Seventy-eight women recounted their experiences of accessing health services during pregnancy, childbirth and early motherhood, 20 in the mental health strand, 18 each in the physical disability, hearing impairment, vision impairment groups and 4 in the intellectual disability strand of the study. A total of 81 face-to-face interviews were conducted (Table 1). One woman in the mental health strand was interviewed 3 times, the first interview during pregnancy, the second in the immediate postnatal period and the third interview was during early motherhood. One woman in the intellectual disability strand was interviewed twice; the first interview was during the early postnatal period and the second in early motherhood (Table 1).
|
Disability Strand |
Pregnancy |
Up to 6 Months |
Up to 2yrs |
|---|---|---|---|
| Physical Disability |
4 |
7 |
7 |
| Hearing Impairment |
5 |
6 |
7 |
| Vision Impairment |
5 |
7 |
6 |
| **Mental Health |
6 |
7 |
9 |
| *Intellectual Disability |
0 |
3 |
2 |
| Total |
20 |
30 |
31 |
**One woman in the mental health strand was interviewed 3 times
* One woman in the intellectual disability strand was interviewed twice
The women's age range was 19-42 years (Mean 31.65 years, SD 4.85) (Figure 1, Table 2). Sixty-one women (78%) were married, 12 (15%) women were single and 5 (7%) were cohabiting. All of the women had support either from their partner or from family, and none were homeless. Three of the 4 women with an intellectual disability were living in supported accommodation. The majority of women (51% n=40) described their occupation as skilled, (23% n=18) as a homemaker, (14% n=11) as professionals, (5% n=4) as semi-skilled, (4% n=3) unemployed and (3% n=2) as students (Figure 2, Table 3). Three of the 4 women with an intellectual disability were living in supported accommodation.
Figure 1 Age profile of all women participating in the study
|
Age Profile |
Number of Women |
|---|---|
| 19-13yrs |
7 |
| 24-28yrs |
9 |
| 29-33yrs |
29 |
| 34-38yrs |
29 |
| 39-44yrs |
4 |
| Total |
n=78 |
Figure 2 Women’s occupation
|
Employment Status |
Number of Women |
|---|---|
| Skilled |
40 |
| Homemaker |
18 |
| Professional |
11 |
| Semi skilled |
4 |
| Unemployed |
3 |
| Student |
2 |
| Total |
n=78 |
Over half (55%, n=43) of the women discussed their experiences during their second or subsequent pregnancies and 35 (45%) recounted their experiences during their first pregnancy. Twenty (25%) of the interviews were conducted during pregnancy, 30 (37%) during the immediate postnatal period and the remaining 31 (38%) in early motherhood.
Forty-five women (58%) lived in the Leinster region (29 of them (37%) in Dublin), 13 (17%) lived in Munster, 10 (13%) in Connacht and 10 (13%) in Ulster (Figure 3, Table 4). The majority (n=49, 63%) of women lived in an urban area and 29 (37%) in a rural location.
Figure 3 Number of women participating per region
|
Disability Strand |
Leinster |
Munster |
Connacht |
Ulster |
|---|---|---|---|---|
| Physical Disability |
14 |
3 |
1 |
0 |
| Hearing Impairment |
11 |
2 |
3 |
2 |
| Vision Impairment |
5 |
8 |
2 |
3 |
| Mental Health |
14 |
0 |
1 |
5 |
| IntellectualDisability |
1 |
0 |
0 |
3 |
| Total n=78 (100%) |
n=45 (58%) |
n=13 (17%) |
n=10 (13%) |
n=10 (13%) |
The largest number of women (n=29, 37%) lived in Dublin, 10 in Donegal, 6 in Limerick, 5 each in Galway, Kildare and Meath. The remaining 18 women lived in Louth, Sligo, Waterford, Cork, Kerry, Carlow, Laois, Mayo, Westmeath or Wexford. Table 5 provides an overview of all demographic details.
Eighteen women had a physical disability. The underlying causes of their disability were as follows: 6 women had a diagnosis of multiple sclerosis, 5 cerebral palsy, 2 spina bifida and 5 other causes, all of which were due to acquired disabilities (Appendix 7, Figure 4). The other causes will not be categorised further, as doing so could possibly lead to women being identified and potentially compromise their right to anonymity. For the 11 women with either multiple sclerosis or another acquired disability diagnosis the length of the duration of the disability ranged between 18 months and 12 years (mean=6.5 years). The women's age range was 20-38 years (mean= 29.66 years, SD=4.31) (Appendix 7, Figure 5). Fourteen (78%) were married and 4 women were single, all of whom were in a long term relationship. The majority of women (n=16, 89%) were employed in a skilled occupation, 1 was a homemaker and 1 was unemployed.
Half of the women discussed their experiences during their first pregnancy and the other half recounted their experience during their second or subsequent pregnancies. Four (22%) women were interviewed during pregnancy, 7 (39%) during the immediate postnatal period and the remaining 7 (39%) in early motherhood. Fourteen (78%) women resided in the Leinster region, 3 (17%) in Munster and 1 (6%) in Connacht. Twelve (67%) women resided in an urban area and 6 (33%) resided in a rural location. Seven (39%) women used aids to assist with mobility, including a wheelchair (5) and walking stick(s) (2).
|
Age |
Occupation |
Region |
Marital status |
Parity |
||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
|
Strands |
19-24 |
25-30 |
31-36 |
37-42 |
Professional |
Skilled |
Semi-skilled |
Home-maker |
Unem-ployed/ student |
U |
Mu |
L |
C |
M |
C |
S |
First baby |
Later baby |
| Physical |
3 |
8 |
6 |
1 |
0 |
16 |
0 |
1 |
1 |
0 |
3 |
14 |
1 |
14 |
0 |
4 |
9 |
9 |
| Hearing |
1 |
3 |
12 |
2 |
2 |
11 |
0 |
5 |
0 |
2 |
2 |
11 |
3 |
16 |
0 |
2 |
5 |
13 |
| Vision |
1 |
5 |
10 |
2 |
2 |
10 |
0 |
4 |
2 |
3 |
8 |
5 |
2 |
15 |
1 |
2 |
9 |
9 |
| Mental Health |
1 |
5 |
10 |
4 |
7 |
3 |
2 |
8 |
0 |
5 |
0 |
14 |
1 |
16 |
4 |
0 |
10 |
10 |
| Intellect-ual Dis-ability |
1 |
1 |
2 |
0 |
0 |
0 |
2 |
0 |
2 |
0 |
0 |
1 |
3 |
0 |
0 |
4 |
2 |
2 |
|
7 |
22 |
40 |
9 |
11 |
40 |
4 |
18 |
5 |
10 |
13 |
45 |
10 |
61 |
5 |
12 |
35 |
43 |
|
U = Ulster, Mu = Munster, L = Leinster, C = Connacht
M = Married, C = Co-habiting, S = Single
Eighteen women had a hearing impairment. Eleven (61%) women were deaf and 7 (39%) had partial hearing. Eight (44%) women wore hearing aids. Thirteen (72%) women discussed their experiences during their first pregnancy and 5 (28%) recounted their experiences during their second or subsequent pregnancies. Five (28%) women were interviewed during pregnancy, 6 (33%) during the immediate postnatal period and the remaining 7 (39%) in early motherhood.
The women's age range was 23-39 years (mean=32.38 years, SD= 3.62) (Appendix 7, Figure 6). The majority (n=16, 89%) of women were married, 2 were single, of which 1 was in a long term relationship. The majority of women (n=11, 61%) were employed in skilled occupations, 5 (28%) were homemakers and 2 (11%) were professionals.
Eleven (61%) women resided in the Leinster region, 3 (17%) in Connacht and 2 (11%) each in Ulster and Munster. Ten (56%) women resided in an urban area and 8 (44%) in a rural location.
Eighteen women had a vision impairment. Eleven (61%) women were partially sighted and 7 (39%) were completely blind. Twelve (67%) women used some aids including corrective glasses (7), guide dog (3) or a stick (2). Fourteen (78%) women had a congenital disability and 4 (22%) had an acquired disability. The women's age range was 20-42 years (mean= 32.94 years, SD=5.21) (Appendix 7, Figure 7). The majority of women (n=15, 83%) were married and 56% (n=10) were employed in a skilled occupation, 4 (22%) were homemakers, 2 (11%) were students and 2 (11%) were professionals.
Half of the women discussed their experiences during their first pregnancy and the other half recounted their experiences during their second or subsequent pregnancies. Five (28%) women were interviewed during pregnancy, 7 (39%) during the immediate postnatal period and the remaining 6 (33%) in early motherhood. Eight (44%) women resided in the Munster region, 5 (28%) in Leinster, 3 (17%) in Ulster and 2 (11%) in Connacht. Fourteen (78%) resided in an urban area and 4 (22%) in a rural location.
Twenty women with mental health difficulties recounted their experiences of accessing health services during pregnancy, childbirth and early motherhood. A total of 22 interviews was conducted in this strand, as one woman was interviewed on 3 occasions, in pregnancy, in the first 6 months postpartum and in early motherhood (after 1 year). Ten women had mental health difficulties prior to becoming pregnant; of these one woman was diagnosed with depression in childhood, began using street drugs in adolescence and is now on a methadone programme. The other 9 women reported receiving a variety of medical diagnosis including psychosis, obsessive compulsive disorder (OCD), bipolar disorder, post traumatic stress disorder (PTSD) depression, depression with anxiety, anxiety and phobia.
For the 10 women with mental health difficulties prior to pregnancy, the duration of the disability ranged from 5 to 14 years. Of the 10 women who developed mental health difficulties during pregnancy or in the postnatal period the mental health difficulties ranged from 9 months to 9 years. Six of these women were given a diagnosis of postnatal depression and experienced depressive symptoms for periods varying from 22 months to 9 years. The age range was 23-40years (mean = 33.05 years, SD=4.17) (Appendix 7, Figure 8). Sixteen women were married and 4 were cohabiting. Seven described their occupation as professional, 3 as skilled, 2 semiskilled and 8 as homemaker. Ten women discussed their experiences during their first pregnancy and 10 recounted their experiences during their second or subsequent pregnancies. Six women were interviewed during pregnancy, 9 were interviewed when their babies were under 1 year old and 7 in early motherhood. Five women received fertility treatment. Six of the women had caesarean sections. Fourteen participants lived in Leinster, 5 in Ulster and 1 in Connacht.
Four women with an intellectual disability recounted their experiences of accessing health services during pregnancy, childbirth and early motherhood. A total of 5 interviews was conducted in this strand, one woman was interviewed on 2 occasions, immediately post the birth and again when the baby was 8 months old. The women's age range was 19-35 years (mean= 29 years, SD=7.6) (Appendix 7, Figure 9), and all were single. Three of the women described themselves as unemployed and one as a semi-skilled worker. Two of the women discussed their experiences during their first pregnancy and 2 recounted their experiences during their second or subsequent pregnancies. One woman was interviewed during the immediate postnatal period and all 4 in early motherhood. Three women resided in the Connacht region and one in Leinster. All were accompanied at interview by an advocate/support person. The profile of these women differs from that of the other groupings, with higher rates of unemployment and single status.
With reference to Table 5, it can be seen that, in general, the women with intellectual disability were younger, were unmarried and had a higher rate of unemployment than women from the other strands, although the numbers are too small for any meaningful comparison. In comparison with national statistics, the women taking part were the same average age (31.65 years compared with 31.1 years nationally), and the same parity (45% having their first baby compared with 42% nationally). Occupation was harder to compare as definitions differed. However, the rates of home-makers (25% in the study sample and 24% nationally), semi-skilled (5% compared with 3%) and unemployed (4% compared with 3%), were similar. A higher proportion were single (15% compared with a national rate of 32%) (Economic and Social Research Institute (ESRI), 2009).
Findings that emerged from the semi-structured interviews with all women are presented in the next 5 chapters, under the 5 themes identified in the literature review as defining access to services - availability, accessibility, accommodation, acceptability and attitudes, and affordability. Results from the focus groups with health care professionals are presented in chapter 7 and the discussion, conclusion and recommendations follow in the next chapter.
The women's words are used to illustrate the themes and categories identified. Words inserted in brackets thus [ ], are the researchers' additions to increase clarity. Words omitted from a direct transcript are indicated by 3 ellipses thus (...). Identifiers are included after each quotation; (M13) indicates the thirteenth woman to take part in the mental health strand and similarly "P" indicates the physical disability strand, "V" visual impairment, "H" hearing impairment and "ID" intellectual disability. One quotation is included from a woman with a mental health difficulty who took part in the pilot study, because her story contributed an important aspect to the whole picture.