Independent Consultant, Brooklyn, New York, USA
Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland.
BMJ Glob Health. 2022 Apr;7(4). doi: 10.1136/bmjgh-2022-008438.
Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power.
Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed.
The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures.
This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
权力影响全球健康的各个方面。权力概念不仅有助于理解当前形势，而且还经常被用于旨在改变权力关系的方案活动中。本文采用总结性内容分析法来描述低收入和中等收入国家的性健康和生殖健康方案如何明确和含蓄地旨在改变权力关系。
内容分析法是一种对文本数据进行分析的定性方法；在我们的分析中，描述旨在改变权力关系以改善性健康的方案的同行评议文章构成了数据。我们在三个数据库中进行了搜索，最终纳入了 108 篇文章。我们将这些文章提取到一个电子表格中，其中包括有关文章和方案的基本详细信息，包括方案活动针对社会生态模式的哪个层次。
所审查的方案反映出优先事项和解决权力问题的方法多种多样，但大多数论文主要基于生物医学框架。大多数方案同时在多个层面上进行干预；其中一些是“结构性”方案，明确旨在改变权力关系，而其他方案则使用更典型的方案理论来解决多个层面的问题，该理论试图改变个人行为和近端驱动因素。这种对近端行为的关注与关于性健康和生殖健康健康不公平现象中权力相关驱动因素的更广泛文献有些不匹配，后者探讨了嵌入式规范和结构的作用。
本文通过总结学术公共卫生界在权力关系和性健康方面选择进行测试和研究的内容，并提出了关于这与改善性健康权利方面改变权力关系的重大任务如何对应相关的问题，从而增加了价值。
