Public Health Unit, Faculty of Medicine, University of Alcalá, Crtra Madrid-Barcelona Km 33.6, Alcalá de Henares, 28871, Spain.
Ciberesp, Madrid, Spain.
Int J Equity Health. 2020 Mar 12;19(1):31. doi: 10.1186/s12939-020-1136-6.
The current focus on monitoring health inequalities and the complexity around ethnicity requires careful consideration of how ethnic disparities are measured and presented. This paper aims to determine how inequalities in maternal healthcare by ethnicity change according to different criteria used to classify indigenous populations.
Nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008-2016) were used to explore coverage gaps across maternal health care by ethnicity using different criteria. Women were classified as indigenous through self-identification (SI), spoken indigenous language (SIL), or indigenous household (IH). We compared the gaps through measuring coverage ratios (CR) with adjusted Poisson regression models.
Proportions of indigenous women changed significantly according to the identification criterion (Bolivia:SI-63.1%/SIL-37.7%; Guatemala:SI-49.7%/SIL-28.2%; Peru:SI-34%/SIL-6.3% & Mexico:SI-29.7%/SIL-6.9%). Indigenous in all countries, regardless of their identification, had less coverage. Gaps in care between indigenous and non-indigenous populations changed, for all indicators and countries, depending on the criterion used (e.g., Bolivia CR for contraceptive-use SI = 0.70, SIL = 0.89; Guatemala CR for skilled-birth-attendant SI = 0.77, SIL = 0.59). The heterogeneity persists when the reference groups are modified and compare just to non-indigenous (e.g., Bolivia CR for contraceptive-use under SI = 0.64, SIL = 0.70; Guatemala CR for Skilled-birth-attendant under SI = 0.77, SIL = 0.57).
The indigenous identification criteria could have an impact on the measurement of inequalities in the coverage of maternal health care. Given the complexity and diversity observed, it is not possible to provide a definitive direction on the best way to define indigenous populations to measure inequalities. In practice, the categorization will depend on the information available. Our results call for greater care in the analysis of ethnicity-based inequalities. A greater understanding on how the indigenous are classified when assessing inequalities by ethnicity can help stakeholders to deliver interventions responsive to the needs of these groups.
当前，人们关注监测健康不平等问题以及种族问题的复杂性，这需要仔细考虑如何衡量和呈现种族差异。本文旨在确定根据用于分类土著人口的不同标准，种族间产妇保健不平等的变化情况。
本研究使用来自玻利维亚、危地马拉、墨西哥和秘鲁的具有全国代表性的人口普查数据（2008-2016 年），根据不同标准探讨了种族间产妇保健覆盖差距。通过自我认同（SI）、使用土著语言（SIL）或土著家庭（IH）对女性进行土著分类。我们通过测量覆盖率比率（CR）并使用调整后的泊松回归模型进行比较，以比较差距。
根据识别标准，土著妇女的比例发生了显著变化（玻利维亚：SI-63.1%/SIL-37.7%；危地马拉：SI-49.7%/SIL-28.2%；秘鲁：SI-34%/SIL-6.3%和墨西哥：SI-29.7%/SIL-6.9%）。所有国家的土著妇女无论其身份如何，其覆盖率都较低。所有国家和所有指标的土著人口和非土著人口之间的保健差距都发生了变化，这取决于使用的标准（例如，玻利维亚 SI 下的避孕措施使用 CR=0.70，SIL=0.89；危地马拉 SI 下的熟练分娩护理人员使用 CR=0.77，SIL=0.59）。当修改参考组并仅与非土著群体进行比较时，这种异质性仍然存在（例如，玻利维亚 SI 下的避孕措施使用 CR=0.64，SIL=0.70；危地马拉 SI 下的熟练分娩护理人员使用 CR=0.77，SIL=0.57）。
土著身份识别标准可能会影响衡量产妇保健覆盖不平等的情况。鉴于观察到的复杂性和多样性，无法就如何界定土著人口以衡量不平等提供明确的方向。在实践中，分类将取决于可用信息。我们的研究结果呼吁在分析基于种族的不平等问题时更加谨慎。在评估种族不平等时，更深入地了解如何对土著进行分类，可以帮助利益攸关方提供针对这些群体需求的干预措施。
