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