FACTORS INFLUENCING POOR UTILIZATION OF ANTENATAL CARE SERVICES

AMONG WOMEN WITH PHYSICAL DISABILITIES IN MAKINDYE DIVISION,

KAMPALA DISTRICT

IMIENU CHARITY SPECIOZA

17/U/7110/CSD/PD

A RESEARCH REPORT SUBMITTED TO THE DEPARTMENT OF COMMUNITY

AND DISABILITY STUDIES IN PARTIAL FULFILMENT OF THE REQUIREMENT
FOR THE AWARD OF THE DEGREE OF BACHELOR’S IN COMMUNITY
DEVELOPMENT AND SOCIAL JUSTICE OF
KYAMBOGO UNIVERSITY

MAY, 2021
 DECLARATION
I Imienu Charity Specioza hereby declare to the best of my knowledge that this report is my
original work, which has not been presented before to any University for any academic award
other than Kyambogo University.

SIGNED………………………………….DATE…………………………

IMIENU CHARITY SPECIOZA

17/U/7110/CSD/PD

i
 APPROVAL
This research report is submitted for examination with my approval as the University supervisor.

SIGNED …………………………………..DATE……………………………………..

SUPERVISOR

ii
 DEDICATION
This Research report is dedicated to my parents, Mr. and Mrs., who are fighting hard for the
progress of my life journey, I am really thankful for the sacrifices they endeavor with the aim
that I always be an inspiration in the family and the world at large. GOD BLESS YOU all

iii
 ACKNOWLEDGEMENTS

Our debt of gratitude goes to Almighty God for his grace, mercy and protection all these years of
our educational life. Glory be unto his name.

I deeply appreciate my supervisor Mrs. a lecturer at the department of Community and Disability
Studies for his unwavering support and professional advice as my supervisor that she shared with
me throughout the period of the study, not forgetting the time she sacrificed for me out of her
tight schedules to supervise my work.

My sincere gratitude goes to all lecturers and staff of Kyambogo University especially the
department of Community and Disability Studies s for their support throughout my bachelors’
program in general and in particular this research. They have added to my knowledge as I
pursued my Bachelor of Community Development and Social Justice.

Special thanks go to my Dad and Mum who laid a strong academic foundation upon which I
have been able to reach this far. It was amidst scarcity of resources that they managed to educate
me as well as instilling important core values of hard work, persistence and determination to me.

I am also grateful to the entire fraternity of Makindye Division, Kampala District who accepted
to provide me with the relevant information so as to see that my study was accomplished.

Finally, I would like to thank everyone including my course mates and friends, and Womayi
Samson who contributed to this study and pray that the almighty God blesses you all thousand
folds.

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 TABLE OF CONTENTS

DECLARATION..............................................................................................................................i
APPROVAL....................................................................................................................................ii
DEDICATION...............................................................................................................................iii
ACKNOWLEDGEMENTS............................................................................................................iv
TABLE OF CONTENTS................................................................................................................v
LIST OF TABLES.......................................................................................................................viii
LIST OF ACRONYMS..................................................................................................................ix
ABSTRACT...................................................................................................................................xi
CHAPTER ONE..............................................................................................................................1
INTRODUCTION...........................................................................................................................1
1.1 Background of study..................................................................................................................1
1.2 Statement of the problem...........................................................................................................3
1.3 Purpose of the study...................................................................................................................4
1.4 Specific objectives.....................................................................................................................4
1.5 Research Questions....................................................................................................................4
1.6 Scope of the study......................................................................................................................5
1.6.1 Content Scope.........................................................................................................................5
1.6.2 Geographical Scope................................................................................................................5
1.7 Significance of the study...........................................................................................................5
CHAPTER TWO.............................................................................................................................7
REVIEW OF RELATED LITERATURE.......................................................................................7
2.0 Introduction................................................................................................................................7
2.1 The causes of poor utilization of antenatal services among women physical disability...........7
2.2 The challenges faced by women physical disability in accessing antenatal services..............10
2.3 The possible solutions to solve problems of poor utilization of antenatal services among
women with physical disability.....................................................................................................13
CHAPTER THREE.......................................................................................................................16
METHODOLOGY........................................................................................................................16
3.0 Introduction..............................................................................................................................16

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3.1 Research Design......................................................................................................................16
3.2 Area of study............................................................................................................................16
3.3 Study participants....................................................................................................................16
3.4 Sample size..............................................................................................................................16
3.5 Sampling Technique................................................................................................................16
3.6 Methods of data collection.......................................................................................................17
3.6.1 Interview Guide....................................................................................................................17
3.7 Procedure of data collection....................................................................................................17
3.8 Data analysis............................................................................................................................17
3.9 Ethical consideration...............................................................................................................17
CHAPTER FOUR.........................................................................................................................19
CHAPTER FOUR: PRESENTATION OF RESULTS, AND ANALYSIS OF RESEARCH
FINDINGS.....................................................................................................................................19
4.1 Introduction..............................................................................................................................19
4.2 Findings on the background information.................................................................................19
4.2.1 Age structure of the participants...........................................................................................19
4.2.2 Religion of participants.........................................................................................................19
4.2.3 Education level of respondents.............................................................................................19
4.2.4 Marital status of respondents................................................................................................20
4.3 The causes of poor utilization of antenatal services among women physical with disabilities
.......................................................................................................................................................20
4.3.1 Kind of health services present in the health centers in Makindye Division municipal
central division...............................................................................................................................20
4.3.2 Factors that influence access to health care services in Makindye Division municipal
central division...............................................................................................................................22
4.4 The challenges faced by women physical disability in accessing antenatal services..............24
4.4.1 What challenges do you often face when accessing these health services in the area?........24
Distance to the health center..........................................................................................................25
4.5 Possible solutions to solve problems of poor utilization of antenatal services among women
with physical disability..................................................................................................................26
4.5.1 What can be done to improve on the access to health care service?....................................26

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CHAPTER FIVE...........................................................................................................................28
CHAPTER FIVE: SUMMARY, DISCUSSION, CONCLUSION AND RECOMMENDATIONS
.......................................................................................................................................................28
5.1 Introduction..............................................................................................................................28
5.2 Summary of the study..............................................................................................................28
5.3 Discussion................................................................................................................................29
5.3.1 The causes of poor utilization of antenatal services among women physical disability......29
5.3.2 The challenges faced by women physical disability in accessing antenatal services...........30
5.3.3 Possible solutions to solve problems of poor utilization of antenatal services among women
with physical disability..................................................................................................................32
5.3 Conclusion of the study...........................................................................................................33
5.4 Recommendation of the study.................................................................................................33
5.5 Areas of further research.........................................................................................................34
REFERENCES..............................................................................................................................35
APPENDICES..................................................................................................................................i
APENDIX I: INTERVIEW GUIDE FOR WOMEN WITH PHYSICAL DISABILITY................i
APENDIX II: INTERVIEW GUIDE FOR HEALTH CARE SERVICE PROVIDERS...............iii

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 LIST OF TABLES
Table 4.1: Age structure of the participants...............................................................................................19

Table 4.2: Religion of participants.............................................................................................................20

Table 4.3: Marital status of respondents....................................................................................................21

LIST OF ACRONYMS

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ANCs: Antenatal care services
ARVs: Antiretroviral
HIV Human Immune Virus
IPTp: Intermittent Preventive Treatment for Malaria during pregnancy
MOH: Ministry of Health
TBAs: Traditional Birth Attendants
UBOS: Uganda Bureau of Statistics
UDHS: Uganda Demographic Healthy Survey
UNICEF: United Nations children‘s Fund
WHO: World Health Organization

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 ABSTRACT
The study focused on factors influencing poor utilization of antenatal care services among
women with physical disabilities in Makindye division, Kampala district. The study was guided
by three research objectives namely; to examine the causes of poor utilization of antenatal
services among women physical disability in Makindye division, to determine the challenges
faced by women physical disability in accessing antenatal services in Makindye division and to
suggest possible solutions to solve problems of poor utilization of antenatal services among
women with physical disability in Makindye division

The study used a cross sectional survey which involved qualitative approaches to gather data
from 30 respondents in all, including key informants selected using simple random sampling and
purposive sampling for key informants. Data was collected using interview guide and presented
using narrative techniques, paraphrasing and direct quotation.

Study findings reveled that utilization of antenatal care services provided to pregnant women
depends on several factors; the education level of pregnant women whereby, highly educated
pregnant women are able to access and utilize education provided in antenatal education
compared to those with low education or completely non literate. If access to antenatal education
by women with physical disabilities is to be more effective, there is need to derive information
and skills that meet the education needs of pregnant women to enable them address their
concerns. Methods of delivering antenatal education to pregnant women need to be appropriate
so as to allow for participation of pregnant women in classes. This can enable pregnant women
acquire knowledge about child birth such that they know what to expect and do when labor
starts, as well as ensuring proper care for their babies.

The study recommended that Providers of antenatal services should be aware that women with
physical disabilities attending antenatal education have varying education levels and their
pregnancy stages differ as well as their personal pregnancy problems.. Providers of antenatal
services need to be aware that handling women with physical disabilities with written materials
like the Mother Child Passport alone may not be useful. The government should also provide
enough of the materials and other requirements like drugs, vaccines so that mothers easily access
them than telling them to buy because some mothers may not have enough money.

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 CHAPTER ONE
INTRODUCTION

1.1 Background of study

Maternal health, child-health and health education are three major concerns of public health
organizations and researchers throughout the world. Health education for mothers is a strategy
many countries have adopted to improve maternal and child health (Soltani et al., 1999). Over
half a million women encounter complications due to childbirth annually and many die (Policy
project, 1999; Ashford, 2004). The report states that almost 40% of women experience
complications after delivery and an estimated 15% of these women develop potentially life-
threatening problems.

This chapter presents the Background of the study, statement of the problem, objectives of the
study, Research questions, and scope of the study, significance of the study, limitation and
delimitations of the study.

Global studies prove that women with disabilities still face a challenge in accessing Maternal
Health Services hence bringing about poor utilization of Antenatal care services (Boezaart,
2012). Institutionalized discrimination, isolation and stereotyping of women with disabilities
continue unabated (WHO, 2015). Violations of the sexual and reproductive rights of the women
with disabilities have been condoned in developed and developing nations. Governments and
development partners, especially in developing countries, have failed to offer affordable and
accessible sexual and reproductive health facilities (UNICEF, 2021). Women with disabilities
particularly in Africa are still viewed as people who cannot take part in sexual and reproductive
activities as observed by (UNICEF, 2021). Negative attitudes towards sexual and reproductive
rights of women with disabilities still exist. Women with disabilities are still perceived as non-
sexual or as not having the capacity to engage in sexual activities (Chikumbu, 2014).

Access to health care services is a human right to everyone including women with disabilities
and there has been global attention on maternal health recently. The United Nations Convention
on the Rights of Persons with Disabilities (UNCRPD) which became part of international law

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stipulates that governments should guarantee access to maternal health services that include
Antenatal care services to people with disabilities (United Nations, 2007).

The population of women with disabilities is estimated to constitute 12% of the world population
(WHO, 2015). It is further estimated that 19% of women with disabilities are domiciled in Third
World countries. These women constitute three-quarters of the women living in absolute poverty
globally. These women are excluded from economic empowerment initiatives on account of their
gender and their disability (Rugoho & Siziba 2014). Women with disabilities are more prone to
sexual abuse and victimization because they are considered to be weak and hence easy targets
(Rugoho & Maphosa 2014;. The maternal Health rights of women with disabilities are further
compromised by factors such as negative attitudes of family and society, and cruel religious and
cultural practices (Kawungezi, et al., 2015). The negative attitudes also cascade to health
providers and medical staff.

In Africa ANC attendance is 80% among rich people. Most women in sub-Saharan Africa, make
their first ANC visits very late (Gudissa, 2015) which ranges from 53% to 89% (Umubyeyi, et
al., 2014). Sub Saharan Africa and South Asia regions with the highest maternal mortality and
fewer women received at least four antenatal visits (49% and 42%, respectively) (WHO, 2015).
However, majority of women start ANC in the second trimester while others start in the third
trimester (Kawungezi, et al., 2015). In this region a woman's life time risk of dying during
pregnancy and childbirth is 1 in 38 as compared to 1 in 3700 in the developed world. It is
however noted that coverage of at least four ANC visits is lower at 44%. Up to 14% or 160,000
more new born lives would be saved with good ANC.

In Uganda most 63% Persons with disabilities have the same health needs as every other member
of the population, including immunization, screening, sexual and reproductive health, and all
other aspects of regular healthcare. They may also have additional or more complex health
needs, because of impairment and the consequences of impairment. Persons with disabilities
may face particular barriers in accessing needed healthcare. Not least of these is the increased
likelihood of living in a situation of poverty and social exclusion, which increases both the
likelihood of ill-health, and the likelihood of facing barriers to accessing healthcare. For all
these reasons, health is a disability rights issue, which is why Article 25 of the Convention on the

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Rights of Persons with Disabilities sets out the normative framework which should govern
disabled people’s access to healthcare (Kawungezi, et al., 2014).

In Uganda, one in every 200 births ends the mother's life where 51% of people do not have any
contact with public healthcare facilities (Kisuule et al., 2013). Only 38% of healthcare posts were
filled in Uganda. Healthcare staffs who were working, had little incentive to work in poor rural
areas (UBOS, 2014). Some 70% of Ugandan doctors and 40% of nurses and midwives were
based in urban areas, serving only 12% of the Ugandan population (MOH, 2015). This scenario
may lead to irregular attendance to ANC due to unavailability of health care providers to attend
to mothers.

According to the Uganda Bureau of Statistics (UBOS) and Uganda Demographic health Survey
(UDHS, 2011) 90% of women attend ANC at least once with only 48% of pregnant mothers who
make four and more ANC visits during the whole gestation period (UDHS, 2014). On the other
hand, 79% of mothers never attend ANC up to four months of pregnancy and maternal mortality
ratio is 438 per 100,000 live births (MOH, 2015).

For women with disabilities in Makindye Division in Kampala District the MHS concerns are
further exacerbated by social attitudes towards sexuality of women with disabilities. MHS
services are often not easily available; they are expensive and out of reach for many women with
physical disabilities. Within, Makindye division, there is lack of adequately trained professionals
to attend to their unique needs. In addition, information on disability related services is not easily
available. Maternal Health Services more so Antenatal health care concerns are often not
prioritized at family level hence it becomes a major challenge for disabled women who are
economically dependent on others for their upkeep and livelihood in the Sub-county. Therefore
this study sought to analyze the factors that influence the poor utilization of Antenatal care
services by women with physical disabilities.

1.2 Statement of the problem

The Ugandan government has enacted legislation and policies to protect the rights of persons
with disabilities. These rights are enshrined in the Persons with Disabilities Act (PDA) 2006. In
addition, the Ministry of Health (MOH, 2015) has adopted the Maternal Health Policy 2015 with
the theme: 'Enhancing the Reproductive Health Status for all Ugandans’. This policy aimed at

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providing a framework for equitable, efficient, and effective delivery of quality Maternal Health
services and emphasized on a need to reach the most vulnerable like Persons with Disabilities
(PWDs). However, despite these efforts, women with disabilities continue to face challenges in
accessing the maternal health services. Chikumbu (2014) reported that women with physical
disabilities experiences challenges of inaccessible health facilities, additional transport costs,
negative and stereotyped attitudes by service providers and society at large towards persons with
disabilities, cultural norms, stigma and discrimination, lack of information, marginalization in
the community and the misconception that disabled people are not sexually active which hinder
their access to maternal health services like Antenatal care services. However, although
Ahumuza and Muhanguzi (2014) carried out their research from Kampala, there is some gaps in
the research since it do not indicate what exactly was found out from Makindye division.
Therefore, this has propelled me to research on the poor utilization of Antenatal care services
within the division of Makindye, Kampala district.

1.3 Purpose of the study

To investigate the experiences women with physical disabilities face while accessing Antenatal
health care services in Makindye division, Kampala District.

1.4 Specific objectives

i. To examine the causes of poor utilization of antenatal services among women physical
disability in Makindye division
ii. To determine the challenges faced by women physical disability in accessing antenatal
services in Makindye division.
iii. To suggest possible solutions to solve problems of poor utilization of antenatal services
among women with physical disability in Makindye division

1.5 Research Questions

i. What are the causes of poor utilization of antenatal services among women physical
disability in Makindye division?
ii. What are the challenges faced by women physical disability in accessing antenatal
services in Makindye division?

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 iii. What are the possible solutions to solve problems of poor utilization of antenatal services
among women with physical disability in Makindye division?

1.6 Scope of the study

1.6.1 Content Scope
The study focused on experiences of women with Physical disabilities in accessing Antenatal
care services. Specifically the study focused on the causes of poor utilization of antenatal
services among women physical disability, the challenges faced by women physical disability in
accessing antenatal services and possible solutions to solve problems of poor utilization of
antenatal services among women with physical disability in Makindye division

1.6.2 Geographical Scope

The study was conducted in Makindye Division is one of the five administrative divisions
of Kampala, the capital and largest city of Uganda. Makindye Division is in the southeastern
corner of the city, bordering Wakiso District to the south and west. The eastern boundary of the
division is Murchison Bay, a part of Lake Victoria. Nakawa Division lies to the northeast of
Makindye Division. Kampala Central Division lies to the north and Rubaga Division lies to the
northwest. The coordinates of Makindye Division are: 0°17'00.0"N, 32°35'00.0"E (Latitude:
0.283334; Longitude: 32.583334). Makindye, where the divisional headquarters are located, sits
approximately 6 kilometres (3.7 mi), by road, southeast of Kampala's central business district.

1.7 Significance of the study

This study might provide information to international agencies and bodies working in the field of
health such as world health organization and those working in the area of human rights and
disability such as united nation to estimate the access to and hindering factor for nonuse of
maternal health services. This may help such agencies to come up with programs and appropriate
strategies to promote access to family planning services for all people including women with
physical impairment.

This study will be useful in finding the factors influencing poor utilization of Antenatal care
services among women with physical disability in Makindye division and this will help the

5
government of Uganda to formulate policies and plans that can promote access to such services
basing on the influencing factors obtain from the study findings.

The study may also help the researcher to understand the life situation of women with physical
disability as far as access to Antenatal care services is concerned and this will help the researcher
to get different means of helping women with physical impairment have access to maternal
health services.

The study might empower women with physical disability by giving them a variety of
opportunities to discover themselves, understand their environment, be aware of their rights and
take control of their lives and take part in important decisions regarding their access to maternal
health services.

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 CHAPTER TWO
REVIEW OF RELATED LITERATURE

2.0 Introduction
This chapter shall present the literatures that other researchers have put forward that are in line
with the objectives of the study; Accessibility of Antenatal care services to women with physical
disabilities, the source of information about Antenatal and other maternal health care services to
women with physical disabilities, Affordability of Antenatal health services to women with
physical disability and how women with physical disabilities are attended to when seeking
maternal health services.

2.1 The causes of poor utilization of antenatal services among women physical disability
Ajaegbu (2013) carried out a study to determine the perceived challenges of accessing Antenatal
care services by women with physical disabilities in Nigeria. The survey collected information
from a nationally representative sample of 385 women with disabilities age 15-49, who had
given birth in the five years. The findings from 56.4% of the respondents noted that money to
access maternal healthcare service is the major barrier that hinders them from accessing maternal
healthcare service even when they have health complications. He said that Nigeria is a country in
which most of its citizens live below one dollar per day. Therefore as long as needs concerning
feeding are not met, money to access good maternal healthcare service remains secondary need.

Ibor (2012) carried out a study to examine the influence of economic status on utilization of
maternal health care among women with physical disabilities in Ibadan, Oyo State. They
obtained data for the study through the administration of 231 copies of questionnaire to child
bearing women with physical disabilities. The study findings revealed that use of maternal health
services by pregnant mothers with physical disabilities in Nigeria is determined by their
socioeconomic status in the society. Some of the barriers he found in this study that affect the use
of maternal health care by Nigerian women with disabilities include getting permission to go for
treatment, getting money for treatment, distance to health facility, transport cost, not wanting to
go alone, for fear that there may not be a female provider or any health provider, to attend to
their needs and concern that drugs may not be available. He concluded that money for treatment
is the major barrier that hinders women from accessing maternal health care service in Nigeria.

7
For women living in the rural areas in Nigeria, transportation and distance to hospital are major
factors affecting the use of maternal Health services in Nigeria.

Tarasoff (2013) found out Costs, including fees for transportation, were cited as another barrier
to access sexual and reproductive health services by women with physical disabilities and visual
impairments. Respondents indicated that each time they need services they have to pay high
transport costs as they have to hire a meter taxi to take them to the hospital or clinic or pay for
someone to accompany them.

Groce (2009) reported that people with disabilities are impeded by high public transportation
costs to get to the health facility. This is because people with disabilities often have to also pay
transport costs to have someone accompany them, may need to give a financial incentive to the
person accompanying them, and/or have to hire specialized means of transport that can, for
example, accommodate them and their wheel chairs. Such costs are not incurred by people
without disabilities, making cost a notable additional barrier to those with disabilities

Mbuagbaw et al. (2017) pointed out that limited ability to pay and high hospital costs have been
identified as the major barriers for the rural poor women with disabilities wishing to access
maternal services, due to economic difficulties in rural areas women are not able to afford costs
related to deliveries even if the services in some places are free of charge they unable to pay for
transport in case of referral or the facility is away from home.

Zingzang (2009) carried out a study in Mumbai India to investigate the extent to which income
levels determines women with physical impairments access to maternal services. The study
sample comprised of 20 participants including; 6 women with physical impairment, 4 service
providers, 6 family members and one from each family of women with physical impairment and
4 local leaders. The findings indicated that there was a clear difference between the working and
non-working women with physical disability in relation to the access to maternal health .The
study shows that those who had a source of income accesses maternal services compared to
those without any source of income.

Access to health care is predominantly determined by factors such as the availability, cost and
quality of health resources and supplies (Levesque, Harris & Russell, 2013). Furthermore, access
to and utilization of services is usually measured using indicators such as the numbers of skilled
8
health care professionals, hospital beds, number of public healthcare facilities and costs incurred
by individuals to obtain health (Guilford et, al, 2002). These indicators are used to access and
utilize services and influence the type of health outcomes that occur. Mostly the regular adverse
health outcomes that result are due to differences in access to health care services and are major
public health priorities (Graves, 2009) Additionally, the high quality of healthcare, easy
accessibility of health services and reduction of health care disparities depend on diversifying the
health work force in terms of education, as they provide services to different population groups
(Williams et al, 2014).

The guidelines that are used during the provision of ANC services generally guide the quality of
care received by pregnant women. In a study by (Bar-Zeev et al, 2014), conclusions were drawn
that poor adherence to the use of local guidelines had some negative influence on the success of
the ANC program me and the quality of ANC. The authors recommended that the identified
problems in the local guidelines needed urgent attention if equity in women's access to high
quality ANC (with the aim of closing the gap in maternal and neonatal health outcomes) is to be
achieved. The factors relating to access to and utilization of ANC services may, in one way or
the other, impact negatively or positively on maternal outcomes

Some health workers are corrupt that they extort money from the patients before they give them
services. In a study carried out in Namibia, extortion of money from expectant mothers during
antenatal visits discouraged mothers coming again to health care facilities to seek health care
services (Blangiardo et al., 2013). Most of the mothers are poor that they cannot afford to meet
all the requirements that are needed by modern health care workers during antenatal care.
Adegoke et al., (2009) in a study carried out in West Africa, noted that, in many public health
centres, in Guine, Gambia, Liberia and sierra Leone, health workers demand money from
patients before they are given services which jeopardizes the rate of antenatal care attendance.
They frequently demanded money from pregnant mothers during antenatal visits and whenever
they seek health care services from them. Majority of the respondents instead prefer self-
medication and advice from friends and family menebrs than spending the little money they
have.

In relation, the behavior of the health care providers significantly influenced seeking of antenatal
care services. In a study done in Ethiopia, by Banteyerga, (2011) revealed that, many mothers do

9
not regularly attend antenatal care because they are tired of the unfriendly behavior of the health
workers in most public health centers. In this study majority of mothers felt angry to health
workers due to their accusation on failure to regularly attend antenatal care again. Some are
accused of indecent dressing and hygiene as reported by Kebede et al., (2013). Majority who
could not standard such embarrassment resorted absconding antenatal care where no one could
reveal the secrets. These were the reasons why government resorted to bringing maternal health
care services near to the people

Health records and health information about patients must be kept safe and private by all medical
and healthcare professionals. Some mothers do not or irregularly attend antenatal care from
health care facilities because there is inadequate privacy. They feel shy to undress before health
care workers open their legs to strangers yet they had ever delivered at home without any
complication. Some mothers reveal that at home they are within safe hands of the relatives who
can provide herbal medicine which can help them to induce labor. Similarly Cham et al., (2009)
in a study carried out in Gambia, showed that, some respondents felt better when they did attend
antenatal care and took some drugs besides the ones prescribed at the health centers. Some
respondents revealed that they can immediately get help such as hot water for bathing and foods
when in antenatal homes unlike at TBAs centers. Similarly in a study on the determinants of
Antenatal Healthcare Utilization by Pregnant Women in Third Trimester in Peri-Urban Ghana,
showed lack of privacy in many public health care facilities located in remote areas (Akowuah et
al., 2018) A study done by Gloria, 2010 in western Uganda revealed that mothers feared
attending antenatal care because they would be forced to deliver from the hospital and yet fear
other people seeing their private parts (Centenary, 2010).

2.2 The challenges faced by women physical disability in accessing antenatal services
Peters et al (2008), WHO (2013) show that the factors that limit PWDs access to healthcare
range from physical proximity in terms of transport that is when the transportation to the health
center is not clear or the victim him/herself cannot afford to have a transporting assistive device
to the health facility or it can be due to physical structure of the health facility and it can be
through its construction where it limits the mobility of the person to access the services needed
for their health.

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(UNECEF & WHO, 2015), PWDs experience multiple barriers to obtaining healthcare and
barriers seem to be more profound for some types of healthcare than others. They include lack of
adaptive equipment and inaccessible environment for patients with disabilities inability to have
time for patients with speech and hearing difficulties as the health workers lack connectivity with
those with hearing impairment, no information about where to refer them for specialized
healthcare thus they are left out in the public service

The communication between the staff and the PWDs especially the deaf patients where there is
telephone communication as an instruction for physical examination, Thew et al (2012) and
Iezzoni et al (2004) found out that the deaf patients experience fear, mistrust and frustration in
the health settings when they experience problems with ways of treatment which can result into
incorrect diagnosis and improper treatment. The way the deaf personalities have to understand
they medication type prescribed and go on with the diagnosis it must be done by a specialized
person which is still a fail within the health centers

According to Mensah et al (2008) the barriers span from health financing as the funds are
limited, structural and physical environment, he based his study in Ghana and discovered that the
health facilities don’t provide disability friendly services making it difficult for most clients
especially wheel chair users to access hospital buildings as they lack the ramps and specialized
lifts for them and more so they are not able to climb onto the medical examination beds to attain
treatment and the health service providers have no ideas to help them out

Bremer & Ruth (2009) conducted a study to find out Antenatal and other maternal health care
experiences among women with physical disabilities in the Northwest Region of Cameroon. The
sample size of respondents was 52 and these included; 24 women with disabilities, 14 Ordinary
women, 8 health workers, and 6 councilors of PWDS. The findings revealed that most
respondents reported the distance to the healthcare facilities as being among the major factor that
constraints the ability of women with disabilities to access maternal services. Respondents
indicated that the health facilities that offer maternal services are located in an area difficult to
reach by foot especially for pregnant women. Pregnancy might add a whole new challenge to
physical disabilities. So respondents rely on the public transport taxis for transportation to reach
sexual and reproductive health services, which is very challenging for them. Respondents

11
reported that the public transport is not only unfriendly for persons with disabilities, but also they
have to walk a long distance to get to the taxi station because there is no transport that operates at
a road closer to their place of residence. A few respondents indicated that even if public
transportation is available, travelling alone may be a challenge so they need someone to
accompany them to access services and if there is no one available to assist, they are not able to
access services alone.

Karamitri & Kaitelidou (2013) carried out a research on accessibility of maternal health services
to women with physical disabilities in Greece. A sample of 29 respondents participated in the
study and these included 11 health workers and 18 women with physical disabilities. The
findings revealed that health facilities often have architectural barriers that a client who is in a
wheel chair or blind cannot access or find it difficult to maneuver in the building most
government health clinics do not have ramps and elevators to accommodate wheelchairs. Also
doorways are too narrow making it difficult for persons using wheel chairs to access.

Ganle et al, (2021) carried out a study on the challenges women with disabilities face in
accessing and using maternal healthcare services in Ghana. Participants in the study comprised
of 257 expectant and lactating mothers, 15 traditional birth attendants, and 20 healthcare
providers, including community health nurses, midwives, doctors, health facility managers,
district and regional public health nurses, district and regional directors of health, and policy
makers at the Ministry of health and Ghana Health Services. The finding revealed that Several
women particularly those suffering physical and visual impairments, reported that most
healthcare facilities currently lack ramps, wheelchairs, disability-friendly delivery beds,
appropriate separate toilets for disabled persons, and personnel to assist the women climb stairs,
examination tables and delivery beds.

Lawler, et al (2013) also found out that the suspension heights on hospitals examining equipment
are too high and not adjustable making it difficult for persons with disabilities to use easily. In
addition to this, respondents stated that the nurses are impatient; they expect them to climb onto
the bed quickly. Respondents also made examples that condoms are placed in areas that 80 are
out of reach for persons in wheel chairs as a result they are sometimes reluctant to take them and
this increases the possibilities of engaging in unprotected sex.

12
Lechthaler et al, (2018) observed that the set-up of examination rooms are inaccessible for
clients with physical disabilities. In this study respondents reported difficulties in transferring to
examination tables because they are too high to reach for people with physique-related
disabilities and the service providers may not have training on how to assist clients with
disabilities or are not even willing to assist them. Women reported that the physicians believed
that a woman with a disability cannot easily access maternal health services.

Sibusisiwe (2013) conducted a study on access to sexual and reproductive health services for
women with disabilities in Durban, KwaZulu-Natal and the study findings revealed that
inaccessible health facilities and equipment at the health centers seems to be one of the biggest
barriers to access healthcare, and is mentioned by many scholars. This is particularly so for
people with physical and visual impairments. Specific barriers cited under this category include
the fact that Health Centre buildings have no ramps, toilets or latrines are inaccessible, there is a
lack of sidewalks, and elevators are non-existent or non-functional.

Mulindwa (2013) also carried study on Reproductive Health and HIV/AIDS among persons with
disabilities, Kampala, Katakwi and Rakai Districts and found out that people with physical
disabilities who use wheelchairs are denied access to such buildings or access them with
inconveniences, especially if they are unaccompanied for example they have to get off their
wheelchairs and move on the ground. He further highlights the experience of physically impaired
women who could not access the delivery ward of a major referral hospital, as it was located on
the 6th floor. The same sources highlight insufficient or absence of equipment such as adjustable
delivery beds for women giving birth, wheelchairs and personnel to assist women to climb
delivery beds and examination tables.

2.3 The possible solutions to solve problems of poor utilization of antenatal services among
women with physical disability
Proper implementation of laws by the ministry of health to ensure strict compliance of the law
and develop monitoring systems to maintain a quality standard with respect to health services for
PWDs as to the Bangladesh report (2015), the laws towards all health sectors both private and
public sectors to ensure the full provision of the environment that can be at the range of not
limiting the PWDs to access health care. Policies and legislation in that to assess the existing

13
policies and services, identify priorities to reduce health inequalities and plan improvements for
access and inclusion

The Disability Act Of Philippines Schedule 3 (2014), the accessibility by ensuring all hospitals,
maternity and diagnostic centers and medical institutions made accessible for patients with
disability, put up signs showing the directions to separate disabled facilities arrange separate
wheelchair access at every building entrance and each floor, ensure lifts in multi-storied
buildings, employ assistants in the health centers to help the disabled patients and also separate
counters for the disabled patients to avoid their being made to stand and wait in long queues to
meet the easy access of the PWDs to access

Mc Doom et al (2012), There is need to engage all the staff and service health providers into
communication of audio and also use of braille materials in hospitals and where necessary
engage in sign language therapists, these can be of hire or trained within the health centers and
reduce on the costs that may occur on those for hire, the trained personalities in braille and sign
language so that they can operate fully in the area. The training which is specialized for doctors,
hospital employees, ward boys, nurses treating the persons with disabilities. Train more sign
language experts to communicate with people with hearing and speech difficulties aimed to build
empathetic behavior and positive attitudes in the WWDs who are to receive the services

Crosson (2008) states that Undertake awareness programs about the existence of district health
centers because some of the personalities have no idea and have no information on how the
health centers operate. The awareness on entitlements of WWDs under the national policies and
disseminate information about such services and programs to enable disabled patients to make
informed decisions regarding the kind of treatment they want to receive, this is an act of
inclusion in the decision making process towards health provision in meeting their expectations
as citizens

Turton (2008) states that there should be use of financial incentives to encourage health care
providers to make services accessible and provide comprehensive assessments, treatment and
follow ups, consider options to reducing or removing out of pocked payments for PWDs who do
not have other means of financing health care services, the incentives can come from privately
owned companies, organizations (NGOs), the international unions, government, positive action

14
from various individuals to facilitate and encourage the provision of accessible health
environments to the WWDs

Shumba, (2011) Change the physical layout of clinics to provide access to people with mobility
difficulties or communicating health information in accessible formats such as braille. Empower
PWDs to maximize their health by providing information, training and peer support; this can also
be through the NGOs and the WWDs organizations in the communities. Promote (CBR) to
facilitate access for the disabled people to the existing services

Cornelly (2011) suggested that integrated living which promotes self-management by engaging
disabled people directly in the design management and delivery of services, disability politics
and community care that traditional relationship between social service departments and disabled
people had began to change as service boundaries about disability are increasingly challenged

Awareness among health workers, health planners and lay people of basic health problems about
the need for co-operation between agencies of education, agriculture, health for equal sharing of
resources, training based on locally assessed health needs like the preventive strategy. According
to Amonoo et al 1984, Recognition of the social nature of much ill health like the lack of
services for rural areas especially the WWDs. It includes recognition with alternative methods of
healthcare delivery considering improvements to be made towards access of all persons

He,Toloo, Hou & FitzGerald, (2021) incorporate disability programmes into primary health care
activities to allow integration of WWDs as indeed they are an enabling part of community health,
the kind of this system can be in coordination of welfare services in the area like medical
rehabilitation for PWDs should be enhanced and appropriate medical service could be offered
and if detected then treatment offered. The system can make it easier to access health care.

The APDDP (2003-12) visualized that since alleviation of disabilities can be expected through
improving, regenerating and complements physical sensory and organic functions of disabilities,
research and development should be promoted for surgical treatment through utilizing the
technologies of minimum invasive surgery and computer regenerative medical treatment for

15
 CHAPTER THREE
METHODOLOGY

3.0 Introduction
This chapter presents research design, area of study, study population, sampling procedure,
methods of data collection, procedure of data collection and methods of data analysis.

3.1 Research Design

A qualitative research design shall be used in the study. This design is to help a researcher to
yield more information and examine in detail sensitive issues such as sexuality, violence and
personal relations. It does not need a strict design plan before it begins, which gives the freedom
to let the study unfold more naturally and dive deeper into the problem.

3.2 Area of study

The study is to be conducted in Makindye division in Kampala district. The researcher shall
conduct the study from this area because it has very many women with physical disabilities
whose access to Antenatal care services was not clearly known and therefore the researcher
sought to investigate the experiences of women with physical disabilities in accessing Antenatal
care services.

3.3 Study participants

The study participants shall include women with physical disabilities because they are the target
population under investigation.

3.4 Sample size

The sample size of study comprised of 30 women with physical disabilities because it is very
difficult to include each and every woman with physical disability in the study.

3.5 Sampling Technique

The researcher used snow ball sampling to select participants because it may be difficult to know
the residences of women with physical disabilities. Therefore the researcher used snow ball

16
sampling to select some women with physical disabilities who provided information about where
the researcher could get other women with physical disabilities.

3.6 Methods of data collection

The researcher shall use interviews where a semi structured interview guide shall be followed in
the study.
3.6.1 Interview Guide
A semi structured interview guide is was used because of its flexibility in enabling probing
especially where specific answers are needed and where the respondent is unable to understand
the questions. It allows a two way communication and this provides viable, detailed information
of individual, personal experience from people about specific issue and helps to get in depth
information on sensitive issues.

3.7 Procedure of data collection

An introductory letter is to be obtained from the Department of Community and Disability
studies Kyambogo University after approval of a research proposal by the research supervisor.
The letter obtained shall be taken to the town clerk of Makindye division to seek permission to
conduct the study. Targeted respondents are to be met and the researcher shall make an
appointment. The respondents shall be assured of confidentiality of the information given and
their consent shall be required on whether or not to record information given during interviews.
Therefore, the researcher shall collect data, analyze it and compile a research report.

3.8 Data analysis

Data was collected through use of interviews by taking notes and recordings which were
transcribed into word processing format. Raw data obtained was edited, checked for accuracy,
consistency and completeness. It was then be coded by generating themes and sub themes
according to research objectives and backing up with quotations from respondents.

3.9 Ethical consideration

During the study, ethical principles were observed at all levels which include ensuring
confidentiality of information got from participants and participation shall purely be on voluntary
basis. No incentives were provided to any participant and no intimidations were instituted for
participants who declined to answer any or all questions.

17
Regarding risks, the participants were assured that the study might have little discomforts,
however, in case participants has an option of leaving any question that they feel makes them
uncomfortable or seeking further clarification on any issue they find confusing.

There were clear message to the participants regarding benefits that there is no any direct
benefits for them as individual participants but the information collected might be used to help
women with physical disabilities access maternal health services in Makindye division and
Kampala district at large.

18
 CHAPTER FOUR
CHAPTER FOUR: PRESENTATION OF RESULTS, AND ANALYSIS OF RESEARCH
FINDINGS

4.1 Introduction
This chapter presents the results, analysis and interprets the data. It is drawn in line with the
objectives of the study which included; Data was collected from 30 respondents and it is
presented below;
4.2 Findings on the background information
4.2.1 Age structure of the participants
Table 4.1: Age structure of the participants
Age structure Frequency Percentage (%)
18-35 yrs 22 73
36-59 yrs 5 17
60 and above yrs 3 10
Total 30 100
Source: Primary Data (2021)

From the 4.1 above, majority of the respondents 22(73%) were in the age bracket of (18-35)
years, followed by 5(17%) respondents who were in the age bracket of (36-59) years, and
3(10%) respondents were in the age bracket of 60 years and above. This means that the study
comprised of people of different ages but mostly those between 18-59 years. It can be construed
that majority of the respondents were mature and hence the information obtained from them
could be trusted and looked at as true and good representation of the information the researcher
was looking at the perspectives poor utilization of antenatal care services among women with
physical disabilities in Makindye division, Kampala district.

19
4.2.2 Religion of participants
Table 4.2: Religion of participants

Religion Frequency Percentage (%)

Muslims 3 10
Catholics 10 33
Anglicans 15 50
Adventists 2 7
Total 30 100
Source: Primary Data (2021)
From the table 4.2 above, majority of the respondents 15(50%) were Anglicans, 10(33%)
Catholics, 3(10%) were Muslims and 2(7%) were Adventist. This means that most of the
common religious sects were represented in the study and hence the data was not biased.

4.2.3 Education level of respondents

Table 4.3: Education level of respondents

Education level Frequency Percentage (%)

Certificates 8 26
Diploma 3 10
Degree 19 63
Total 30 100
Source: Primary Data (2021)
Findings from the table 4.3 show that majority of the respondents 19(63%) had acquired a
degree, 8(26%) had acquired certificates and 3(10%) had acquired a diploma. This implies that
all of the respondents at least attended school though ended at various levels; therefore their
being literate made it necessary for their participation.

20
4.2.4 Marital status of respondents
Table 4.4: Marital status of respondents

Marital status Frequency Percentage (%)

Married 20 67
Divorced 7 23
Single 3 10
Total 30 100
Source: primary data (2021)
From the 4.3 above, majority of the respondents 20(67%) were married, 7(23%) had divorced
and 3(10%) were single. The study revealed that marital status plays a significant role in
determining women’s utilization of ANC service. It was discovered that most married women
attend antenatal care regularly as compared to their counterparts the unmarried.
4.3 The causes of poor utilization of antenatal services among women physical with
disabilities

4.3.1 Kind of health services present in the health centers in Makindye Division
Family planning services
In antenatal education for women with disabilities were introduced to the concept of family
planning. All respondents had been educated about family planning in general where some
understood it as child spacing while to others it was producing few children one can manage to
look after. In an interview discussion, women with disabilities were asked how they utilized
family planning and many had a bias against it. They complained on the side effects about it
among them were causing excessive weight, loss of libido, failure to have normal periods,
prolonged bleeding among others. It was realized that basing on the complications raised many
had stopped using family planning

In an in-depth interview with Agatha this is what she said

“I lost 10kg in the fourth month I swallowed pills and I thought I had contracted
HIV/AIDS. Later when I tested thinking I was sick, the doctor told me I wasn’t. My
friends advised me that pills were the cause of this huge weight loss. Then later changed
to injector plan and gained nine kilograms in 2 months which appeared abnormal. I

21
 decided to leave both methods and now I am pregnant. An expression of Agatha about
family planning, an in-depth interview held on10th March 2021.

The presentation above shows that women with disabilities access antenatal care services
however the skills and information provided, the methods of delivery, content, participation of
pregnant women and how they are utilizing the antenatal education provided, is still wanting if
we are to improve maternal and infant health.

Care for the new born baby services

All respondents reported to have been educated about care for the new born baby by the health
worker such as wrapping the baby in dry warm clothes and starting to breast feed immediately
after birth. In many instances these are done in hospital with the help of a midwife, however
what lies ahead for the mother as she left the hospital was more challenging to pregnant women.

In an interview with Nabateesa a multigravida, this is how she narrated her experience with her
first child;

When I gave birth to my first child, everything was new to me; I feared bathing the baby
most especially the cord though the midwives were talking about it regularly in antenatal
class. I could not properly position the baby because I thought the bones would break. It
was my mother in law bathing the baby until the cord got off, an in-depth interview with
Nabateesa about care for the new born baby conducted on 9th March 2021.

It was realized that much as Nabateesa had been educated, she could not utilize the skills because
she was still fearful of practicing what she had been taught and not ready to handle and care for
the baby.

Birth plan services

A birth plan was mainly understood by pregnant women as supplies needed in a hospital during
birth. Pregnant women took the trouble to buy the required necessities when going to the hospital
for delivery as informed by the midwives. However when asked about issues like someone to
accompany them to the hospital when labor starts, a person to stay with at the hospital, and
someone to live home when going for delivery in case there are other children to look after,

22
many had no immediate answer for those questions, meaning their birth plan was not yet
complete as they still needed to plan and get those people to help them when labor starts.

“Health workers explain to us about making a birth plan such that we can prepare for
birth but sometimes we lack enough money and fail to buy and prepare all the required
necessities in time. It is also hard to know when labor will start, you might have booked
someone to escort you to hospital, but the labor pains start when that person is not
around, in such a case you have no option but to go with who-ever is around to help you
during labor and delivery. Views expressed about utilizing a birth plan in a an interview
held with pregnant women on 16th March 2021.

4.3.2 Factors that influence access to health care services in Makindye Division municipal
central division
When asked about the factors influencing access to health care services in Makindye Division
municipal central division, the following views were given; physical availability of services,
distance to the health center, economic costs as well as cultural and social factors that may
impede access and the utilization of antenatal care service by women with disabilities.

Physical availability of antenatal care education

Participants (n=15) noted that physical availability of antenatal education in hospitals is lacking
because health workers allocate limited time for antenatal health education talks concentrating
more on checkups and diagnosing. Research findings by Pell et al, (2013) attributed this to the
transition of hospitals to focused antenatal care where information is no longer provided to
pregnant women during health talks. Findings by the study clearly show that women with
disabilities receive insufficient information with no systematic procedures in place to ensure that
pregnant women receive all the relevant information on pregnancy. This makes it somehow
difficult for pregnant women to recall certain information and knowledge which could be
important during pregnancy.

Distance to the health center

Participants (n=6) asserted that women with disabilities finding difficulties in accessing antenatal
services at St. Francis hospital in Makindye came from surrounding urban areas with relatively
basic transport networks. The fact that their areas had no proper health care facility that meets

23
required standards, they had to journey the long distance to St. Francis hospital to receive
adequate antenatal information and antenatal care services as informed by health workers.

One participant indicated that;

“These lengthy journeys where women with disabilities walked for two or three hours
were associated with risks and the related tiredness, could not allow women with
disabilities to concentrate in class hence they missed out some vital information, which
meant inadequate utilization of such information in the course of their pregnancy”
Economic costs associated with utilization of antenatal care services
Participants (n=6) revealed that Charges levied for antenatal procedures add to a range of several
costs that women with disabilities have to meet when attending antenatal services reducing
utilization of the education provided in hospital. Women with disabilities had to incur transport
costs to the hospital so as to attend antenatal education; they had to pay antenatal fees in case of
those coming for the first visit; purchase a Mother to Child Health Passport and laboratory fees
for women with certain complications.

The key informant noted that:

It was observed that the mother to child health passport was used as a reference in
antenatal education and contained information about the pregnant woman and her
pregnancy health history, therefore failure to have it a pregnant woman could not fully
understand and utilize antenatal education provided.

This was also observed by (Chapman, 2003) as cited in ( Finlayson et al, 2013) in a number of
cases the practice of giving antenatal cards to pregnant women is poorly managed and has
detrimental effect on the continued access and utilization of antenatal services. Some health care
providers use the clinic card as a passport and refuse to admit laboring women to a hospital if
they don’t have one. This kind of negative reinforcement has created a situation in which
pregnant women visit an antenatal facility only once –to get a clinic card.

Social-cultural factors associated with utilization of antenatal care services

Participants (n=3) also revealed that socio-cultural belief systems, values, and practices also
shape women with disabilities’ knowledge and perception of health and illness/disease, and

24
health care seeking practices and behaviors. These shared norms guide self-care practices, access
and utilization of antenatal education by pregnant women.

Another participant indicated that the dominant patriarchal culture in Uganda where men play an
important role in determining what counts as a health care need for pregnant women; men are in
control of almost all the resources in the family. Men and women, who are often inclined to
customary beliefs, object to their wives going for antenatal care services and education especially
under skilled health providers.

4.4 The challenges faced by women physical disability in accessing antenatal services
4.4.1 What challenges do you often face when accessing these health services in the area?
When asked about the challenges faced by women physical disability in accessing antenatal
services, the following views were given

Physical proximity of antenatal care education

Participants (n=15) noted that physical proximity of antenatal education in hospitals is lacking
because health workers allocate limited time for antenatal health education talks concentrating
more on checkups and diagnosing. Research findings by Pell et al, (2013) attributed this to the
transition of hospitals to focused antenatal care where information is no longer provided to
pregnant women during health talks. Findings by the study clearly show that women with
disabilities receive insufficient information with no systematic procedures in place to ensure that
pregnant women receive all the relevant information on pregnancy. This makes it somehow
difficult for pregnant women to recall certain information and knowledge which could be
important during pregnancy.

One participant revealed that “when the transportation to the health center is not clear
or the victim him/herself cannot afford to have a transporting assistive device to the
health facility or it can be due to physical structure of the health facility and it can be
through its construction where it limits the mobility of the person to access the services
needed for their health”.

Participants (n=6) noted that the communication between the staff and the PWDs especially the
deaf patients where there is telephone communication as an instruction for physical examination,

25
Thew et al (2012) and Iezzoni et al (2004) found out that the deaf patients experience fear,
mistrust and frustration in the health settings when they experience problems with ways of
treatment which can result into incorrect diagnosis and improper treatment. The way the deaf
personalities have to understand they medication type prescribed and go on with the diagnosis it
must be done by a specialized person which is still a fail within the health centers

Another participant indicated that “health facilities don’t provide disability friendly services
making it difficult for most clients especially wheel chair users to access hospital buildings as
they lack the ramps and specialized lifts for them and more so they are not able to climb onto the
medical examination beds to attain treatment and the health service providers have no ideas to
help them out”.

Distance to the health center

Participants (n=23) asserted that women with disabilities finding difficulties in accessing
antenatal services at St. Francis hospital in Makindye came from surrounding urban areas with
relatively basic transport networks. The fact that their areas had no proper health care facility that
meets required standards, they had to journey the long distance to St. Francis hospital to receive
adequate antenatal information and antenatal care services as informed by health workers.

One participant indicated that;

“These lengthy journeys where women with disabilities walked for two or three hours
were associated with risks and the related tiredness, could not allow women with
disabilities to concentrate in class hence they missed out some vital information, which
meant inadequate utilization of such information in the course of their pregnancy”
The findings revealed that most respondents reported the distance to the healthcare facilities as
being among the major factor that constraints the ability of women with disabilities to access
maternal services. Respondents indicated that the health facilities that offer maternal services are
located in an area difficult to reach by foot especially for pregnant women. Pregnancy might add
a whole new challenge to physical disabilities. So respondents rely on the public transport taxis
for transportation to reach sexual and reproductive health services, which is very challenging for
them.

26
Another respondents reported that the public transport is not only unfriendly for persons with
disabilities, but also they have to walk a long distance to get to the taxi station because there is
no transport that operates at a road closer to their place of residence. A few respondents indicated
that even if public transportation is available, travelling alone may be a challenge so they need
someone to accompany them to access services and if there is no one available to assist, they are
not able to access services alone.

Participants (n=13) asserted that the suspension heights on hospitals examining equipment are
too high and not adjustable making it difficult for persons with disabilities to use easily. In
addition to this, respondents stated that the nurses are impatient; they expect them to climb onto
the bed quickly. Respondents also made examples that condoms are placed in areas that 80 are
out of reach for persons in wheel chairs as a result they are sometimes reluctant to take them and
this increases the possibilities of engaging in unprotected sex.

To support the findings, another participant observed that the set-up of examination rooms are
inaccessible for clients with physical disabilities. In this study respondents reported difficulties in
transferring to examination tables because they are too high to reach for people with physique-
related disabilities and the service providers may not have training on how to assist clients with
disabilities or are not even willing to assist them. Women reported that the physicians believed
that a woman with a disability cannot easily access maternal health services.

4.5 Possible solutions to solve problems of poor utilization of antenatal services among
women with physical disability

4.5.1 What can be done to improve on the access to health care service within Makindye
Division?
When asked about what can be done to improve on the access to health care service within the
Makindye Division, the following responses were raised;

Participants (n=19) revealed proper implementation of laws by the ministry of health to ensure
strict compliance of the law and develop monitoring systems to maintain a quality standard with
respect to health services for women with disabilities, the laws towards all health sectors both
private and public sectors to ensure the full provision of the environment that can be at the range

27
of not limiting the women with disabilities to access health care. Policies and legislation in that
to assess the existing policies and services, identify priorities to reduce health inequalities and
plan improvements for access and inclusion

The Disability Act Of Philippines Schedule 3 (2014), the accessibility by ensuring all hospitals,
maternity and diagnostic centers and medical institutions made accessible for patients with
disability, put up signs showing the directions to separate disabled facilities arrange separate
wheelchair access at every building entrance and each floor, ensure lifts in multi-storied
buildings, employ assistants in the health centers to help the disabled patients and also separate
counters for the disabled patients to avoid their being made to stand and wait in long queues to
meet the easy access of the women with disabilities to access

Participants (n=11) noted the need to engage all the staff and service health providers into
communication of audio and also use of braille materials in hospitals and where necessary
engage in sign language therapists, these can be of hire or trained within the health centers and
reduce on the costs that may occur on those for hire, the trained personalities in braille and sign
language so that they can operate fully in the area. The training which is specialized for doctors,
hospital employees, ward boys, nurses treating the persons with disabilities. Train more sign
language experts to communicate with people with hearing and speech difficulties aimed to build
empathetic behavior and positive attitudes in the women with disabilities who are to receive the
services

Participants (n=16) states that undertake awareness programs about the existence of district
health centers because some of the personalities have no idea and have no information on how
the health centers operate. The awareness on entitlements of women with disabilities under the
national policies and disseminate information about such services and programs to enable
disabled patients to make informed decisions regarding the kind of treatment they want to
receive, this is an act of inclusion in the decision making process towards health provision in
meeting their expectations as citizens

Participants (n=16) stated that there should be use of financial incentives to encourage health
care providers to make services accessible and provide comprehensive assessments, treatment
and follow ups, consider options to reducing or removing out of pocked payments for women

28
with disabilities who do not have other means of financing health care services, the incentives
can come from privately owned companies, organizations (NGOs), government, positive action
from various individuals to facilitate and encourage the provision of accessible health
environments to the women with disabilities

CHAPTER FIVE
CHAPTER FIVE: SUMMARY, DISCUSSION, CONCLUSION AND
RECOMMENDATIONS

5.1 Introduction
This chapter presents the summary and conclusive statements drawn from the discussion of the
findings and based on the specific objectives.

5.2 Summary of the study

Access to utilization of antenatal care services among women with physical disabilities acquaints
them with information about; pregnancy, birth, baby care and parenting skills. The education
level of women with physical disabilities, and anticipated mode of delivery as well as presence
of pregnancy complications were associated with seeking appropriate information and skills by
pregnant women in antenatal education.

It is noted that antenatal education was delivered to women with physical disabilities who
attended ANC services conducted at St. Francis hospital, Makindye division. There were several
methods used, but the group discussion method was more comfortable to pregnant women, this is
because groups facilitated participation whereby pregnant women shared experience with the
help of the facilitators. This can be attributed to the support and feedback from fellow pregnant
women during the provision of antenatal education. Groups were also time saving and cost
effective to the side of facilitators.

Learning materials and teaching aids used to deliver antenatal services to women with physical
disabilities did not create much impact because of the varying education levels of women with
physical disabilities. This is because women with physical disabilities with limited education and
no education at all, could not understand them especially where no clarifications were made by
health workers. Teaching aids used for demonstrations in antenatal classes sometimes depict

29
western culture and pregnant women usually objected to materials and teaching aids developed
for another culture.

Previous and on-going pregnancy complications prompt women to attend and participate in
utilization of antenatal services to seek advice and correct past mistakes as well as solving
current pregnancy problems. In the same way parity had an impact on pregnant women’s
attendance and participation in antenatal education to seek advice from health workers.

The utilization of antenatal care services provided to pregnant women depends on several
factors; the education level of pregnant women whereby, highly educated pregnant women are
able to access and utilize education provided in antenatal education compared to those with low
education or completely non literate.

Economic costs, social and cultural values commanded by the dominant patriarchal culture
where men control resources and decision making in homes interferes with adequate utilization
of antenatal care services by women with physical disabilities.

If access to antenatal education by women with physical disabilities is to be more effective, there
is need to derive information and skills that meet the education needs of pregnant women to
enable them address their concerns. Methods of delivering antenatal education to pregnant
women need to be appropriate so as to allow for participation of pregnant women in classes. This
can enable women with physical disabilities acquire knowledge about child birth such that they
know what to expect and do when labor starts, as well as ensuring proper care for their babies.
Failure to design appropriate information and delivering antenatal education in a way preferred
by pregnant women will not create any impact in promoting maternal and infant health. They
will not be able to make proper birth plans, detect danger signs and care for their babies, which
can adversely affect their health and the un born-baby. When antenatal education is accessed in
the right way, it can protect pregnant women from the risks and danger signs associated with
pregnancies, hence reducing on maternal and infant mortality rates.

5.3 Discussion
5.3.1 The causes of poor utilization of antenatal services among women physical disability
The study findings are in agreement with Ajaegbu (2013) who carried out a study to determine
the perceived challenges of accessing Antenatal care services by women with physical

30
disabilities in Nigeria. The survey collected information from a nationally representative sample
of 385 women with disabilities age 15-49, who had given birth in the five years. The findings
from 56.4% of the respondents noted that money to access maternal healthcare service is the
major barrier that hinders them from accessing maternal healthcare service even when they have
health complications. He said that Nigeria is a country in which most of its citizens live below
one dollar per day.

Study findings are also supported by Ibor (2012) who carried out a study to examine the
influence of economic status on utilization of maternal health care among women with physical
disabilities in Ibadan, Oyo State. They obtained data for the study through the administration of
231 copies of questionnaire to child bearing women with physical disabilities. The study findings
revealed that use of maternal health services by pregnant mothers with physical disabilities in
Nigeria is determined by their socioeconomic status in the society. Some of the barriers he found
in this study that affect the use of maternal health care by Nigerian women with disabilities
include getting permission to go for treatment, getting money for treatment, distance to health
facility, transport cost, not wanting to go alone, for fear that there may not be a female provider
or any health provider, to attend to their needs and concern that drugs may not be available. He
concluded that money for treatment is the major barrier that hinders women from accessing
maternal health care service in Nigeria. For women living in the rural areas in Nigeria,
transportation and distance to hospital are major factors affecting the use of maternal Health
services in Nigeria.

Tarasoff (2013) also found out Costs, including fees for transportation, were cited as another
barrier to access sexual and reproductive health services by women with physical disabilities and
visual impairments. Respondents indicated that each time they need services they have to pay
high transport costs as they have to hire a meter taxi to take them to the hospital or clinic or pay
for someone to accompany them.

Study findings above are in congruence with Mbuagbaw et al. (2017) who pointed out that
limited ability to pay and high hospital costs have been identified as the major barriers for the
rural poor women with disabilities wishing to access maternal services, due to economic
difficulties in rural areas women are not able to afford costs related to deliveries even if the

31
services in some places are free of charge they unable to pay for transport in case of referral or
the facility is away from home.

5.3.2 The challenges faced by women physical disability in accessing antenatal services.
The findings above are in agreement with Peters et al (2008), WHO (2013) who show that the
factors that limit women with physical disabilities access to healthcare range from physical
proximity in terms of transport that is when the transportation to the health center is not clear or
the victim him/herself cannot afford to have a transporting assistive device to the health facility
or it can be due to physical structure of the health facility and it can be through its construction
where it limits the mobility of the person to access the services needed for their health.

Findings above are also supported by UNECEF & WHO, (2015), who noted that women with
disabilities experience multiple barriers to obtaining healthcare and barriers seem to be more
profound for some types of healthcare than others. They include lack of adaptive equipment and
inaccessible environment for patients with disabilities inability to have time for patients with
speech and hearing difficulties as the health workers lack connectivity with those with hearing
impairment, no information about where to refer them for specialized healthcare thus they are
left out in the public service

Study findings are also supported by Karamitri & Kaitelidou (2013) who carried out a research
on accessibility of maternal health services to women with physical disabilities in Greece. A
sample of 29 respondents participated in the study and these included 11 health workers and 18
women with physical disabilities. The findings revealed that health facilities often have
architectural barriers that a client who is in a wheel chair or blind cannot access or find it
difficult to maneuver in the building most government health clinics do not have ramps and
elevators to accommodate wheelchairs. Also doorways are too narrow making it difficult for
persons using wheel chairs to access.

Findings are in congruence with Ganle et al, (2021) carried out a study on the challenges women
with disabilities face in accessing and using maternal healthcare services in Ghana. Participants
in the study comprised of 257 expectant and lactating mothers, 15 traditional birth attendants,

32
and 20 healthcare providers, including community health nurses, midwives, doctors, health
facility managers, district and regional public health nurses, district and regional directors of
health, and policy makers at the Ministry of health and Ghana Health Services. The finding
revealed that Several women particularly those suffering physical and visual impairments,
reported that most healthcare facilities currently lack ramps, wheelchairs, disability-friendly
delivery beds, appropriate separate toilets for disabled persons, and personnel to assist the
women climb stairs, examination tables and delivery beds.

Relatedly, Lechthaler et al, (2018) observed that the set-up of examination rooms are
inaccessible for clients with physical disabilities. In this study respondents reported difficulties in
transferring to examination tables because they are too high to reach for people with physique-
related disabilities and the service providers may not have training on how to assist clients with
disabilities or are not even willing to assist them. Women reported that the physicians believed
that a woman with a disability cannot easily access maternal health services.

5.3.3 Possible solutions to solve problems of poor utilization of antenatal services among
women with physical disability

The study findings about solutions to solve problems of poor utilization of antenatal services
among women with physical disability are in agreement with Mc Doom et al (2012), who posit
that there is need to engage all the staff and service health providers into communication of
audio and also use of braille materials in hospitals and where necessary engage in sign language
therapists, these can be of hire or trained within the health centers and reduce on the costs that
may occur on those for hire, the trained personalities in braille and sign language so that they can
operate fully in the area. The training which is specialized for doctors, hospital employees, ward
boys, nurses treating the persons with disabilities.

Relatedly, Crosson (2008) states that undertake awareness programs about the existence of
district health centers because some of the personalities have no idea and have no information on
how the health centers operate. The awareness on entitlements of PWDs under the national
policies and disseminate information about such services and programs to enable disabled
patients to make informed decisions regarding the kind of treatment they want to receive, this is

33
an act of inclusion in the decision making process towards health provision in meeting their
expectations as citizens

Study findings are in congruence with Turton (2008) who stated that there should be use of
financial incentives to encourage health care providers to make services accessible and provide
comprehensive assessments, treatment and follow ups, consider options to reducing or removing
out of pocked payments for WWDs who do not have other means of financing health care
services, the incentives can come from privately owned companies, organizations (NGOs), the
international unions, government, positive action from various individuals to facilitate and
encourage the provision of accessible health environments to the women with physical disability.

Shumba, (2011) Change the physical layout of clinics to provide access to people with mobility
difficulties or communicating health information in accessible formats such as braille. Empower
PWDs to maximize their health by providing information, training and peer support; this can also
be through the NGOs and the PWDs organizations in the communities. Promote (CBR) to
facilitate access for the disabled people to the existing services

5.3 Conclusion of the study

The utilization of antenatal care services provided to pregnant women depends on several
factors; the education level of pregnant women whereby, highly educated pregnant women are
able to access and utilize education provided in antenatal education compared to those with low
education or completely non literate.

If access to antenatal education by women with physical disabilities is to be more effective, there
is need to derive information and skills that meet the education needs of pregnant women to
enable them address their concerns. Methods of delivering antenatal education to pregnant
women need to be appropriate so as to allow for participation of pregnant women in classes. This
can enable pregnant women acquire knowledge about child birth such that they know what to
expect and do when labor starts, as well as ensuring proper care for their babies.

It‘s also found that marital status, husband‘s involvement and mother‘s knowledge about ANC
had significant relationship with regular uptake of ANC services at the health centre. However,
age of the mother, level of education, religion, employment status, gravidity, trimester of starting

34
ANC, mother‘s privacy at the health center, availability of health workers and general
cleanliness of the health centre had insignificant relationship with ANC regular uptake.

5.4 Recommendation of the study

Providers of antenatal services should be aware that women with physical disabilities attending
antenatal education have varying education levels and their pregnancy stages differ as well as
their personal pregnancy problems. Although the group study was widely welcomed by women
with physical disabilities and midwives, there is need to put in mind what group size is
manageable in terms of learning because larger numbers are difficult to control, cost more and
can inhibit contributions from less confident pregnant women. Providers of antenatal services
need to be aware that handling women with physical disabilities with written materials like the
Mother Child Passport alone may not be useful. When written materials are used, they need to be
written at a simpler level than they are now and should be tested as to whether they actually
communicate the information in a comprehensible way.

The government should also provide enough of the materials and other requirements like drugs,
vaccines so that mothers easily access them than telling them to buy because some mothers may
not have enough money.

The already available policies and guidelines concerning antenatal care education utilization
should be put in place because there is a very critical policy gap especially in early starting of
antenatal care visits.

More emphasis should be put on educating and sensitization of men on the importance of ANC
visits through these men would work hand in hand with their wives to see that they at least finish
the four visits, they would support their wives financially to access ANC services and also they
would go with their wives for these services especially testing for some diseases such as
HIV/AIDS, sickle cells to stop the spread of these diseases to the baby.

The intervention programs should try improving the level of education among women and their
husbands to higher to increase the level of antenatal health care utilization among pregnant
mothers in Makindye division. This is because education level among women revealed a positive
relationship with the utilization of antenatal health care. This increases their chance of becoming
employed in different high income earning ventures. The increase in income level enables them

35
to offer financial support to their wives for example in facilitating transport costs to health
facilities payments for tests and required drugs.

The health care providers at all levels should provide the Information Education and
Communication to pregnant mothers house hold heads and the entire community about the
available antenatal health care services concerning where and when to get them and their
importance regarding the pregnant mother and the baby's health. This can be done through mass
media awareness campaigns on radios, televisions, community meetings and songs directly
stipulating the advantages of attaining the services

5.5 Areas of further research

From this study, further research should be made to assess the reasons as to why some men in all
the rural areas of Uganda and other areas including the urban ones do not want to take part in
ANC services and they are referring to them as a role for only women.

36
 REFERENCES

Ajaegbu (2013) Determinants of Antenatal Healthcare Utilization by Pregnant Women in Third

Trimester in Peri-Urban Ghana, Journal of Tropical Medicine, Volume 2018 (2018),
Article ID 1673517, 8 pages
Alenoghena, I.O., Isah, E.C., Isara, A.R. (2015) maternal health services uptake and its
determinants in public primary health care facilities in Edo state, Nigeria. Niger Postgrad
Med J; 22(1):25–31.
Asiimwe.K.J, (2010), Utilization of antenatal services among adolescents in Western Uganda.
(n.d.).
Atuyambe.L, (2005), Experiences of Pregnant adolescents-voices from Wakiso district, Uganda:
African Health. (n.d.).
Babalola, S. and Fatusi, A. (2009) Determinants of Use of Maternal Health Services in Nigeria-
Looking Beyond Individual and Household Factors, BMC Journal of Pregnancy and
Childbirth; 9(1):43.
Byamugisha, et al (2011) Male partner antenatal attendance and HIV testing in eastern Uganda: a
randomized facility-based intervention trial. J Int AIDS Soc, 14: 43-10.1186/1758-2652-
14-43
Ganle, et al (2015). Socio-cultural Barriers to Accessibility and Utilization of Maternal and
Newborn Healthcare Services in Ghana after User-fee Aboli-tion. International Journal of
Maternal and child health. 3. 1-14
Groce (2009) Determinants of Focused Antenatal Care Uptake among Women in TharakaNithi
County, Kenya, Advances in Public Health, 2017 (2017), Article ID 3685401, 4 pages.
Gulema, H. and Berhane, Y. (2017) Timing of First Antenatal Care Visit and its Associated
Factors among Pregnant Women Attending Public Health Facilities in Addis Ababa,
Ethiopia, Ethiop J Health Sci, 27(2): 139-149

37
He, et al (2021) Qualitative study of patients' choice between public and private hospital
emergency departments. Emergency Medicine Australasia, doi: 10.1111/1742-
6723.12530
Kagawa, et al, D. (2012) The scale of faith based organization participation in health service
delivery in developing countries: systematic [corrected] review and meta-analysis. PLoS
ONE7,e48457.
Kanyangarara et al (2017). Quality of antenatal care service provision in health facilities across
sub-Saharan Africa: Evidence from nationally representative health facility assessments.
Journal of Global Health.7 (2)
Kawungezi, P.C., et al. (2015) Attendance and Utilization of Antenatal Care (ANC) Services:
Multi-Center Study in Upcountry Areas of Uganda. Open J Prev Med;5(3):132–42.
Kebede, et al (2013) Use of previous maternal health services has a limited role in the attendance
for skilled institutional delivery: cross-sectional survey in Northwest Ethiopia. Intern J
Women’s Health; 5:79–85.
Lechthaler et al (2018).Bottlenecks in the provision of antenatal care: rural settled and mobile
pastoralist communities in Chad.Trop Med Int Health. 23(9):1033-1044
Mbuagbaw et al (2015). Health system and community level interventions for improving
antenatal care coverage and health outcomes.Cochrane Database Syst Rev. 1;
(12):CD010994.
Ministry of Health, (2010) Uganda Clinical Guidelines: antenatal care. 2010, 325-Revised first
edition;
National institute of statistics of Rwanda, (2021) Fourth Population and Housing Census
(RPHC). 2021.
Oyerinde, K., Harding, Y., Philip, A., Garbrah-Aidoo, N., Kanu, R., Oulare, M., Shoo, R. and
Daoh, K. (2012) Barriers to Uptake of Emergency Obstetric and Newborn Care Services
in Sierra Leone: A Qualitative Study. J Commun Med Health Educ, 2 (5): 1-8.
Perumal, N., Cole, D.C., Ouedraogo, HZ., Sindi, K., Loechl, C., Low, J., Levin, C., Kiria, C.,
Kurji, J. and Oyunga, M. (2013) Health and nutrition knowledge, attitudes and practices
of pregnant women attending and not-attending ANC clinics in Western Kenya: A
crosssectional analysis. BMC Pregnancy Childbirth, 13: 146-150.

38
Rahman, M., Islam, R. and Rahman, M. (2010) Antenatal care seeking behaviour among slum
mothers. A Study of Rajshahi City Corporation, Bangladesh.SQU Med J; 10:50-6.
Rashid, M. (2014) Socio-economic position as a determinant of maternal healthcare utilization: a
population-based study in Namibia.
Sanjel, S., Ghimire, R., and Pun, K. (2012) Antenatal care practices in Tamang community of
hilly area in central Nepal. Kathmandu Univ Med.; 9: 57-61.
Santon, C., Blanc, A.K., Croft, T. and Choi, Y. (2007) Skilled care at birth in the developing
world: progress to date and strategies for expanding coverage.J Biosoc Sci.; 39(1):109–
20.
Serizawa, A., Ito, K., Algaddal, A.H. &Eltaybe, R.A.M. (2014) Cultural perceptions and health
behaviors related to safe motherhood among village women in Eastern Sudan:
Ethnographic study. International Journal of Nursing Studies 51(4): 572–81.
Shiferaw, S., Spigt, M. and Godefrooi, M. (2013) Why do women prefer home births in
Ethiopia? BMC Pregnancy Childbirth; 13:5.
Simkhada, B. Van Teijlingen, E.R., Porter, M. and Simkhada, P. (2008) ―Factors affecting the
utilization of antenatal care in developing countries: systematic review of the literature,‖
Journal of Advanced Nursing, 61(3); 244–260.
Srivastava A, Mahmood S, Mishra P, Shrotriya V. (2014) Correlates of maternal health care
utilization in rohilkhand region, India. Ann Med Health Sci Res; 4(3):417–25.
Sudhakaram, V. (2014) Institutional deliveries in India: A socio-economic and cultural view.
Sutton, J., He, M., Despard, C. and Evans, A. (2007) Barriers to breastfeeding in a
Vietnamese community: a qualitative study. Can J Diet Pract Res, 68 (4): 195-200.
Tawiah, (2011), maternal health care in five sub-Saharan African countries, Regional Institute
for Population Studies-University of Ghana, Legon; African Population Studies. (n.d.).
Thiam, S., Kimotho, V. and Gatonga, P. (2013) Why are IPTp coverage targets so elusive in sub-
Saharan Africa? A systematic review of health system barriers.Malar J., 12(1): 353-360.
Titaley, C.R., Cynthia, L. and Peter, H. (2010) Why don’t some women attend antenatal and
postnatal care services? A qualitative study of community members’ perspectives in
Garut, Sukabumi and Ciamis districts of West Java Province, Indonesia. BMC Pregnancy
Childbirth;10:61.

39
Tunçalp, Ö., Were, W.M., MacLennan, C., Oladapo, O.T., Gülmezoglu, A.M. and Daelmans, B.
(2015) Quality of care for pregnant women and newborns-the WHO
vision.BJOG.;122(8):1045–1049.
Tweheyo, R., Konde-Lule, J., Tumwesigye, N.M. and Sekandi, J.N. (2010) Male partner
attendance of skilled antenatal care in peri-urban Gulu district, Northern Uganda. BMC
Pregnancy Childbirth, 10: 10-53.
Tweheyo, R., Konde-Lule, J., Tumwesigye, NM. and Sekandi, JN. (2010) Male partner
attendance of skilled antenatal care in peri-urban Gulu district, Northern Uganda. BMC
Pregnancy Childbirth, 10: 53-10.1186/1471-2393-10-53.
UBOS, (2014) The population of the Regions of the Republic of Uganda and all Cities and
Towns of more than 15,000 Inhabitants, Citypopulation. De Quoting, Uganda Bureau of
Statistics (UBOS). Ministry of Statistics.
UBOS, (2014)"The Population of the Regions of the Republic of Uganda And All Cities And
Towns of More Than 15,000 Inhabitants". Citypopulation.de Quoting Uganda Bureau of
Statistics (UBOS).
UNICEF, (2015) Monitoring the situation of Women and children, Trends in accessing antenatal
care, WHO.
UNICEF, (2015) Trends in accessing antenatal care, WHO.
UNICEF, (2017) Monitoring the situation of Women and children, Trends in accessing antenatal
care, WHO.
Wanyenze, et al (2013) Trends in antenatal care attendance and health facility delivery following
community and health facility systems strengthening interventions in Northern Uganda,
BMC Pregnancy and Childbirth; 13:189.
WHO, (2014c) Adolescents: Health risks and solutions; Geneva, WHO.
WHO, (2015) Adolescents: Health risks and solutions; Geneva, WHO.
Yuba Raj Paudel, Trishna Jha and Suresh Mehata. (2017) Timing of First antenatal care and
inequalities in early initiation of ANC in Nepal; 5:242

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 APPENDICES

APENDIX I: INTERVIEW GUIDE FOR WOMEN WITH PHYSICAL DISABILITY

Dear Respondent,
I am, Imienu Charity Specioza a student of Kyambogo University undertaking a Bachelor of
Bachelor’s of Community Development and Social Justice. I am undertaking a research titled
“The factors influencing poor utilization of antenatal care services among women with physical
disabilities in Makindye division, Kampala district”. The interview provides a set of structured
questions seeking responses on the topic as provided. Please be as objective as possible in filling
this questionnaire. All responses provided will remain confidential; and will be used purely for
academic purposes.
1. Please tell me about yourself, (choose from the brackets)

A. Age………………… (18-65)

B. Marital status………………….(Single, Married, Divorced)

C. Religion…………………………. (Catholics, Anglican, Muslim, Others specify)

D. Level of education acquired……………………(Primary, Secondary, Tertiary

) E. Type of disability

…………………………………………………………………………...

2. What kind of health services are present in the health centers in Makindye Division municipal
central division (WWDs)

…………………………………………………………………………………………………
…………………………………………………………………………………………………

What kind of health services do you usually need from the health centers of the central division?
…………………………………………………………………………………………………
…………………………………………………………………………………………………

i
What are some of the factors that influence you to access health care services in Makindye
Division?

………………………………………………………………………………………………
………………………………………………………………………………………………

Kindly tell me what kind of experiences do you go through when accessing those health care
services in Makindye Division?

…………………………………………………………………………………………………
…………………………………………………………………………………………………

What challenges do you often face when accessing these health services in the area?

………………………………………………………………………………………………
……………………………………………………………………………………………....

As a WWD, What you think can be done to improve on the access to health care service within
the Makindye Division?

………………………………………………………………………………………………
………………………………………………………………………………………………

What achievements have you gained from the service providers?

………………………………………………………………………………………………
………………………………………………………………………………………………

THANK YOU FOR YOUR COOPERATION

ii
 APENDIX II: INTERVIEW GUIDE FOR HEALTH CARE SERVICE PROVIDERS

Dear Respondent,
I am, Imienu Charity Specioza a student of Kyambogo University undertaking a Bachelor of
Bachelor’s of Community Development and Social Justice. I am undertaking a research titled
“The factors influencing poor utilization of antenatal care services among women with physical
disabilities in Makindye division, Kampala district”. The interview provides a set of structured
questions seeking responses on the topic as provided. Please be as objective as possible in filling
this questionnaire. All responses provided will remain confidential; and will be used purely for
academic purposes.

1. Please, tell me about yourself (choose from the brackets)

A. Age……………. (25-50)

B. Profession, ………………………. (Doctor, Nurse, Nursing assistants. others specify)

C. Marital status, ………………………………. (Single, Married, Divorced)

D. Religion, …………………………… (Catholics, Anglican, Muslim, Others specify)

E. Level of education,………………………… (Primary, Secondary, Tertiary)

2. What type of health care services is offered to WWDs in Makindye Division health centers?

………………………………………………………………………………………………
………………………………………………………………................................................

What kind of factors do you think influences WWDs to access health care services in the area as
you mentioned?

…………………………………………………………………………………………

4. What are some of the experiences WWDs face when accessing these health care services?
………………………………………………………………………………………………
………………………………………………………………………………………………

iii
5. What are the challenges you face when dealing with WWDs while giving them health services
they need

………………………………………………………………………………………………
………………………………………………………………………………………………

6. As a health service provider, what do you think can be done to improve on the accessibility of
PWDs to health care services?

…………………………………………………………………………………………
…………………………………………………………………………………………

7. What are some of the achievements gained working with WWDs?

…………………………………………………………………………………………
……………......................................................................................................................

THANK YOU FOR YOUR COOPERATION

iv