Prior studies suggest that women with disabilities experience health disparities before, during and after pregnancy. Yet, this literature is dominated by retrospective single-site studies of small sample sizes, with no comparison groups of women without disabilities. As a result, many questions remain unanswered about the needs of women with disabilities, particularly women with mobility disabilities, around the time of pregnancy. In the proposed study, we plan to fill this gap in the literature and use our findings to develop perinatal care recommendations to improve care for women with mobility disabilities.
The specific aims of this study are to (1) examine access to perinatal care and explore differences in pregnancy-related outcomes for women with and without disabilities;(2) examine unmet needs and barriers to perinatal care for women with mobility disabilities and compare these unmet needs to those of other women;and (3) develop and disseminate recommendations for perinatal care for women with mobility disabilities. The study will be conducted using population-based data derived from the Massachusetts and Rhode Island Pregnancy Risk Assessment Monitoring System (PRAMS) and the Massachusetts PRAMS-Pregnancy to Early Life Longitudinal (PELL) system to document differences in health care utilization and outcomes around the time of pregnancy between women with and without disabilities. Next, focus groups will be conducted of women with mobility disabilities to learn about their unmet needs and barriers to perinatal care. Using these data, a follow-up survey will be devised for women with and without disabilities identified in the Massachusetts PRAMS to document their unmet needs, experiences, and outcomes related to their pregnancy. We will also conduct interviews with obstetric clinicians to develop recommendations for perinatal care for women with mobility disabilities.

Public Health Relevance

The U.S. Department of Health and Human Services has declared achieving eliminating disparities, and improving the health of all groups as one of the overarching goals of Healthy People 2020. The proposed study will document the existence of disparities in maternal outcomes and rates of complications among women with and without disabilities using existing population-based data. Through focus groups and a follow-up survey of the unmet needs and barriers to care, it will seek to explain any such disparities and improve care by creating a set of recommendations for perinatal care for women with mobility disabilities.

National Institute of Health (NIH)
Eunice Kennedy Shriver National Institute of Child Health & Human Development (NICHD)
Research Project (R01)
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Study Section
Special Emphasis Panel (ZRG1-HDM-T (50))
Program Officer
Willinger, Marian
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University of Massachusetts Medical School Worcester
Family Medicine
Schools of Medicine
United States
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Smeltzer, Suzanne C; Mitra, Monika; Long-Bellil, Linda et al. (2018) Obstetric clinicians' experiences and educational preparation for caring for pregnant women with physical disabilities: A qualitative study. Disabil Health J 11:8-13
Mitra, Monika; Akobirshoev, Ilhom; Moring, Nechama Sammet et al. (2017) Access to and Satisfaction with Prenatal Care Among Pregnant Women with Physical Disabilities: Findings from a National Survey. J Womens Health (Larchmt) 26:1356-1363
Powell, Robyn M; Mitra, Monika; Smeltzer, Suzanne C et al. (2017) Family Attitudes and Reactions toward Pregnancy among Women with Physical Disabilities. Womens Health Issues 27:345-350
Mitra, Monika; Smith, Lauren D; Smeltzer, Suzanne C et al. (2017) Barriers to providing maternity care to women with physical disabilities: Perspectives from health care practitioners. Disabil Health J 10:445-450
Mitra, Monika; Long-Bellil, Linda M; Iezzoni, Lisa I et al. (2016) Pregnancy among women with physical disabilities: Unmet needs and recommendations on navigating pregnancy. Disabil Health J 9:457-63
Mitra, Monika; Clements, Karen M; Zhang, Jianying et al. (2016) Disparities in Adverse Preconception Risk Factors Between Women with and Without Disabilities. Matern Child Health J 20:507-15
Smeltzer, Suzanne C; Mitra, Monika; Iezzoni, Lisa I et al. (2016) Perinatal Experiences of Women With Physical Disabilities and Their Recommendations for Clinicians. J Obstet Gynecol Neonatal Nurs 45:781-789
Clements, Karen M; Mitra, Monika; Zhang, Jianying et al. (2016) Pregnancy Characteristics and Outcomes among Women at Risk for Disability from Health Conditions Identified in Medical Claims. Womens Health Issues 26:504-10
Mitra, Monika; Long-Bellil, Linda M; Smeltzer, Suzanne C et al. (2015) A perinatal health framework for women with physical disabilities. Disabil Health J 8:499-506
Mitra, Monika; Iezzoni, Lisa I; Zhang, Jianying et al. (2015) Prevalence and risk factors for postpartum depression symptoms among women with disabilities. Matern Child Health J 19:362-72

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