Conditions of access to maternity care for women with physical disabilities of the lower limbs in Kinshasa, Democratic Republic of Congo

doi:10.21203/rs.3.rs-4924325/v1

Download PDF

Research Article

Conditions of access to maternity care for women with physical disabilities of the lower limbs in Kinshasa, Democratic Republic of Congo

https://doi.org/10.21203/rs.3.rs-4924325/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

Introduction

It has been clearly demonstrated that throughout the world, women with disabilities do not have easy access to health services in general or maternity services in particular. Although the DR Congo stresses the importance of universal health coverage, virtually no specific approach has been developed to enable women with motor disabilities to access maternity services. The aim of this study is to describe these women's experiences with maternity care in Kinshasa to gain a better understanding of the problem and propose transformative action.

Methods and results

This qualitative study aims to explore the representations of maternity care as perceived by women with motor disabilities. Their experiences and subjective perceptions were collected through semistructured interviews. The Attride-Stirling framework was used to analyze the data. Our results show that women living with motor disabilities have more difficulty accessing maternity care than women who are considered able to do so. They felt that the main reasons were the lack of physical accessibility of premises, technical and material aids, the lack of medical skills among health professionals and the financial barrier.

Conclusion

Maternity services must eliminate barriers to improve access for women with motor disabilities. This must be done in the context of the right to health and access to health cover for all.

Sexual & Reproductive Medicine

Women with motor disabilities

Maternity

Accessibility

The right to health without discrimination is enshrined in various international instruments. The Constitution of the World Health Organization (WHO) states, "The enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition". [1]

The United Nations Convention on the Rights of Persons with Disabilities (CRPD) addresses the right to health for people living with disabilities. Article 25 of this Convention requires states to "recognize that persons with disabilities have the right to the enjoyment of the highest attainable standard of health without discrimination on the basis of disability", and together with Articles 20 (Personal mobility) and 26 (Habilitation and rehabilitation), it sets out the measures that states should take to ensure that people living with disabilities have access to gender-sensitive health services, including medical rehabilitation[2].

According to the WHO, a higher prevalence of disability is reported among women, the elderly and low-income families [3]. Many women of childbearing age have experienced significant difficulties in daily life due to a disabling condition [4]. Disabled women have the same desire and legitimate right to become mothers as other women do, but their ability to parent is often questioned [5]. However, many women with disabilities have become mothers and have given birth to healthy babies [6]. However, barriers to access to healthcare providers and facilities have been reported for many women with physical disabilities [7, 19, 20];

To ensure a safe pregnancy and a healthy baby, healthcare professionals should focus more on women's abilities rather than just their disabilities, and care and communication should aim to empower women [4]. The results of the qualitative survey conducted in Uganda and Korea suggest that maternity care needs have not been met for many pregnant women with disabilities [8, 19]. Many women living with disabilities report feeling invisible in the healthcare system, indicating that their problems are not just medical but also social and political and that access means more than just physical accessibility [9].

Our research focuses on the experiences of women with motor disabilities accessing maternity services in DRcongo. In fact, in DRcongo, the maternal health situation remains worrisome, with 8 out of 10 pregnant women giving birth in a health facility, but the maternal death rate remains high because the quality of obstetric care is not optimal. The programs proposed to improve women's access to maternity care address the general needs of these women [25] without dwelling on the specific needs of vulnerable categories, particularly disabled women. Although the DRCongo stresses the importance of universal health coverage, virtually no specific approach has been developed to enable disabled women to access maternity services.

The main objective of this study is to explore the conditions of access of women with physical disabilities to maternity services from the point of view of limited resources.

Nature of the study

This qualitative study aims to explore the representations of maternity care as perceived by women living with motor disabilities in Kinshasa in the Democratic Republic of the Congo. The study was carried out between February 2019 and March 2021. Using a descriptive and interpretative approach, it examined the views of women with motor disabilities on current practices and possible improvements in maternity care. The experiences and subjective perceptions of disabled women were collected through semistructured interviews. Data analysis was based on an inductive understanding of the research [10].

Study environment

The study was carried out in Kinshasa, the capital of the Democratic Republic of the Congo. Kinshasa was chosen as the study site because there is a movement of women with disabilities grouped together in coordination, and it was therefore appropriate to contact these women via this coordination and to invite them to the study.

Recruitment and sampling

The study was carried out by first contacting the Kinshasa office for the coordination of disabled women, which contacted 3 disabled people's organisations (DPOs) across the city of Kinshasa so that they could identify and mobilize women at the local level. Two disabled women's associations with head offices in the communes of Ndjili and Ngaba were identified and agreed to take part in the study. Women from these associations were recruited to take part in the study on the basis of the inclusion criteria (a woman with a physical impairment of the pelvis or of at least one lower limb who had experienced motherhood in the 20 years preceding the study) and the diversity of the place of childbirth to avoid interviewing women who had only given birth in the same maternity hospital; in our selection, we were interested in women who had given birth in different maternity hospitals to have a variety of experiences. Therefore, 33 women from the Ndjili association, who, for the purposes of this study, we call "Mukaji wa mushinga", a borrowed name meaning "women of value" in Tshiluba, a national language of the Democratic Republic of the Congo, to preserve the confidentiality of this association, met these criteria. A total of 8 focus groups of 6 to 8 women were organized with the women from this association, and 2 women from the Ngaba association took part in the individual interviews. A disabled woman from the commune of Gombe who met the criteria and had been informed by a disabled woman from Ngaba contacted us to take part in our study and was interviewed for this purpose. In all, women living in 8 communities in the city of Kinshasa were interviewed individually or in focus groups.

Data collection and analysis

We targeted a sample of 36 disabled women to gain a better understanding of a range of perspectives and experiences and to arrive at an understanding of the problem [10].

In-depth semistructured interviews were used to collect the data. A semistructured interview guide was developed, reviewed and validated by the research team. The guide was developed in consultation with disabled women. Most of the interviews were conducted in Lingala, a national language of the DRC, and a few were conducted in French. They lasted between 1 and 1.5 hours. The data were recorded and transcribed, and all the Lingala transcripts were translated into French. All transcripts were exported to Nvivo for coding, categorization and identification of themes. The data were analyzed via Attride-Stirling's thematic network analysis framework [11]. The framework was also used to discover concepts and themes and their interconnections in a methodical way. Where necessary, verbatim quotes from interview transcripts are used to illustrate relevant themes. For the interviews, we preferred to take verbatim notes. The discussions were organized around a discussion guide and conducted in accordance with the study objectives [10]. A semistructured discussion guide based on open-ended questions was used to elicit enriching responses and explain perceptions that were of interest for understanding the research topics.

Ethical considerations

In accordance with the Declaration of Helsinki, the Université Protestante du Congo has given ethical approval for this research. Given the sensitive nature of this study, the following measures were taken to ensure that research ethics were met. First, only women aged 18 years or over were asked to take part in the study; second, written consent was obtained from each participant before any in-depth interview or group discussion took place; and third, no photographs were taken without the participants' consent. Participation in the study was voluntary, and participants could withdraw at any time they wished. Confidentiality was maintained throughout the study, and no names were used in any of the quotes included in this study.

A total of 36 women with lower limb disabilities, all of whom had suffered from poliomyelitis as children, were interviewed. The average age of the women interviewed was 36 years, with a standard deviation of 4.8 years. Nine women living with disabilities were primiparous, 17 women were multiparous, and 9 women were very multiparous. Six of the 36 women interviewed had given birth by cesarean section, and 30 others had given birth vaginally. Just over 80% of the women had given birth to their first child before the age of 31. Only one woman said she had given birth at the age of 15 and another at 52. Just under two-thirds of the women surveyed were unmarried. All the women surveyed said they were in a relationship. The spouses of almost 64% of the women surveyed were people without disabilities.

Conditions of access to maternity services for women with motor disabilities of the lower limbs.

The women questioned on the conditions of access for women with motor disabilities to pre, pre- and postnatal maternity services highlighted three major expectations and three major fears, namely, from their responses, three major expectations linked to the management of pregnancy were highlighted

Physical accessibility of premises, equipment and technical aids

Most of the women interviewed said that they had experienced enormous difficulties in gaining physical access to the maternity unit. They deplored the lack of accessible roads to reach the maternity unit and the limited access to the buildings as well as to the maternity unit's materials and equipment. Their wish was to be able to move around easily and freely in a wheelchair.

Their expectations therefore concerned road access, physical access to the maternity unit and adapted equipment.

A woman in a wheelchair said:

It was not easy for me to get from my home to the maternity hospital because of the rough roads... when I got to the entrance of the maternity hospital, the doors were so small that my wheelchair could not fit through...".

Another woman testifies

"I would have liked to have climbed onto the delivery table alone and with dignity like the other women (so-called able-bodied women), but instead I was lifted up and put down by the nursing staff".

Most of the women mentioned the need to obtain mobility aids, materials and equipment adapted to their needs.

The women interviewed usually use aids and technical aids, but they say that these aids are not suitable during pregnancy.

The medical skills of healthcare professionals

Disability training and awareness

All the women interviewed stressed the need to be monitored by staff who are aware of first the issue of disability and second, the need to manage pregnancies for women with disabilities in general and motor disabilities in particular.

The medical world is a constant source of irritation for these women, who feel that it only leads to misunderstandings. Establishing a relationship of trust between carers and patients is a challenge; in the eyes of these women, a sense of respect and dignity toward them seems to be lacking among medical staff.

The testimony of the woman interviewed highlights this point.

"When I arrived at the maternity hospital to give birth to my first child, the doctor gave me a disdainful look and said, 'That is the one who's adding a childbirth problem to her disability. She's truly unconscious; she needs to learn to keep her legs closed". I was in a lot of pain, but with the pains of childbirth, I could not do anything, so I decided that for my next pregnancy, I would only go to the maternity hospital for the birth, because I'm forced to, and I will not go for antenatal consultations".

The majority of the women interviewed stressed that many negative rumors circulate around them about the pregnancy of a woman with a disability. This is a constant source of anxiety, even though for them, becoming a mother is an extraordinary moment. A better understanding of pregnancy and disability is necessary for them on the path they have chosen. They all emphasized their desire to be informed about all stages of pregnancy monitoring, from prenatal consultations to postnatal monitoring, associated complications and practical advice from medical staff, as shown in the following testimonials.

"...on the delivery table after being examined by the nurse and then by two doctors, a deafening silence pervaded the room without explaining anything to me, although my family had already been informed that I was going to give birth by cesarean section but not myself...without any information from the nursing staff, I thought I had lost my baby and I was afraid for my life".

There was a consensus among all the women interviewed about their ability to make decisions about their pregnancy. One woman made this clear in the comments below.

"Just because I have lost my legs does not mean I'm not in my right mind".

The women interviewed all stressed their desire to retain their freedom and independence. They also agreed that the welcome they received from health professionals at the maternity hospital was not favorable. While reception implies intention and desire, they feel neither the will nor the desire to be received.

The women interviewed all asked for a special relationship with the care staff. For them, a relationship based on trust and respect gives them the confidence they need to become mothers-to-be. This was highlighted in the words of one of the women interviewed, quoted below:

"... when I had to go to the ante-natal appointment, I made sure that doctor X was there that day because he knew me and did not judge me...".

Fears and difficulties

With respect to the fears and difficulties encountered by women using maternity services, three main themes emerged:

Fears linked to pregnancy in cases of motor disability

The fear of successfully carrying a pregnancy to term was expressed by virtually all the women studied.

Most women also fear a cesarean section as a method of childbirth; for some, a cesarean section represents an admission of weakness after a journey fraught with obstacles and having to compensate for this by a vaginal delivery.

In fact, these women felt that a cesarean section called into question their ability to give birth vaginally, something they often protested against. There are also women who worry about Cesarean sections because they are afraid of surgery, afraid of anesthetics, afraid of missing the birth of their child, and even afraid of being excluded from the privileged circle of women who have given birth naturally.

Fears about the unborn child with a transmitting disability

Most of the women spoke of worrying about passing on their disability to their child. They said that they had questions and feared that they would have difficulty looking after their child or that they would not be good mothers.

The difficulties faced by women

Human obstacles

Feelings of guilt about wanting to be a mother, sometimes because of the way other people look at them, often relatives who are hostile to seeing disabled women become pregnant, and health professionals who are not trained in caring for these women. The majority of the women we audited faced barriers caused by discriminatory words and attitudes directed at them by healthcare staff. Nursing staff constantly questioned their right to parenthood. Often labeled "neglect" and "negative words" during the group discussions, these attitudes had a negative impact on both the short-term pregnancy of these women and their long-term desire to have children.

Financial obstacles

One woman interviewed had this to say...the contractions surprised me on the way, and I decided to go to the maternity hospital on my own after phoning my family; I was almost abandoned on the maternity ward. The nurse demanded that I pay for the consultation before she would see me, while I was writhing in pain. She thought I was destitute and could not afford the hospital fees. When my family arrived with two big cars, she rushed over to me with a smile and took care of me. She'd heard it was my family who was there. I wondered for months: if my family could not afford the hospital, was the nurse going to let me die?

The women were unanimous in highlighting the difficulties most of them faced because they were unable to pay hospital fees. This affects their dignity because health professionals are often very unpleasant toward them. They denounce the commercialization of maternity care.

¬Solutions alternatives

The women interviewed said that some of them had set up strategies to access care because of various problems concerning hospital charges. These strategies are sometimes very aggressive, as explained below:

...I'm going to kill myself if no one takes care of me, and then the staff rush in on me.... The women unanimously see this as a way of defending themselves against what they see as discriminatory behavior and attitudes on the part of healthcare staff.

...we have to come as a group to the maternity hospital to put pressure on them to free us (one of us has given birth but is being kept in the hospital for lack of funds).

Our study on the expectations and challenges of women with motor disabilities in accessing maternity care showed that the conditions of access for women to maternity care were difficult. The expectations of these women, which are linked to the infrastructure of maternity hospital buildings and the behavior of the nursing staff, are not met by maternity hospitals. Their fears about the pregnancy or the unborn child require a relationship of trust, a listening ear and personalized support from the health staff, as well as the human and financial obstacles they face, all of which highlight the difficult conditions for women with motor disabilities to use maternity services.

General population data

The population of women studied had a median age of 25.5 years at the time of their first pregnancy, which was greater than the 22 years reported in Kinshasa and the 20 years reported in the country as a whole [12]. This difference can be explained by all the barriers faced by disabled women who want to become mothers, such as the lack of information about pregnancy and childbirth, people questioning their ability to become mothers, and fears of not being good mothers, as mentioned in the literature [8, 13]. All the women interviewed were disabled as a result of poliomyelitis, which differs from the findings of certain Western studies where the main cause was spinal trauma. [13]. Most of the women audited were multiparous (75%), with an average of 5.8 deliveries per woman, which is slightly lower than the average for the Democratic Republic of the Congo, which is 6.2 [14]. Almost all the patients gave birth vaginally (91%), contrary to some studies that justify scheduled cesarean sections for medical reasons [13, 15].

Women's expectations regarding access to maternity care

Physical accessibility of premises and technical and material aids

According to our results, none of the maternity units used by the women surveyed met their expectations in terms of the physical accessibility of the premises, technical aids and equipment. These maternity units are therefore not prepared to receive this category of the population, making pregnancy difficult for women with motor disabilities.

All the women mentioned that they use maternity services, but they are not satisfied with the accessibility of the premises and equipment they encounter. This difficulty is clearly mentioned in studies looking at their experiences with maternity [13, 16]. For these women, this is seen as an exclusion from society and an obstacle to their plans to become mothers. Moreover, no maternity hospital has been able to meet the needs of these women, whether it is a question of getting to the maternity hospital, moving around the premises or using the toilets to benefit from fully independent care. The unavailability of equipment and buildings not adapted for women with disabilities confirms the obstacles mentioned in the literature reviewed [13, 17 18, 19]. On the basis of the International Classification of Functioning and Disability, which highlights the social participation of people with disabilities as the ultimate objective of an inclusive society [20], it is clear that the difficulties encountered by the women audited lead to a restriction in their social participation, considering that the lack of adapted premises and equipment prevents the full participation of women with motor disabilities in this maternity project and reinforces the situation of disability of these women. This raises the issue of getting disabled people more involved in projects and programs so that their specific needs are known and taken into account from the outset, in this case, during the construction of maternity units and the acquisition of maternity unit equipment. This is possible through regular exchanges with disabled people's organizations and the implementation of inclusive policies that consider accessibility standards for disabled people.

Perception of the medical skills of healthcare professionals

Health professionals need to acquire specific skills and experience and inform their teams to avoid inappropriate behavior and technical gestures for women with motor disabilities.

Importantly, our study focused in particular on patients' perceptions of healthcare professionals' knowledge of disability.

The group interviews highlighted their perception of health professionals' ignorance of how to deal with disabled women who have come to give birth. For them, this lack of skills and know-how in dealing with women with disabilities is reflected in discriminatory language or systematic referrals to other health facilities. Women experience this as a refusal and exclusion from the healthcare system and consequently a lack of accessibility to maternity units.

Disabled women's poor perceptions of the ability of healthcare professionals to care for them show that the specific needs of these women are not met by healthcare professionals and that the quality of maternity services for this category of women must therefore be improved. Professionals need to establish clear and comprehensive communication with disabled women, as this is a sign of respect and a fundamental pillar of the doctor‒patient relationship. It also helps women make informed decisions. Indeed, motor disability in no way prevents a disabled pregnant woman from making decisions. This confirms the findings of numerous studies involving patients and healthcare professionals, which have highlighted the lack of knowledge of motor disabilities among professionals and their inappropriate behavior toward pregnant women with disabilities. [21, 22, 23].

From the point of view of the women interviewed, it is the attitude of care staff that is at the root of a poor relationship with women living with disabilities. In fact, this problem has been largely developed by women in the form of what they call "neglect" but also by words that have challenged or shocked them. For these women, this "negligent" attitude often conceals a refusal of access to care, disguised by other behaviors, enabling healthcare staff to conceal this discrimination. The results highlighted the many warnings given to them by health staff about the ability of pregnant women living with disabilities to carry their pregnancies to term. This attitude weakens these women's desire to have another child and therefore has a long-term influence on their life choices. [19, 24].

Difficult financial conditions for women

In this respect, the system of direct payment for care by the women interviewed is a major obstacle for them. They consider their socioeconomic conditions difficult and feel doubly vulnerable because of their status as women and their disability. They do not have the capacity to pay for care and therefore demand the right to free care. This situation raises the thorny issue of the disability card. This card, issued by authorities in the city of Kinshasa, is supposed to entitle holders to reduced or even free access to healthcare. However, some women have pointed to the controversial nature of this card in health care facilities, whose managers explain that the difference between the price paid with the discount and the full rate is supposed to be covered by the country's administration, which in practice is not the case. This situation could therefore put pressure on health establishments, which are unable to renew their equipment and materials, and could therefore be an indirect factor in restricting access to care for women living with disabilities.

5. Strengths and limitations of the study

Study strengths

The subject of motor disability and pregnancy developed in this study is a constantly evolving public health issue. This is one of the main strengths of the study. Moreover, all the women interviewed had to deal with motor disability and had at least one experience of motherhood. They freely gave their opinions and perceptions on the conditions of access to maternity. In addition, although the groups of women interviewed were homogeneous, there were differences in the maternity hospitals to which these women lived, implying different life experiences. Notably, the exploratory nature of the study facilitated an understanding of the experiences of these women living with disabilities, which is largely consistent with what has been documented in the literature reviewed in this research.

Limitations of the study

The qualitative nature of the study and the small sample size limit the generalisability of the results beyond the scope of the study. The results are marked by subjectivity. There may be a difference between what was said by the women and what was transcribed by the researcher during the interviews. There is also memory bias, as some women were interviewed several years after giving birth.

Although our study presents important results, the elements observed cannot be representative of the conditions of access to maternity for all women living with disabilities. It creates a window of opportunity to improve maternity services for these women.

This study revealed that women with motor disabilities have difficulty accessing maternity services. The results of this study show that the obstacles to this access are maternity facilities that are not physically accessible, equipment and materials that are not adapted, difficult relations between women and health professionals due to the latter's ignorance of how to care for women living with motor disabilities, and, finally, the precarious financial conditions of these women. This highlights the role that disabled women's associations have to play in lobbying the authorities to implement inclusive policies in maternity wards. This association also has a role in educating disabled girls and women about sexual and reproductive health rights in general and maternity rights in particular. It is also important for health professionals to be trained in disability issues and, above all, to establish a climate of trust and respect through clear communication.

Ethics approval and consent to participate:

Participation in the study was voluntary, and participants could withdraw at any time they wished. Confidentiality was maintained throughout the study, and no names were used in any of the quotes included in this study. The Université Protestante du Congo has given ethical approval for this research. Given the sensitive nature of this study

Consent for publication:

Not applicable

Competing interests:

The authors declare that they have no competing interests.

Funding:

No financing

Authors' contributions:

Y.K. wrote the main manuscript text. P.M. has reread the text and provided guidance on the methodology and discussion. The manuscript has been reviewed by all

Acknowledgments:

The authors would like to thank the women who agreed to take part in this study.

Authors' information (optional): Not applicable.

Availability of data and materials:

Not applicable. I do not have any research data outside the submitted manuscript file.

WHO (1946) constitution of the World Health Organization
United Nations Convention on the Rights of Persons with Disabilities
World Health Organization (WHO) Disability, including prevention, management and rehabilitation (2011) http://www.who.int/nmh/a5817/en/. Accessed 09-11-2020
Steinmetz E (2006) Americans with disabilities: Report No.P70-107. US Census Bureau, Washington (DC)
Lipson JG, Rogers JG (2000) Pregnancy, birth, and disability: women's health care experiences. Health Care Women Int 21:11–26 [PubMed] [CrossRef] [Google Scholar]
Blackford KA Grieve S.Prenatal Education for Mothers with disabilities. J Adv Nurs 2000, 32(4)
Coyle CP, Santiago MC (2002) Healthcare utilization among women with physical disabilities. Medscape Women Health 7(4):2
Lee LO, Heykyung OH A wise wife and good mother: reproductive health and maternity among women with disability in South Korea
Gill C, Kerotoski MA, Turk NMA (1996) D. M. Women with physical disabilities: Achieving and maintaining health and wellbeing. Pall H. Brookes, Baltmore, pp 5–15
MA, SOLO (2012) Masiala. Guide for researchers in the humanities and social sciences
Attride-Stirling J (2001) Thematic networks: an analytic tool for qualitative research. Qualitative Res 1(3):385–405
Lince-Deroche N et al Grossesses Non planifiées et Avortements à Kinshasa (République Démocratique du Congo):Défis et progrès, New York :Guttmacher Institute, 2019,p.8
CADIC J. Handicap Moteur Maternelle et Grossesse: Evaluation de la satisfaction des Patientes face à une Prise en charge Spécifique, Mémoire de diplôme d'Etat de sage-femme Paris descartes, (2013)
Statista, Average number of children per woman DRC (2019), consulted 4 June 2021 https://en.statista.com/statistics/688901/average-number-of-children-per-woman-rdc/
Lee LO, Heykyung OH (2005) A wise wife and good mother: reproductive health and maternity among women with disability. In South Korea Sexuality Disabil, 23
GHIDINI A.,SIMONSON M.R.Pregnancy after spinal cord injury:a review of the literature.Top Spinal Cord inj Rehabil (2011) p 93–103
Prilleltensky O ED D. A Ramp to Motherhood:the Experiences of Mothers with Physical Disabilities. Sex Disabil ,21.2003.25
Morrison J, Basnet M, Budhathoki B, Adhikari D, Tumbahangphe K, Manandhar D et al Disabled Women's Maternal and Newborn Health care in Nepal:A qualitative study. Midwifery 30 2014:1132–1139.[PMC free article][PubMed][Google Scholar]
Ahumuza SE, Matovu JK, Ddamulira JB, Muhanguzi FK (2014) Challenges in accessing sexual and reproductive health services by people with physical disabilities in Kampala. Uganda Reprod Health 11:59. 10.1186/1742-4755-11-59PMID: 25086444; PMCID: PMC4131806
Bremer K, Cockbum L, Ruth A (2010) Reproductive Health Experiences Among Women with Disabilities in the Northwest region of Cameroon. Int J Obstet Gynecol 108:211–213 [PubMed][Google Scholar]
Faivre E (2006) et CNGOF.Extrait des mises à jour en Gynécologie et Obstétrique. Les 30 emes journées nationales. Handicap et Grossesse. Paris
Humelière AP, Maternity (2012) Taking care of a paraplegic woman pre, per and post partum. Mémoire de diplôme d'Etat de sage-femme Nancy
Potier E (2005) Maternité et Handicap Moteur, Parcours de femmes. Mémoire de diplôme d'Etat de sage-femme Baudelocque, Paris
Kuumori J, Otupiri E, Obeng B, Kwaku AE, Ankomah A, Adanu R (2016) Challenges Women with Disability Face in Accessing and Using Maternal Healthcare Services in Ghana. A Qualitative Study,Plos One
UNFPA UNFPA engagé à sauver des vies de femmes et nouveau-nés en RDC, news,2021

The authors declare no competing interests.

Download PDF

Version 1

posted

You are reading this latest preprint version

Conditions of access to maternity care for women with physical disabilities of the lower limbs in Kinshasa, Democratic Republic of Congo

Status:

Version 1

Abstract

Introduction

Methods

Results

Discussions

Conclusions

Declarations

Competing interests:

Funding:

Authors' contributions:

Acknowledgments:

Availability of data and materials:

References

Additional Declarations

Status:

Version 1