Disabled women's maternal and newborn health care in rural Nepal: A qualitative study Joanna Morrison, PhD, MSc (Dr) a,n , Machhindra Basnet, MPH (Researcher) b , Bharat Budhathoki, MA (Researcher) b , Dhruba Adhikari, MA (Researcher) b , Kirti Tumbahangphe, MSc (Researcher) b , Dharma Manandhar, MBBS, DCH, MRCP (Dr) b , Anthony Costello, MA MB BChir FRCP, FRCPCH FMedSci (Professor) a , Nora Groce, PhD (Professor) c a Institute for Global Health, University College London, 30 Guildford Street, London WC1N 1EH, UK b MIRA, PO Box 921, Thapathali, Kathmandu, Nepal c Leonard Cheshire Disability and Inclusive Development Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK article info Article history: Received 13 November 2013 Received in revised form 18 March 2014 Accepted 22 March 2014 Keywords: Disability Neonatal Equity Quality Access Respectful care abstract Objective: there is little evidence about disabled women's access to maternal and newborn health services in low-income countries and few studies consult disabled women themselves to understand their experience of care and care seeking. Our study explores disabled women's experiences of maternal and newborn care in rural Nepal. Design: we used a qualitative methodology, using semi-structured interviews. Setting: rural Makwanpur District of central Nepal. Participants: we purposively sampled married women with different impairments who had delivered a baby in the past 10 years from different topographical areas of the district. We also interviewed maternal health workers. We compared our findings with a recent qualitative study of non-disabled women in the same district to explore the differences between disabled and non-disabled women. Findings: married disabled women considered pregnancy and childbirth to be normal and preferred to deliver at home. Issues of quality, cost and lack of family support were as pertinent for disabled women as they were for their non-disabled peers. Health workers felt unprepared to meet the maternal health needs of disabled women. Key conclusions and implications for practice: integration of disability into existing Skilled Birth Attendant training curricula may improve maternal health care for disabled women. There is a need to monitor progress of interventions that encourage institutional delivery through the use of disaggregated data, to check that disabled women are benefiting equally in efforts to improve access to maternal health care. & 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/). Introduction Disabled persons are estimated to constitute 15% of the world's population and a disproportionate percentage of the world's poor (WHO and The World Bank, 2011; Hosseinpoor et al., 2013; Mitra et al., 2013). Their inclusion in development efforts is essential for the attainment of the Millennium Development Goals (MDGs), but tracking progress among disabled people is difficult as disaggre- gated data are often unavailable (WHO and The World Bank, 2011). Equity analyses of MDG targets for maternal and child health have been useful in highlighting inequalities in access to life saving interventions between rich and poor (Barros et al., 2012), and there is little evidence regarding the access of disabled women to reproductive health services in low income countries. There is also a paucity of research that asks disabled women themselves about their experiences and opinions about the maternal health services they receive. We present qualitative findings from research to explore disabled women's maternal and newborn health care in rural Nepal. Our research partnership of the Institute for Global Health, University College London (UCL), and MIRA Nepal has been testing the impact of community-based interventions on maternal and Contents lists available at ScienceDirect journal homepage: www.elsevier.com/midw Midwifery http://dx.doi.org/10.1016/j.midw.2014.03.012 0266-6138/& 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/3.0/). n Corresponding author. E-mail address: Joanna.morrison@ucl.ac.uk (J. Morrison). Please cite this article as: Morrison, J., et al., Disabled women's maternal and newborn health care in rural Nepal: A qualitative study. Midwifery (2014), http://dx.doi.org/10.1016/j.midw.2014.03.012i Midwifery ∎ (∎∎∎∎) ∎∎∎–∎∎∎