Gardiner Caitlin Victoria, Mohlomi Lerato, Draper Catherine E, Hlungwani Tsakani, Lye Stephen J, Norris Shane A, Muller-Kluits Noreth, Torres Neusa, Watson Daniella, Pentecost Michelle
Global Health and Social Medicine, King's College London, London, UK.
SAMRC/Wits Developmental Pathways for Health Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
J Biosoc Sci. 2025 Jun 24:1-20. doi: 10.1017/S0021932025100345.
Premised on the Developmental Origins of Health and Disease theory and on the limited effectiveness of antenatal interventions, interventions in the preconception period are being conducted to potentially improve intergenerational health and non-communicable disease burdens. The Healthy Life Trajectories Initiative (HeLTI) is an international health research consortium primarily investigating the intergenerational effects of behavioural interventions on obesity via a complex four-phase intervention initiated preconceptionally, through pregnancy, and into early childhood. HeLTI, in partnership with the World Health Organization, aims to generate evidence that will shape health policy focused on preconception as part of a life course approach to population health. It is necessary to ensure that a renewed public health focus on preconception prioritises justice and equity in its framing. This article presents collaborative interdisciplinary work with HeLTI-South Africa. It applies a feminist bioethics methodology, which is empirical, situated, intersectional, and fundamentally concerned with justice, to investigate what South African HeLTI community health workers, or 'Health Helpers', who deliver the complex behavioural intervention, think about preconception health and responsibility. Seven semi-structured interviews were conducted with HeLTI-SA Health Helpers, and data were analysed using reflexive thematic analysis. Our findings show that Health Helpers' perceptions of preconception health and related responsibility were significantly gendered, heteronormative, and concerned with child-bearing intentionality and desires. These themes were inflected with Health Helpers' perceptions about how attributions of responsibility are shaped by culture, demonstrating the situated nature of epistemologies. Their ideas also highlight how preconception health knowledge can distribute responsibility unjustly. Understanding the contextual impact and relevance of values around responsibility is critical to prospectively design preconception health interventions that promote equity and fairness. This understanding can then be used for effective policy translation, with the goal that public health policy is founded upon contextual responsivity and justice for the public it aims to serve.
基于健康与疾病的发育起源理论以及产前干预效果有限的情况，目前正在进行孕前干预，以期改善代际健康状况并减轻非传染性疾病负担。健康生活轨迹倡议（HeLTI）是一个国际健康研究联盟，主要通过孕前启动、贯穿孕期并持续至幼儿期的复杂四阶段干预措施，研究行为干预对肥胖的代际影响。HeLTI与世界卫生组织合作，旨在生成相关证据，以形成关注孕前的健康政策，作为人口健康生命历程方法的一部分。有必要确保重新聚焦孕前的公共卫生在其框架中优先考虑公正和平等。本文介绍了与HeLTI-南非的跨学科合作工作。它应用了一种女性主义生物伦理学方法，该方法是实证性的、情境化的、交叉性的，并且从根本上关注公正，以调查实施复杂行为干预的南非HeLTI社区卫生工作者，即“健康助手”，对孕前健康和责任的看法。对HeLTI-南非的健康助手进行了七次半结构化访谈，并使用反思性主题分析对数据进行了分析。我们的研究结果表明，健康助手对孕前健康和相关责任的认知存在显著的性别差异、异性恋规范特征，并且与生育意愿和欲望有关。这些主题受到健康助手对责任归属如何受文化影响的看法的影响，表明了认识论的情境性。他们的观点还凸显了孕前健康知识如何可能不公正地分配责任。理解围绕责任的价值观的情境影响和相关性对于前瞻性地设计促进公平公正的孕前健康干预措施至关重要。然后，这种理解可用于有效的政策转化，目标是使公共卫生政策基于对其旨在服务的公众的情境响应性和公正性。
