Bohren Meghan A, Iyer Aditi, Barros Aluisio J D, Williams Caitlin R, Hazfiarini Alya, Arroyave Luisa, Filippi Veronique, Chamberlain Catherine, Kabakian-Khasholian Tamar, Mayra Kaveri, Gill Roopan, Vogel Joshua P, Chou Doris, George Asha S, Oladapo Olufemi T
Gender and Women's Health Unit, Nossal Institute for Global Health, School of Population and Global Health, University of Melbourne, Carlton, Victoria, Australia.
Ramalingaswami Centre on Equity & Social Determinants of Health, Public Health Foundation of India, Bangalore, India.
EClinicalMedicine. 2023 Dec 6;67:102180. doi: 10.1016/j.eclinm.2023.102180. eCollection 2024 Jan.
An equity lens to maternal health has typically focused on assessing the differences in coverage and use of healthcare services and critical interventions. While this approach is important, we argue that healthcare experiences, dignity, rights, justice, and well-being are fundamental components of high quality and person-centred maternal healthcare that must also be considered. Looking at differences across one dimension alone does not reflect how fundamental drivers of maternal health inequities-including racism, ethnic or caste-based discrimination, and gendered power relations-operate. In this paper, we describe how using an intersectionality approach to maternal health can illuminate how power and privilege (and conversely oppression and exclusion) intersect and drive inequities. We present an intersectionality-informed analysis on antenatal care quality to illustrate the advantages of this approach, and what is lost in its absence. We reviewed and mapped equity-informed interventions in maternal health to existing literature to identify opportunities for improvement and areas for innovation. The gaps and opportunities identified were then synthesised to propose recommendations on how to apply an intersectionality lens to maternal health research, programmes, and policies.
从公平视角审视孕产妇健康,通常侧重于评估医疗服务及关键干预措施在覆盖范围和使用情况上的差异。虽然这种方法很重要,但我们认为,医疗体验、尊严、权利、正义和福祉是高质量且以患者为中心的孕产妇医疗保健的基本要素,也必须予以考虑。仅从一个维度审视差异,并不能反映孕产妇健康不平等的根本驱动因素——包括种族主义、基于族裔或种姓的歧视以及性别权力关系——是如何发挥作用的。在本文中,我们描述了如何运用交叉性方法来分析孕产妇健康问题,以阐明权力和特权(以及相反的压迫和排斥)是如何相互交织并导致不平等的。我们对产前护理质量进行了基于交叉性的分析,以说明这种方法的优势以及缺乏这种方法会带来的损失。我们将孕产妇健康领域基于公平的干预措施与现有文献进行了回顾和梳理,以确定改进的机会和创新的领域。然后,我们综合了所发现的差距和机会,就如何将交叉性视角应用于孕产妇健康研究、项目和政策提出了建议。