厄瓜多尔生殖、孕产妇、新生儿和儿童健康干预措施中的种族不平等：对2004年和2012年全国调查的研究

Ethnic inequalities in reproductive, maternal, newborn and child health interventions in Ecuador: A study of the 2004 and 2012 national surveys.

作者信息

Rios-Quituizaca Paulina, Gatica-Domínguez Giovanna, Nambiar Devaki, Santos Jair L Ferreira, Barros Aluisio J D

机构信息

Facultad de Ciencias Medicas, Universidad Central del Ecuador. Facultad de Medicina de Ribeirao Preto, Universidad de São Paulo. La Armenia, Quito, Ecuador.

International Center for Equity in Health, Universidade Federal de Pelotas, Brazil.

出版信息

EClinicalMedicine. 2022 Mar 6;45:101322. doi: 10.1016/j.eclinm.2022.101322. eCollection 2022 Mar.

DOI:10.1016/j.eclinm.2022.101322

PMID:35284805

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8904232/

Abstract

BACKGROUND

Analysis of health inequalities by ethnicity is critical to achieving the Sustainable Development Goals. In Ecuador, similar to other Latin American countries, indigenous and afro-descendant populations have long been subject to racism, discrimination, and inequitable treatment. Although in recent years, Ecuador has made progress in health indicators, particularly those related to the coverage of Reproductive, Maternal, Neonatal and Child Health (RMNCH) interventions, little is known as to whether inequalities by ethnicity persist.

METHODS

Analysis was based on two nationally representative health surveys (2004 and 2012). Ethnicity was self-reported and classified into three categories (Indigenous/Afro-Ecuadorian/Mixed ancestry). Coverage data for six RMNCH health interventions were stratified for each ethnic group by level of education, area of residence and wealth quintiles. Absolute inequality measures were computed and multivariate analysis using Poisson regression was undertaken.

FINDINGS

In 2012, 74.4% of women self-identifying as indigenous did not achieve the secondary level of education and 50.7% were in the poorest quintile (Q1); this profile was relatively unchanged since 2004. From 2004 to 2012, the coverage of RMNCH interventions increased for all ethnic groups, and absolute inequality decreased. However, in 2012, regardless of education level, area of residence and wealth quintiles, ethnic inequalities remained for almost all RMNCH interventions. Indigenous women had 24% lower prevalence of modern contraceptive use (Prevalence ratio [PR] = 0.76; 95% IC: 0.7-0.8); 28% lower prevalence of antenatal care (PR = 0.72; 95% IC: 0.6-0.8); and 35% lower prevalence of skilled birth attendance and institutional delivery (PR = 0.65; 95% IC: 0.6-0.7 and PR = 0.65; 95% IC: 0.6-0.7 respectively), compared with the majority ethnic group in the country.

INTERPRETATION

While the gaps have narrowed, indigenous people in Ecuador continue in a situation of structural racism and are left behind in terms of access to RMNCH interventions. Strategies to reduce ethnic inequalities in the coverage services need to be collaboratively redesigned/co-designed.

FUNDING

This paper was made possible with funds from the Bill & Melinda Gates Foundation [Grant Number: INV-007,594/OPP1148933].

摘要

背景

按种族分析健康不平等对于实现可持续发展目标至关重要。在厄瓜多尔，与其他拉丁美洲国家类似，土著和非裔人口长期遭受种族主义、歧视和不公平待遇。尽管近年来厄瓜多尔在健康指标方面取得了进展，特别是在生殖、孕产妇、新生儿和儿童健康（RMNCH）干预措施的覆盖方面，但对于种族不平等是否仍然存在却知之甚少。

方法

分析基于两项具有全国代表性的健康调查（2004年和2012年）。种族由受访者自我报告，并分为三类（土著/厄瓜多尔非裔/混血）。六项RMNCH健康干预措施的覆盖数据按每个种族群体的教育水平、居住地区和财富五分位数进行分层。计算绝对不平等指标，并使用泊松回归进行多变量分析。

结果

2012年，自我认定为土著的女性中，74.4%未达到中等教育水平，50.7%处于最贫困五分位数（Q1）；自2004年以来，这一情况相对未变。从2004年到2012年，所有种族群体的RMNCH干预措施覆盖率均有所提高，绝对不平等有所下降。然而，2012年，几乎所有RMNCH干预措施的种族不平等在教育水平、居住地区和财富五分位数方面仍然存在。与该国多数种族群体相比，土著妇女现代避孕方法的使用率低24%（患病率比值[PR]=0.76；95%置信区间：0.7-0.8）；产前护理使用率低28%（PR=0.72；95%置信区间：0.6-0.8）；熟练助产和机构分娩的使用率分别低35%（PR=0.65；95%置信区间：0.6-0.7和PR=0.65；95%置信区间：0.6-0.7）。