Shannon Geordan D, Motta Angelica, Cáceres Carlos F, Skordis-Worrall Jolene, Bowie Diana, Prost Audrey
a Institute for Global Health , University College London (UCL) , London , UK.
b DB Peru , Lima , Peru.
Glob Health Action. 2017 Jan-Dec;10(sup2):1330458. doi: 10.1080/16549716.2017.1330458.
In the Peruvian Amazon, historical events of colonization and political marginalization intersect with identities of ethnicity, class and geography in the construction of gender and health inequities. Gender-based inequalities can manifest in poor health outcomes via discriminatory practices, healthcare system imbalances, inequities in health research, and differential exposures and vulnerabilities to diseases. Structural violence is a comprehensive framework to explain the mechanisms by which social forces such as poverty, racism and gender inequity become embodied as individual experiences and health outcomes, and thus may be a useful tool in structuring an intersectional analysis of gender and health inequities in Amazonian Peru.
The aim of this paper is to explore the intersection of gender inequities with other social inequalities in the production of health and disease in Peru's Amazon using a structural violence approach.
Exploratory qualitative research was performed in two Loreto settings - urban Iquitos and the rural Lower Napo River region - between March and November 2015. This included participant observation with prolonged stays in the community, 46 semi-structured individual interviews and three group discussions. Thematic analysis was performed to identify emerging themes related to gender inequalities in health and healthcare and how these intersect with layered social disadvantages in the reproduction of health and illness. We employed a structural violence approach to construct an intersectional analysis of gender and health inequities in Amazonian Peru.
Our findings were arranged into five interrelated domains within a gender, structural violence and health model: gender as a symbolic institution, systemic gender-based violence, interpersonal violence, the social determinants of health, and other health outcomes. Each domain represents one aspect of the complex associations between gender, gender inequity and health. Through this model, we were able to explore: gender, health and intersectionality; structural violence; and to highlight particular local gender and health dynamics. Intersecting influences of poverty, ethnicity, geography and gender served as significant barriers to healthcare in both rural and urban settings.
在秘鲁亚马逊地区，殖民和政治边缘化的历史事件与种族、阶级和地域身份相互交织，影响着性别和健康不平等的形成。基于性别的不平等可通过歧视性做法、医疗系统失衡、健康研究中的不平等以及对疾病的不同暴露和易感性等表现为不良健康结果。结构性暴力是一个综合框架，用于解释贫困、种族主义和性别不平等之类的社会力量如何具体体现为个体经历和健康结果，因此可能是构建秘鲁亚马逊地区性别与健康不平等交叉分析的有用工具。
本文旨在采用结构性暴力方法，探讨秘鲁亚马逊地区健康与疾病产生过程中性别不平等与其他社会不平等的交叉情况。
2015年3月至11月期间，在洛雷托省的两个地区——伊基托斯市和下纳波河农村地区——开展了探索性定性研究。研究内容包括在社区长期停留进行参与观察、46次半结构化个人访谈和3次小组讨论。通过主题分析确定与健康和医疗保健方面性别不平等相关的新出现主题，以及这些主题在健康与疾病再现过程中如何与多层次社会劣势相互交织。我们采用结构性暴力方法构建了秘鲁亚马逊地区性别与健康不平等的交叉分析。
我们的研究结果纳入了一个性别、结构性暴力和健康模型中的五个相互关联的领域：作为象征性制度的性别、系统性基于性别的暴力、人际暴力、健康的社会决定因素以及其他健康结果。每个领域代表了性别、性别不平等与健康之间复杂关联的一个方面。通过这个模型，我们得以探讨：性别、健康与交叉性；结构性暴力；并突出特定的地方性别与健康动态。贫困、种族、地域和性别的交叉影响在农村和城市地区都是获得医疗保健的重大障碍。
