School of Public Health, University of California, Berkeley, United States of America.
Institute for Social and Environmental Research-Nepal, Pokhara, Nepal.
PLoS One. 2018 Jul 13;13(7):e0200370. doi: 10.1371/journal.pone.0200370. eCollection 2018.
Studies report that vulnerable groups like people with disabilities have less access to healthcare. This study compares health service access between women with and without disabilities in general and explores the challenges encountered by women with disabilities in accessing maternal healthcare services during pregnancy.
A mixed method study was conducted in Rupandehi district of Nepal implementing a cross-sectional survey among 354 women including 79 women with disabilities, supplemented by 43 in-depth interviews. Descriptive and bivariate statistical analysis of quantitative data using Pearson's Chi-square test for association was carried out, while qualitative data were analysed following the theme content analysis using a framework approach.
The vast majority of women from both groups, women with and without disabilities (71% vs 74%) reported that the nearest health facility from their location was more than 30 minutes walking distance (P>0.05). Half of the women with disabilities walked to health facilities for ANC check-ups. Over one-third of women without disabilities and a slightly lesser proportion of women with disabilities (29%) used a low-cost means of transport (rikshaw, bi/tri-cycles) (P>0.05). Distribution of health facilities found uneven and poorly linked with road transport facilities. None of the health facilities accommodated the needs of women with disabilities with accessible buildings and convenient opening time. The travel cost and the extra cost of services, staff shortage, often delayed and inadequate drug supplies were common problems for both women with and without disabilities. Unavailability of beds during delivery, insensitive providers with negative attitudes and abusive behaviour, inadequate knowledge and experience in providing services to the people with disabilities as well as unwelcoming health facility environment made services particularly inaccessible to women with disabilities.
Maternal healthcare services are not easily and equitably accessible to women with disabilities. To increase access to healthcare for this vulnerable group, improvements are needed in distribution and management of resources from transportation through service delivery, as well as improved provider knowledge and awareness of a human rights approach to disability and health.
研究报告表明，残疾人等弱势群体获得医疗保健的机会较少。本研究比较了普通女性和残疾女性在获取医疗服务方面的差异，并探讨了残疾女性在孕期获取孕产妇医疗保健服务时所面临的挑战。
本研究在尼泊尔鲁潘德希县开展了一项混合方法研究，对包括 79 名残疾女性在内的 354 名女性进行了横断面调查，此外还进行了 43 次深入访谈。采用 Pearson's Chi-square 检验对定量数据进行描述性和双变量统计分析，同时采用框架方法对定性数据进行主题内容分析。
绝大多数来自残疾女性和非残疾女性两组的女性（分别为 71%和 74%）报告称，距离她们所在地最近的医疗设施需要步行 30 多分钟（P>0.05）。一半的残疾女性步行去医疗保健机构进行 ANC 检查。超过三分之一的非残疾女性和略少比例的残疾女性（29%）使用低成本的交通工具（人力车、自行车或三轮车）（P>0.05）。调查发现，医疗设施分布不均，与道路运输设施联系不紧密。没有一家医疗设施的建筑和开放时间能够满足残疾女性的需求。残疾女性和非残疾女性都面临着旅行费用高、服务费用额外增加、工作人员短缺、药品供应经常延迟且不足等常见问题。在分娩期间没有床位、提供者态度冷漠且行为不当、缺乏向残疾人士提供服务的知识和经验，以及不友好的医疗环境都使得残疾女性难以获得医疗服务。
残疾女性难以获得和非残疾女性一样容易和公平的孕产妇医疗保健服务。为了增加这个弱势群体获得医疗保健的机会，需要在从交通到服务提供的资源分配和管理方面进行改进，还需要提高提供者对残疾和健康的人权方法的知识和认识。
