Communication barriers in perinatal care for autistic women: A qualitative study using the hermeneutic-dialectic circle in Brazil
5 affiliations
- 1Department of Women’s, Children’s and Adolescent Health, Faculty of Medicine, Federal University of Ceará (UFC), Fortaleza, Ceará, Brazil
- 2Graduate Program in Collective Health, University of Fortaleza (UNIFOR), Fortaleza, Ceará, Brazil
- 3Leiden University Medical Center (LUMC), Leiden, South Holland, The Netherlands
- 4Department of Neurology, School of Medicine, University of São Paulo, São Paulo, Brazil
- 5Professor Fernando Figueira Institute of Integral Medicine (IMIP), Recife, Brazil
Abstract
Autistic women experience increased obstetric and perinatal risks, partly driven by communication barriers within maternity care. Evidence on how these barriers are experienced in low- and middle-income countries remains scarce. This study aimed to analyze communication barriers in perinatal care based on narratives of autistic women who experienced pregnancy, childbirth, and postpartum care in Brazil. A qualitative study was conducted using the Hermeneutic-Dialectic Circle (HDC) approach. Thirty-four autistic women (22 with support level 1 and 12 with support level 2, including three non-speaking participants with complex communication needs) were recruited through convenience sampling, supplemented by active recruitment through participant referral, and participated in semi-structured interviews conducted in multiple accessible formats (video call, real-time messaging, in-person, and augmentative and alternative communication). Data were analyzed using constant comparative methods within the hermeneutic-dialectic framework, guided by the social model of disability and the neurodiversity paradigm. Three central categories were constructed: (1) communicational demands of autistic women and their non-recognition, including alexithymia, sensory hypersensitivity, and need for predictability; (2) institutional and interpersonal communication failures, encompassing symptom invalidation, disrespectful care, and exclusion of non-speaking women; and (3) experiences of respectful and effective communication, demonstrating that adapted strategies promote safety and autonomy. Participants’ narratives indicate that communication barriers in perinatal care for autistic women operate systemically rather than individually. Training healthcare professionals and implementing accessible communication strategies are essential to promote respectful, safe, and inclusive maternity care.
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BibTeX
@article{brilhante2026communication,
title = {{Communication barriers in perinatal care for autistic women: A qualitative study using the hermeneutic-dialectic circle in Brazil}},
author = {Aline Veras Morais Brilhante and Christina César Praça Brasil and Raimunda Magalhães da Silva and Marjan Askari and Luciana Andrade da Mota Sampaio and Jonas Loiola Gonçalves and Layane Sabóia and Lucas Alessandro Macedo Cruz and Helena Rodrigues Dias and Luciel Almeida Cavalcanti and Maria Julya Albuquerque Parente and Mariana Tavares Rocha and Melania Maria Ramos de Amorim},
journal = {PLOS One},
year = {2026},
month = sep,
doi = {10.1371/journal.pone.0358429},
url = {https://doi.org/10.1371/journal.pone.0358429},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Communication barriers in perinatal care for autistic women: A qualitative study using the hermeneutic-dialectic circle in Brazil
AU - Aline Veras Morais Brilhante
AU - Christina César Praça Brasil
AU - Raimunda Magalhães da Silva
AU - Marjan Askari
AU - Luciana Andrade da Mota Sampaio
AU - Jonas Loiola Gonçalves
AU - Layane Sabóia
AU - Lucas Alessandro Macedo Cruz
AU - Helena Rodrigues Dias
AU - Luciel Almeida Cavalcanti
AU - Maria Julya Albuquerque Parente
AU - Mariana Tavares Rocha
AU - Melania Maria Ramos de Amorim
PY - 2026
DA - 2026/09/16
JO - PLOS One
DO - 10.1371/journal.pone.0358429
UR - https://doi.org/10.1371/journal.pone.0358429
AB - Autistic women experience increased obstetric and perinatal risks, partly driven by communication barriers within maternity care. Evidence on how these barriers are experienced in low- and middle-income countries remains scarce. This study aimed to analyze communication barriers in perinatal care based on narratives of autistic women who experienced pregnancy, childbirth, and postpartum care in Brazil. A qualitative study was conducted using the Hermeneutic-Dialectic Circle (HDC) approach. Thirty-four autistic women (22 with support level 1 and 12 with support level 2, including three non-speaking participants with complex communication needs) were recruited through convenience sampling, supplemented by active recruitment through participant referral, and participated in semi-structured interviews conducted in multiple accessible formats (video call, real-time messaging, in-person, and augmentative and alternative communication). Data were analyzed using constant comparative methods within the hermeneutic-dialectic framework, guided by the social model of disability and the neurodiversity paradigm. Three central categories were constructed: (1) communicational demands of autistic women and their non-recognition, including alexithymia, sensory hypersensitivity, and need for predictability; (2) institutional and interpersonal communication failures, encompassing symptom invalidation, disrespectful care, and exclusion of non-speaking women; and (3) experiences of respectful and effective communication, demonstrating that adapted strategies promote safety and autonomy. Participants’ narratives indicate that communication barriers in perinatal care for autistic women operate systemically rather than individually. Training healthcare professionals and implementing accessible communication strategies are essential to promote respectful, safe, and inclusive maternity care.
SN - 1932-6203
ER -