Lindstrom David P, Muñoz-Franco Elisa
Brown University Providence, RI, USA.
Soc Sci Med. 2006 Aug;63(3):706-21. doi: 10.1016/j.socscimed.2006.02.007. Epub 2006 Mar 31.
This article examines the relationship between migration and the use of formal maternal health-care services among rural women in Guatemala. We identify assimilation, diffusion, and remittances as three potential pathways through which migration can affect health-care service utilization in rural areas. Using data from the 1995 Guatemalan Survey of Family Health and multi-level regression models, we estimate the impact of migration experience at the individual, household, and community level on the use of formal prenatal care and delivery assistance. We find that urban migration experience and having relatives abroad are associated with a greater likelihood of formal prenatal care utilization, after taking account of background characteristics and enabling resources. Migration experience at all levels is also strongly associated with formal delivery assistance; however, this association operates primarily through the positive association between migration and enabling resources. The differential effects of out-migration on maternal health-care service utilization reflect the different barriers to service use that exist for formal prenatal care and delivery assistance. Financial cost and geographic access are the most important barriers to formal delivery assistance, whereas awareness and acceptance remain as important barriers to the use of formal prenatal care in rural Guatemala. Urban migration experience and social ties to urban and international migrants lower the barriers to formal maternal health-care utilization through the acquisition and diffusion of new ideas and practices, and the return flow of financial resources.
本文探讨了危地马拉农村妇女的迁移与正规孕产妇保健服务利用之间的关系。我们确定同化、传播和汇款是迁移可能影响农村地区医疗服务利用的三种潜在途径。利用1995年危地马拉家庭健康调查的数据和多层次回归模型，我们估计了个人、家庭和社区层面的迁移经历对正规产前护理和分娩援助利用的影响。我们发现，在考虑背景特征和有利资源后，城市迁移经历和有海外亲属与更高的正规产前护理利用率相关。各级迁移经历也与正规分娩援助密切相关；然而，这种关联主要通过迁移与有利资源之间的正相关来发挥作用。外出迁移对孕产妇保健服务利用的不同影响反映了正规产前护理和分娩援助在服务使用方面存在的不同障碍。经济成本和地理可及性是正规分娩援助最重要的障碍，而意识和接受度仍然是危地马拉农村地区使用正规产前护理的重要障碍。城市迁移经历以及与城市和国际移民的社会联系，通过新观念和做法的获取与传播以及资金回流，降低了正规孕产妇保健利用的障碍。
