Health Care for Women with Physical Disabilities: Literature Review and Theory

This paper identifies, describes and analyzes the significance of the literature as it impacts on health care for women with physical disabilities. It considers both scholarly reviews of the literature as well as the literature written by women with physical disabilities themselves. It covers the topics of the disability field itself, the mainstream feminist movement, experimental disability writings, characteristics of the literature, health issues, reproductive health services, sexuality and sexual abuse and the future challenge.     

National Study of Women with Physical Disabilities: Final Report

The final report of the National Study on Women with Disabilities provides an overview of the research conducted from 1992 to 1996 at the Center for Research on Women with Disabilities. The report addresses the methodologies used in the recruitment of women and reviews the various analyses conducted on the data. In addition, the report provides a discussion of recruitment techniques used for nondisabled women and the analysis used for this population as well. It provides a summary of findings in the areas of sense of self, relationships, information about sexuality, sexual functioning, pregnancy, sexually transmitted diseases, abuse, chronic conditions, health maintenance behaviors, gynecologic health, and health care utilization.     

Family Attitudes and Reactions toward Pregnancy among Women with Physical Disabilities

BackgroundHistorically, people with disabilities who become parents have confronted discriminatory societal attitudes and public policies. Today, although more women with disabilities are bearing children, little is known about the perceptions of their pregnancies, even among their family members. In addition, little is understood about how family members’ attitudes and reactions affect women with physical disabilities around the time of pregnancy.MethodThis qualitative study involved interviews with 25 women with physical disabilities from across the United States who had a baby within the past 10 years. Semistructured telephone interviews were conducted. Interviews were audio-recorded, professionally transcribed, and analyzed using an iterative, interpretive process.FindingsWomen reported a wide range of physical disabilities. Before, during, and after pregnancy, participants reported experiencing wide-ranging attitudes and reactions from family members concerning their pregnancies. These responses fell into six categories: 1) initial negative reactions, 2) concern about mother's well-being, 3) questioning of parenting capability, 4) negative perceptions of disability, 5) genetic concerns, and 6) excited and supportive.ConclusionsThis study sheds light on the attitudes and reactions toward pregnancy that women with physical disabilities experience from family members. Our findings suggest the need for increased social support and family education. Greater availability of peer supports as well as information for women with disabilities considering pregnancy is also needed.     

孕产妇分娩与保健双向转诊调查分析

目的 开展孕产妇分娩与保健双向转诊的实证研究.方法 分析深圳市公明人民医院及其社区康复中心(站)就诊与保健的孕产妇.结果 孕产妇分娩后由医院下转入社区康复中心(站),转诊率为99.99%,孕妇上转到医院分娩和保健的比例为42.40%,孕产妇分娩与保健双向转诊率远高于居民门诊患者和住院患者的转诊率.结论 在目前双向转诊落实难的现实情况下,我们认为当地的孕产妇分娩与保健双向转诊落实得非常好.     

Dating Behaviors of Women with Physical Disabilities

According to societal stereotypes, women with physical disabilities are asexual and therefore do not date. Another stereotype, and a fear of many women with disabilities, is that no one will want to date them because they have a disability. Consequently, little is known about their dating behaviors. Qualitative research methods were used to code and analyze 31 in-depth interviews of women with a variety of disabling conditions. Themes emerging from their stories indicated that the timing of onset of disability, and the response to disability of family, friends, and society in general, were critical in establishing patterns of dating behavior for women with physical disabilities.     

Reproductive Technologies for Women with Physical Disabilities

Issues regarding reproductive technologies for women with physical disabilities are discussed. Consideration is given to birth control, motherhood, access issues, the artificial insemination process, prenatal and genetic testing, and the issue of choice. An interview with a woman with a physical disability, who is a feminist and a disability rights activist, about her experience with reproductive technologies, provides a personal perspective for this discussion.     

Dating Issues for Women with Physical Disabilities

A study of dating issues for 250 single women with physical disabilities and 180 single women without disabilities was undertaken to determine (a) differences between women with and without disabilities and (b) predictors of dating outcomes for women with disabilities. A survey was sent to a national sample of women with disabilities along with a similar survey to give to a female friend without a disability. Dating outcomes included (a) satisfaction with dating frequency, (b) perceived constraints on attracting partners, (c) perceived personal barriers to dating, (d) perceived societal barriers to dating, and (e) perceived communication problems. Women with disabilities were disadvantaged on all but (e). Between 21% and 47% of the variance in the outcomes was accounted for in multiple regression analyses. Potential interventions suggested by the findings are discussed.     

Health Disparities Among Childrearing Women with Disabilities

This study examines leading health indicators for childrearing women with disabilities, including health-related quality of life, chronic health conditions, adverse and preventive health behaviors, health care access, and social and emotional support. The study analyzes aggregated data from the Washington State Behavioral Risk Factor Surveillance System (n = 28,629). The weighted prevalence of key health indicators of childrearing women with disabilities (aged 18–59) are compared with childrearing women without disabilities. A series of adjusted logistic regression analyses are applied, controlling for confounding variables. When compared to childrearing women without disabilities, childrearing women with disabilities are less likely to have a partner or spouse, report lower income and education levels and are older. Childrearing women with disabilities, compared to childrearing women without disabilities, report significantly lower health-related quality of life including poor general health (adjusted odds ratio[AOR] = 6.85; p < .001), frequent mental distress (AOR = 4.02; p < .001), and frequent poor physical health (AOR = 9.34; p < .001); higher prevalence of chronic health conditions, including arthritis, cardiovascular diseases, diabetes, asthma, high blood pressure and cholesterol, and obesity (the range of AORs = 1.59 to 5.65; p < .001); higher prevalence of adverse health behaviors including smoking (AOR = 2.14; p < .001) and lack of exercise (AOR = 1.61; p < .001); more financial barriers to health care (AOR = 2.11; p < .001) and lack of social and emotional support (AOR = 2.05; p < .001) while controlling for age, education, income, and relationship status. Based on population level data, the study reveals that childrearing women with disabilities experience elevated risks of health disparities across many key health indicators, many of which are preventable and modifiable. These findings underscore the importance of identifying contributing factors and developing interventions to improve the health and quality of life of childrearing women with disabilities.     

Understanding of Sexuality and Reproductive Health Among Women With and Without Physical Disabilities

This study compares differences in how women with disabilities and women without disabilities learned about their sexuality and reproductive functioning. A written questionnaire was sent to a national sample of women with disabilities and their non-disabled woman friends recruited through independent living centers and announcements in the media. Responses were received from 504 women with disabilities and 442 women without disabilities. Participants were asked how old they were when they first learned about the physical aspects of sexual intercourse. Women with disabilities learned about the physical aspects of sexual intercourse at about the same age (M = 13.16) as women without disabilities (M = 12.93). The most commonly reported sources for learning about sexuality and sexual functioning for both groups were books and other printed material, having sex, partners, friends, and teachers in primary school. More women with disabilities received information from a woman with a disability and a rehabilitation counselor. Women in both groups indicated that sex was never or seldom the subject of general family conversation. On average the women with physical disabilities had their first date at age 16.6, which is later than women without physical disabilities (M = 14.91). Women with physical disabilities who reported having acquired sexuality information at a later age reported having sexual intercourse at an older age (M = 20.37) than women without physical disabilities (M = 17.75). Age at acquiring sexuality information was neither associated with frequency of intimate touch nor frequency of sexual intercourse. The results of this study can be used to generate recommendations for health care professionals concerning ways to respond more effectively to the special needs for sexuality information of physically disabled women.     

Primary Cesarean Delivery Patterns among Women with Physical,Sensory, or Intellectual Disabilities

BackgroundLittle is known about the relationship between disability and mode of delivery. Prior research has indicated elevated risk of cesarean delivery among women with certain disabilities, but has not examined patterns across multiple types of disability or by parity.ObjectiveThis study sought to determine whether physical, sensory, or intellectual and developmental disabilities are independently associated with primary cesarean delivery.MethodsWe conducted a retrospective cohort study of all deliveries in California from 2000 to 2010 using linked birth certificate and hospital discharge data. We identified physical, sensory, and intellectual and developmental disabilities using International Classification of Diseases, 9th revision, clinical modification codes. We used logistic regression to examine the association of these disabilities and primary cesarean delivery, controlling for sociodemographic characteristics and comorbidities, and stratified by parity.ResultsIn our sample, 0.45% of deliveries (20,894/4,610,955) were to women with disabilities. A greater proportion of women with disabilities were nulliparous, had public insurance, and had comorbidities (e.g., gestational diabetes) compared with women without disabilities (p < .001 for all). The proportion of primary cesarean in women with disabilities was twice that in women without disabilities (32.7% vs. 16.3%; p < .001; adjusted odds ratio, 2.05; 95% confidence interval, 1.94–2.17). The proportion of deliveries by cesarean was highest among women with physical disabilities due to injuries compared with women without disabilities (57.8% vs. 16.3%; p < .001; adjusted odds ratio, 6.83; 95% confidence interval, 5.46–8.53).ConclusionsWomen across disability subgroups have higher odds of cesarean delivery, and there is heterogeneity by disability type. More attention is needed to this population to ensure better understanding of care practices that may impact maternal and perinatal outcomes.     

Physical Activity Among Cambodian Americans: An Exploratory Study

Available data indicate that Asian Americans as a group have lower levels of physical activity than non-Latino whites. However, few studies have focused on physical activity among Asian American sub-groups. Our objectives were to describe levels of physical activity, as well as individual and environmental correlates of physical activity among Cambodian Americans. We conducted a telephone survey of Cambodians living in three geographic areas (Central California, Northern California, and the Pacific Northwest) during 2010. Physical activity levels were assessed using the International Physical Activity Questionnaire (IPAQ) short version. Survey items addressed demographic characteristics, knowledge about the health benefits of physical activity, social norms and supports with respect to physical activity, the availability of neighbourhood recreational facilities, and neighbourhood characteristics. Our study group included 222 individuals. Only 12% of the study group reported low levels of physical activity, 40% reported moderate levels, and 48% reported high levels. Physical activity was strongly associated with the availability of neighborhood recreational facilities such as parks, but not with neighborhood characteristics such as heavy traffic. Our results suggest that a majority of Cambodian Americans are adherent to current physical activity guidelines. Neighborhood recreational facilities that provide opportunities for leisure-time physical activity are associated with higher levels of physical activity in Cambodian communities. Future research should assess the reliability and validity of the IPAQ in a Cambodian American study group.     

Postpartum Hospital Utilization among Massachusetts Women with Intellectual and Developmental Disabilities: A Retrospective Cohort Study

Objectives This study examined the risk of postpartum hospital admissions and emergency department (ED) visits among US women with intellectual and developmental disabilities (IDD). Methods We used the 2002–2012 Pregnancy to Early Life Longitudinal Data System and identified deliveries to women with and without IDD. Women with IDD (n?=?1104) or case subjects were identified from the International Classification of Diseases and Related Health Problems 9th Revision (ICD-9 CM) codes. The study primary outcome measures were any postpartum hospital admission and any ED visit during three critical postpartum periods (1–42, 43–90, and 1–365 days). We conducted unadjusted and adjusted survival analysis using Cox proportional hazard models to compare the occurrence of first hospital admission or ED visits between women with and without IDD. Results We found that women with IDD had markedly higher rates of postpartum hospital admissions and ED visits during the critical postpartum periods (within 1–42, 43–90, and 91–365 days) after a childbirth. Conclusion for Practice Given the heightened risk of pregnancy complications and adverse birth outcomes and the findings of this study, there is an urgent need for clinical guidelines related to the frequency and timing of postpartum care among new mothers with IDD. Further, this study provides evidence of the need for evidence-based interventions for new mothers with IDD to provide preventive care and routine assessments that would identify and manage complications for both the mother and the infant outside of the traditional postpartum health care framework.     

Reproductive and Sexual Health of People with Physical Disabilities: A Metasynthesis

This article provides an overview on reproductive and sexual health of people with physical disabilities in developed and underdeveloped countries from 1995 to 2011. Based on the metasynthesis approach, the authors reviewed 15 qualitative studies. These studies were searched using Medline, CINAHL, CINAHL (health), ProQuest Central, Google Scholar, Cochrane, Embase, Informit Health, Sciences Direct, Pubmed, Pubmed Health, AAHD (abstracts), ProQuest Journal (sexuality and disability) and were also manually searched. All studies were judged on their qualities using the Critical Appraisal Skills Programme. Reproductive health, sexual attractiveness and experiences, reproductive and sexual health knowledge, and dealing with reproductive and sexual health issues were four main themes that emerged from these studies. This paper proposes a new model to explain the factors that impacted the reproductive and sexual life of people with physical disabilities: internal and external factors. Implications for health and social care are discussed in light of the findings.     

Reproductive Health,Sexual Function and Satisfaction Levels in Women with Physical,Hearing, and Visual Disabilities

Sexuality and Disability - This study was carried out to determine the reproductive health, sexual function and sexual satisfaction levels of women with disabilities. The sample of the study was...     

Physical Activity Patterns and Maternal Well-Being in Postpartum Women

OBJECTIVE: To examine changes in activity prepregnancy to postpartum; examine postpartum activity and sociodemographic predictors of maternal well-being; and, examine maternal well-being in subjects on the basis of sport/exercise activity prepregnancy to postpartum. METHODS: Ninety-one postpartum women completed a Kaiser Physical Activity Survey (KPAS) Ainsworth BE, Sternfeld B, Richardson MT, Jackson K. Evaluation of the Kaiser Physical Activity Survey in women. Med Sci Sports Exerc 2000; 32:1327-38. and the Lederman Postpartum Questionnaire (PPQ) Lederman RP, Weingarten CT, Lederman E. Postpartum self-evaluation questionaire: Measures of maternal adaptation. In: Raff BS, Carrol P, editors. Perinatal parental behaviour: Nursing research and implications for newborn health. New York: Alan R. Liss, 1981:201-31. Subjects recalled activity prepregnancy and postpartum for the KPAS indexes that included household/care giving (HC), active living habits (AL), occupation (0), and sports/exercise (SE). The PPQ has seven well-being subscales. RESULTS: Subjects with older infants or no other children increased HC and decreased O prepregnancy to postpartum compared to subjects with younger infants or > or =1 other child. Predictors of the variance in the PPQ subscales included SE and AL (21% in subscale one), SE (6.0% in subscale two), HC (5.3% in subscale three), socioeconomic status (19.7% in subscale four), O (5.0% in subscale five), education (5.2% in subscale seven). Subjects who maintained or increased SE showed better well-being as compared to subjects who reported no SE or decreased SE prepregnancy to postpartum. Conclusions: In this group of women, subjects with older infants or no other children reported higher HC and lower O prepregnancy to postpartum. Postpartum SE, education, and socioeconomic status were predictors of maternal well-being. In general, better maternal well-being was found among subjects maintaining or increasing SE compared to no SE or decreased SE prepregnancy to postpartum. Support from partner/husband, family, and friends were significant factors in maintaining or increasing SE.     

Women's Sexuality After Childbirth: A Pilot Study

A pilot study was carried out investigatingwomen's sexual health in the postnatal period. Postalquestionnaires were sent to a cohort of 158 primiparouswomen approximately 7 months after delivery. Women who had resumed sexual intercourse were askeda detailed set of questions about problems experienced,sexual practices, frequency of intercourse, satisfactionwith sex life, and consultation for postnatal sexual problems. All women were asked about theinformation they received on postnatalhealth prior tothe birth and any information or help and advice theyreceived from health professionals on the subject after the birth. Ninety-eight women (62%)responded. Women experienced significant levels ofmorbidity in the postnatal period; 3 months afterdelivery 58% experienced dyspareunia, 39% experiencedvaginal dryness, and 44% suffered loss of sexualdesire. These figures had reduced to 26, 22, and 35%,respectively, by the time of answering the questionnaire(approximately 8 to 9 months after delivery). Compared to before pregnancy, there was a decrease infrequency and satisfaction with sexual intercourse,although sexual practices changed little. Of the 67women who reported a postnatal sexual problem, only 19% discussed this with a health professional.Conversations with health professionals in routinepostnatal health contacts were mainly aboutcontraception, and only rarely discussed problems withintercourse.     

The Contributions of the Australian Government in Meeting the Health Needs of Queensland Women with Physical Disabilities

This article overviews the Australian federal and state government disability strategies, as well as the Women's Health Centres' contributions, in meeting the health needs of Queensland women with physical disabilities. It also explores one of the least considered intersections of multiple identity discourses—feminism and disability studies and argues that access to health and related services is an equity issue that must be addressed in particular ways for women with physical disabilities. In fact, it elaborates how our women's health services still largely continue to see the needs of women with disabilities as too narrow for their attention and our disability services continue to see their clients as ungendered and untouched by sociopolitical constructions of gender.