UCL Institute for Global Health, 30 Guilford St., London, WC1N 1EH, UK.
Soc Sci Med. 2020 May;252:112912. doi: 10.1016/j.socscimed.2020.112912. Epub 2020 Mar 10.
How women make decisions about care-seeking during pregnancy and childbirth, is a key determinant of maternal and child health (MCH) outcomes. Indigenous communities continue to display the highest levels of maternal and infant mortality in Mexico, a fact often accounted for by reference to inadequate access to quality services. A growing body of research has identified gender inequality as a major determinant of MCH, although this has rarely been situated historically in the context of major social and epistemological shifts, that occurred under colonialism. I used a feminist ethnography to understand the structural determinants of Indigenous maternal health. I drew on research about the colonial and post-colonial origins of ethnic and gender inequality in Mexico and specifically the Wixárika Indigenous region, in order to identify the different ways in which women have historically been disadvantaged, and the processes, situations and interaction dynamics that emerged from this. Sixty-four Wixárika women were interviewed while pregnant, and followed up after the birth of their child between January 2015 and April 2017. These data were triangulated with structured observations and key informant interviews with healthcare providers, teachers, community representatives and family members. The findings suggest that gender inequalities were introduced with the colonial system for governing Indigenous regions, and became naturalised as Wixárika communities were increasingly integrated into the Mexican nation. The associated structures of marriage, community and interpersonal relationships now operate as forms of institutionalised gender oppression, to increase Indigenous women's vulnerability, and influence decisions made about care and childbirth. Ethnographic data analysed in historical context evidence the continuity of colonial forms of inequality, and their impact on wellbeing. While welfare and health programmes increasingly aim to address gender inequality on social and relational levels, by rebalancing gendered household dynamics or empowering women, the historical and colonial roots of these inequalities remain unchallenged.
女性在怀孕期间和分娩时如何做出护理决策，是母婴健康 (MCH) 结果的关键决定因素。在墨西哥，土著社区的孕产妇和婴儿死亡率仍然最高，这一事实通常归因于无法获得高质量服务。越来越多的研究表明，性别不平等是 MCH 的一个主要决定因素，尽管这在历史上很少从殖民主义时期发生的重大社会和认识论转变的背景下来考虑。我使用女性主义民族志来了解土著孕产妇健康的结构决定因素。我借鉴了关于墨西哥种族和性别不平等的殖民和后殖民起源的研究，特别是关于 Wixárika 土著地区的研究，以确定女性在历史上处于不利地位的不同方式，以及由此产生的过程、情况和相互作用动态。2015 年 1 月至 2017 年 4 月期间，我对 64 名怀孕的 Wixárika 女性进行了访谈，并在她们分娩后进行了随访。这些数据与结构化观察和与医疗保健提供者、教师、社区代表和家庭成员的关键知情人访谈进行了三角分析。调查结果表明，性别不平等是随着殖民统治土著地区的制度而产生的，并随着 Wixárika 社区越来越融入墨西哥民族而自然化。婚姻、社区和人际关系的相关结构现在作为制度化性别压迫的形式运作，增加了土著妇女的脆弱性，并影响了护理和分娩的决策。从历史背景分析的民族志数据证明了不平等的殖民形式的连续性，以及它们对福祉的影响。虽然福利和卫生方案越来越旨在通过重新平衡性别化的家庭动态或赋予妇女权力来解决社会和关系层面的性别不平等，但这些不平等的历史和殖民根源仍然没有受到挑战。
