Breaking barriers for pregnant women with disabilities: A case study on inclusive maternal care in Tanzania

Meaningful inclusion of women with disabilities in maternal care

Mariam was informed of free maternal services for pregnant women with disabilities by a friend. This provision can meaningfully promote health equity for women and girls with disabilities who are usually rarely consulted on issues of maternal and child health, and wider sexual and reproductive health and rights. They are also often discriminated against or denied these services because they can be considered asexual or health workers fear that their pregnancy will be too complicated.

Accessibility as a key consideration to navigate health care facilities

Mariam is guided through the facilities of the obstetric clinic by midwife Intisar. To promote more inclusive health services, it is essential to think about the way that service users have to navigate the facilities. It is also important to adapt communication and information according to people’s needs. For example, the use of Braille signage or a health worker who provides clear guidance can go a long way to promote the accessibility and improve the quality of health services for persons with disabilities.

Affordable services in the community contributes to health equity for persons with disabilities

A midwife is checking Mariam’s blood pressure, which is normal. Her pregnancy is progressing well. To receive this simple but essential health care service, Mariam visited the clinic near her house. Ensuring affordable services in the community where people live contribute to enhance gender equality. Evidence shows that gender inequality contributes to poorer health outcomes for women and girls with disabilities. Globally, they remain disadvantaged compared to men with disabilities in the social determinants of health, such as employment, education, and risk of violence. Ensuring gender responsive and gender equitable approaches will contribute to reducing health inequities for all.

Ensuring quality health care and informed consent for women with disabilities

Mariam consults with a radiographer during her appointment. The radiographer makes the time to explain the ultrasound procedure to Mariam so that she can be empowered to understand, participate, and make the most of her consultation. This quality of healthcare is important but often denied to many persons with disabilities. Persons with disabilities can be subjected to a range of coercive measures and involuntary practices within the health system, and particularly in sexual and reproductive health services, which undermine their dignity and well-being and lead to unwillingness to seek help and engage with practitioners.

Accessibility of the medical equipment in maternal health services

Mariam is lying down on the examination table for an ultrasound scan. To promote inclusive maternal health services, it is essential to think about the accessibility of the medical equipment. For example, adjustable examination tables can greatly benefit women with disabilities, especially women of short stature or with mobility difficulties. Without adjustable tables, women may be asked to lie down on the floor or be denied the consultation. This can be uncomfortable or painful, discriminatory, and profoundly undermine their dignity.

Key principles to advance health equity for persons with disabilities

At the end of the consultation, the doctor discusses Mariam’s results and provides information on birth preparedness, expectations during delivery, and danger signs to look out for. He also plans for the follow-up appointments. Mariam can express her own needs and concerns, receive answers to her questions, and be empowered to make informed decisions about her health. To advance health equity for persons with disabilities, WHO recommends:

1. Include health equity for persons with disabilities at the centre of any health sector action.
2. Ensure the empowerment and meaningful participation of persons with disabilities and their representative organizations when implementing any health sector action.
3. Monitor and evaluate the extent to which health sector actions are leading to health equity for persons with disabilities.