Amatya Rakchya, Tipayamongkholgul Mathuros, Suwannapong Nawarat, Tangjitgamol Siriwan
GTA Foundation, Lalitpur, Nepal.
Master of Public Health Program, Faculty of Public Health, Mahidol University, Bangkok, Thailand.
Health Equity. 2023 May 19;7(1):271-279. doi: 10.1089/heq.2022.0186. eCollection 2023.
The study compares the uses of postnatal care (PNC) and women's autonomy gradients across social caste and used intersectionality concepts to estimate odds ratio of women's autonomy and social caste on complete PNC.
A community-based cross-sectional study among 600 women aged 15-49 years who had at least one child younger than the age of 2 years in Morang District, Nepal, was conducted from April to July 2019. PNC, women's autonomy (decision-making power, freedom of movement, and control over finances) and social caste were collected by both methods. Multivariable logistic regressions were used to determine associations between women's autonomy, social caste, and complete PNC.
Complete PNC totaled 13.5% of respondents. About one-fourth of respondents reported poor overall autonomy; however, non-Dalit demonstrated higher autonomy than Dalit. Non-Dalit exhibited greater odds of complete PNC by four times. Women exhibited high women's autonomy in decision-making power, control over finance, and freedom of movement and have greater odds of complete PNC than low autonomy by 17, 3, and 7 times, respectively.
The study raises awareness of intersectionality (gender and social caste), relating to maternal health in caste-based system countries. To improve maternal health outcomes, health care personnel should identify and systematically address barriers that women of lower-caste membership face and offer these women appropriate advice or resources to obtain care. A multilevel change program that involves different actors like husbands and community leaders is needed for improving women's autonomy and lessening stigmatized perceptions, attitudes, or practices toward non-Dalit caste-members.
本研究比较了不同社会阶层产后护理（PNC）的使用情况以及女性自主权的差异，并运用交叉性概念来估计女性自主权和社会阶层对接受完整产后护理的比值比。
2019年4月至7月，在尼泊尔莫朗区对600名年龄在15 - 49岁且至少有一个2岁以下孩子的女性进行了一项基于社区的横断面研究。通过两种方法收集了产后护理、女性自主权（决策权、行动自由和对财务的控制权）以及社会阶层的数据。采用多变量逻辑回归来确定女性自主权、社会阶层与接受完整产后护理之间的关联。
接受完整产后护理的受访者占总数的13.5%。约四分之一的受访者表示总体自主权较差；然而，非达利特人的自主权高于达利特人。非达利特人接受完整产后护理的几率高出四倍。在决策权、对财务的控制权和行动自由方面女性展现出较高的自主权，并且接受完整产后护理的几率分别比自主权较低的女性高出17倍、3倍和7倍。
该研究提高了人们对基于种姓制度国家中与孕产妇健康相关的交叉性（性别和社会阶层）的认识。为改善孕产妇健康结果，医护人员应识别并系统解决低种姓女性面临的障碍，为这些女性提供适当的建议或资源以获得护理。需要一个涉及丈夫和社区领袖等不同行为者的多层次变革计划，以提高女性自主权并减少对非达利特种姓成员的污名化认知、态度或行为。
