'보호에서 권리로 !' : ‘아동권리’ 관점에서 본 미국 장애아동청소년 복지서비스의 변화 메커니즘

국문 초록 (Abstract)

이 연구는 아동권리관점에서 미국 장애아동청소년 복지서비스의 변화 매커니즘을 살펴보고자 한 것이다. 이 주제가 매우 광범위하기 때문에 미국의 학계 동향 및 공동연구자와의 협력상황에 의거하여 연구주제를 보다 세분화하여 연구를 진행하였다. 권리에 근거한 실천(Right-based approach)라는 관점을 가지고, 세부 연구주제를 탐색하는 과정에서 이차자료분석이 가능한 Washington State-Behavioral Risk Factor Surveillance System (WA-BRFSS) data 를 활용하여 장애아동을 둘러싼 다양한 환경 및 복지의 매커니즘을 분석하게 되었다. 이 과정에서, 1차 연구주제로는 아동을 양육하는 여성장애인의 건강불평등에 대해 연구하였고, 후속연구로 장애아동청소년의 정신건강과 함의를 연구할 예정이다. 1차 연구인 아동을 양육하는 여성장애인의 건강불평등에 대한 연구는 미국내에서조차 아직 연구되지 않은 주제로,아동을 양육하는 여성장애인, 아동을 양육하지 않은 여성장애인, 그리고 아동을 양육하는 일반여성의 건강불평등 상황을 비교 분석하는 것이다. 이를 통해 이들의 건강 평등을 향상 시킬 수 있는 함의 등을 제시하고 있다. 이 주제는 미국 뿐 아니라 국내 관련연구에도 함의를 갖는 것으로, 아래 영문초록은 이에 대한 것이고, 향후 장애아동청소년의 정신건강에 대한 후속연구를 진행할 예정이다.

다국어 초록 (Multilingual Abstract)

Health Disparities of Childrearing Women with Disabilities


Purpose: Childrearing women with disabilities may experience heightened risks of health disparities due to discrimination and marginalization from the society as well as lack of resources for childrearing. Unmet health care needs of this population could negatively impact on health status of their children as well as of themselves (Smith & Ruiz, 2009). Health-related needs and concerns of women with disabilities, however, have rarely been identified in disability research. Many studies on women with disabilities focus on discrimination comparing to women without disabilities and men with disabilities (Emmett & Alant, 2006). The objective of this study is to uncover the health-related indicators that can be modified to improve health-related quality of life among childrearing women with disabilities. To this end, we examine health disparities by comparing prevalence of health care access, risky health behaviors, preventive health behaviors, health status, social support, and life satisfaction between childrearing women with disabilities, women with disabilities not living with children, and childrearing women without disabilities.


Methods: Washington State-Behavioral Risk Factor Surveillance System (WA-BRFSS) data were analyzed in this study (N=37,841). BRFSS is an annual population-based telephone survey study designed by the Centers for Disease Control and Prevention to investigate health conditions and behaviors of US adult residents aged 18 or older. We analyzed merged WA-BRFSS data collected from 2003 to 2009 since several key variables of interest for this study were not asked every year. We stratified our sample (age between 18 and 60) into three groups including childrearing women with disabilities, women with disabilities not living with children, and childrearing women without disabilities. Multiple adjusted logistic regression analyses were conducted to compare prevalence of health indicators for childrearing women with disabilities with other two groups. We controlled for socio-demographic characteristics (i.e., age, education, income, and marital status).


Results: The weighted percentages of the three groups within our sample were respectively 9%, 12%, and 45%. Childrearing women with disabilities were more likely to have financial barriers to health services than women with disabilities not living with children (OR=0.46; p<.001). In terms of health behaviors, childrearing women with disabilities showed higher prevalence of smoking (OR=0.47; p<.001) and lack of exercise (OR=0.64; p<.001) when compared to childrearing women without disabilities. In addition, childrearing women with disabilities showed heightened risks of poor health status compared to childrearing women without disabilities; higher prevalence of poor general health (OR=0.15; p<.001), frequent mental distress (OR=0.25; p<.001), and frequent poor physical health (OR=0.11; p<.001). Childrearing women with disabilities were more likely to report lack of social support (OR=0.47; p<.001) and life dissatisfaction (OR=0.20; p<.001) when compared to childrearing women without disabilities.


Implications: Findings underscore the need for social work practices to increase health care access, improve health status, and provide social and emotional supports for childrearing women with disabilities who have been doubly disadvantaged with two life challenges: being a mother in addition to being a disabled. Findings also indicate the need for future research investigating the factors that might have influences on health disparities of childrearing women with disabilities.