Table 2 General characteristics of included studies

Barr et al. [55]

United States

N = 42

Physical, sensory and intellectual impairments

WWD

Focus group interviews (n = 6)

To identify barriers to mammography screening among women with different disabilities

Four themes:

1. Access

2. Beliefs

3. Social supports

4. Comfort/accommodations

Barriers: Lack of physical and economic access, skepticism about mammography and vulnerability while receiving care, lack of Sufficient support from people and the facilities, physical discomfort, communication issues, the stress and burden of thinking about arranging for a mammogram

5

Magasi and Hammel [31]

United States

N = 19

Physical impairment

WWD Healthcare providers

Individual interviews and Focus group interviews

To explore women with disabilities’ perceptions of their lived experiences in nursing homes

Five themes:

1. Lost choice, control, and occupational engagement

2. Social isolation

3. Social control

4. The political economy of the nursing home

5. Active resistance

Barriers: Loss of valued occupations and life roles , social isolation, isolation, poverty, lack of affordable and accessible housing, and loss of control, the economic subsequent treatment.motivation in the nursing home industry

4

Lezzoni, Klibridge and Park [79]

United States

N = 20

Physical impairment

WWD

Individual interviews

To explore the perceptions of breast cancer patients with mobility impairments of the physical accessibility of health care equipment and facilities

Three themes:

1. Inaccessible Equipment

2. Access Difficulties

3. Policies and Procedures

Barriers: Inaccessible mammography equipment, examining table, radiation therapy equipment, weight scale, Difficulty positioning while standing and lying down, Inaccessible office doors, equipment are not available when patients come for appointment, Staff injuries while transferring patients,

5

McIlfatrick et al. [42]

UK

N = 18

Intellectual impairment

Healthcare providers

Individual interviews and Focus group interviews

To explore the role of healthcare professionals on supporting women with intellectual disability to access breast screening in one region in the UK

Three themes:

1. Knowledge and awareness of breast cancer and breast screening

2. Role in supporting women with intellectual disability

3. Perceived barriers to women with intellectual disability accessing breast screening services

Barriers: Personal aspects: women’s cognitive deficits, communication and level of understanding, mobility and physical health of women, consent for the procedure and subsequent treatment

Lack of carer support, negative carer attitudes, transport and waiting time, healthcare staff’ lack of awareness of intellectual disability

4

Truesdale-Kennedy et al. [46]

UK

N = 19

Intellectual impairment

WWD

Individual semi structured interviews

To understand breast cancer and experiences of breast mammography among women with an intellectual disability

Four themes:

1. Women’s understanding of breast cancer

2. Women’s experiences of breast mammography

3. Perceived barriers to attendance

4. Perceived solutions to barriers

Barriers: Limited knowledge around cancer, the signs and symptoms

Lack of information, lack of understanding about the breast screening procedure

Feeling of fear, anxiety and embarrassment

5

Gibson and Mykitiuk [80]

Canada

N =  74

Physical, sensory, intellectual, and/or psychiatric impairment

WWD

Focus group interviews (n = 11)

To examine whether the fundamental human rights to physical, social, and psychological health are being upheld in Canada for disabled women

Three themes

1. Labyrinthine health service ‘systems,’

2. Assumptions, attitudes, and discriminatory practices

3. Inadequate sexual health or reproductive services and supports

Barriers: Disconnected services

Lack of communications between of NGOs

Lack of coordination between policies and programs

Problems to receive financial Assistance and eligibility

Erroneous assumptions about capacities and abilities of PWD

5

Morrison et al. [57]

Nepal

N = 27

Physical, sensory, and intellectual impairment

WWD

Semi-structured interviews

To explore disabled women's experiences of maternal and newborn care in rural Nepal

Four themes:

1. Lack of awareness

2. Experience of care

3. Normalcy of pregnancy and home delivery

4. Embarrassment

Barriers: Feeling of shame and embarrassment as a barrier to care seeking and antenatal check-up, lack of awareness about the services available, Being rude, unkind and impolite to WWD, difficulty with communication to WWD, difficulties with the infrastructure and equipment

4

Peters and Cotton [81]

Australia

N = 12

Physical impairment

WWD

Individual semi structured interviews and telephone Interviews

To explore the experiences of breast cancer screening for women with physical disabilities

Four themes:

1. Feeling I’m not in control

2. Being ignored and not listened to

3. Being helpless, alone and afraid

4. Pain, torture and humiliation

Barriers: lack of control and sense of powerlessness, lack of consultation and/or notification, unfamiliar and unfriendly healthcare environment, feeling isolated and ignored, feelings of pain and being tortured

4

Bradbury-Jones et al. [43]

Scotland

N = 5

Physical, sensory, intellectual, and psychiatric impairment

WWD

Individual interviews

To identify how women approach maternity care services, their expectations of services and whether they are able to get the type of care that they need and want

Four themes:

1. Attitudes

2. Knowledge

3. Social norms

4. Perceived control

Barriers: Unfamiliar biomedical jargon, Lack of information or incorrect information, lack of knowledge about health services and their provider, negative past experiences, societal misconceptions about disability and domestic abuse, respecting women’s choices and preferences, lack of involvement in care decisions, fear of disclosure

4

Bradbury-Jones et al. [49]

Scotland

N = 45

NA

Healthcare providers

Focus group interviews (n = 7)

To identify the priority areas for improving access to maternity services for women with disabilities

Two themes:

1. Awareness

2. Disclosure

Barriers: Understandings and awareness of disability and domestic abuse, fear of disclosure among women and professionals

3

Lee et al. [44]

Philippines

N = 32

NA

Healthcare providers

In-depth interviews and Focus group interviews

To examine service providers’ perceptions of disability and their experiences providing sexual and reproductive health services to women with disability.

Five themes:

1. Perceptions of disability, Understanding of the SRH needs and rights of WWD

2. Understanding of violence against WWD

3. Perceptions of barriers to SRH services for WWD

4. Capacity of service providers

5. The role of family

Barriers: Limited awareness, inadequate understanding of women’s rights, little training in relation to disability, limited access to the human and financial resources, negative attitudes, inappropriate behaviors, communication difficulties, stigma, financial dependence, violence or abuse

3

Neille and Penn [51]

South Africa

N = 30 (Female:15, Male:15)

Physical, sensory, psychiatric and intellectual impairment

WWD

Individual semi-structured interviews

To explore barriers to policy implementation and service provision experienced by persons with disabilities living in a rural context

Three themes:

1. Increasing mortality rates

2. Violence

3. Corruption and lack of transparency in government policies and practices

Barriers: Physical Dependence

Loss of Friendship

Feeling of isolation

Difficulties with accessing health, information, education, employment

3

Ganle et al. [45]

Ghana

N = 72

Physical and sensory impairment

WWD

In-depth semi-structured interviews

To explore the challenges women with disabilities encounter in accessing and using institutional maternal healthcare services

Two themes:

1. Desire for children and experiences with pregnancy and childbirth

2. Challenges to maternal healthcare access

Barriers: Mobility problems , limited support, Unfriendly healthcare infrastructure, providers’ insensitivity, Communication problems, lack of knowledge, negative attitudes of service providers

4

Coffey et al. [53]

United States

N = 33 (Female:16 , Male:17)

Physical impairment

WWD

Individual semi-structured interviews

To identify preferred sources of health information and services for persons with physical disability and discover how accessibility could be improved

Four themes:

1. Information sources

2. Medical sources

3. Support groups

4. Access

Barriers: Lack of Internet access

Finding credible sources

Understandability

Time constraints

Cultural appropriateness

4

Mitra et al. [82]

United States

N = 25

Physical impairment

WWD

Individual semi-structured interview

To examine unmet healthcare needs during and around the time of pregnancy among a sample of women with physical disabilities

Three themes:

1. Clinician knowledge and attitudes

2. Physical accessibility of health care facilities and equipment

3. Need for information related to pregnancy and postpartum supports

Barriers: Lack of information within the gynecologist community, being viewed as asexual, incapable of bearing children, and being a mother, unwillingness to help WWD, inaccessible medical offices and equipment, having difficulty being in the wheelchair, inaccessible hospital rooms, receiving very little information about prenatal care, postpartum supports and interaction of disability and pregnancy

4

Peters and Cotton [50]

Australia

N = 12

Physical impairment

WWD

In-depth interviews and telephone interviews

To explore barriers in breast cancer screening for women with physical disability

Four themes:

1. Environmental barriers

2. Structural barriers

3. Process barriers

4. System change

Barriers: Difficulties with access to breast cancer screening facilities, lack of lifts and ramps, the inflexibility of the machine, problems with dignity and respect, inadequate education and training

4

Tarasoff [48]

Canada

N = 13 WWD

Physical impairment

WWD

In-depth interviews

To identify the perinatal care experiences and outcomes of women with physical disabilities in one Canadian province

Five themes:

1. Inaccessible care settings

2. Negative attitudes

3. Lack of knowledge and experience

4. Lack of communication and collaboration among providers

5. Misunderstandings of disability and disability-related needs

Barriers: Difficulty with finding information, lack of communication and collaboration among providers, inability to be pregnant , inaccessible assistive devices, inaccessible perinatal care settings, feelings of anxiety during pregnancy, lack of knowledge and experience, lack of understanding of disability and disability related needs, being uninterested in consulting

3

Mitra et al. [39]

United States

N = 14

Physical impairment

Healthcare Providers

semi-structured telephone interviews

To explore the maternity care experiences of women with physical disabilities

Four themes:

1. Practitioner level clinical

2. Practice level system level

3. Lack of scientific evidence

Barriers: Unwillingness to provide care

Problems with office equipment like adjustable exam tables

Time limits, Insurance reimbursement policies

Lack of disability specific clinical information and data on the interaction of disability and pregnancy, lack of maternity practice guides, lack of training, and education

5

Dean et al. [54]

India

N = 22

Physical impairment

WWD

individual In-depth interviews

To explore commonality and heterogeneity in the experiences of disabled women in relation to their sexual and reproductive needs and rights

Two themes:

1. Decision making

2. Sexual and reproductive health service use

Barriers: Awareness and perceived need, autonomy in decision making, fear of poor treatment in state-run facilities, the derogatory language of medical staff, lack of money to pay for private care, negative behaviors, Physical accessibility challenges,

3

Methley et al. [56]

UK

N = 24 (F: 19 , M: 5) People with MS

N =  34 (F: 28 , M: 6) Healthcare professionals

Physical impairment

WWD Healthcare providers

individual Semi-structured interviews

To explore perspectives and experiences of people with MS and healthcare professionals of UK healthcare services for MS

Three themes:

1. Access

2. Interpersonal interactions

3. Continuity of care

Barriers: Identification of candidacy, navigation, permeability, adjudications, appearances at health care services, Offers and resistance, operating conditions (Local structural and financial influences on service provision)

5

Malouf et al. [32]

UK

N =  9

Intellectual impairment

WWD

In-depth semi-structured interviews

To explore the lived experiences of pregnancy, childbirth, prenatal and postnatal care and services received by this women with learning disability

Four themes:

1. I hate being treated differently

2. I find it harder to understand than other people

3. We’ve had to prove ourselves

4. Make sure you’ve got very good support around you

Barriers: Disrespectful attitudes and denial of choice, problem with understanding of normal care, the lack of needed written information, problem with verbal communication, negative reactions from the members of the family, and Being judged by professionals, discrimination to safeguard their children

4

Schildberger et al. [40]

Austria

N = 10

Physical and sensory impairment

WWD

In-depth individual, semi-structured interviews

To examine the experiences of women with mobility or sensory impairments with regard to pregnancy, childbirth and the puerperium in Austria

Three themes:

1. Social networks

2. Self-efficacy and self-awareness

3. Communication, transparency and information

Barriers: discriminatory attitudes, lack of support and lack of confidence, Anxiety, uncertainty and awkwardness, lack of verbal or non-verbal communication, inadequate information about per partum care, lack of knowledge

5

Soltani et al. [41]

Iran

N = 50

Physical and Intellectual impairment

WWD Healthcare providers Policy makers

individual Semi-structured interviews

To identify cultural barriers in access to healthcare services for people with disability in Iran

Three themes:

1. Personal barriers

2. Structural barriers

3. Social barriers

Barriers: Providers’ Reluctance to provide health services, to humiliate PWD when receiving health care, Misconceptions about disability, discrimination towards disability

3

Gartrell et al. [30]

Cambodia

N = 33

Physical, sensory and Intellectual impairment

WWD

In-depth interviews and Focus group interviews (N = 1)

To provide foundational understanding of persons with disabilities’ current sexual and reproductive health care and needs and to inform future project Interventions

One theme:

1. Access

Barriers: Lack of physical, communicative and financial access, low access to information

3