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Breaking Down Barriers to Health Care for
Women with Disabilities Presenter Sharman
Word Dennis, M.Ed., CEO Rose, Inc., Washington,
DCROSEINC2002_at_AOL.COM

• Office on Disability and the Office on Womens
  Health
• US Department of Health Human Services
• Co-sponsored by The Interagency Committee for
  Disability Research December 6, 2004

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OBJECTIVES

• This Workshop objectives
• To highlight the many challenges facing women
  with disabilities in obtaining appropriate
  healthcare To provide model systems, practical
  examples and useful strategies and techniques to
  address the needs of women of color with
  disabilities.
• To explore ways that health care professionals
  and facilities can overcome the barriers to
  providing quality care

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WHO ARE WOMEN WITH DISABILITIES??

• According to the NATIONAL WOMENS HEALTH
  INFORMATION CENTERAmerican women today have many
  roles and are busy juggling families, friends,
  and careers. Did you know that 28 million of
  these women are living with disabilities?
  Disabilities are physical and mental limitations
  that come along with different health problems.
  The Department of Justice defines disability as
• any physiological disorder, or condition,
  cosmetic disfigurement, or anatomical loss
  affecting one or more of the following body
  systems neurological, musculoskeletal, special
  sense organs, respiratory (including speech
  organs), cardiovascular, reproductive, digestive,
  genitor-urinary, hemic and lymphatic, skin, and
  endocrine or
• any mental or psychological disorder, such as
  mental retardation, organic brain syndrome,
  emotional or mental illness, and specific
  learning disabilities."
• In general, the severity of a disability is
  described in terms of how much it limits one's
  daily activities. As the number of older
  Americans is steadily rising, so is the number of
  those living with a disability. But, women are
  more likely than men to be limited in the amount
  or kind of major activity they can perform.

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CHALLENGES TO ACCESSING APPROPRIATE HEALTH CARE

• Some of the challenges faced by women with
  disabilities include
• physical barriers (poor access to enter
  buildings, a lack of transportation and support
  services to keep appointments, to receive medical
  care)
• financial barriers (having lower wage jobs and no
  health insurance)
• lack of reliable health information and services
  that address their needs that is communicated in
  the appropriate communication modality, i.e.
  Braille, sign language, appropriate grade level
  of written material

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HEALTH ISSUES

• Health Issues
• Women with disabilities also face challenging
  barriers to health care. Women with disabilities
  have described limited access to these important
  health care services 1. Obstetrical care
  providers with knowledge about specific
  disabilities2. Screening procedures with
  accessible mammography and pelvic exam equipment
  and3. Adequate fertility control services and
  health information, especially regarding
  sexuality. (Szalda-Petree, Unpublished focus
  group testimony, 1995). Prevention is also
  important to women with disabilities, since
  significantly more women with disabilities report
  urinary tract infections, depression,
  osteoporosis, restrictive lung disease,
  inflammatory bowel disease, heart disease,
  seizure disorders, and kidney disease than able
  bodied women (Nosek et al., 1997). Most of these
  secondary conditions are at least partially
  preventable.

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HEALTH SAFETY ISSUES

• Early pregnancy among adolescent females with
  serious emotional disturbances
• Females with Autism and other Developmental
  Disabilities and Sexual Issues
• Abuse of females with developmental disabilities

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WOMEN OF COLOR

• We continue to live in a society that is less
  accepting of people of color
• Adequate health care for people of color
  continues to be an issue regardless of SES
• Studies have shown that women of color receive a
  lower standard of healthcare than their white
  sisters

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WOMEN OF COLOR WITH DISABILITIES

• Women of color with disabilities are victims of
  the impact of a "triple jeopardy" syndrome race,
  gender, and disability.
• Besides having to cope with the usual problems of
  a disability, minority women also have to deal
  with economic, social, and cultural factors that
  can hurt their health.
• Disparities in educational resources, lower wage
  jobs, and higher unemployment rates found in some
  minority groups are barriers to high-quality,
  affordable, and accessible health care
  4woman.gov

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HEALTH ISSUES FACING WOMEN OF COLOR

• Minority Access to Health Care in the US
• Studies reporting on disparities in access to
  health care among women of different racial and
  ethnic origins in the US have been summarized in
  reports by the Agency for Health Care Quality and
  Research.
• Receipt of certain major procedures by
  hospitalized adults varies by race and sex.
  Harris, Andrews, and Elixhauser, Ethnicity and
  Disease 7, pp. 91-105, 1997.An analysis of 1.7
  million hospitalizations, reveals that black
  women had a significantly lower rate of
  therapeutic procedures than white women for
  nearly all female reproductive system diseases.
  And, in general, blacks had a significantly lower
  rate of therapeutic procedures than whites for
  several common cancers such as colon, bladder,
  cervical, and breast cancer.
• Health insurance coverage disparities related to
  race, ethnicity, and sex. Health Insurance Status
  of Workers and Their Families 1996 . AHCPR
  Publication No. 97-0065.In 1996 employed black
  women were more likely than employed black males
  to obtain public insurance (9.5 vs. 2.7), and
  Hispanic women were much more likely than
  Hispanic men to obtain work-related coverage
  (62.4 vs. 49.7). Although minority women workers
  were less likely to be uninsured than minority
  male workers, they still were much more likely to
  be uninsured than employed white women.
• Among working women, 29.9 of Hispanics, 22.2
  of blacks, and 12.6 of whites were uninsured.

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HEALTH ISSUES FACING WOMEN OF COLOR

• Screening and health promotion Hispanics are
  less likely than whites to be screened for
  cancer. Perez-Stable, Otero-Sabogal, Sabogal, et
  al., Archives of Internal Medicine 154, pp.
  1073-1081, 1994. Researchers interviewed 844
  Hispanic and 510 non-Hispanic whites who were 35
  to 74 years of age and members of the Kaiser
  prepaid health plan. They found that 90 of white
  and Hispanic women had a Pap smear within the
  past 3 years. However, a substantially greater
  proportion of Hispanic women had never had a Pap
  smear and were somewhat less likely than white
  women ever to have had a screening mammogram (85
  vs. 95). Hispanic women were less likely than
  white women to estimate that their chances were
  excellent or good of being cured if cervical
  cancer (46 vs. 64, respectively) or breast
  cancer (48 vs. 60) were detected early.
• Personal health maintenance behavioral risk
  factors of Hispanic women are unfavorable
  compared with non-Hispanic white women.
  Perez-Stable, Marin, and Marin, American Journal
  of Public Health 84(6), pp. 971-976, 1994.
  Researchers conducted a community survey of
  behavioral risk factors for poor health among 652
  Hispanics and 584 non-Hispanic whites living in
  San Francisco. Forty-six percent of Hispanic
  women had engaged in no leisure-time physical
  activity in the past week compared with 23 of
  non-Hispanic white women. Hispanic women were
  less likely than non-Hispanic white women to have
  ever had a Pap smear (76 vs. 93) or clinical
  breast examination (81 vs. 96).

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HEALTH ISSUES FACING WOMEN OF COLOR

• Heart Disease
• Cancer
• Accidents
• Diabetes
• Stroke
• Chronic liver disease and cirrhosis
• Chronic lower respiratory diseases
• Influenza and pneumonia
• Kidney disease
• Perinatal conditions
• Septicemia

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HEALTH ISSUES FACING WOMEN OF COLOR

• Minority women are also less likely to have
  access to reproductive health care, including
  medically appropriate contraceptives, annual
  gynecological exams, and prenatal care.

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HEALTH ISSUES RELATED TO WOMEN WITH DISABILITIES

• Access
• Being invisible
• Gender Inequity
• Service Barriers
• Lack of accommodations
• Invalidation of Sexuality and Reproductive Health
• Abuse
• Privacy
• Medical negligence
• Mental Health
• Stress
• Depression and suicide

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ISSUES FOR WOMEN OF COLOR WITH DISABILITIES

• Cancer
• Cancer in a woman with a low IQ
• Cancer in a woman of color with a low IQ, poor
  and speaks with an accent
• Prenatal care
• Prenatal care in a woman who has mental health
  issues
• Prenatal care in a woman who has mental health
  issues who is black homeless

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WOMEN OF COLOR WITH DISABILITIES

• Women of color with disabilities use fewer health
  services and continue to suffer more from
  premature death, disease, and secondary
  disabilities 4woman.gov
• For white women with disabilities there also are
  invisible barriers to care, such as policies that
  deny service to women who cannot easily get up
  onto exam tables, or that let doctors refuse to
  see women with disabilities.

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WOMEN OF COLOR WITH DISABILITIES

• For women of color with disabilities, especially
  dark skin color or those who speak with an
  accent, the barriers are VERY visible
• Ignored
• Talked at instead of talked to or with
• No communication to discover your needs or issues
• Lack of validation
• Total disrespect
• Lack of confidentiality
• Lack of accessibility to services due to a
  variety of issues
• Lack of referral for needed services
• Lack of follow up by health care providers
• Lack of insurance and therefore not able to
  receive adequate services

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RECOMMENDATIONS

• Identify health care providers who are accepting
  of all people people of color and those with
  disabilities
• Train medical students
• Enforce legislation but work to change attitudes

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RECOMMENDATIONS

• Create a paradigm shift within society
• For total acceptance and inclusion of people with
  disabilities and people of color