Improving access to skilled maternal health services among pregnant women with disabilities in Uganda: What are disability-responsive maternal health services?

Pregnant women with disabilities (WWDs) face increased challenges in accessing skilled birth health services than women without disabilities, especially in low and middle-income countries, which puts them at a higher risk of worse maternal health outcomes. Limited studies have been conducted in Uganda that address the needs of pregnant WWDs from a health system perspective. This paper aims to explore the demand and supply side needs of pregnant WWDs in Uganda and explain what disability-responsive maternal health services look like at the health systems level. A qualitative study was conducted in Iganga and Mayuge districts in Eastern Uganda. Thirteen key informant interviews were conducted with district health team members and community leaders. In-depth interviews were conducted with 12 WWDs and 12 caregivers, and eight focus group discussions were conducted with health workers, community members, and traditional birth attendants. Analysis was done manually using the framework approach. Barriers included a lack of disability-friendly transport to get to the facility of choice, a lack of childbirth autonomy, poor attitudes and disrespectful maternity care by health workers, physical inaccessibility of health facility infrastructure, lack of specialized medical equipment to meet the needs of pregnant WWDs, and lack of health worker training to meet the unique needs of WWDs. There is a need for holistic, multifaceted, and multisectoral approaches to ensure disability-responsive maternal health services at the health systems level. This includes policies that support inclusive maternal health services that meet the needs of pregnant WWDs, dedicated funding and prioritization of disability-related health interventions, improved physical environment of health facilities to make them more accessible to PWDs, a trained workforce to meet the health needs of pregnant WWDs at all health system levels and overcome poor attitudes and disrespectful maternity care towards WWDs, and disability data which is disaggregated by key social stratifiers to guide planning, monitoring and decision-making around disability-responsive maternal health services.