Ibáñez-Cuevas Midiam, Heredia-Pi Ileana B, Meneses-Navarro Sergio, Pelcastre-Villafuerte Blanca, González-Block Miguel A
Centre for Health Systems Research, National Institute of Public Health, Avenida Universidad # 655, Colonia: Santa María de Ahuacatitlán, CP: 62100, Cuernavaca, Morelos, Mexico.
Regional Centre for Public Health Research, National Institute of Public Health, Tapachula, Mexico.
Int J Equity Health. 2015 Dec 23;14:156. doi: 10.1186/s12939-015-0289-1.
Mexico has undertaken important efforts to decrease maternal mortality. Health authorities have introduced intercultural innovations to address barriersfaced by indigenous women accessing professional maternal and delivery services. This study examines, from the perspective of indigenous women, the barriers andfacilitators of labor and delivery care services in a context of intercultural and allopathic innovations.
This is an exploratory study using a qualitative approach of discourse analysis with grounded theory techniques. Twenty-five semi-structured interviews were undertaken with users and non-users of the labor and delivery services, as well as with traditional birth attendants (TBAs) in San Andrés Larráinzar, Chiapas in 2012.
The interviewees identified barriers in the availability of medical personnel and restrictive hours for health services. Additionally, they referred to barriers to access (economic, geographic, linguistic and cultural) to health services, as well as invasive and offensive hospital practices enacted by health system personnel, which limited the quality of care they can provide. Traditional birth attendants participating in intercultural settings expressed the lack of autonomy and exclusion they experience by hospital personnel, as a result of not being considered part of the care team. As facilitators, users point to the importance of having their traditional birth attendants and families present during childbirth, to allow them to use their clothing during the attention, that the staff of health care is of the female sex and speaking the language of the community. As limiting condition users referred the different medical maneuvers practiced in the attention of the delivery (vaginal examination, episiotomy, administration of oxytocin, etc.).
Evidence from the study suggests the presence of important barriers to the utilization of institutional labor and delivery services in indigenous communities, in spite of the intercultural strategies implemented. It is important to consider strengthening intercultural models of care, to sensitize personnel towards cultural needs, beliefs, practices and preferences of indigenous women, with a focus on human rights, gender equity and quality of care.
墨西哥已为降低孕产妇死亡率做出了重要努力。卫生当局引入了跨文化创新举措，以解决土著妇女在获得专业孕产妇和分娩服务时面临的障碍。本研究从土著妇女的角度，审视了跨文化和对抗疗法创新背景下分娩护理服务的障碍与促进因素。
这是一项探索性研究，采用定性的话语分析方法及扎根理论技术。2012年，在恰帕斯州圣安德烈斯拉兰萨进行了25次半结构化访谈，访谈对象包括分娩服务的使用者和非使用者，以及传统接生员。
受访者指出了医务人员配备不足以及医疗服务时间受限等障碍。此外，他们还提到了获得医疗服务的障碍（经济、地理、语言和文化方面），以及卫生系统人员实施的侵入性和冒犯性医院行为，这些行为限制了他们所能提供的护理质量。参与跨文化环境的传统接生员表示，由于未被视为护理团队的一员，他们感受到医院人员的缺乏自主性和排斥。作为促进因素，使用者指出分娩时有传统接生员和家人在场的重要性，在接受护理时可以穿自己的衣服，医护人员为女性且会说社区语言。作为限制条件，使用者提到了分娩护理中实施的不同医疗操作（阴道检查、会阴切开术、催产素给药等）。
研究证据表明，尽管实施了跨文化策略，但土著社区在利用机构分娩服务方面仍存在重大障碍。重要的是要考虑加强跨文化护理模式，使工作人员对土著妇女的文化需求、信仰、做法和偏好更加敏感，重点关注人权、性别平等和护理质量。
