Date of Award

11-10-2023

Degree Type

Thesis

Degree Name

Master of Health Policy and Management

First Advisor

Mr. Waqas Hameed

Second Advisor

Dr. Muhammad Asim

Third Advisor

Dr. Seema Lasi

Department

Community Health Sciences

Abstract

Background Despite being the largest minority, women with disabilities are invisible population in the maternity care. During pregnancy, labor, and the postpartum period, women with disabilities face barriers due to their unique needs. However, there is scarcity of research regarding childbirth experience of women with disabilities, especially in Pakistan.
Objectives To explore lived experience of women with disabilities during childbirth and pregnancy and the perspectives of maternity service providers in provision of care to women with disabilities.
Methods The qualitative exploratory descriptive study design was used to explore the childbirth experiences of women with disability and challenges faced by maternity service providers. Women with disabilities meeting eligibility were identified with the help of community health workers, facility-based providers, and snowball sampling technique. The maternity care providers were employed by purposive sampling from the district's public and private healthcare facilities. The data were collected in person through face-to-face interviews, by using two separate semi-structured interview guides for each type of participants. Data was analyzed manually through deductive thematic analysis using the socio-ecological framework.
Results We found that the childbirth experiences of women with disabilities is influenced by range of complex and interconnected individual, interpersonal and institutional factors. At the individual level, women experience anxiety and fear about the possibility of hereditary of disability to the child and financial constraints for transportation and medical expenditures for pregnancy and childbirth services. Moreover, at community level, stereotypical beliefs and stigma are prevalent in the community related to marriage and transfer of disability to the children. At interpersonal level, there is lack of adequate communication and informed decision among the health care providers and women with disabilities. At institutional level, the barriers 5 were lack of disability related knowledge and skills of maternity care providers at the primary and secondary health facilities, unnecessary referral, geographical barriers, and physical inaccessibility in the health facilities such as absence of ramps, disability friendly beds, and toilets for women with physical disabilities. The facilitators for positive childbirth experience were family support and proper communication and information exchange from the health care providers.
Conclusion Our study shows that women with disabilities experience emotional distress due to the cultural and community stereotypic beliefs and prejudices, compounded by lack of health facility preparedness for disability-inclusive maternity services. At the community level, there is a need to eliminate stigma surrounding maternal healthcare for disabled women. Within the healthcare system, there is a need to build the capacity of maternity care providers, enhance infrastructure, and offer financial support for healthcare access. Furthermore, there is a necessity for developing inclusive maternity care guidelines and policies across all healthcare facili

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