The grace of motherhood: disabled women contending with societal denial of intimacy,pregnancy, and motherhood in Ethiopia

This study aimed to provide better understanding of intimacy and marriage, pregnancy, birth, and motherhood experiences of women with disability in Ethiopia. Qualitative, in-depth, and semi-structured interviews along with personal observations were used to explore the full experiences of participants, as told in their own words. The result of the interviews indicated that relationships and motherhood proved a very rewarding option for women with disabilities. They also expressed their need for intimacy regardless of society’s denial. Challenges identified include negative societal attitudes toward women with disabilities regarding relationship, pregnancy, and child-rearing. Accessibility of health centers in addition to the ignorance and negative attitudes of the physicians are also reported to be major challenges for the interviewees. This study highlights how rewarding the experience of motherhood was for the interviewees and also shows that women with disabilities face challenges at every step of their experiences, because of society’s prejudices toward disability.     

Disability, Religion and Health: a literature review in search of the spiritual dimensions of disability

Religious belief and practice plays an important role in the lives of millions of people worldwide, and yet little is known of the spiritual lives of people with a disability. This review explores the realm of disability, religion and health, and draws together literature from a variety of sources to illustrate the diversity of the sparse research in the field. An historical, cross-cultural and religious textual overview of attitudes toward disability throughout the centuries is presented. Studies in religious orientation, health and well-being are reviewed, highlighting the potential of religion to effect the lives of people with a disability, their families and caregivers. Finally, the spiritual dimensions of disability are explored to gain some understanding of the spiritual lives and existential challenges of people with a disability, and a discussion ensues on the importance of further research into this new field of endeavour.     

One Woman's Experience of Living with Chronic Pain

ABSTRACT

Emphasis within chronic pain literature is placed upon lost productivity of patients, escalating health care costs, and denunciation of compensation/disability claims, with exiguous recognition of the personal costs of chronic pain. Sufferers, particularly women, are vulnerable to being pathologized and labeled through the psychologizing of their pain and subsequently silenced in the pursuit of health care services. By means of an illness narrative, this article illustrates the invaluable contribution the chronic pain sufferer can make towards the understanding of her pain. Social work, as a health profession, will be challenged to listen to women's stories and to empower sufferers in the proclamation of their own voices, in an efficient movement towards participatory service delivery.     

The twain meet: empirical explanations of sex differences in health and mortality

Health statistics routinely show higher morbidity and health services use for women, while mortality rates are higher for men. This analysis empirically identifies reasons for women's poorer health. It is based on retrospective (interview) and prospective (health diaries) data from the Health In Detroit Study. Three kinds of risk factors, which may help explain females' excess, are considered: acquired risks, psychosocial aspects, and health-reporting behavior. Men and women differ markedly in acquired risks: smoking and job hazards are higher for men, but inactivity, nonemployment, stress, and many other factors are higher for women. Psychosocial aspects predispose women to more illness and health care. Women also had keener interest in the survey. When all of the risk factors are controlled, the morbidity gap narrows considerably. In fact, indicators of general and chronic health reverse to reveal higher morbidity for men. Similarly, females' excesses for therapeutic care (short- and long-term disability, medical visits, lay consultation, drug use) diminish when risks and morbidity level are controlled. They actually reverse to a male excess for disability and medical care. Though most of the unveiled male excesses are statistically nonsignificant, their pattern allows a reasonable interpretation. Our results are closely compatible with recent analyses of sex mortality differences in several California sites, which could not eliminate men's mortality excess by controlling for social factors. In conclusion, contemporary women's poorer health profile stems largely from their roles and stress (acquired risks), and to a smaller degree from their health attitudes. When social factors are taken into account, health data suggest a disadvantage for men, and mortality data maintain men's disadvantage. Do the reasons lie in biology?     

The contextual and social locations of older women's experiences of disability and decline

Understandings of disability and decline within health and social care seem to focus mainly on the bodies and function of older persons. However, the way that older people's experiences of disability and decline are fixed into rigid functional classifications such as ‘frailty’ are problematic. Drawing on the narratives of twelve diverse older English-speaking women in Montreal, Canada, I will argue that older women's experiences are more connected with the contexts within which they experience disability and decline, and the social locations they bring to these experiences, than the functional limitations of their bodies. Older women's stories – particularly those related to the home and the bus – reveal the clash between dominant understandings of ‘frailty’ and older women's contextual and social experiences of disability and decline; expose tensions within health and social care practices; and highlight the potential which exists in both context and social location.     

Health, Illness, Disability and Black Minorities: A Speculative Critique of Present Day Discourse

The idea of incorporating a user perspective was central to the design of a study looking at services for, and the needs of, Black minorities. The initial assumption of this work was that health, illness and disability are intimately connected to the way people construct their social realities. The ideas and attitudes individuals hold about their health and disability, however, are also organised within a particular discourse. This discourse is not neutral, and a critical understanding that unravels it is necessary. This is the intent of the article, which includes an exploration of the construction of health, illness and disability in western societies and how this is subsequently discussed in relation to Black minorities. At a general level this is addressed with reference to the humanist philosophy which pervades the entire discourse and provides the dominant framework of power in society.     

Toward a Holistic View of Health and Health Promotion in Social Work with People with Disabilities

Abstract

The individual medically oriented model of disability suggests that people with disabilities seldom achieve health and wellness because of their impairments and disabilities. This paper provides an alternative to the tendency in social work to focus on the medicalization of disability without a due consideration of the social context. It draws insights from the social model that asserts disability is a form of social restriction encountered by people with disabilities and that social barriers of disability must be removed through collective action. Also, this model posits that people with disabilities can be healthy if the barriers preventing good health are removed. However, medical aspects of a person with a disability should not be forsaken entirely. Therefore, this article proposes a holistic view that converges insights of the individual and social models toward a better understanding of health issues for people with disabilities. It shows the implications for social work that follow from the convergence.     

High incidence of disability pension with a psychiatric diagnosis in western Sweden. A population-based study from 1980 to 1998

Regional differences in Sweden in the prevalence of disability pension with a psychiatric diagnosis are unexplained, in spite of the significant impact on the population's health, rehabilitation systems, and the health care system. The purpose of this study was to describe the pattern of disability pensions with a psychiatric diagnosis and to analyze the impact of age and gender. We examined the incidence rates in one urban and one semi-rural region and compared these to national rates. The study sample was drawn from employed persons between 16-64 years of age who, because of their sickness insurance coverage, would be eligible to access disability pensions should it be necessary. Analysis of annual incidences and standardized morbidity ratios were made for 1980, 1985, 1990, 1995, and 1998. Data on disability pension cases were collected from the National Social Insurance registers. In the urban region we found that the proportion of men and women clearly outnumbered the national average: approximately twice the number of persons between 16-64 years of age with a psychiatric diagnosis were receiving a disability pension. In the semi-rural region there were fewer men overall on disability pensions with psychiatric disorders, but in 1980, 1985, and 1995 women clearly outnumbered men. Access to psychiatric care, unemployment, alcohol dependence, and previous sickness absence are suggested as possible factors that might affect the rates of disability pension in different geographical settings.     

Using discourse analysis to study the experiences of women with learning disabilities

There has been a steady rise in interest in qualitative research methods in the area of learning disability over recent years. Discourse analysis has found relatively little use though, particularly in studying the experiences of people with learning disabilities directly, rather than the accounts of non-disabled informants. The present study used a discourse analytic approach in examining the accounts of women with learning disabilities, in order to arrive at an understanding how they position themselves in relation to gender and disability. The results indicate that, while the learning disability literature and services are largely ‘gender blind’, for women with learning disabilities gender and disability cannot be separated. Instead, they may be faced with marked contradictions and dilemmas when they position themselves within dominant discourses of gender, while also subject to powerful discourses of disability.     

Suranho healing: Filipino concepts of intellectual disability and treatment choices in Negros Occidental

This qualitative study investigated the use of folk medicine by families for people with intellectual disability in the Philippines. Workers from Negros Occidental who support people with intellectual disability participated in semi-structured interviews. Findings show families seek the intervention of a folk healer before seeking primary healthcare support and a prosperous cultural use of folk medicine exists across the Philippines. Intellectual impairment is perceived by some Filipinos to be caused by supernatural forces. Socio-cultural constructs of intellectual disability probably influence health outcomes for this populace. If primary healthcare tools and resources for people with intellectual disability that are developed in higher-income nations are to have the potential to be transferred into other settings, understanding of attitudes towards alternative medicine is needed.     

Explanatory models for disability: perspectives of health providers working in Malawi

Health providers’ understanding of disability determines how disabled people are treated, and hence it is imperative to address conceptualisations of disability, as this will contribute to better opportunities and realisation of human rights for disabled people. This article will use data from a qualitative study exploring conceptualisations of disability by 22 health service providers from the total health care system in Malawi, including the professional sector (e.g. medical doctors and nurses) and the folk sector (healers and indigenous practices). We will discuss how these perceptions influence the lives of disabled people, using the case of a health service user with physical and speech impairment as an example. Our data show that health providers largely conceptualise disability according to the medical model for disability, contributing to the exclusion of disabled people. The bio-psycho-social model for disability, largely absent as an explanatory model for disability among our informants, is the most inclusive and rights based.     

The choice agenda in the Australian supported housing context: a timely reflection

The last 30 years has seen significant developments in the Australian housing sector for people with disabilities. Despite much change in the sector, and advancements in disability services, the range of current supported housing options for younger Australian adults with a neurological disability remains vastly under-developed. This is despite a widely accepted and endorsed recognition that, as is the general population, people with all forms of disability have a right to housing of their choice. This paper presents a timely critique of the key actions made by the Australian disability and housing sectors and subsequently proposes a more informed approach to supported housing design and development: one that is based on a comprehensive understanding of consumer housing priorities and preferences, and is conducive to a person’s biopsychosocial health.     

Embodying and enacting disability as siblings: experiencing disability in relationships between young adult siblings with and without disabilities

Abstract

Where one sibling has a disability, research has examined the role of disability in sibling relationships; however, the majority has reflected a normative understanding of sibling relationships and a deficit understanding of disability. Reacting to this history, this paper draws on the concepts of embodiment (absorption of bodily experience into self/identity) and enactment (performance of self/identity) to provide a new way of understanding the role of disability in sibling relationships. Using data from an Australian study of young adult siblings with and without disabilities, the paper discusses how disability is embodied and enacted in: how siblings engage in supportive and conflictual talk and everyday chat with each other; how they enact recreation and seek connection with each other; and how they strive to understand and experience their emotions about each other. The paper ends by discussing how embodiment and enactment allow a clearer understanding of disability in sibling relationships, which may be empowering for siblings.     

Exploring the impact of health inequalities on the health of adults with intellectual disability from their perspective

Across every indicator of health inequality, adults with intellectual disability are disadvantaged. However, first-hand accounts from adults with intellectual disability exploring the impact health inequalities have for their health and are absent from the literature. The research was underpinned by a participatory approach, involving Men with intellectual disability as members of a steering group and through 20 interviews. Thematic analysis revealed how low income and reduced employment had a negative impact on the men’s physical and psychological health. New findings show how living in deprived areas exposed men to constant threats to their safety with an adverse effect on their health.     

(In)visibility: accounts of embodiment of women with physical disabilities and differences

This qualitative study explored relationships between contemporary western cultural representations of bodies and the experiences of women born with physical disabilities and differences. In multiple, in-depth interviews, 14 women described the ways their embodiments are shaped by cultural discourses of disability, difference and gender. The findings indicated myriad ways in which the participating women experienced their embodied selves, paradoxically as both invisible and visible across sociomaterial places. Given the narrow range of normative appearances and capacities of 'acceptable' bodies, the women's bodies were frequently seen as undesirable whereas their subjectivities and lives were rendered invisible. The women articulated accounts of imposed ways of being seen by others and how these views structured and delimited their agency and resistances. This article highlights the fluid and multiple ways embodiment is produced, seen and experienced, and the importance of taking into account the interplay of gender with experiences of physical disability and difference.     

"Women and disability don't mix]" Double discrimination and disabled women's rights

Oxfam's experience with groups of disabled people has revealed that gender affects how disabled people are treated in various cultures. This experience runs counter to the often voiced (even by a consultant hired by Oxfam) assumption that gender analysis serves only to confuse any analysis undertaken of disability-based circumstances. This assumption is echoed in the disability movement itself where activists fear fragmentation through the introduction of gender analysis. Thus, gender is not yet understood as a factor which affects every aspect of life including race, class, ethnicity, caste, and disability. Because 75% of the 250 million disabled women in the world live in developing countries, development programs must consider the specific needs and rights of disabled women who suffer from double discrimination and are more likely than disabled men to live impoverished and isolated lives which lead to depression and despair. In many societies, disabled women, but not disabled men, lose their rights to marriage, family life, education, and health care. Mothers of disabled children are stigmatized, and fathers tend to "blame" defective genes on the mothers and to ignore their disabled offspring. These factors combine to make it difficult to improve the status and livelihoods of disabled women through development work. Disabled women activists have also voiced complaints about their lack of access to the preparatory meetings for the Fourth UN Women's Conference, but disabled women intend to use the Conference to lobby for their rights and to call for scrutiny of health policies which discriminate against the disabled.     

Feminist disability theory: domestic violence against women with a disability

Women with a disability continue to experience social oppression and domestic violence as a consequence of gender and disability dimensions. Current explanations of domestic violence and disability inadequately explain several features that lead women who have a disability to experience violent situations. This article incorporates both disability and material feminist theory as an alternative explanation to the dominant approaches (psychological and sociological traditions) of conceptualising domestic violence. This paper is informed by a study which was concerned with examining the nature and perceptions of violence against women with a physical impairment. The emerging analytical framework integrating material feminist interpretations and disability theory provided a basis for exploring gender and disability dimensions. Insight was also provided by the women who identified as having a disability in the study and who explained domestic violence in terms of a gendered and disabling experience. The article argues that material feminist interpretations and disability theory, with their emphasis on gender relations, disablism and poverty, should be used as an alternative tool for exploring the nature and consequences of violence against women with a disability.     

Pushing the boundaries of our understanding of disability and violence: voices from the Global South (Guyana)

Our knowledge about disabled people’s lives is largely based on research in the Global North. This article considers disability and violence in the Global South, specifically in Guyana. It aims to push conceptual and empirical boundaries of our understanding of violence and disability. Conceptually, it argues for a social model materialist theory of disability attuned to how material barriers to disabled people’s inclusion in society and space are reproduced through processes of exclusion unfolding across geographic scales ranging from the global, to the inter-personal and intra-personal. It argues that Lacanian psycho-analytic theory provides a complimentary lens for understanding why people engage in acts that construct disabled people as ‘deserving’ of violence. Empirically, the article broadens our understanding of disability and violence by focusing on poverty, violence as a cause of impairment and disability, and disabled women’s and men’s experiences of violence in a majority world context.     

Fetal Alcohol Spectrum Disorder Information Dissemination by Health Care Professions

Fetal alcohol spectrum disorder (FASD) is the leading preventable intellectual and developmental disability. There is no safe level of alcohol consumption at any point during pregnancy. Findings of this study indicate that the information disseminated by health care professionals is not always in keeping with this understanding. Physicians and midwives appeared to be the least consistent in advocating to women that they abstain from alcohol consumption while pregnant. We explore ways in which social workers can support the medical profession to provide more consistent messaging of alcohol abstinence during pregnancy to lower the incidence of FASD.