TABLA 1 ASPECTOS DE LA COOPERACIÓN

6.5.1. Introduction

All Norwegian women are entitled to free maternity care, with 99% availing of this, and this care is mediated via ‘decentralised and differentiated ante/postnatal’

services (Norwegian Ministry of Health and Care Services, 2007a:55), with continuity of care and safety of mothers paramount. These principles are consistent with the stated value of ‘equality of access for all’ which underpins Norwegian health policy (Norwegian Ministry of Health and Care Services, 2007a:55).

6.5.2. Legislation relating to people with disabilities

Two key pieces of Norwegian legalisation were sourced – The Act of 2nd July 1999 No. 63 relating to Patient’s Rights (the Patients’ Right Act) (Norwegian Ministry of Health and Care Services, 1999a) and the Act of 2nd July 1999 No 64 Relating to Health Personnel (The Health Personnel Act) (Norwegian Ministry of Health and Care Services, 1999b). Neither of these Acts refers specifically to people with disabilities but the provisions within the Acts have the potential to impact on the healthcare accessed by these people. The Patient’s Rights Act (Norwegian Ministry of Health and Care Services, 1999a) affords all citizens in Norway specific rights such as the equal access to quality healthcare and the promotion of a trusting

relationship when the person is interfacing with the health services. It provides for the right to access care, the right to participation in planning their care and obtaining information about their care and treatment; it addresses the issue of consent, the right of access to medical records and the special rights of children. However, people with disability are not mentioned.

The Health Personnel Act (Norwegian Ministry of Health care Services, 1999b) applies to all health professionals and healthcare providers and it has 2 core

objectives - the safety of patients and quality within the health services. It mandates on the professional conduct, organisation of facilities; confidentiality and the right of discourse; documentation and notification requirements; training and regulation of specialist training for health professions. Again, there is no specific reference to people with disabilities but the provision of the Act will protect these individuals when accessing health services in Norway.

Accessibility to the built environment is regulated by the Programme of Action for Universal Design (Norwegian Ministry of the Environment, 2003) and provisions of the Norwegian Discrimination and Accessibility Act (Norwegian Ministry of Health and Care Services, 2009). The Act sets out the requirements to ensure universal design of environments and accessibility of workplaces, schools and day care centres. The objective of the Programme for Action for Universal Design was to increase and ensure equality in access to public spaces for people with disabilities. Subsequently the Delta Centre, the national resource centre for participation and accessibility for people with disabilities, published guidelines in relation to Universal Design. The guidelines, based on 7 principles, are a mechanism of avoiding discrimination for people with disabilities and advocate that all environments, information and services be designed in such a way that they are accessible and usable by everyone. The guidelines encourage the embracement of diversity and their primary objective is to afford people with disabilities equal opportunities and the ability to participate fully in society (Delta Centre, 2009).

6.5.3. Policies relating to women with physical and sensory disabilities Specific Norwegian policies relating to the care of women with physical and sensory disabilities were not identified by the team. In the preamble to the National Health Plan 2007-2010 (Norwegian Ministry of Health and Care Services, 2007a), the Ministry of Health acknowledge that the goals therein are ambitious but should be achievable. It is envisaged that the 4-year plan will result in a high quality public service accessible to all regardless of social status, gender, age, economic status

and ethnic background. Disability is not mentioned specifically. One strategic objective is equal access for all people regardless of where they live, but again disability is not highlighted.

The plan outlines how maternity care for pregnant women will be delivered from public health centres located locally and resourced by a multidisciplinary team comprising of midwives, physicians and physiotherapists, thus ensuring good

proximity of services for all women. The Ministry recognise that some individuals will require the services of an advocate and have undertaken measures to address this including a proposal to amend the law regulating advocacy services in order that people attending municipal health services will have access to an advocate. Referring to people with disabilities, the plan notes how this is not a homogeneous group and indicates the importance of providing accessible health services for these clients. It determines that accessibility encompasses more than just access to the physical built environment it also includes transport, communication and information, and equitable access to care is promoted. Currently, legislation in the form of the Planning and Building Act is being drafted to regulate accessibility to the built environment and the Ministry of Health is participating in the consultation process (Norwegian Ministry of Health and Care Services, 2007a).

6.5.4. Policies relating to women with mental health difficulties

Johnsen (2006) reviewed the Norwegian Mental Health system for the WHO but did not make reference to perinatal mental health policy. An extensive search failed to find any relevant policy documents.

6.5.5. Policies relating to women with intellectual disabilities Norway has seen a significant shift in social policies relating to persons with

intellectual disabilities during the past century, during which time the country moved from a strong eugenic stance grounded in the practice of sterilisation, to embrace the tenets of normalisation and social role valorisation that had been developing in Denmark and Sweden (Roll-Hansen, 2005; Race, 2007). Despite this paradigm shift, this review found little information of relevance to the maternity services for women

with intellectual disabilities. The 2 principal documents examined were the National Health Plan for Norway 2007-2010 (Norwegian Ministry of Health and Care Services, 2007a) and the Minister for Health and Social Care’s proposals, entitled ‘Proposition to the Storting No. 1 (2006-2007) Chapter 6: National Health Plan,’ to the Norwegian Parliament for that National Health Plan (Norwegian Ministry of Health and Care Services, 2007b).

Through the National Health Plan for Norway (2007–2010) the government is committed to developing a fairer and more equal provision of healthcare. The plan highlights the need for greater patient involvement in the development of health services (including maternity care). Whilst it acknowledges that some people with intellectual disabilities may not be best able to ensure that their needs and rights are fully met, it encourages greater involvement of relatives as advocates and promotes the role of patient organisations in policy and service development.

The Ministry of Health and Care Services also recognises the limited knowledge base of many health and social care professionals in meeting the care needs of people with intellectual disabilities and has therefore instructed the Directorate for Health and Social Affairs to carry out a review of services to identify specific issues needing to be addressed (Norwegian Ministry of Health and Care Services, 2007b). At this point the review will not consider the specific needs of women with disabilities (Norwegian Ministry of Health and Care Services, 2008).