title: Barriers to accessing safe motherhood and reproductive health services: the situation of women with disabilities in Lusaka, Zambia.
abstract: OBJECTIVE
  To ascertain how well health services in Lusaka, Zambia currently meet the safe motherhood and reproductive health care needs of women who have physical impairment leading to disability.
  
  
  METHODS
  A qualitative study was conducted in Lusaka, Zambia. In-depth tape-recorded interviews were conducted with 24 purposively selected women with disabilities and with 25 safe motherhood/reproductive public sector health service providers. Qualitative analysis was conducted using NVivo software.
  
  
  RESULTS
  Women with disabilities encounter various social, attitudinal and physical barriers to accessing safe motherhood and reproductive health (RH) services in this particular setting. The strong desire for children and affection can increase vulnerability to sexual exploitation. At the same time, a generalized assumption among reproductive health service providers that women with disabilities will not be sexually active, and not require RH services, leads to increased vulnerability to sexually transmitted infection including HIV. Once pregnant, traditional beliefs about transmission of disabilities can create barriers to integration in ante-natal clinics. Nurse-midwives' fear of delivery complications in women with physical impairments can also result in routine over-referral to a tertiary maternity facility which is outside the locality and harder for women with mobility limitations to get to.
  
  
  CONCLUSIONS
  Greater understanding of the influences underpinning societal attitudes towards sexuality and disability in this setting, and more extensive communication between health care staff and women with disabilities would facilitate positive action towards improving safe motherhood and reproductive health services for women with disabilities.
authors.affiliation: Centre for Internationa Child Health, Institute of Child Health , London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Smith
authors.forename: S F
authors.initials: SF
authors.lastname: Murray
authors.forename: A K
authors.initials: AK
authors.lastname: Yousafzai
authors.forename: L
authors.initials: L
authors.lastname: Kasonka
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D006233:Persons with Disabilities; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008427:Maternal Health Services; D008875:Middle Aged; D011203:Poverty; D011287:Prejudice; D036301:Qualitative Research; D034121:Reproductive Health Services; D035862:Vulnerable Populations; D015024:Zambia