Disability and women's health

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Women with disabilities have the same health issues as any other women, such as the need for routine breast and cervical cancer screening. [1] However, women with impaired mobility are often not given basic tests, such as weight monitoring, due to the lack of accessible equipment. [2]

Contents

Article 12 of the United Nations Convention on the Elimination of All Forms of Discrimination against Women outlines women's protection from gender discrimination when receiving health services and women's entitlement to specific gender-related healthcare provisions. [3] Article 25 of the Convention on the Rights of Persons with Disabilities specifies that "persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability." [4] However, it has been noted that the women with disabilities face obstacles and hardships and cannot access the same medical resources as those without. [5]

Because traditionally, men have been used to model and test health treatments, the approaches to health services, such as physical therapy, were not properly aligned with disabled women's needs. [6] It wasn't until after the 1990s that women's health issues were studied in-depth in the United States. [7] In addition, researching the health issues of women with disabilities is also understudied. [8] Starting in the early 2000s, health issues for people with disabilities began to be studied in the United States. [9] The first long-term study involving the experiences of women with disabilities and gynecological services was not published until 2001. [10]

Women with physical and or intellectual disabilities often face a medical bias within their communities. Factors can include unconscious bias, symptoms, negative perceptions, and even harsh assessments that can contribute to such discrimination. [11] Physicians can have gender bias in a diagnostic assessment of symptoms they cannot explain. As many before studying women's anatomy had thought prior that both men and women functioned the same way. As when doing assessments for both intellect and physical disabilities. They used the men's traits to correlate to symptoms for women. When in reality symptoms are shown differently. [12]

Women with disabilities, especially individuals who belong to minority groups or who live in rural settings, are often underserved in their healthcare needs. [13] In addition, women with disabilities are more likely to live in poverty, which puts them at a greater health risk. [7] [14] In general, because of a lack of social connectedness that many disabled women experience, they often become disconnected from sources of support which can include healthcare providers. [15] In Brazil, women with disabilities are also less likely to seek out gynecological health care due to various reasons, including cultural attitudes and cost. [16]

When disabled women need routine services for anything other than their main impairment(s), they can be perceived as "problematic patients" by healthcare providers. [17] Women with disabilities have reported that they are seen through the lens of their disability first and as a person second by healthcare providers. [18] Conversely, a 2003 report found that not only did healthcare providers, in general, have positive attitudes toward people with physical disabilities in Saudi Arabia, regardless of gender, which cited that most healthcare professionals worldwide have positive attitudes. [19]

In countries with strict gender segregation, such as in Saudi Arabia, women must use women-only clinics, many of which do not have access for people with physical disabilities. [20]

Sexual health and contraception

Contraceptives are used by women with intellectual disabilities for various reasons, including pregnancy prevention, menstrual suppression, and management of teratogenic medications. [21] Women with intellectual disabilities are more likely to use contraceptives or request a hysterectomy to manage menstruation. [22] [23] Different types of contraception are available to women with disabilities, but the prescription of a specific type of birth control is based on the type of disability and the associated side-effects. [23]

Menstrual cycles are sometimes affected by different types of disabilities, such as rheumatoid arthritis. [23] In addition, women who become disabled later in life sometimes experience transient menstrual disorders. [23]

Healthcare professionals are less likely to refer women with disabilities for various gynecological screenings. [24] This could be due to the healthcare provider's unfamiliarity with disability or the assumption that women with disabilities are asexual in nature. [25] Women who have a spinal cord injury above the T6 vertebra can have autonomic dysreflexia during a pelvic exam which can be life-threatening. [26] Women with intellectual disabilities are less likely to receive Pap smears because the process may be upsetting to the patient. [27] [28]

In the case that the examination table cannot be lowered during a Pap smear, women with physical disabilities can use alternative examination positions during the procedure, such as knee-chest position, diamond-shaped position, M-shaped position and V-shaped position. [29] These alternative procedures can accommodate women who are unable to position their feet into stirrups or need greater body support. [29] In addition, lithotomy stirrups can be used for additional comfort. [30] The Welner table, designed by American obstetrician-gynecologist and disability rights activist Sandra Welner, is an examination table designed with a wider range of adjustments and positions to facilitate accessibility for both patients and doctors with physical disabilities. [31] Welner also compiled the handbook, Welner's Guide to the care of women with disabilities. [32]

A study conducted in 1989 found that 19% of women with physical disabilities had been counseled on sexuality in a medical setting and were rarely offered information about contraceptives. [6] Women with intellectual disabilities often lack both education about sexual health and the ability to learn about it informally. [33] In addition, their medical providers are less likely to discuss contraception with them. [22] Women with intellectual disabilities can use supported decision-making with family members or other support persons to determine their preferred contraceptive option. [34]

In Zimbabwe, people with disabilities are often treated as second-class citizens. Women in Zimbabwe face increased barriers when accessing services for sexual health. [35] The National Reproductive Health Policy implemented in 2006 did not address the needs of women with disabilities. [36] Zimbabwean women with disabilities faced negative attitudes about their reproductive health, such as those of female nurses who expressed the idea that "sex was not meant for the disabled." [37]

Women with intellectual disabilities have been advised to become sterilized to possibly prevent sexual assault or because doctors may consider them unfit to become mothers. [38] [39] In the United States, a 1927 Supreme Court case, Buck v. Bell , allowed the forced sterilization of women with intellectual disabilities. [40] In Singapore, the Voluntary Sterlisation Act (VSA) was passed in 1970 and which allowed any spouse, parent or guardian of persons who are "afflicted with any hereditary form of illness that is recurrent, mental illness, mental deficiency or epilepsy" to consent to the sterilization on their behalf. [41] In Brazil, many healthcare providers and individuals with disabilities both see sterilization as the only option for contraception. [24]

Maternity care

Some studies have highlighted potential obstacles for pregnant women with disability. For example, a 1996 study discovered that over 50% of United States hospitals lacked the necessary infrastructure to cater to the needs of physically disabled pregnant women, which rendered their facilities inaccessible. [42] These barriers may include lack of adjustable examination tables, wheelchair compatible features, and accessible weight scales. [43]

A study published in the Journal of Applied Research in Intellectual Disabilities demonstrated that pregnant women and mothers with intellectual disabilities benefit from the inclusion of a doula both before and after they gave birth. [44] This approach contrasts with "crisis driven" services that are more often given to parents who have intellectual disabilities. [45] Participants in one small study felt that they gained a trusting relationship with their doulas and that helped them stay calm both during labor and after. [46] Additionally, the women felt that they were able to make better, more informed choices about their own care because of the information and support they received from their doulas. [46]

Expectant mothers with intellectual disabilities may need more specialized training and guidance in regards to childcare after they give birth. [47] Important themes in training may include consistent formal obstetric training and education for both providers and mothers. [47]

Breast health

Many women with a disability do not regularly receive or are not regularly referred for breast cancer screenings. [48] Women with some physical disabilities may need to be referred to special mammography centers because most equipment is not designed to accommodate women who are unable to stand. [23] [49] Some women with disabilities may be unable to receive breast cancer screening due to financial concerns. [49] Clinical depression is also a complication involved in whether or not women with disabilities get annual mammograms. [50] There is also potential concern that ionizing radiation applied to the spine too early on in life may cause an increased risk of developing breast cancer. [23]  This is of particular concern for those women and girls who experienced disabilities relating to the spine from a young age. [23]

Later life

Standards of successful aging may be different for those experiencing disabilities and they may require additional support as they age. [51] Older women are more likely to be disabled than younger women. [23] The most common disability affecting elderly women worldwide is osteoarthritis. [52] Older women who have disabilities that affect their mobility are at risk of losing contact with their communities and may experience degraded life outcomes associated as a result. [53]

Women with physical disabilities are at a greater risk of having lower bone mass and are at risk for osteoporosis. [54] Women with ID and Down syndrome often go through menopause at an earlier age than other women. [55] Women with various disabilities sometimes show different symptoms from decreased estrogen levels during menopause. [23]

Loss of estrogen after menopause can also lead to a greater likelihood of urinary incontinence [23] Treatment and therapy interventions for incontinence have not been tested or modified for women with disabilities. [56]

See also

Related Research Articles

Sterilization is any of a number of medical methods of permanent birth control that intentionally leaves a person unable to reproduce. Sterilization methods include both surgical and non-surgical options for both males and females. Sterilization procedures are intended to be permanent; reversal is generally difficult.

<span class="mw-page-title-main">Doula</span> Non-medical companion who supports a person through significant health-related experiences

A doula is a trained professional who provides expert guidance for the service of others and who supports another person through a significant health-related experience, such as childbirth, miscarriage, induced abortion or stillbirth, as well as non-reproductive experiences such as dying. A doula might also provide support to the client's partner, family, and friends.

<span class="mw-page-title-main">Family planning</span> Planning when to have children

Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marital situation, career or work considerations, financial situations. If sexually active, family planning may involve the use of contraception and other techniques to control the timing of reproduction.

Women's health differs from that of men's health in many unique ways. Women's health is an example of population health, where health is defined by the World Health Organization (WHO) as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity". Often treated as simply women's reproductive health, many groups argue for a broader definition pertaining to the overall health of women, better expressed as "The health of women". These differences are further exacerbated in developing countries where women, whose health includes both their risks and experiences, are further disadvantaged.

<span class="mw-page-title-main">Compulsory sterilization</span> Government policies which force people to undergo sterilization

Compulsory sterilization, also known as forced or coerced sterilization, is a government-mandated program to involuntarily sterilize a specific group of people. Sterilization removes a person's capacity to reproduce, and is usually done through surgical procedures. Several countries implemented sterilization programs in the early 20th century. Although such programs have been made illegal in most countries of the world, instances of forced or coerced sterilizations persist.

<span class="mw-page-title-main">Sexual and reproductive health</span> State of the reproductive system without evidence of disease, disorders, or deficiencies

Sexual and reproductive health (SRH) is a field of research, health care, and social activism that explores the health of an individual's reproductive system and sexual well-being during all stages of their life. Sexual and reproductive health is more commonly defined as sexual and reproductive health and rights, to encompass individual agency to make choices about their sexual and reproductive lives.

<span class="mw-page-title-main">Right to health</span> Human right towards individual health

The right to health is the economic, social, and cultural right to a universal minimum standard of health to which all individuals are entitled. The concept of a right to health has been enumerated in international agreements which include the Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights, and the Convention on the Rights of Persons with Disabilities. There is debate on the interpretation and application of the right to health due to considerations such as how health is defined, what minimum entitlements are encompassed in a right to health, and which institutions are responsible for ensuring a right to health.

<span class="mw-page-title-main">Reproductive justice</span> Social justice movement

Reproductive justice is a critical feminist framework that was invented as a response to United States reproductive politics. The three core values of reproductive justice are the right to have a child, the right to not have a child, and the right to parent a child or children in safe and healthy environments. The framework moves women's reproductive rights past a legal and political debate to incorporate the economic, social, and health factors that impact women's reproductive choices and decision-making ability.

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<span class="mw-page-title-main">Birth control</span> Method of preventing human pregnancy

Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unintended pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth control only became available in the 20th century. Planning, making available, and using human birth control is called family planning. Some cultures limit or discourage access to birth control because they consider it to be morally, religiously, or politically undesirable.

Various topics in medicine relate particularly to the health of lesbian, gay, bisexual, transgender, queer, intersex and asexual (LGBTQIA) individuals as well as other sexual and gender minorities. According to the US National LGBTQIA+ Health Education Center, these areas include sexual and reproductive health, mental health, substance use disorders, HIV/AIDS, HIV-related cancers, intimate partner violence, issues surrounding marriage and family recognition, breast and cervical cancer, inequities in healthcare and access to care. In medicine, various nomenclature, including variants of the acronym LGBTQIA+, are used as an umbrella term to refer to individuals who are non-heterosexual, non-heteroromantic, or non-cis gendered. Specific groups within this community have their own distinct health concerns, however are often grouped together in research and discussions. This is primarily because these sexual and gender minorities groups share the effects of stigmatization based on their gender identity or expression, and/or sexual orientation or affection orientation. Furthermore, there are subpopulations among LGBTQIA+ groups based on factors such as race, ethnicity, socioeconomic status, geographic location, and age, all of which can impact healthcare outcomes.

<span class="mw-page-title-main">Birth control in the United States</span> History of birth control in the United States

Birth control in the United States is available in many forms. Some of the forms available at drugstores and some retail stores are male condoms, female condoms, sponges, spermicides, and over-the-counter emergency contraception. Forms available at pharmacies with a doctor's prescription or at doctor's offices are oral contraceptive pills, patches, vaginal rings, diaphragms, shots/injections, cervical caps, implantable rods, and intrauterine devices (IUDs). Sterilization procedures, including tubal ligations and vasectomies, are also performed.

<span class="mw-page-title-main">Birth control in Africa</span>

Access to safe and adequate sexual and reproductive healthcare constitutes part of the Universal Declaration of Human Rights, as upheld by the United Nations.

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Women's reproductive health in the United States refers to the set of physical, mental, and social issues related to the health of women in the United States. It includes the rights of women in the United States to adequate sexual health, available contraception methods, and treatment for sexually transmitted diseases. The prevalence of women's health issues in American culture is inspired by second-wave feminism in the United States. As a result of this movement, women of the United States began to question the largely male-dominated health care system and demanded a right to information on issues regarding their physiology and anatomy. The U.S. government has made significant strides to propose solutions, like creating the Women's Health Initiative through the Office of Research on Women's Health in 1991. However, many issues still exist related to the accessibility of reproductive healthcare as well as the stigma and controversy attached to sexual health, contraception, and sexually transmitted diseases.

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<span class="mw-page-title-main">Disability in Zambia</span>

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Menstrual suppression refers to the practice of using hormonal management to stop or reduce menstrual bleeding. In contrast to surgical options for this purpose, such as hysterectomy or endometrial ablation, hormonal methods to manipulate menstruation are reversible.

Menopause in incarceration is a social and policy campaigning issue in which people work to raise awareness of the gender specific impact menopause symptoms can have on people in prison. Although women are a minority of those incarcerated, the age of women in the prison system is increasing across the world. As this happens it becomes necessary for inmates to be assessed for menopausal symptoms and offered the gender and age-specific services and support they need. Researchers have identified this as a gap in prison healthcare which leaves the needs of many people unmet.

References

Citations

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  40. ↑ Wills, Matthew (2017-08-03). "When Forced Sterilization was Legal in the U.S." JSTOR Daily. Retrieved 2017-08-03.
  41. ↑ Wong, Meng Ee; Ng, Ian; Lor, Jean; Wong, Reuben (2017). "Navigating Through the 'Rules' of Civil Society: In Search of Disability Rights in Singapore". In Song, Jiyoung (ed.). A History of Human Rights Society in Singapore: 1965-2015. New York: Routledge. p. 173. ISBN   9781315527406.
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  49. 1 2 Todd & Stuifbergen 2012, p. 75.
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  53. ↑ Mohamed 2013, p. 414.
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Sources

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