Introduction
Medical, demographic, and sociocultural shifts require adjustments of health systems to respond to the specific health needs of women with physical disabilities (WPD).
Whereas in the past women with WPD were seen by society as “sexually unattractive” and stigmatised, recent advances in medicine and non-discrimination policies have empowered WPD to participate normally in daily life. Currently, WPD do not receive the same quality of ObGyn care as non-disabled women (1). Many health systems, including those in high-income countries, are struggling to cope with the health needs of the steadily growing number of WPD (2). Services on reproductive health are not routinely provided to WPD as part of standard obstetric and gynaecological (ObGyn) health care. Thus, WPD are less likely to receive preventive measures (e.g. pelvic exams, PAP smears, mammograms), and counselling on family planning (e.g., contraception, infertility treatment), pregnancy and menopause (3, 4).
Disabilities vary significantly and while some health conditions associated with disabilities result in poor health and extensive health care needs, others do not. Thus, services need to be specifically tailored to individuals’ health needs. For example, women with neurological disorders, such as SCI, commonly suffer from motor and sensory impairments (5). Due to the effects of such impairment (e.g. temperature dysregulation, neurogenic bowel and bladder, altered sexual response), women with SCI may experience greater severity of symptoms (e.g. vaginal dryness or increased risk for osteoporosis) or need tailored medications (6). Thus, WPD require proper life stage adjusted services and an interconnected health system for effective disability management. Improving the process of care for women with an SCI during their reproductive lifespan should lead to improvements in many other conditions and lifespan needs as well. However, if left unmanaged, adverse health outcomes could exacerbate existing co-morbidities.
Currently, information from national surveys is not properly disaggregated by disability status (7). Thus, nationally representative information related to reproductive health care for WPD (e.g. maternity care) is lacking. The Swiss Spinal Cord Injury Cohort Study (SwiSCI) (8) offers such data and the unique opportunity to study the reproductive health and care of WPD. This is important since, individuals with SCI constitute a highly representative group of people living with physical disabilities. The aim of this study was to describe a cohort of WPD (specifically, with SCI) in various reproductive life stages to support the development of specific management targets, especially during the fertile life stage.
Methods