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Exploring Health Disparities for Women and Pregnant/Postpartum Persons with Disabilities and Barriers to Achieving Health Equity� �

Background

There are significant differences in health outcomes between people with and without disabilities during pregnancy and the postpartum period

Purpose:

Part 1: To identify barriers in prenatal, pregnancy, and postpartum care for persons with disabilities
Part 2: To determine the state of the literature addressing barriers through healthcare provider knowledge and training

Methods

Methods:

Part 1-Scope of Barriers

Informal search for articles discussing barriers to care for pregnant and postpartum persons with disabilities
Scope focused on identified barriers until no new studies were cited in identified articles

Part 2 Systematic Review:

Databases (abstracts & titles): PubMed, CINAHL (Ebsco), PsychInfo, Proquest
Conducted screening of the title and abstract
Full review of relevant articles to determine inclusion

Amanda N. Chastain & Arden Handler

Miscarriage	Gestational Diabetes
Preeclampsia	Placenta Previa
Premature Rupture of the Membrane	Hemorrhage
Thromboembolism	Maternal Death

Background: There are significant differences in health outcomes between people with and without disabilities during pregnancy and the postpartum period. More specifically, WWD experience higher rates of miscarriage, gestational diabetes, preeclampsia, placenta previa, premature rupture of the membrane, hemorrhage, thromboembolism, and maternal death.

Purpose:

Part 1: the purpose of part 1 was to identify barriers in prenatal, pregnancy, and postpartum care for persons with disabilities.

Based on the results of part 1, we included a systematic literature review to determine the state of the literature addressing barriers through provider knowledge and training.

Methods:

Part 1:

In part one we completed a scoping literature review to identify perceived barriers experienced by persons with disabilities during pregnancy and the postpartum periods

Part 2:

In part 2 we conducted a systematic literature review to determine the current state of the literature directed at educating healthcare providers to address these barriers. [State inclusion criteria. State exclusion criteria]

-keywords concepts for 1) physical disability, 2)health care provider, 3)health care provider training, 4) prenatal/pregnancy/postpartum care (NOTE I am not going to go over ALL of the words searched because of the restrictions for space and time for this presentation. This is meant to be a brief overview of the project.)

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Key Findings

Scope of Barriers

Economic Barriers

Financial barriers
Access to healthcare

Healthcare Systems Barriers

Physical accessibility
Information accessibility

Control over pregnancy experience
Stigma / Provider Bias
Untrained/nonresponsive providers

Systematic Literature Review

Initial Search Results: 400 articles

Abstract and Title Screening: 22
Duplicates Removed: 15
Final Inclusion: 6

Current state of the literature focused on addressing barriers through provider knowledge and training
Provider Bias/Stigma	1
Provider Training/Education	5
Control over Pregnancy Experience	0
Physical Accessibility	1
Information Accessibility	1
DIRECT TRAININGS	1
SHARED KNOWLEDGE/EXPERIENCE	4
ASSESSMENT OF PROVIDER BIAS	1
ASSESSMENT OF EXISTING PROVIDER TRAINING / KNOWLEDGE	2

The majority of articles identified within the scope of the literature were qualitative studies assessing the lived experience of pregnant persons with disabilities. Additional papers found spoke about larger economic barriers, such as socioeconomic status and access to healthcare. Taken together, we determined that barriers to care for pregnant persons with disabilities include…[read the slide]

Given that several perceived barriers involved healthcare providers (stigma, control over pregnancy experience, information accessibility, physical accessibility), our systematic literature review assessed the state of the literature addressing barriers through healthcare provider knowledge and training (as discussed earlier). Our search returned a total of 400 articles across three databases. Following the title and abstract screening, removal of duplicates, and a full review of 9 articles, a total of 6 articles were included for analysis.

Of the 6 identified papers, 1 addressed provider bias and stigma, 5 addressed provider training and education, 1 addressed physical accessibility, and 1 addressed information accessibility. Note that some papers addressed multiple barriers and are thus included in multiple places on this table. Looking at the red portion of the table here, we broke down the data further by type of knowledge, training, and education. We identified 1 article that provided direct training in the form of a workshop for perinatal care for pregnant persons with spinal cord injuries (SCI). Just one direct training.

4 articles included gathering information on working with pregnant persons with disabilities and shared it for other practitioners. One study was the collaborative workshop on SCI and pregnancy, another was a case report on treating a common complication for pregnant women with SCI, another surveyed obstetricians to gather and share information on their experiences working with pregnant persons with physical disabilities. The final study in this category was a review of common pregnancy complications for a variety of specific disabilities for the purpose of educating healthcare providers. There was one study that evaluated healthcare provider attitudes toward disability, and two studies assessing existing provider knowledge and training related to pregnancy and disability (one with urologists and one with healthcare providers more generally.

Taken together, results suggest that there are many barriers faced by pregnant women with disabilities when it comes to accessing the care that they need. While there are not enough data here to make a general claim about all provider training, results of the systematic review suggest that there is a gap in educating and training for healthcare providers on pregnancy and disability, and there is limited information available on providing care for pregnant persons with disabilities (e.g., complications of pregnancy and viable solutions to mitigate risk, etc.).

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Recommendations and Implications

Future Research

Continue to survey provider knowledge about the needs of pregnant and postpartum persons with disabilities
Develop trainings to address gaps in knowledge
Advocate for policy to address:

Economic Barriers
Healthcare System Barriers
Gaps in Provider Training

Implications

Reduced provider bias
Improved care for pregnant persons with disabilities
Greater understanding of pregnancy and specific disabilities
Reduce existing health disparities during pregnancy and postpartum

Future research should continue to survey existing knowledge for all providers who commonly work with persons with disabilities during prenatal, pregnancy, and postpartum periods. Take this knowledge and knowledge of existing barriers to care and generate trainings for healthcare providers, and increased visibility of these topics in peer-reviewed journals, conferences, etc.

At the same time, advocate for policy change to address the economic barriers, healthcare system barriers, and gaps in provider knowledge and training)

Implications of this work may include reducing provider bias through education about disability and pregnancy. We may also see improved care for pregnant persons with disabilities as bias decreases and knowledge/training increases and providers have a greater understanding of how specific physical disabilities impact pregnancy. The end goal with this line of work would be to reduce the existing health disparities seen during pregnancy and postpartum between women with and without disabilities.