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.
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.
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