Exploring Access to Perinatal Care Services for Women with Physical Disability in Rural Ethiopia: A Qualitative Case Study

Abstract

Background: Globally, women with physical disability face barriers to perinatal care, despite efforts to promote inclusive services. Stigma, ableist attitudes, and inaccessible facilities are common, particularly in countries like Ethiopia. These challenges are more severe in rural areas, where distance and poor infrastructure restrict access. However, most research in Ethiopia focused on urban settings, leaving the experiences of rural women with physical disability largely unexplored. Understanding these experiences is essential for designing context-specific, inclusive perinatal care strategies. Purpose: The aim of this dissertation was to explore how women with physical disability access perinatal care services at primary health care units in East Dembia woreda, a rural setting in Ethiopia. Methodology: I used Stake’s instrumental case study approach within a constructivist paradigm. Intersectionality theory guided the analysis, while Levesque’s health care access framework used to conceptualize access to perinatal care. East Dembia woreda served as a single case. Data collection involved semi-structured interviews with twelve women with physical disability, seven perinatal care providers, and five close individuals of the women. Additional data were gathered through document reviews and health facility observations. Reflexive thematic analysis and data triangulation were used to develop key themes. Result: There were three main themes and seven sub-themes. The main themes included: 1) Journeys to motherhood: Reactions, community perceptions, and information sources influence motherhood for women with physical disability; 2) Navigating the physical environment: The challenges of travelling to the health centers and the lack of convenient infrastructure in the facilities; and 3) Exploring perinatal care services in primary health care units. These themes reflected the complex process of accessing perinatal care, which was influenced by intersecting positionalities like gender, disability, marital and economic status, rurality and socio-cultural context. Conclusion: Reforms are needed to ensure equity and inclusivity for women with physical disability to access perinatal care in rural Ethiopia. Key priorities include constructing accessible infrastructure, providing affordable transportation, offering disability-inclusive training for health care providers, and educating communities to reduce stigma. Implementing these changes will enhance perinatal care quality and contribute to improved access to health care.