A total 182 women with disability were obtained in Busiro HSD with a response rate of 95.3%. Overall, 150 (82.3%) of the disabled women had attended ANC during pregnancy and 147 (80.8%) had delivered their babies at the health facility.
Background characteristics of participants
As shown in Table 1; majority of participants were physically disabled (98.4%), 39.0% were above 35 years, and 47.8% were married. Among the participants, 58.8% had attained primary education and (46.7%) were self-employed. Regarding spouses of the participants, 34.1% had attained primary education while 47.3% were self-employed. Majority of the women with disability (55.5%) had had at least 1-3 pregnancies, while 65.4% had 1-3 children. Less than half (42.0%) of the participants had attended ANC four or more times. Most participants (43.8%) did not have any means of transport to go to public health facility or felt the need, while 50.3% started ANC at less than 20 weeks of gestation. Over 78.2% of the participants reported that they had not been given special attention by nurses/midwives at maternal health facility, and 51.9% had received support from family members to be able to access ANC services. Majority of women with disability (83.0%) had normal deliveries. Among the women with disability that had a caesarian section, 69.7% reported that it was due to their disability. When the women with disability were due to deliver their baby, the first option was to go to a government medical facility (48.9%). Among the participants, 62.3% had delivered their babies at government run health facilities, while 16.5% had complications during delivery. Among those that had complications, 55.6% sought medical attention. When asked about accessibility to maternal health care services in Busiro HSD, 48.6% compared to 51.4% of the disabled women had knowledge where the health centre could be accessed. In contrast, midwives reported that few women with disability had visited the health facilities during pregnancy for ANC. “One disabled pregnant woman in a month and at times after three months; women with disability rarely come to the health facility. They may be going to Mpigi Health centre IV which is far and costly or Entebbe Grade B hospital.” KI, Midwife, Kajjansi HC IV
Among the women with disability, 41.7% lived less than 5Km from the nearest health facility, while 56.2% reported that maternal health care services were always available in Busiro HSD. However, more than half (59.5%) reported that there were no special delivery beds at the health facility for physically disabled women. Most of the women with disability thought that the available delivery beds at the health facilities were too high. In addition, 56.7% thought that the health care providers were friendly as they sought maternal care, while 69.5% of them were charged user fees at the maternal unit. Among the women with disability that were charged a fee at ANC, 39.6% paid 5000Ugx (1.34USD), 22.9% paid 10,000Ugx (2.69 USD), 20.8% paid 20,000Ugx (5.37USD) and 16.7% paid more than 20,000 Ugx (>5.37 USD). Also, 70.2% were charged at maternity units with the amount of money ranging from less than 20,000Ugx (5.37USD) to more than 200,000Ugx (53.71USD) for the specific services offered during child birth. In contrast, the key informants reported that the maternal services were offered free of charge by the government. This was stressed by one key informant in the narrative; ‘All the key informants reported that the maternal health care services were free of charge, although they received appreciation tokens (in cash) from women with disability’. KI, Kajjansi Health Centre IV
Key informants also mentioned different things they are doing to raise awareness of the importance of maternal and child health services to the disabled and the general population such as carrying out community outreaches and dialogues. This was stressed by one key informant in the narrative; ‘The midwives go to the communities for outreaches where some of these women with disability are captured. Of late community dialogues have also come up, community members are asked about service delivery and health education talks are being carried out by the assistant health educator on the available services.” KI, Kajjansi Health Centre IV
Factors associated with ANC attendance and place of delivery among women with disabilities
As shown in Table 2: parity significantly influenced utilization of maternal health care services of women with disability. A disabled woman with 1-3 children was more likely to attend ANC during pregnancy compared to those than had more than four children (AOR 7.710; 95% CI 0.249-239.040). The study findings revealed that a disabled woman having 1 to 3 children was twice as likely to attend ANC compared with a woman who had 4-6 children (AOR 2.6; 95% CI: 0.139-49.004). The odds of a disabled woman attending ANC was twice as likely if she had a normal delivery during the most recent pregnancy compared to those who had cesarean section (AOR 2.605; 95% CI:0.296-22.921). In addition, a woman with disability was 3.3 times less likely to attend ANC if she was not seeking care from a health facility than if she was visiting a private health facility (AOR 3.361; 95% CI: 0.732-15.424). The odds of a disabled woman attending ANC was 4.5 times lower among those who visited TBAs than those who went to the private health facility (AOR 4.562; 95% CI: 0.922-22.576). A woman with disability was twice more likely to attend ANC if she resided less than 5 Km from a health facility compare to those who stayed more than 5 Km away (AOR 2.308; 95% CI: 0.695-7.661). Also, the friendliness of the health care providers was found to influence ANC attendance of women with disability in Busiro South HSD, Wakiso district. A disabled woman was less likely to access ANC services if the health care providers were unfriendly (AOR 0.393: 95% CI: (0.127-1.212). In addition, distance to the health facility was found to significantly influence delivery of a disabled woman at the health facility, as shown in table 3. A disabled woman living less than 5Km from a health facility was more likely to deliver her baby at the health facility in comparison with those that stayed more than 5 Km (AOR 4.546; 95% CI: 1.597-12.938). It was reported that people with disability had no handles on the walk ways, unsuitable reception chairs, too many staircases to climb, no specialized medical equipment, lack of wheel chairs to support entrance into the building, and no specialized support health workers. This was stressed by one key informant in the narrative; “At the entrance of Kajjansi Health Centre IV, there are no steps; there is a walk way that allows use of a wheelchair to ease access to maternity ward, however, this remains a big challenge at out-patient department. We have tried to ensure that these midwives handle those mothers with priority so that they do not over stay at the facility, the blind are not allowed to be in queues and samples are taken at ANC to limit movements.” KI, Kajjansi HC IV
The health workers also reported that a few disabled women visited Kajjansi HC for ANC and delivery, and that most preferred hospitals that are better equipped. This was stressed by one key informant in the narrative; “NO, only a few pregnant disabled women attend ANC for screening. After identification, midwives refer the disabled pregnant women to Entebbe hospital for future management. This is because there are no theater services and few interventions have been put in place to cater for the needs of women with disability at Kajjansi H/C 1V in Busiro South HSD, Wakiso district,” KI, Kajjansi HC IV. “Also Kasanje Health H/C III is the only government run health facility in Kasanje town council serving seven parishes and more than 30 villages. We do not have the provisions to cater for the disabled women.” KI, Kasanje HC III. Further, it was also established from the key informant interviews that there was need to construct more latrines for the disabled. This was stressed by the key informants at the different health facilities as narrated below; “The available latrine is not in use because it has to be serviced. It is not user really friendly; it does not have stairs. It is spacious, so a disabled woman can enter with her wheel chair “but it is not suited for disabled.” KI, Kajjansi Health Centre IV. “An NGO called VAD constructed new toilets with provisions for the disabled patients. Although the lame still say they are not to their standards.” KI, Kasanje Health Centre III. “There are no latrines for the disabled patients, the few latrines available are not user friendly for the non-disabled patients.” KI, Nakawuka H/C III.
Most of the key informants reported that they had not received special training in handling disabled pregnant women at the respective health facilities. When asked if the health care workers attend to mothers with disability, the key informants said they normally refer them to other health facilities although they deliver some during emergencies. The health workers reported that they were not well equipped to handle the needs of women with disability. As narrated; “When identified early during ANC, the pregnant women with disability are advised to visit better equipped public health facilities with more specialized services for better management. But if the disabled woman comes in when already in labor, we try to manage using the available resources.” KI, Kasanje HC III.
“No. During ANC screening, the midwives assess if the woman with disability will be able to have a baby naturally (normal delivery or not) to avoid complications they are referred to Entebbe Hospital. There is no theatre, so timely referral for difficult cases in done,” KI, Kajjansi HC IV