Again, in the UK, a guidance document was published that establishes standards for the promotion of health and well-being of mothers (UK Department of Health, 2004a). Standard 11 of this document focuses on the development of an accessible,
supportive quality maternity service planned around women’s individual needs. Recognising that women with disabilities often feel excluded and disconnected from the services, actions to ensure more inclusiveness are proposed. Specific reference is made to women with physical and intellectual disabilities, and service providers are advised to ensure that local maternity services are inclusive and that attention is given to women’s communication, equipment and support needs. In contrast, a more recent document designed to improve choice, access and care for all women
requiring maternity services, makes no specific recommendations for women with disability (UK Department of Health, 2007).
With regard to mental health services in the perinatal period, the National Institute for Health and Clinical Excellence in the UK has developed organisation of care
guidelines recommending clinical networks, the use of specialist mother and baby units, and provision of expert advice about the risks and benefits of psychotropic medication during pregnancy and breastfeeding (NICE, 2007). Further guidelines
from the Scottish Intercollegiate Network also suggest that high risk mothers may benefit from postnatal visits, psychological therapy and/or antenatal education, and that women with a high risk of puerperal psychoses should be reviewed by
psychiatric specialists (SIGN, 2002).
No specific reference to the maternity needs of women with intellectual disabilities was found in the key strategy and review documents from the 4 regions of the UK (Scottish Executive, 2000b; UK Department of Health, 2001; Welsh Assembly, 2001; UK Department of Health, Social Service and Public Safety, 2004; 2007). Two policy documents, however, do reflect a view that maternity and intellectual disability
services should work in partnership, with an emphasis on multidisciplinary community services.
In New Zealand, the Action Plan for New Zealand Women (New Zealand Ministry of Women’s Affairs, 2004) set out a number of measures to improve the quality of life of New Zealand women, including the improvement of women’s mental health and sexual and reproductive health. In Australia, a number of policies address generalist healthcare, but without mentioning women with disabilities specifically. The Victorian Women’s Health and Wellbeing Strategy 2002-2006 (Victorian Government
Department of Human Services, 2002b) does refer to women with disabilities,
acknowledges that they can be one of the most disadvantaged groups in society, and identifies the importance of providing accessible health information and services for this population. The Australian Capital Territory Women’s Plan (ACT Office for Women, 2004) does refer to women with physical disabilities in the context of
accessible built environment but this is the only reference to this cohort. ‘Women with Disabilities Australia’ (WWDA) recently produced a policy paper highlighting principal human rights for women with disabilities including ‘motherhood, sexuality and
reproductive rights’ (WWDA, 2008:12).
The Canadian Women’s Health Strategy (Government of Canada, 1999) acknowledges how women with disabilities are disadvantaged and doubly
discriminated against on the basis of gender and disability, but does not address the specific needs of these women. In the area of mental health, Canada’s National
Guidelines on Family Centred and Newborn Care (Public Health Agency of Canada, 2008b) recommends the introduction of psychosocial risk assessments for every woman during prenatal care. None of the Canadian maternity documents located made any reference to women with intellectual disabilities.
Although there is comprehensive disability legislation in the United States of America and a number of strategy and policy documents on disability, there is no national strategy addressing specifically the needs of women with disabilities during pregnancy, childbirth and early motherhood. One policy document on intellectual disabilities identifies the need for education in safe sex and family planning as well as protection of people from rape and sexual abuse, and stresses the importance of individualised services.
The remaining 4 countries had very little in the way of published policy in English in this area. Disability policy in the Netherlands is in the early stages of development. In Norway, the National Health Plan 2007-2010 (Norwegian Ministry of Health and Care Services, 2007a) emphasises the importance of providing accessible health services for people with disabilities, but there is no detail relating to maternity care. The Danish Government does not have an overall policy on care of people with disabilities, but one paper does recommend early interventions for postpartum depression, and emphasises the need to protect the mother child-relationship (Government of Denmark, 2002). Sweden’s disability policy (Ministry of Health and Social Affairs, 2001) does not consider health or maternity care in any detail.
6.11.5. Conclusion
All countries reviewed possessed legislation relating to the care of people with disabilities, and the 4 English-speaking countries discussed (UK, New Zealand, Australia and Canada) also had guidance from their professional bodies on this area of care. Three of those 4 countries (UK, New Zealand and Australia) had a country- wide disability strategy, and 3 countries (Canada, Australia and New Zealand) had a national women’s strategy but only 2 of the strategies (from Australia and New Zealand) referred to women with disabilities. The UK, in particular, has a number of
well developed policies and guidelines in this area. In general, women with
intellectual disabilities were the least recognised group included in the available plans in all countries.
Overall, Ireland compares reasonably well with the other countries reviewed. The Irish Government has recently enacted a Disability Act (Government of Ireland, 2005a), which forms the core element of the National Disability Strategy
(Government of Ireland, 2004b). There is, however, little or no guidance from
professional bodies on the care of people with disabilities in the areas of pregnancy, childbirth and early motherhood in the country. With the exception of the UK, Ireland appears to have better-developed plans than all other European countries and many of the states in the USA and Canada. However, there is no room for complacency, as the Irish policies are not specific to the care of women with disabilities during
pregnancy, childbirth and early motherhood, nor are they implemented universally or completely. In the final chapter of this review, a summary overview is provided. The main policy deficiencies are highlighted and recommendations are made for all key stakeholders.