An integrated qualitative and quantitative study on sexual and reproductive health problems faced by women with disabilities in Chandigarh, India

OBJECTIVES

To estimate the prevalence of sexual and reproductive health (SRH) problems among women with disabilities (WWD) in Chandigarh, India, and to ascertain the difficulties experienced by WWD in accessing hospital services.

METHODS

This cross-sectional study was conducted during 2014 to 2017 in Chandigarh, India. The study participants were women 15 years and older with at least 40% disability. A pretested questionnaire and in-depth interview were used to determine sociodemographic profile, medical history, sexual and reproductive morbidity, treatment-seeking behavior, and the type, extent, and course of the disability. Verbatim responses of the participants were noted. Data were manually coded and collated into possible themes.

RESULTS

Postpolio residual paralysis (80; 30.7%) was the main reported disability, followed by severe sight impairment (52; 19.9%). A majority (170; 65%) of participants were unmarried. Of them, 66 (39%) were not willing to get married. The prevalence of SRH problems was high (151; 57.9%) among WWD, and only 82 (54%) took treatment. Dysmenorrhea (47; 31.1%), irregular periods (36; 23.8%), and vaginal discharge (17; 11.3%) were the main problems reported. The WWD in this study were likely to hide their SRH problems from others out of shame or fear.

CONCLUSION

Among WWD, the prevalence of SRH problems is high and obtaining relief is difficult.

Unmet needs, limited access: A qualitative study of postpartum health care experiences of people with disabilities

AIM

To understand the postpartum care received by birthing people with disabilities and their newborns, from their own perspectives.

DESIGN

A qualitative study with semi-structured interviews.

METHODS

Between July 2019 and February 2020, in-person and virtual interviews were conducted with 31 people with physical, sensory, and intellectual/developmental disabilities in Ontario, Canada, about the formal inpatient and outpatient services and supports they used in the first few months after they gave birth. Thematic analysis was used identify common themes.

RESULTS

We identified three overall themes concerning participants' postpartum care experiences and the different types of formal services received in and out of hospital: (1) lack of adequate care, (2) lack of provider awareness of disability and disability accommodations, and (3) fear of judgement, discrimination, and intrusive surveillance. The identified themes were applicable across disability groups. However, most comments on disability accommodations came from participants with physical or sensory disabilities, while participants with intellectual/developmental disabilities most commonly reported concerns about lack of adequate care and fear of judgement, discrimination, and intrusive surveillance.

CONCLUSION

Findings indicate that postpartum care often fails people with disabilities. This could contribute to negative health consequences for them and their newborns.

IMPACT

Birthing people with disabilities need multidisciplinary, proactive, and strengths-based postpartum care to mitigate risk for health complications. Further, disability-related training and guidelines for health and social service providers is required.

REPORTING METHOD

Consolidated criteria for reporting qualitative research (COREQ).

PATIENT OR PUBLIC CONTRIBUTION

Our research team included two peer researchers with physical disabilities who served as co-interviewers and participated in data analysis, contributing their lived experience of disability and interactions with the health care system. All stages of the study were also informed by feedback from the study's Advisory Committee, which comprised women with disabilities (many of whom are parents), disability organization staff, clinicians, and policy representatives.

Comparison of Cervical Cancer Screening Used between Individuals with Disabilities and Individuals without Disabilities

OBJECTIVE

Cervical cancer is the fourth most prevalent cancer in women worldwide. It is vital to achieve a high cervical cancer screening rate among women. We compared the Pap smear test (PST) used between individuals with disabilities and those without disabilities in Taiwan.

METHODS

Individuals registered in the Taiwan Disability Registration File and the National Health Insurance Research Database (NHIRD) were screened for this nationally representative retrospective cohort study. Women aged 30 and above in 2016 and who were still alive in 2016 were matched in a 1:1 ratio via propensity score matching (PSM); 186,717 individuals with disabilities and 186,717 individuals without disabilities were included. Controlling for relevant variables, the odds of receiving PST were compared using conditional logistic regression analysis.

RESULTS

A lower percentage of individuals with disabilities (16.93%) received PST than those without disabilities (21.82%). The odds of individuals with disabilities receiving PST were 0.74 times that of individuals without disabilities (OR = 0.74, 95% CI = 0.73-0.76). Compared to individuals without disabilities, individuals with intellectual and developmental disabilities had the lower odds of receiving PST (OR = 0.38, 95% CI = 0.36-0.40), followed by individuals with dementia (OR = 0.40, 95% CI = 0.33-0.48) or multiple disabilities (OR = 0.52, 95% CI = 0.49-0.54).

CONCLUSIONS

We highly recommend that healthcare practitioners recognize the unique needs of individuals with different types of disabilities, especially those with cognitive impairments.

Opioids and Disability Among Women of Reproductive Age

Background: Despite nearly one in five U.S. women of reproductive age reporting a disability, limited research exists on opioid behaviors in this vulnerable population. This study examined associations between disability and past-year prescription opioid use and misuse, and described types of opioids, sources, and motives for opioid misuse among nonpregnant women of reproductive age. In addition, the effects of social, medical, and behavioral determinants of health on opioid use and misuse were assessed in this population of women with disabilities. Materials and Methods: Data were used from the 2015-2019 National Survey on Drug Use and Health (n = 93,679). Descriptive statistics and logistic regression models were used in the analyses. Results: Overall, 48.0% of women with a disability reported past-year prescription of any opioid use compared to 32.3% of women without disabilities, and 10.4% of women with disabilities reported opioid misuse relative to 4.2% of women without disabilities. Hydrocodone was the most used (29.3%) and misused (5.87%) opioid. Women with disabilities had higher adjusted odds of opioid use (adjusted odds ratio [AOR] 1.59; 95% confidence interval [CI], 1.50-1.67) and misuse (AOR 2.01; 95% CI, 1.82-2.21) than those without disabilities. Tobacco, alcohol use, and poor to fair health were all associated with higher odds of opioid misuse. For their last opioid misuse, 5.2% attained the opioids from a dealer or stranger, and 22.1% used opioids to get high. Conclusion: Women with disabilities are at an amplified risk for prescription opioid use and misuse. Improved medical provider education, training and capacity, and reinforcing related community-based support programs for this population are imperative.

Cumulative Contexts of Vulnerability to Intimate Partner Violence Among Women With Disabilities, Elderly Women, and Immigrant Women: Prevalence, Risk Factors, Explanatory Theories, and Prevention

Some groups of women are more vulnerable to intimate partner violence (IPV) due to particular risks and/or experiences: women with disabilities, elderly women, and immigrant women (DEI). Too often, their reality goes unnoticed, especially for those belonging to more than one of these groups. In this literature review, researchers used an intersectional approach to document the similarities and differences in how DEI women experience IPV, in terms of forms and consequences, as well as related risk factors, explanatory theories, and prevention strategies. Researchers selected 56 articles for review based on the following inclusion criteria: studies on adults living in a situation of IPV, studies on one of the three demographics under study (DEI), studies about one or multiple research questions, and studies based on empirical data relying on research methodology in either French or English. Researchers evaluated each selected article for its quality according to a chart that was specially developed for this review. The results highlight existing "intersections" between these groups to help understand the influence of belonging to more than one vulnerability group on these women's experiences with IPV. The importance to better training social workers and developing policies and programs that target the social determinants of health to prevent IPV experienced by DEI is also discussed.

"We do not dare to love": women with disabilities' sexual and reproductive health and rights in rural Cambodia

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.

Supporting female survivors of intimate partner violence with disabilities: Recommendations for social workers in the emergency department

Intimate partner violence (IPV) is a pervasive problem with grave consequences. Women with disabilities are among the most vulnerable groups disproportionately affected, with higher IPV rates than either women without disabilities or men with disabilities. The emergency department (ED) in particular affords a gateway into health services for female survivors of IPV, placing ED social workers in a prime position to observe potential signs of IPV and connect survivors to further assistance. This article explores the critical role ED social workers can fill in addressing the needs of female survivors of IPV with disabilities. We begin by providing background on the characteristics of IPV among women with disabilities, followed by a discussion of the opportunities and challenges inherent to assessing and intervening with survivors. We conclude by outlining recommendations for working with female survivors of IPV with disabilities in EDs, using our previous research on the topic as a guide.

"Freedom to go where I want": improving access to sexual and reproductive health for women with disabilities in the Philippines

Women with disabilities experience a range of violations of their sexual and reproductive rights. The Philippines ratified the United Nations Convention on the Rights of Persons with Disabilities and have laws in place to promote the rights to sexual and reproductive health and protection from violence. However, limited resourcing, and opposition to such laws undermine access to these rights for all women. Inadequate disability inclusion within policy and programming, and limited disability awareness of services, further impedes women with disabilities from attaining these rights. The W-DARE project (Women with Disability taking Action on REproductive and sexual health) was a three-year participatory action research program designed to (1) understand the sexual and reproductive health experiences and needs of women with disabilities; and (2) improve access to quality sexual and reproductive health, including violence response services, for women with disabilities in the Philippines. In response to the highlighted need for more information about sexual and reproductive health and greater access to services, the W-DARE team developed and implemented a pilot intervention focused on peer-facilitated Participatory Action Groups (PAGs) for women with disabilities. This paper focuses on the qualitative findings from the evaluation of this PAG intervention.

Peace, justice and disabled women's advocacy: Tamil women with disabilities in rural post-conflict Sri Lanka

This article draws on grounded qualitative research with rural Tamil women who acquired a disability during the civil war in Sri Lanka and conceptualizes an intersectionality-peace framework. Three main themes were developed from the interviews: narratives of conflict, survival outcomes of social assistance and mobilization of cross-ethnic relationships. With the support of a local women's disability advocacy organization, Tamil women with disabilities were enabled to overcome social stigma and claim a positive identity as women with disabilities. The organization's focus on realizing disability rights created new opportunities for these highly marginalized rural women. The women were also supported to form cross-ethnic relationships with women who similarly faced multiple oppressions. These relationships transformed the women into 'agents of peace', using their newfound disability identity to foster cross-ethnic dialogue and create safe spaces in the post-conflict context.

Perinatal Experiences of Women With Physical Disabilities and Their Recommendations for Clinicians

OBJECTIVE

To explore the perinatal experiences of women with physical disabilities (WWPD) and their associated recommendations for maternity care clinicians to improve care.

DESIGN

A mixed-methods study was conducted with a semistructured interview guide to identify the experiences of WWPD. This qualitative descriptive study was part of a larger study of the unmet needs and barriers to perinatal care experienced by WWPD SETTING: Telephone interview.

PARTICIPANTS

Twenty-five women with physical disabilities who gave birth within the last 10 years and were 21 to 55 years of age were recruited and agreed to participate in the study.

METHODS

Participants were asked about their interactions with clinicians during pregnancy and their recommendations for clinicians to improve perinatal care for women with physical disabilities. Content analysis was used to analyze transcribed interviews. Themes that emerged from analysis of the interviews were identified and coded. Kurasaski's coding was used to establish the reliability of the coding.

RESULTS

Three themes emerged from analysis of the interview data: Clinicians' lack of knowledge about pregnancy-related needs of WWPD; Clinicians' failure to consider women's knowledge, experience, and expertise about their own disabilities; and Clinicians' lack of awareness of the reproductive concerns of WWPD. Women provided recommendations that warrant attention from clinicians who provide perinatal care for women who live with physical disabilities.

CONCLUSION

Participants experienced problematic interactions with clinicians related to pregnancy and identified recommendations for maternity care clinicians to address those problems with the goal of improving perinatal health care for WWPD.

Maternal Characteristics, Pregnancy Complications, and Adverse Birth Outcomes Among Women With Disabilities

OBJECTIVES

The objective of this study is to describe the maternal characteristics, pregnancy complications, and birth outcomes among a representative sample of Rhode Island women with disabilities who recently gave birth.

METHODS

Data from the 2002-2011 Rhode Island Pregnancy Risk Assessment Monitoring System survey were analyzed.

RESULTS

Approximately 7% of women in Rhode Island reported a disability. Women with disabilities reported significant disparities in their health care utilization, health behaviors, and health status before and during pregnancy and during the postpartum period. Compared with nondisabled women, they were significantly more likely to report stressful life events and medical complications during their most recent pregnancy, were less likely to receive prenatal care in the first trimester, and more likely to have preterm births (13.4%; 95% CI, 11.6-15.6 compared with 8.9%; 95% CI, 8.5-9.3 for women without disabilities) and low-birth-weight babies (10.3%; 95% CI, 9.4-11.2 compared with 6.8%; 95% CI, 6.8-6.9). There was no difference in the rates of cesarean section between women with and without disabilities.

CONCLUSIONS

These findings support the need for clinicians providing care to pregnant women with disabilities to be aware of the increased risk for medical problems during pregnancy and factors that increase the risk for poor infant outcomes.

Prevalence and experiences of intimate partner violence against women with disabilities in Bangladesh: results of an explanatory sequential mixed-method study

This study was aimed to estimate the prevalence of intimate partner violence (IPV) in a sample of 226 women with disabilities living in four different districts of Bangladesh. It also explored the physical and psychological suffering of women experiencing violence and their various coping strategies. A cross-sectional survey was carried out with 226 women with disabilities to measure the prevalence of IPV, and 16 in-depth interviews were conducted to document in detail the experiences of violence encountered by the abused women. Among the 226 women interviewed in the survey, about 84% reported ever having experienced at least one act of emotional abuse, physical, or sexual violence from their partner during their lifetime. Women who were older (aged above 32 years), separated, and members of economic/savings group were more likely to report ever having experienced any IPV than women with disabilities who were younger (aged 32 years and less), married, and not members of economic/savings group. Most of the women experiencing violence reported sufferings from physical and psychological problems. Of all the women who experienced violence, less than half (45%) reported seeking support to minimize or avoid violence experiences. However, seeking support from informal network such as family and relatives was commonly reported by many (81.4%) of them. Study findings suggest that women with disabilities who possess poor socio-economic status coupled with economic dependency on husbands' income and wide-spread social stigma against disability make them vulnerable to IPV. Future interventions to address IPV against women with disabilities should include building community knowledge of disability and IPV, countering the pervasive social stigma against disabilities, and improving the socio-economic conditions of women with disabilities through education and employment.

The prevalence and psychological costs of household violence by family members against women with disabilities in Cambodia

Women with disabilities (WWDs) are at triple jeopardy due to the combined risks associated with gender, disability, and violence. Not only are WWDs marginalized socially but the violence against them in their own homes is largely neglected in domestic violence research. Evidence from developing countries is particularly sparse. A cross-sectional survey conducted in Cambodia found rates of violence by household members besides intimate partners were significantly higher among WWDs than non-disabled women. This violence engendered increased levels of psychological distress and higher rates of physical injury but low rates of disclosure to health workers and other formal sources of potential support. Community-based strategies are recommended to radically change social and cultural attitudes, beliefs, and responses to WWDs who are victims of household violence to reduce negative social reactions toward them and to make it safer for them to disclose and receive psychosocial, legal, and other necessary support for this underreported type of violence.

Intimate partner violence in Mexican-American women with disabilities: a secondary data analysis of cross-language research

The aim of this qualitative descriptive study, guided by Antonovsky's salutogenic model, was to explore the manifestations of strength within the interviews of Spanish-speaking Mexican-American women aging with mobility impairments who also experienced intimate partner violence (IPV). IPV events gleaned from 26 audiotaped interviews from 7 Spanish-speaking Mexican-American women, who ranged in age from 55 to 75 years, constituted the sample for this secondary analysis. Five categories were identified: abuse from early on that shaped sense of coherence; violencia tan cruel--threatened sense of coherence; "salutogenic" choices within the context of IPV; a quest for peace; and strength amid struggle.

The effects of hormone therapy decision support for women with mobility impairments

Deciding about hormone therapy (HT) use is particularly complex for women with mobility impairments. While HT controls menopausal symptoms, the potential increased risk of blood clots resulting from physical inactivity can contraindicate HT use. These women, therefore, may benefit from interventions to help them tailor standard information about HT. We randomly assigned women to receive either a tailored decision support intervention or standard menopausal information. Both groups (n = 176) significantly decreased their decisional conflict and uncertainty and increased knowledge after receiving the treatment materials. We interpret the findings in the context of limited medical information about HT for women with disabilities.

Health disparities among Latinas aging with disabilities

Latinas with disabilities report greater levels of disablement than non-Hispanic, White women with disabilities. Over the life course, Latinas experience increased numbers of functional limitations, more difficulties with activities of daily living, and more unemployment due to impairments. The reasons for this health disparity are unclear. The purpose of this article is to explore the empirical evidence surrounding health disparities in disablement among Mexican American women. From this exploration, recommendations are made, including moving beyond the correlational documentation of disparities, to building a knowledge base that provides theoretical reasons for disparities amenable to intervention.