Appendix 3 - Tables 2 and 3

Northern Ireland

To examine the level of access for women with disabilities to family planning clinics and sexual education and information in Northern Ireland.

Quantitative. Self reported questionnaire

54 family planning clinics in NI. Response rate of 63% (physical and hearing impairment)

People with disabilities encounter challenges with physical access to family planning clinics. Access to information and services offered by family planning clinics were limited. Expectations that people with disabilities are asexual and these persons continue to experience exclusion and denial of access to reproductive services.

U.S.A.

To explore the reproductive health care experiences of women with physical disabilities and to recommend improvements.

Qualitative

descriptive, exploratory. Semi structured interviews.

10 women with a physical disability aged between 18-50yrs.

Concept of asexuality was prominent. Challenges were encountered in relation to physical access to the facilities and inappropriate equipment. Health professionals were insensitive and there was a general lack of awareness and knowledge about the impact disability would have on pregnancy and vice versa.

Canada

To explore the prenatal education and maternity care experiences of mothers with a disability.

Qualitative descriptive, exploratory. Semi structured interviews.

8 women with a chronic illness/disability (physical and visual impairment)

Gaps exist in the information received by women during prenatal education sessions. Women received insufficient and inappropriate information in relation to pregnancy and their disability. The needs of this population are overlooked and women's ability to parent is challenged.

U.K.

To explore accessibility of health information provided by NHS to people with disabilities.

Quantitative. Review key information booklets and leaflets.

130 people with a physical and sensory disability.

People with disabilities do not receive health information in appropriate formats.

Canada

To examine the availability of preventative maternal health care and the provision of childbirth education services to women with a physical disability in Vancouver

Quantitative. Self reported survey.

20 agencies in Vancouver that provide childbirth education services for women with a physical disability.

Childbirth education for women with a physical disability is limited; women are usually referred elsewhere. Challenges encountered with physical accessibility. Educators do not consider provision of classes for this population as part of their function. Educators lack knowledge about the impact pregnancy will have on disability. Not willing to embrace concept of normality and mainstreaming of this population.

Ireland

To explore the experiences of people with disabilities in accessing mainstream health services.

Qualitative descriptive, exploratory. Unstructured interviews.

32 participants, 12 women, 15 men with disability, 5 relatives/ advocates. 4 women with disabilities (physical and hearing) with experience of maternity services

People with disabilities experience a multitude of inequalities in accessing and utilising the health services. Services are fragmented and uncoordinated, inequalities not addressed by institutions, principles of equity, fairness and person centeredness are not operationalised, and the person's autonomy is impaired by lack of support mechanisms. Communication, physical and attitudinal challenges were frequently encountered and unaddressed.

U.S.A.

To determine if primary care physicians and access to their offices are in compliance with U.S.A. Disabilities Act (1990)

Quantitative Cross sectional survey. Self-reported questionnaire

220 physicians (GPs, internists obstetricians). 62 responded. Response rate = 28%.

18% of physicians could not provide a service to people with disabilities and were non- compliant with disability legislation. Barriers were identified in relation to physical access, inaccessible equipment and inappropriate referral of people. Practices were discriminatory.

Norway

To explore the mothering experiences of mothers with a physical disability.

Qualitative descriptive, exploratory. Semi structured interviews.

30 women with a physical disability aged between 28-49 years

Becoming a mother afforded women a sense of normality, focus was on mothering not disability. Women had to overcome societal attitudes that perceived them as different to the norm. Perceived as dependent recipients of care rather than autonomous carers. Fear that their children will be taken into custody.

U.S.A.

To determine reproductive conditions, potential complications and behaviours in women post spinal cord injury.

Quantitative. Questionnaire.

472 women, one year post spinal cord injury.

Reproductive health concerns of women with spinal cord injury. Sexual experiences and complications associated with the injury are discussed. Challenges in access to reproductive health care were encountered.

U.S.A.

To develop a greater understanding of women's experiences of and their satisfaction with the health care services utilised during pregnancy, birth and the postpartum period.

Qualitative. Semi structured interviews.

12 women with mobility limited physical disability.

Women's experiences shaped by 3 factors - specific disability, resources, personality and approach to pregnancy. Health professionals had little experience and lacked awareness and knowledge of pregnancy and disability. No referral to allied professionals. Birth experience was medicalised and technology used frequently. Postpartum health professionals were insensitive, communication was inappropriate and referral mechanisms nonexistent.

U.K.

To investigate childbirth experiences of women with a physical disability and to examine the experiences of midwives providing care to women with a physical disability during childbirth.

Qualitative descriptive, exploratory.Semi structured interviews.

8 midwives, and 5 mothers with a physical disability.

Five themes emerged from mothers - their quest for normality, the disability taking precedence over pregnancy, midwives' lack of awareness and knowledge about the women's disability, importance of disability awareness and positive attitudes for midwives, the need for effective communication. Three themes emerged from the midwives' perspective - midwives' varied knowledge and experience, positive attitudes and positive communication.

Canada

To investigate the mothering experiences of mothers with a physical disability

Qualitative descriptive, exploratory. Unstructured interviews.

11 mothers with a physical disability using wheelchairs and scooters

Mothering experience influenced by ability to access the physical environment and home care services. Assistance was rarely given despite an identified need. Impaired mobility impacts on the mothering role.

U.K.

To explore health and life experiences of mothers with rheumatoid arthritis.

Qualitative. Semi structured interviews.

7 women with rheumatoid arthritis aged between 21-41 yrs.

Five themes emerged from women's experiences: inner strength gained from their illness, their illness was an antecedent to depression, women were labelled despite their desire to feel normal, felt like a failure as wife and mother. Women expressed the need for education about their illness and its effect on pregnancy and associated complications.

Ireland

To explore the general population's perceptions of disability and people with disabilities.

Quantitative. Social survey interviews.

1,000 adults from the general population.

Positive and negative public attitudes in relation to a variety of topics including defining disability, treatment of people, education & employment and difficulties encountered by people with disabilities, who is responsible for caring for them, the rights of people with disabilities to have relationships and be sexual.

Ireland

To explore the general population's perceptions of disability and people with disabilities

Quantitative. Social survey interviews.

1,004 adults from the general population.

Public attitudes were more positive than in the 2002 survey. Attitudes were determined in relation to the same topics as in the 2002 survey (above)

U.S.A.

To examine barriers to reproductive health maintenance among women with physical disabilities.

Qualitative descriptive, exploratory. Unstructured interviews.

31 women with a physical disability.

Physical and attitudinal challenges were encountered by women when accessing reproductive health care. Health professionals were insensitive to women and care was influenced by medical systems. An analytic model towards disability is suggested to influence a person's behaviour and reproductive health.

U.S.A.

To examine the broad range of issues that women with a physical disability encounter in relation to sexual functioning, and sexual and reproductive health care

Triangulation - Qualitative and quantitative. Unstructured interviews and questionnaire.

Qualitative - 31 with a physical disabilityQuantitative - 1,150 women, of whom 946 completed the questionnaire (504 with and 442 without disability). 45% response rate

Women with disabilities have difficulty establishing relationships, social and environmental factors impact on women's self esteem, abuse was prevalent among women, women had sexual desires but limited opportunity to participate in sexual activity, women with physical disabilities encounter challenges when accessing reproductive health care including difficulty locating a physician to administer care.

Ireland

To investigate how people with multiple identities understand their identities and sense of belonging to different social groups. To examine their experiences of accessing public health services.

Qualitative interviews.

9 minority ethnic people with disabilities (physical and hearing impairment).

Minority ethnic people are invisible in Irish society. This population encounters difficulties in getting to and obtaining physical access to health care institutions. They encounter negative attitudes, language and communication challenges. Health professionals lack cultural awareness and did not respond to people's health need with any degree of urgency. Care was not culturally sensitive.

U.S.A.

To explore the meaning of motherhood for mothers with a physical disability and to determine their mothering related experiences, issues and priorities.

Qualitative. Interviews and focus groups

35 women with a physical disability.

Women experienced a variety of responses to their pregnancy including opposition and scepticism. Women's needs and level of formal support varied and depended on the disability. Women emphasised the need to retain control over their mothering role and lack of adequately funded resources was identified as a major challenge which impacted on their parenting abilities.

U.K.

To identify and explore the specific concerns and issues for women with multiple sclerosis during pregnancy.

Qualitative interviews.

15 women with multiple sclerosis

Women struggled with decision to become pregnant as they did not know the impact pregnancy might have on MS. MS was considered an abnormal state but becoming a mother facilitated a sense of normality and a change in roles and focus, from dependent women with a disability, to independent autonomous mother. Negative reactions to pregnancy from family, friends and close relatives.

U.S.A.

To explore women's perceptions of barriers to obtaining care, sources of information, ways to improve health care and health information.

Qualitative. Focus groups.Online survey.

61 - 59 women with a physical or sensory impairment. 2 physicians with an interest in women with disabilities.

The 7 themes (below) indicate the challenges experienced by the study population: Communication barriers, lack of knowledge and awareness among healthcare providers, access issues, working the system, systems issues, outreach to healthcare providers, reaching hard to reach women with disabilities.

U.K.

To explore the social barriers women with a physical and/or sensory impairment encounter when thinking about having a baby, during pregnancy, when they access maternity and related services and become mothers.

Qualitative. Semi structured interviews.

17 women with a physical disability and/or sensory impairment.

Challenges include difficulties gaining physical access and moving around the environment. Women did not receive information about accessible facilities and resources. Deficits in health information were common and any information given was often contradictory. Practice and policies were inflexible and not women centred. Help was often inappropriate and women felt a burden. Fear of losing custody common and women were afraid to ask for help fearing this may be considered as their inability to cope and care for their baby.

U.K.

To explore key dimensions of the reproductive experiences of women with a disability and/or sensory impairment who are or who are thinking about becoming mothers.

Qualitative. Semi structured interviews.

17 women with a physical and/or sensory impairment.

Three themes: The first refers to medical risk discourse which women accepted. Genetic counselling was viewed as the norm and termination of pregnancy either an option or recommendation. Women's self belief that they could fulfil mothering responsibilities was impaired. Second theme: mothering - women feared they were being judged and that they would lose custody. Felt vulnerable and insecure. Third theme: inappropriate help that health professionals offered to the detriment of women's self-esteem and confidence.

Canada

To examine extent, access to and satisfaction with primary health care services for people with physical disabilities living in the Toronto region.

Quantitative. Question-naire.

1026 people with disabilities. 201 completed questionnaires were returned. Response rate = 20%.

Findings indicate that people with a disability have difficulty locating a physician and were refused treatment because of their disability. People experience difficulty in gaining physical access to the built environment and the majority of people felt that the care they received was inappropriate.

Australia

To compare child-bearing and early childrearing experiences of mothers with and without physical disabilities. To compare the support received.

Qualitative. Structured interviews.

70 women - 25 women with a physical disability and 45 women without.

Experienced barriers in prenatal education classes and within the maternity care setting. Major obstacles encountered were negative attitudes. Health professionals described as domineering, displayed bullying behaviours and did not take account of women's special needs. Prenatal classes unhelpful and inappropriate. Staff described as rude, unhelpful, and unsupportive

Ireland

To identify issues to be addressed when developing a strategy for the future maternity services in the Eastern Regional Health Authority.

Qualitative. Focus groups

16 service providers and 10 services users - 4 women with a disability (3 deaf and 1 with a physical disability).

Findings framed within principles of the health strategy. Participants identified measures that could be taken to ensure maternity services are equitable, fair, women-centred and accountable. Women expressed the desire to be treated individually; requested reform in information provision, continuity of care and effective communication. Women expect staff to be familiar with their needs and different types of disability.

Canada

To explore relationships between contemporary Western cultural representations of bodies and experiences of women born with a physical disability.

Qualitative. Unstructured interviews.

14 women with a physical disability.

Women perceived themselves to be both visible and invisible in society. The women's body was viewed as undesirable and deviated from the norm. Women's identities were denied and their experiences and lives were seen as insignificant. Others' views impacted significantly on women's ability to cope and their value was defined by their disability.

U.K.

See Table 5

Quantitative. Review key information booklets and leaflets.

130 people with a physical and sensory disability.

The report proposes a number of recommendations that should be adapted in order that health information is available in appropriate formats; this will facilitate informed consent and decision making.

Norway

To explore the mothering experiences of mothers with a physical disability.

Qualitative descriptive, exploratory. Semi structured interviews.

30 women with a physical disability aged between 28-49 yrs.

Becoming a mother afforded women a sense of normality, the focus was on mothering rather than on disability. Women discuss the efforts they go to in order to address other's attitudes and to be accepted as mothers

U.K.

See Table 5

Qualitative descriptive, exploratory.Semi structured interviews.

8 midwives and 5 mothers with a physical disability.

Women brought out important themes from their perspective: Importance of disability awareness and positive attitudes for midwives, the need for effective communication. Three themes emerged from the midwives' perspective - midwives' varied knowledge and experience, positive attitudes and positive communication.

Canada

See Table 5

See Table 5

See Table 5

Home modifications helped in the mothering roles.

U.S.A.

See Table 5

Qualitative descriptive, exploratory.

31 women with a physical disability.

An analytic model towards disability is suggested to influence a person's behaviour and reproductive health.

U.S.A.

To determine if the internet can be used effectively to educate women with disabilities about reproductive health.

Quantitative. Survey.

26 women with mobility impairments from the U.S.A. and Canada.

The internet was an effective medium to increase women's knowledge about reproductive health issues. The internet is a valuable education tool and a health information site specifically for women with disabilities will address the information deficit experienced by this population.

U.S.A.

See Table 5

Qualitative. Focus groups.Online survey.

See Table 5

The authors suggest that women with disabilities should be recognised as a critical source of education.

Ireland

To identify issues to be addressed when developing a strategy for the future maternity services in the Eastern Regional Health Authority.

Qualitative. Focus groups

See Table 5

The provision of professional sign language interpreters for each interaction was recommended and more flexible visiting hours to enhance women's support mechanisms requested. Disability awareness and the provision of additional time are key to the facilitation of a positive interaction between staff and women.