"Under great anxiety": Pregnancy experiences of Vietnamese women with physical disabilities seen through an intersectional lens

Mental health outcomes across the reproductive life course among women with disabilities: a systematic review

PURPOSE

This systematic review examined literature on mental health outcomes among women with disabilities living in high-income countries within the context of reproductive health, spanning menstruation through menopause.

METHODS

Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched MEDLINE, CINAHL, and PsycINFO databases for studies published through June 2023. Eligible studies were observational, quantitative, and included a comparison group without disabilities.

RESULTS

A total of 2,520 studies were evaluated and 27 studies met inclusion criteria. These studies assessed mental health during prepregnancy, pregnancy, postpartum, and parenting among women with and without disabilities. None of the studies examined reproductive health time periods related to menstruation, fertility, or menopause. Women of reproductive age with disabilities were more likely to have poor mental health outcomes compared to women without disabilities. During pregnancy and the postpartum, women with disabilities were at greater risk of diagnosed perinatal mental disorders and psychiatric-related healthcare visits. Findings also suggested mental distress and inadequate emotional and social support related to parenting among women with disabilities. The greatest risks of poor mental health outcomes were often observed among women with intellectual and developmental disabilities and among women with multiple types of disabilities, compared to women without disabilities.

CONCLUSIONS

Routine reproductive healthcare visits provide significant prevention and treatment opportunities for poor mental health among women with disabilities. Further research examining mental health outcomes within the context of reproductive health, especially understudied areas of menstruation, fertility, parenting, and menopause, among women with disabilities is needed.

The pathways to reproductive health education for women with physical disabilities in vietnam

OBJECTIVE

To examines the access to reproductive health information by women with physical disabilities in Ho Chi Minh City, Vietnam.

METHODS

An ethnography was used in this research. Data collection was conducted by using observations, photovoice, and in-depth interview with 30 participants, which including 20 women with physical disabilities, 5 healthcare providers, and 5 key informants.

RESULTS

Research findings revealed that women with physical disabilities had variable reproductive health knowledge with some women being more informed than others. They obtained reproductive health knowledge via four pathways: family, school, community, and self-learning via peers and the Internet. They learned different types of information from these sources, but their reproductive health resources remained limited, leading to very little reproductive health knowledge for women.

CONCLUSION

Most women in this research are not educated by family members about reproductive health issues due to the Vietnamese cultural and social norms about sexual and reproductive health and ideas about disability. Some women have the opportunity to complete grade 9 and higher education levels, hence they are able to access authorized information via biology classes and other sexual and reproductive health training courses. Some recommendations are given including [1] Comprehensive sexual and reproductive health education should be taught in schools; [2] The Ministry of Education and Training works with NGOs to provide more authoritative sexual and reproductive health documents or workplace training for all people with disabilities; [3] Social policy makers in Vietnam should review their policies regarding improving the quality of life of people with disabilities.

Childbearing Women's Experiences of and Interactions With the Health System in Vietnam: A Critical Interpretive Synthesis

Scholars have long argued that the care experience is shaped by context, and by evolutions in this context. Using Vietnam as a case, we critically interrogate the literature on women's experiences with maternity care to unpack whether and if it engages with the major social, economic, and health system impacts of the Doi Moi reforms in Vietnam and with what consequences for equity. We conducted a critical interpretive synthesis of this literature in light of the social, economic, and health system transformations driven by the Doi Moi reforms. We offer three critiques: (1) an overwhelming focus on public maternity care provision in rural/mountainous regions of Vietnam, (2) a narrow focus on women's ethnic identity, and (3) a misplaced preoccupation with women's limited autonomy and agency. We argue that future research needs to consider the impact of Vietnam's shift towards market-oriented care provision, and the broader societal and health system changes impacting both rural and urban areas, as well as ethnic minority and Kinh majority populations.

A qualitative examination of factors influencing pregnancy-related anxiety in Northern Ghana

INTRODUCTION

Despite high prevalence of anxiety among pregnant women in low- and -middle-income countries, research on context-specific conceptualisation, measurement, and predictors of pregnancy-related anxiety (PrA) is limited in these contexts. We explored local conceptualisations of factors influencing PrA in the Northern Region of Ghana.

METHODS

We conducted 15 focus group discussions with antenatal care seekers in the Mion District, Savelugu Municipality, and Tamale Metropolis of the Northern Region, in July and August 2021. Multistage stratified purposive sampling was used to select respondents (n = 108). The data were audio-recorded and transcribed, and then we conducted a thematic analysis of the data.

RESULTS

At the individual level, fear of anaemia; pre-existing health conditions; challenges with daily activities; and physical, emotional, and sexual abuses from spouses contributed to PrA. Health system failures resulting in unexpected out-of-pocket payments, negative health worker attitudes, diagnostic errors, constraints on birth preparation and birth process, and potential adverse birth outcomes were understood as driving PrA. Socio-cultural factors influencing PrA comprised beliefs and practices around baby naming/outdooring ceremonies, fear of spiritual attacks, social construction of gender roles, and contextual factors such as transportation challenges.

CONCLUSION

Pregnant women in the region understood, experienced, and could identify perceived predictors of PrA. To address PrA, we recommend that mental health services should be integrated into the basic package of antenatal care and rural health services should be improved. Perceived predictors of PrA identified here could be included in the design of a context-specific PrA measure for use in the region.

Women with disabilities and their motherhood: scoping review

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.

Exploring the Application of Intersectionality as a Path toward Equity in Perinatal Health: A Scoping Review

OBJECTIVE

To conduct a scoping review to determine how past studies have applied the theory of intersectionality, a critical feminist research paradigm, to understand the physical health and mental health outcomes of perinatal people as a step toward addressing maternal health disparities and injustice. The study includes a review of existing research on maternal physical and mental health outcomes, presents the strengths and limitations of existing studies, and provides recommendations on best practices in applying intersectionality in research to address systemic issues and improve outcomes for the perinatal population.

METHODS

We conducted an extensive literature search across four search engines, yielding 28 publications using the intersectionality framework that focused on the outcomes of perinatal people, with a total sample of 9,856,042 participants. We examined how these studies applied intersectionality and evaluated them based on three areas: conceptualization, research method, and interpretation/findings.

RESULTS

Our findings indicate that maternal health researchers have provided good descriptions of the interaction of systemic inequalities and have used analysis that allows for the examination of interlocking and mutually reinforcing social positions or systems. We find that improvement is needed in the areas of conceptualization, reflexivity, and understanding of power structure. Recommendations are provided in the form of a checklist to guide future research toward an impactful approach to addressing perinatal health disparities.

RELEVANCE

Our scoping review has implications for improving applied health research to address perinatal health disparities, mortality, and morbidity. Recommendations are given along with references to other tools, and a guidance checklist is provided to support scholars in creating an impactful approach to applying intersectionality in the goal of addressing maternal health disparities.

Intersectionality, health equity, and EDI: What's the difference for health researchers?

Many countries adopted comprehensive national initiatives to promote equity in higher education with the goal of transforming the culture of research. Major health research funders are supporting this work through calls for projects that focus on equity, resulting in a proliferation of theoretical frameworks including "intersectionality," "health equity," and variations of equity, diversity and inclusion, or EDI. This commentary is geared at individual principal investigators and health research teams who are developing research proposals and want to consider equity issues in their research, perhaps for the first time. We present histories and definitions of three commonly used frameworks: intersectionality, health equity, and EDI. In the context of health research, intersectionality is a methodology (a combination of epistemology and techniques) that can identify the relationships among individual identities and systems of oppression; however, it should also be used internally by research teams to reflect on the production of knowledge. Health equity is a societal goal that operationalizes the social determinants of health to document and address health disparities at the population level. EDI initiatives measure and track progress within organizations or teams and are best suited to inform the infrastructure and human resourcing "behind the scenes" of a project. We encourage researchers to consider these definitions and strive to tangibly move health research towards equity both in the topics we study and in the ways we do research.

Whose decision? Caesarean section and women with physical disabilities in Northern Vietnam: A qualitative study

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.