among the strongly influencing factors for negative attitudes towards pregnancy of PWDs were educational status (p<0.001) and perceptions that the disability is caused by accidents (p<0.001) or spiritual issues (p<0.01). Regarding the relationship between perceived cause of disability and the resultant attitudes, respondents were three times more likely to have negative attitude and perceptions towards pregnant women with disabilities if their causes of disabilities were perceived to be spiritual compared to the cause being medical. Conclusion Our findings indicate that there are generally negative societal attitudes towards pregnant PWDs. The evidence suggests that a degree of prejudice and misconceptions exists towards the pregnancy of women living with disabilities. Generally, there is a public perception that women living with disabilities cannot have a safe motherhood experience and are capable of transferring their disability to an unborn child of another pregnant woman.
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Hall J, Hundley V, Collins B, Ireland J. Dignity and respect during pregnancy and childbirth: a survey of the experience of disabled women. BMC Pregnancy Childbirth 2018; 18:328. [PMID: 30103731 PMCID: PMC6088410 DOI: 10.1186/s12884-018-1950-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 07/26/2018] [Indexed: 11/25/2022] Open
Abstract
Background Despite the increasing number of women with disability globally becoming pregnant, there is currently limited research about their experiences. A national survey of women’s experience of dignity and respect during pregnancy and childbirth raised concerns about the possibility of women with disability having unequal care with overall less choice and control. To address this further we conducted a study to explore the experiences of dignity and respect in childbirth of women with disability. Methods The study involved a self-selecting, convenience sample of 37 women who had given birth in the United Kingdom and Ireland and had completed an internet-based survey. Women were identified through online networks and groups of and for disabled parents and for people with specific medical conditions. Data were collected using an online survey tool. Survey data were analysed using descriptive statistics. Thematic analysis was used for open questions. Results Despite generally positive responses, just over half of the group of women expressed dissatisfaction with care provision. Only 19% thought that reasonable adjustments or accommodations had been made for them (7/37). When reasonable adjustments were not in place, participants’ independence and dignity were undermined. More than a quarter of women felt they were treated less favourably because of their disability (10/37, 27%). At all points in the pregnancy continuum more than a quarter of women felt their rights were either poorly or very poorly respected; however this was greatest in the postnatal period (11/35, 31%). In addition, more than half of the women (20/36, 56%) felt that maternity care providers did not have appropriate awareness of or attitudes to disability. Conclusions Women’s experiences of dignity and respect in childbirth revealed that a significant proportion of women felt their rights were poorly respected and that they were treated less favourably because of their disability. This suggests that there is a need to look more closely at individualised care. It was also evident that more consideration is required to improve attitudes of maternity care providers to disability and services need to adapt to provide reasonable adjustments to accommodate disability, including improving continuity of carer.
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Affiliation(s)
- Jenny Hall
- Centre for Excellence in Learning, Bournemouth University, Bournemouth, UK.
| | - Vanora Hundley
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK
| | - Bethan Collins
- Institute of Clinical Sciences, Faculty of Health and Life Science, University of Liverpool, Liverpool, UK.,Occupational Therapy, School of Health Sciences, University of Liverpool, Liverpool, UK
| | - Jillian Ireland
- Centre for Midwifery, Maternal & Perinatal Health, Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.,Poole NHS Foundation Trust, Poole, UK
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Hasson-Ohayon I, Hason-Shaked M, Silberg T, Shpigelman CN, Roe D. Attitudes towards motherhood of women with physical versus psychiatric disabilities. Disabil Health J 2018; 11:612-617. [PMID: 29798828 DOI: 10.1016/j.dhjo.2018.05.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2017] [Revised: 04/08/2018] [Accepted: 05/07/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Women with disabilities may face social negative attitudes with regard to their being mothers. In addition, attitudes toward different disabilities form a hierarchy, with more positive attitudes being displayed toward persons with physical disabilities than toward persons with psychiatric disabilities. OBJECTIVE Current observational study examined whether the relationship between a woman's type of disability (psychiatric vs. physical) and the social attitude towards her would be moderated by her being presented as a mother. METHOD University students (N = 100) filled out the Multidimensional Attitudes Scale Toward Persons With Disabilities and the Social Distance Scale, after reading one of six randomly assigned fictitious vignettes. The vignettes consisted of a woman with a physical disability/a woman with a psychiatric disability/a woman without a disability, who either was or was not a mother. RESULTS Type of disability was found to have a main effect in some attitude domains, suggesting that attitudes toward women with physical disabilities were better than attitudes towards women with psychiatric disabilities. An interaction between type of disability and motherhood was found for the interpersonal distress subscale of the attitudes scale. It was found that when women had physical disabilities, there was no change in attitude towards them regardless of whether they were presented as mothers or not; However, when the target woman had a psychiatric disability, and she was presented as a mother, negative attitudes were generated towards her. CONCLUSIONS The study demonstrates the existence of a hierarchy of stigmatization and the effect of being a mother on stigmatization.
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Affiliation(s)
| | | | - Tamar Silberg
- Department of Psychology, Bar-Ilan University, Ramat-Gan, Israel
| | | | - David Roe
- Community Mental Health Department at the University of Haifa, Haifa, Israel
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Gartrell A, Baesel K, Becker C. "We do not dare to love": women with disabilities' sexual and reproductive health and rights in rural Cambodia. REPRODUCTIVE HEALTH MATTERS 2018; 25:31-42. [PMID: 28784072 DOI: 10.1080/09688080.2017.1332447] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
There is an urgent need for an evidence base to inform the implementation of disability inclusive sexual and reproductive health (SRH) policy and programming to address women with disabilities' largely unattained SRH rights. This paper presents findings from a qualitative study on the sexual and reproductive health and rights (SRHR) of women with disabilities in rural Cambodia. The findings highlight three critical steps to enhance the physical, communicative and financial accessibility of SRHR information and services. Firstly, strengthen women with disabilities' economic livelihoods, social and financial resources, and thereby, their capacity to make and act on their own SRHR decisions. Secondly, engage women with disabilities as community role models and advocates who actively provide input into health service decision-making, planning and delivery. Thirdly, ensure health centre staff have access to communication resources and aids to strengthen their skills to communicate with women with hearing impairments. Together these steps will support women with disabilities to claim their sexual and reproductive rights and transform the social attitudes of persons in the lives of women with disabilities, including health care staff.
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Affiliation(s)
| | - Klaus Baesel
- b Junior Advisor, Improving Maternal and Newborn Care Project , GIZ , Cambodia
| | - Cornelia Becker
- c Program Manager, Improving Maternal and Newborn Care Project , GIZ , Cambodia
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Atarodi-Kashani Z, Kariman N, Ebadi A, Majd HA, Beladi-Moghadam N, Hesami O. Exploring the perception of women with epilepsy about pregnancy concerns: a qualitative study. Electron Physician 2018; 10:6843-6852. [PMID: 29997770 PMCID: PMC6033129 DOI: 10.19082/6843] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 08/06/2017] [Indexed: 11/25/2022] Open
Abstract
Background and aim Epilepsy is a common neurological disorder in pregnancy, which is associated with increased maternal and fetal adverse outcomes. This study aimed to explore the reproductive healthcare needs of women with epilepsy before, during and after childbirth. Methods This was a qualitative study using a content analysis method. The study population was marital women with epilepsy in reproductive age (15–45 years) referred to Imam Hossein Hospital, Tehran, Iran. Participants were 16 women chosen using purposive sampling with the consideration of maximum variation in sampling. Semi-structured interviews were held with the participants until data saturation was reached. The data were analyzed using the content analysis method. The MAXQDA software, version 2010, was used for the management of data. Results The data analysis led to the development of two categories. The first one is named ‘resilience against threats to safe pregnancy’ and has the following subcategories: (1) real physical complications and perceived (mental) conditions due to unwanted pregnancies, (2) the predisposing factors of anxiety related to safe pregnancy, (3) perceived consequences of pregnancy’, and (4) the approach to encounter perceived consequences of pregnancy. The second category is called ‘adverse experiences under inefficient supportive systems’ and has the following subcategories: (1) the insufficiency of reproductive healthcare services for women with epilepsy, (2) doubt about the advantages and disadvantages of breastfeeding, (3) stigma as a block to the treatment of the postpartum depression, and (4) playing the motherhood role under the shadow of self-esteem to lack of self-esteem. Conclusion In the prenatal, natal and postnatal duration, because of supportive system disruption and not receiving proper consultation, participants were often worried about not being able to get favorable conditions for safe pregnancy and controlling process of their pregnancy. Therefore, they often experienced unwanted pregnancy. They were also concerned about the adverse fetal outcomes. In postpartum period, they often experienced postpartum depression and were very doubtful about breastfeeding.
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Affiliation(s)
- Zahra Atarodi-Kashani
- Ph.D. Candidate of Reproductive Health, International Branch, Department of Midwifery and Reproductive Health, Nursing and Midwifery School, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nourossadat Kariman
- Ph.D. of Reproductive Health, Assistant Professor, Midwifery and Reproductive Health Research Center, Faculty of Nursing and Midwifery, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Ebadi
- Ph.D. of Nursing Education, Associate Professor, Behavioral Sciences Research Center, Life style Institute, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Hamid Alavai Majd
- Ph.D. of Biostatistics, Professor, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Nahid Beladi-Moghadam
- MD., Neurologist, Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Omid Hesami
- MD., Neurologist, Assistant Professor, Department of Neurology, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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Review of gynecologic and reproductive care for women with developmental disabilities. Curr Opin Obstet Gynecol 2018; 28:350-8. [PMID: 27379438 DOI: 10.1097/gco.0000000000000299] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW Care for women with developmental disabilities requires special consideration for unique needs related to their cognitive and physical abilities. These women and their caregivers require more support and guidance during reproductive health care. We review the literature and provide expert opinion surrounding gynecological issues for women with developmental disabilities to support healthcare providers better understand and care for this population. RECENT FINDINGS Women with developmental disabilities are more vulnerable to abuse and experience poorer gynecological healthcare outcomes. Many women with developmental disabilities are fertile and participate in sexual activity without adequate knowledge. They are at higher risk of pregnancy and birth complications. They are less likely to receive appropriate preventive screening. SUMMARY The review highlights important issues and practice suggestions related to the reproductive health care of women with developmental disabilities. Topics include clinic visits, menstruation, sexuality, sexual abuse, sexual health education, contraception, sexually transmitted infections, pregnancy, labor and delivery, and cancer screening/prevention. We emphasize the need for an individualized, comprehensive approach for these patients and review perceived and actual barriers to care. More education is needed on the aforementioned topics for women with developmental disabilities, their caregivers, and their providers.
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Pariseau-Legault P, Holmes D. [Sexual health and intellectual disability: a narrative literature review and its implications for nursing practice.]. Rech Soins Infirm 2017; 130:12-30. [PMID: 29192460 DOI: 10.3917/rsi.130.0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Issues associated with affectivity and sexuality in the context of intellectual disability have recently been the subject of various interdisciplinary discussions in academia. In nursing, interventions in sexual health are supported with hesitation and those issues constitute a marginal field of nursing research. A narrative literature review was realized in order to establish a portrait of the knowledge produced on this topic in the last decade. This paper illustrates three specific research areas recently developed, namely issues related to sexual autonomy, contextual factors positively or negatively contributing to emotional and sexual life, and the experiences of people identified as having an intellectual disability in this regard. On the basis of these results, different issues related to sexuality and intellectual disability are discussed, including those associated with the negotiation process of affective and sexual life, parenthood as a mediator of emotional and sexual expression, and the inclusiveness issues of sexual diversity in health interventions. Implications for nursing are finally discussed in light of the recent development of its role in sexual health.
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Clark LL, Merrick I, O'Driscoll F, Lycett H, White R, White A. Template for action for patients with intellectual disabilities in mental health services. ACTA ACUST UNITED AC 2017. [DOI: 10.12968/bjmh.2017.6.6.279] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Louise L Clark
- Senior Teaching Fellow, Florence Nightingale Faculty of Nursing and Midwifery, Kings College London
| | - Ian Merrick
- Professional lead occupational therapist, community services, West London Mental Health Trust, London
| | - Fiona O'Driscoll
- Lead occupational therapist, Ealing Recovery Services, West London Mental Health Trust, London
| | - Helen Lycett
- Strategic trust lead for occupational therapy and allied health professions, West London Mental Health Trust, London
| | - Robert White
- Primary care mental health service team manager, West London Mental Health NHS Trust, London
| | - Anna White
- Service user carer; honorary psychotherapist, West London Mental Health Trust, London
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Mitra M, Akobirshoev I, Moring NS, Long-Bellil L, Smeltzer SC, Smith LD, Iezzoni LI. Access to and Satisfaction with Prenatal Care Among Pregnant Women with Physical Disabilities: Findings from a National Survey. J Womens Health (Larchmt) 2017; 26:1356-1363. [PMID: 28832265 DOI: 10.1089/jwh.2016.6297] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Previous qualitative studies suggest that women with physical disabilities face disability-specific barriers and challenges related to prenatal care accessibility and quality. This study aims to examine the pregnancy and prenatal care experiences and needs of U.S. mothers with physical disabilities and their perceptions of their interactions with their maternity care clinicians. MATERIALS AND METHODS We conducted the first survey of maternity care access and experiences of women with physical disabilities from 37 states. The survey was disseminated in partnership with disability community agencies and via social media and targeted U.S. women with a range of physical disabilities who had given birth in the past 10 years. The survey included questions regarding prenatal care quality and childbirth and labor experiences. RESULTS A total of 126 women with various physical disability types from 37 states completed the survey. Almost half of the respondents (53.2%) reported that their physical disability was a big factor in their selection of a maternity care provider and 40.3% of women reported that their prenatal care provider knew little or nothing about the impact of their physical disability on their pregnancy. Controlling for maternal demographic characteristics and use of mobility equipment, women who reported that their prenatal care provider lacked knowledge of disability and those who felt they were not given adequate information were more likely to report unmet needs for prenatal care. CONCLUSIONS The findings from this study suggest the need for training and education for clinicians regarding the prenatal care needs of women with physical disabilities.
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Affiliation(s)
- Monika Mitra
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Ilhom Akobirshoev
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Nechama Sammet Moring
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Linda Long-Bellil
- 2 Center for Health Policy and Research, University of Massachusetts Medical School , Shrewsbury, Massachusetts
| | - Suzanne C Smeltzer
- 3 Center for Nursing Research, Villanova University College of Nursing , Villanova, Pennsylvania
| | - Lauren D Smith
- 1 The Lurie Institute for Disability Policy, The Heller School for Social Policy and Management, Brandeis University , Waltham, Massachusetts
| | - Lisa I Iezzoni
- 4 Department of Medicine, Harvard Medical School, The Mongan Institute for Health Policy , Massachusetts General Hospital, Boston, Massachusetts
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Malouf R, Henderson J, Redshaw M. Access and quality of maternity care for disabled women during pregnancy, birth and the postnatal period in England: data from a national survey. BMJ Open 2017; 7:e016757. [PMID: 28729324 PMCID: PMC5642776 DOI: 10.1136/bmjopen-2017-016757] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES More disabled women are becoming mothers, and yet, their care is rarely the focus of quantitative research. This study aimed to investigate access and quality of maternity care for women with differing disabilities. DESIGN Secondary analysis was conducted on data from a 2015 national survey of women's experience of maternity care. Descriptive and adjusted analyses were undertaken for five disability groups: physical disability, sensory impairment, mental health disability, learning disability and multiple disability, and comparisons were made with the responses of non-disabled women. SETTING Survey data were collected on women's experience of primary and secondary care in all trusts providing maternity care in England. PARTICIPANTS Women who had given birth 3 months previously, among whom were groups self-identifying with different types of disability. Exclusions were limited to women whose baby had died and those who were younger than 16 years at the time of the recent birth. RESULTS Overall, 20 094 women completed and returned the survey; 1958 women (9.5%) self-identified as having a disability. The findings indicate some gaps in maternity care provision for these women relating to interpersonal aspects of care: communication, feeling listened to and supported, involvement in decision making, having a trusted and respected relationship with clinical staff. Women from all disability groups wanted more postnatal contacts and help with infant feeding. CONCLUSION While access to care was generally satisfactory for disabled women, women's emotional well-being and support during pregnancy and beyond is an area that is in need of improvement. Specific areas identified included disseminating information effectively, ensuring appropriate communication and understanding, and supporting women's sense of control to build trusting relationships with healthcare providers.
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Affiliation(s)
- Reem Malouf
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Jane Henderson
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- Policy Research Unit in Maternal Health and Care, National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK
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“We don't know. We've never had anybody like you before”: Barriers to perinatal care for women with physical disabilities. Disabil Health J 2017; 10:426-433. [DOI: 10.1016/j.dhjo.2017.03.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2016] [Revised: 03/06/2017] [Accepted: 03/09/2017] [Indexed: 11/17/2022]
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Devkota HR, Murray E, Kett M, Groce N. Healthcare provider's attitude towards disability and experience of women with disabilities in the use of maternal healthcare service in rural Nepal. Reprod Health 2017; 14:79. [PMID: 28662710 PMCID: PMC5492880 DOI: 10.1186/s12978-017-0330-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Accepted: 05/24/2017] [Indexed: 11/10/2022] Open
Abstract
Background Women with disabilities are less likely to receive maternal healthcare services compared to women without disabilities. While few studies have reviewed healthcare experience of women with disabilities, no studies have been conducted to understand provider’s attitude towards disability in Nepal, yet the attitude and behaviour of healthcare providers may have a significant influence on aspects of care and the use of service by women with disabilities. This study examines healthcare provider’s attitudes towards disability and explores the experience of women with disabilities in maternal healthcare service utilization during pregnancy and childbirth. Method The study used mixed method approach. An attitude survey was conducted among 396 healthcare providers currently working in public health facilities in Rupandehi district of Nepal. For additional insight, eighteen in-depth interviews with women with disabilities who used maternal healthcare services in a healthcare facility within the study district in their last pregnancy were undertaken. The Attitude Towards Disabled Persons (ATDP) scale score was used to measure the attitudes of healthcare providers. For quantitative data, univariate and multivariate analysis using ANOVA was used to understand the association between outcome and independent variables and qualitative analysis generated and described themes. Results Mean ATDP score among healthcare providers (78.52; SD = 14.75), was low compared to the normative score of 100 or higher. Nurses/auxiliary nurse midwives obtained the highest mean score (85.59, SD = 13.45), followed by general clinical health workers (Mean score = 82.64, SD 15.10). The lowest score was obtained by Female Community Health Volunteers (FCHV) (Score = 73.75, SD = 13.40) (P < 0.001). Younger providers were more positive compared to older age groups (P < 0.001). Similarly, providers working in urban health facilities compared to those working in rural health facilities, and non-Dalit providers compared to Dalit providers reported more positive attitudes towards disability (P < 0.05). However, there were no significant differences in ATDP mean scores between those who had or had not previously provided services for women with disabilities. The mean score difference between those who received disability training and who did not was also found statistically insignificant (P > 0.05). This may reflect the small number of individuals, who have had training on disability thus far, or the nature or quality of the training currently available. The majority of qualitative interview participants perceived providers to have the negative attitude with poor knowledge, skills and preparation for providing care to persons with disabilities. Few participants perceived the providers as kind, respectful, caring or helpful. Conclusion Overall, provider’s attitude towards disability was found to be negative with poor knowledge and skills about providing services. This may have adversely impact maternal healthcare service utilization by women with disabilities. More organized, effective training for healthcare providers is required through on-going mainstream efforts to develop favorable attitudes towards disability. Further research on this subject is also needed. Electronic supplementary material The online version of this article (doi:10.1186/s12978-017-0330-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | | | - Maria Kett
- Leonard Cheshire Disability and Inclusive Development Center, Department of Epidemiology and Public Health, University College London (UCL), London, UK
| | - Nora Groce
- Leonard Cheshire Disability and University College London (UCL), London, UK
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