Institute of Global Health, Heidelberg University, Im Neuenheimer Feld 130/3, 69120 Heidelberg, Germany.
Nouna Health Research Center, Rue Namory Kéita, Nouna, Burkina Faso.
Health Policy Plan. 2020 Jun 1;35(5):536-545. doi: 10.1093/heapol/czaa012.
A growing body of literature urges policymakers, practitioners and scientists to consider gender in the design and evaluation of health interventions. We report findings from formative research to develop and refine an mHealth maternal nutrition intervention in Nouna, Burkina Faso, one of the world's most resource-poor settings. Gender was not an initial research focus, but emerged as highly salient during data collection, and thus guided lines of inquiry as the study progressed. We collected data in two stages, first using focus group discussions (FGD; n = 8) and later using FGDs (n = 2), interviews (n = 30) and observations of intervention delivery (n = 30). Respondents included pregnant women, breastfeeding mothers and Close-to-Community (CTC) providers, who execute preventative and curative tasks at the community level. We applied Morgan et al.'s gender framework to examine intervention content (what a gender-sensitive nutrition programme should entail) and delivery (how a gender-sensitive programme should be administered). Mothers emphasized that although they are often the focus of nutrition interventions, they are not empowered to make nutrition-based decisions that incur costs. They do, however, wield some control over nutrition-related tasks such as farming and cooking. Mothers described how difficult it is to consider only one's own children during meal preparation (which is communal), and all respondents described how nutrition-related requests can spark marital strife. Many respondents agreed that involving men in nutrition interventions is vital, despite men's perceived disinterest. CTC providers and others described how social norms and gender roles underpin perceptions of CTC providers and dictate with whom they can speak within homes. Mothers often prefer female CTC providers, but these health workers require spousal permission to work and need to balance professional and domestic demands. We recommend involving male partners in maternal nutrition interventions and engaging and supporting a broader cadre of female CTC providers in Burkina Faso.
越来越多的文献敦促政策制定者、实践者和科学家在设计和评估卫生干预措施时考虑性别因素。我们报告了在布基纳法索努纳开展的形成性研究结果，以开发和完善一项移动医疗产妇营养干预措施，努纳是世界上资源最匮乏的地区之一。性别最初并不是研究的重点，但在数据收集过程中变得非常突出，因此在研究进展过程中指导了研究方向。我们分两个阶段收集数据，首先使用焦点小组讨论（FGD；n=8），然后使用 FGD（n=2）、访谈（n=30）和干预措施实施观察（n=30）。受访者包括孕妇、哺乳期母亲和接近社区（CTC）提供者，他们在社区一级执行预防和治疗任务。我们应用摩根等人的性别框架来检查干预内容（一个对性别敏感的营养方案应该包含什么）和实施（一个对性别敏感的方案应该如何管理）。母亲们强调，尽管她们通常是营养干预措施的焦点，但她们没有权力做出涉及成本的营养决策。然而，她们确实对营养相关任务（如耕种和烹饪）有一定的控制权。母亲们描述了在准备饭菜（这是公共的）时很难只考虑自己的孩子，所有受访者都描述了营养相关的请求如何引发婚姻冲突。许多受访者认为，尽管男性被认为不感兴趣，但让男性参与营养干预措施至关重要。CTC 提供者和其他人描述了社会规范和性别角色如何支撑 CTC 提供者的看法，并决定他们可以在家庭中与谁交谈。母亲们通常更喜欢女性 CTC 提供者，但这些卫生工作者需要得到配偶的许可才能工作，并且需要平衡专业和家庭需求。我们建议在产妇营养干预措施中让男性伴侣参与，并在布基纳法索吸引和支持更多的女性 CTC 提供者。
