Yamin Alicia Ely, Bazile Junior, Knight Lucia, Molla Mitike, Maistrellis Emily, Leaning Jennifer
Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Franςois-Xavier Bagnoud Center for Health and Human Rights, Harvard University, Boston, MA, USA.
Partners In Health-Abwenzi Pa Za Umoyo, Neno, Malawi.
Soc Sci Med. 2015 Jun;135:143-50. doi: 10.1016/j.socscimed.2015.04.033. Epub 2015 May 1.
Driven by the need to better understand the full and intergenerational toll of maternal mortality (MM), a mixed-methods study was conducted in four countries in sub-Saharan Africa to investigate the impacts of maternal death on families and children. The present analysis identifies gender as a fundamental driver not only of maternal, but also child health, through manifestations of gender inequity in household decision making, labor and caregiving, and social norms dictating the status of women. Focus group discussions were conducted with community members, and in depth qualitative interviews with key-informants and stakeholders, in Tanzania, Ethiopia, Malawi, and South Africa between April 2012 and October 2013. Findings highlight that socially constructed gender roles, which define mothers as caregivers and fathers as wage earners, and which limit women's agency regarding childcare decisions, among other things, create considerable gaps when it comes to meeting child nutrition, education, and health care needs following a maternal death. Additionally, our findings show that maternal deaths have differential effects on boy and girl children, and exacerbate specific risks for girl children, including early marriage, early pregnancy, and school drop-out. To combat both MM, and to mitigate impacts on children, investment in health services interventions should be complemented by broader interventions regarding social protection, as well as aimed at shifting social norms and opportunity structures regarding gendered divisions of labor and power at household, community, and society levels.
出于更全面深入地了解孕产妇死亡（MM）及其代际影响的需求，在撒哈拉以南非洲的四个国家开展了一项混合方法研究，以调查孕产妇死亡对家庭和儿童的影响。本分析确定，性别不仅是孕产妇健康的根本驱动因素，也是儿童健康的根本驱动因素，这体现在家庭决策、劳动和照料方面的性别不平等，以及规定女性地位的社会规范之中。2012年4月至2013年10月期间，在坦桑尼亚、埃塞俄比亚、马拉维和南非与社区成员进行了焦点小组讨论，并对关键信息提供者和利益相关者进行了深入的定性访谈。研究结果表明，社会建构的性别角色将母亲定义为照料者，将父亲定义为挣钱养家的人，这限制了女性在儿童照料决策等方面的自主权，在孕产妇死亡后满足儿童营养、教育和医疗需求方面造成了相当大的差距。此外，我们的研究结果表明，孕产妇死亡对男孩和女孩有不同的影响，并加剧了女孩面临的特定风险，包括早婚、早孕和辍学。为了应对孕产妇死亡问题，并减轻对儿童的影响，在投资于卫生服务干预措施的同时，应辅以更广泛的社会保护干预措施，并旨在改变家庭、社区和社会层面关于性别分工和权力的社会规范及机会结构。
