 Now we are reaching to our presentation today. Our presenter, his name is Bociano Kawabanga. He is a specialist, a public health specialist with interest in inclusive practice. He is a BHEG, Disability Studies student at the University of Cape Town, South Africa. His BHEG thesis is entitled The Mixed Experience of Breakdown Tournament with Physical Disabilities in Accessing and Utilizing Antinatal Care Services in rural southwestern Uganda. Currently, Bociano is a lecturer in Cambridge University, Uganda. His research is interested in sexual and reproductive and right. Bociano is a maternal and child-salesable motion, a specialty. When you turn the lecture, he is a medical clinical officer and half 15 years of his experience. He's also a medical officer in charge of BTOA Health Center. Bociano also is one of the four members technical team that developed as a community development officer of manual for integration of sexual and reproductive health, young people and women, in HIV health revision in the community development labor and the social development in Uganda. He is a registered medical practitioner and the member of the a light health professional in Ministry of Health in Uganda. Now, we are welcome. We are welcome Bociano and now we give him the chance to give you the chance Bociano. The floor is with you Bociano, so you can start your presentation kindly please. Thank you. Thank you, Professor Hayat. And also thanks to Chris for this. It has started raining here. I'm putting on my camera so that you can see what he's presenting. I hope the network connection will be good. Yeah, thank you, Professor Hayat for the introduction and I'm happy to be here. Good morning, good afternoon, good evening. Members, wherever you are joining from, I'm happy to present this topic fit for purpose and mental care services. Our perspectives from women with physical disabilities and midwives. And this is part of my PhD study that was conducted in Uganda. And this presentation is going to address specifically two objectives of the study. And I'm a PhD student at the University of Cape Town and a professor, Sira's position and Professor Theresa. And the presentation is going to take a format of about eight items that will include the introduction, the problem, the study aim and objectives, the study location methods, findings, conclusion and recommendation. In many African countries, sexuality of women with physical disabilities has little or no empirical investigation. It has been constructed on hearsay and second hand narratives usually from health workers, from family members and a significant others, and therefore moving barriers to utilization of antenatal care services for women with physical disabilities requires understanding their lived experiences. And meaning for engaging them would help to distorting their social realities and therefore enhancing the development of inclusive antenatal care services for improved rigorous experiences. World Health Organization recommends that antenatal care services be designed and continually improved based on locally generated data to overcome the utilization barriers. And the problem is that in low and middle income countries, several barriers impede utilization of antenatal care services by women with physical disabilities. And some of these barriers include inaccessible infrastructure and equipment, cost of services, healthcare providers, inadequate knowledge and skills, healthcare providers, negative attitudes, limited independence of women of women to make decisions for themselves on matters that directly affect their health among other many barriers. And this situation is more pronounced in rural areas than in urban areas in sub-Saharan Africa, including Uganda. And there is minimal understanding of the experiences of these pregnant women with physical disabilities in especially in underserved corporations when it comes to utilizing antenatal care services. Yet, antenatal care is a critical entry point for pregnant women to receive quality maternity care services. The aim of this study was to investigate the experiences of pregnant women with physical disabilities in utilizing antenatal care services and suggest the strategies for improving these services. And then the objective specifically was, as addressed in this presentation, was to find out the relationship between women with physical disabilities and healthcare providers during antenatal care services in rural southwestern Uganda. And then two was to explore how the women with physical disabilities and midwives perceive the disability and the provision of antenatal care services in rural southwestern Uganda. To give you the context, this study started in rural southwestern Uganda as indicated in the figure. And Uganda is born in East Africa. I was shown here in this figure. This study was a qualitative one and we used a mud-pocket study design. And the unit for analysis was the process of accessing and utilizing antenatal care services where the cases were looking at all the women with physical disabilities who access and utilize and antenatal care services at the head facilities and also those who are accessing and utilizing antenatal care services at care center 1. Those who are accessing and utilizing antenatal care services at care center. No, at care center 4. And then another case were those who were using and accessing antenatal care services at the district general hospital. The study was conducted in November 2020 to January 2021, and it involved the health facilities in rural south-western Uganda. The population was women with physical disabilities and midwives. And the communities were edged between 1845. And it was the women were those who were pregnant or had been pregnant in the last three years, and those who had attended the antinatal care clinic and had the physical disability affecting one or more of their limbs, both upper and lower limbs, their pelvis or the vertebrae. The inclusion criteria for health workers were midwives, comprehensive nurses, or double-trained nurses who were working in antinatal care clinics. The double-trained nurses are those who are trained in nursing and then midwifery. The exclusion criteria for women with physical disabilities was that women with physical disabilities that did not affect their mobility, stability, or dexterity were not included in this study. And exclusion for health workers was that those who worked in other sections of the health facility other than the antinatal care clinic were not included. And those who had no experience attending to women, pregnant women with physical disabilities were also not included. And then the clinical officers and the medical officers who are working in other sections of the facilities were not part of the study. The sample size and the sampling, snow ball was specifically used to identify total women with physical disabilities, and the women were identified with the help of the CDOs, the committed government officers, working in the communities and the village health teams. The leaders of the village health teams in the villages where they were living. And then per passive sampling technique was used to identify six midwives from the three selected health facilities. That is health center three, health center four, and the district general hospital. The methods that were used in gathering data were in-depth first-first interviews with women and midwives, and also a focus group discussion with only women. And this structured interview and focus group guides were used as tools to collect the data. Then data was transcribed, translated, and then later mathematically analyzed using an inductive approach. Conduct this study, ethical approval was sold and obtained from the University of Cape Town, and then later a counter-approval was obtained from Uganda National Council of Science and Technology. In summary, before I go in details of the findings, these are the findings under the theme fit for purpose and mental care services. And the first theme was women's, the first sub-theme was women's mixed experiences of midwives and other health workers. This one had three categories of which all came from, both from women and the midwives. The second sub-theme was preparing midwives and other health workers. And these had two categories. The first category was health workers have inadequate knowledge on disability, which came from both women's data and midwives data. And then the second category of midwives are emotionally prepared, was only described by the midwives. The third sub-theme is enabling disability inclusion, which has three categories, dedicated and mental care clinic. That one came from both, the dedicated and mental care clinic came from women and midwives. But the last two categories incentivizing women and health workers, and then making connections with health with stakeholders only came from. So to have the findings in detail, the first sub-theme is women's mixed experiences of midwives and other health workers. And the women and the midwives felt that the health workers were supportive and the kids enjoyed the remap that I think they feel compassion for a woman with a physical disability. They, midwives treat you well, in good condition. Then midwife number five commented that being disabled does not mean that you are not supposed to get services like others. So we have to make her a priority. We work on her and we help them in case one phase to get there on the examination date. You have to support her and put her on the date. We encourage them to come back again. So the midwives also felt that they were compassionate and welcoming and they took priority in attending women with disabilities. And the second category under the same sub-theme is that health workers were unapproachable. And under this, both midwives and women felt that the health workers were unapproachable. They described them as being rude, intimidating, abusive. And for example, Masi indicated that they, midwives can tell you to climb on the examination date, talking to you rudely, that what did you come to do if you knew that you can't climb the date? And Esther also remarked that you suffer, you walk with difficulties and you end up being caught up by time and then they don't feel compassion for you and eventually abuse at the clinic. The same views were reflected from the data of midwives. For example, midwife number three says that it happens sometimes and some midwives behave negatively towards women when they are tired and midwife number six says that some of us call it our issues of stress right from home. We have them here, rude midwives and they behave terribly. So also midwives acknowledge that some health workers are unapproachable and rude to women with physical disabilities. The last category under this sub-theme is that health workers would leave you there and women felt that health workers would not attend to them because they would leave you there even when they would be in pain and they are weak and they have physical disability. For example, Philly commented that if they are not used to issues of disability, they leave you there. You stay there and you are in pain and they attend to the ones without a disability. Jordan also emphasized that really, why can't they see you as one who is disabled and attend to you very fast? Why do they first put you there on the chair and you first sit when you are in pain? They leave you there, you stay there and be the one to be worked on or attended to last. And the same came from, was described by the midwives. For example, midwives number three says we serve them on the principle of first-come, first-serve basis, whether you are disabled or not this midwife says it is first-come, first-serve basis principle. Then the second sub-theme is preparing midwives and other health workers, which has two categories. Key of both midwives and women showed that health workers have inadequate knowledge on disability. And a woman with disability says there are some health workers who don't understand well the issues concerning disability. And Joyce also noted that when you reach there at the health facility, they, the health workers don't want to know, they don't want to appreciate that you are disabled. Yet you don't have all the necessary care and support. And actually midwife number six also emphasized that there is locally under-researched. This issue of disability inclusion is locally under-researched. And she says that we had never gotten such kind of people coming to us investigating disability issues. And now that you have come, you have sensitized our brains. And the second category under the same sub-theme is that midwives were emotionally unprepared to attempt women with disabilities. Midwife number three highlighted that first of all, I got scared and I thought, eh, this person, would she make it? Would she deliver? How am I going to handle this person? Showing that she was not emotionally prepared. And midwife number six says we could help her and bring her to the examination bed. But it is a painful experience and it hurts. And she says that not every midwife can do it. But the attitude is the cause as to why one cannot do it. And practically some of them may not have had or may not have seen such cases during their practice. The first time I helped her, it was very hard. You know, she was describing and remembering her what she went through as she attended to a woman with a disability. The last sub-theme is enabling disability inclusion which has three categories. The first one is dedicated to Antenokia Clinic and the midwives and midwives here and the women felt that there should be a special, be special attention given to women with physical disabilities where they should have a special room for examination. And Esther says when you arrive, they should see you and attend to you as a person with a disability, with a physical disability. And then they can process. They should put a special room for disabled people in every health facility so that we also get services and easily get help whenever we visit them. However, some women were opposed to the idea of having a special room and hope for her instead says that the midwives should be educated that women with physical disabilities should be worked on fast. It's not right if they are segregators. They feel like if they are segregated, they would cause some envy and acrimony among the non-disabled women during Antenokia. And first she says it's a matter of educating the midwives on disability inclusion. Midwife number four was in agreement that they should do a special program or an Antenokia program considering different types of disabilities for these people. Like the other programs for adolescents, for those who are living with HIV, like others who are given specific days and specific clinic days to. The same should apply also to women with physical disabilities. Then incentivizing women under the same sub-theme. The midwife felt that if there could be incentives, maybe it could enable perhaps other women without this acrimony. And then it could facilitate their attendance. Midwife number six says maybe if the managers can help to appreciate those working with good attitude because they know all of us, they know everyone of us. So if they could appreciate those with a positive attitude towards women with disabilities, it could enable disability inclusion in Antenokia services. And midwife number four says maybe some other people come to the hospital for Antenokia because there are some incentives like recently because we want mothers to attend Antenokia as early as four weeks. We have told them that a mother who makes eight Antenokia lists will always take two mama kits. And so that's exciting the mothers. Mama kits are given to pregnant women as a portion in Uganda. And the mama kits contain materials that are used, that are needed by women in the margins at the time of giving birth. Like a pair of styrogrants, surgical blade and a cord ligature, a gauze, a towel, soap, and other things that the mother needs at the time of giving birth. And then lastly, the last category under this sub theme is making connections. And midwife is fed that if there are connections with stakeholders who will do refer or connect with health facilities, this will facilitate disability inclusion. Midwife number four says, if there is a woman with a physical disability in a certain village, the VHT, that is a health theme, connects with the health facility. And midwife number three, also a mother who gets pregnant should be known to inform us like the nearest health facility. If there's good community and find that person that is a woman with physical disability. We didn't hear you, Bonciano. Bonciano, you stopped here, we didn't hear you. We are so sorry, I think the internet connection. I think we lost Bonciano, he will join us soon. We are so sorry, you know that the internet sometimes is not our friend. Oh my God, really unexpected. I think, I think when Bonciano will join us, you know, speak about the three themes. What you, the first one is women makes it experience midwife and the others healthcare worker. The second one, it will be referring to midwife and the others healthcare worker, enabling the disability. And what is the theme of his recommendation? And the first theme, we have to supportive and caring. We have unapproachable and also they leave you there. So this is the, maybe this is the more common comment they are giving to them. Also in preparing the midwife and the others healthcare worker have inadequate knowledge and disability. Midwives also are emotionally unbearable. And this is really go to what is really bad for the disability's women. A dedicated antinatal care clinic in self-defense, women and the health workers make connection and with the stakeholder for this is a well in conclusion. In conclusion, he said women with physical disability expressed makes it experience of midwife and the other healthcare worker. Also there are limited understanding of communication of physical disability and women utilization of anti-care. And the third one, it is an improvement in health system would be benefit to all women making win-win for everyone. The recommendation from his study, there are a need for dedication antinatal care clinic with accommodative health workforce in provision fit for verbose for antinatal services and also the appearance knowledge and the skill deficit regarding disability among midwife and other healthcare workers need to address education, training and mentoring. Also midwife should consider equal partner with women in an engaged model and the professional relationship. Midwife, as I said, midwife should consider equal bartering with women in an engaged model and the professional relationship as known, not an option in midwifery practice. The last one here, respect for women with disability, dignity, needs should be emphasizes in midwife training practice. And thank you for your attendance and we are so, so happy that you are joining us here. The four slides I read it in behalf of Benciano because unfortunately we are lost his own connection. So here.