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1.
BMC Pregnancy Childbirth ; 20(1): 21, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906876

RESUMO

BACKGROUND: Husbands' involvement in maternal care is considered as a crucial step in scaling up women's utilization of the services. However, the factors related with how husband's involvement in maternal health care have hardly been studied to date in the study areas. Therefore, this study aimed to explore barriers to husbands' involvement in maternal health care, in Sidama zone, Southern Ethiopia. METHODS: The study employed a qualitative method. A pre-tested interview guide questions that prepared in English and translated in to Amharic language were used for data collection. The data were collected using focus group discussions, in-depth interviews and key-informants' interview in April and May 2015. The data were analyzed thematically. RESULTS: The study identified a range of factors that-deterred husbands to involve in their female partners' maternal health care. These are childbirth is a natural process, pregnancy and childbirth are women's business, preference for TBAs' care and husband's involvement in pregnancy and birth care is a new idea were identified as barriers for husbands' involvement in maternal health care, in this study. CONCLUSIONS: A range of factors related with clients' and service delivery factors' were identified as barriers to husbands' involvement in maternal health care. Based on the study findings we recommend a contextual based awareness creation programs about husbands' involvement in maternal health care need to be established.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Saúde Materna , Parto/etnologia , Papel (figurativo) , Normas Sociais/etnologia , Cônjuges/psicologia , Adolescente , Adulto , Etiópia , Feminino , Grupos Focais , Humanos , Masculino , Serviços de Saúde Materna , Gravidez , Pesquisa Qualitativa
2.
Women Birth ; 33(3): e209-e215, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31097412

RESUMO

BACKGROUND: Having a baby in a new country can be challenging, especially if unable to communicate in a preferred language. The aim of this paper is to explore the provision of health information for Afghan women and men during pregnancy, childbirth and the first year after birth in Melbourne, Australia. METHODS: Community engagement underpinned the study design. Qualitative study with bicultural researchers conducting semi-structured interviews. Interviews and focus groups were also conducted with health professionals. RESULTS: Sixteen Afghan women and 14 Afghan men with a baby aged 4-12 months participated. Thirty four health professionals also participated. Verbal information provided by a health professional with an interpreter was the most common way in which information was exchanged, and was generally viewed favourably by Afghan women and men. Families had limited access to an interpreter during labour and some families reported difficulty accessing an interpreter fluent in their dialect. Availability of translated information was inconsistent and health professionals occasionally used pictures to support explanations. Women and men were unsure of the role of health professionals in providing information about issues other than pregnancy and infant wellbeing. CONCLUSION: Both individual and health system issues hinder and enable the availability and use of information. Consistent, understandable and 'actionable' information is required to meet the needs of diverse families. Health professionals need to be supported with adequate alternatives to written information and access to appropriate interpreters. Inconsistent provision of information is likely to contribute to low health literacy and poor maternal and child health outcomes.


Assuntos
Assistência à Saúde Culturalmente Competente , Família/psicologia , Comunicação em Saúde , Letramento em Saúde , Pessoal de Saúde/psicologia , Parto/psicologia , Refugiados/psicologia , Adulto , Afeganistão , Austrália , Feminino , Grupos Focais , Humanos , Lactente , Entrevistas como Assunto , Masculino , Parto/etnologia , Gravidez , Pesquisa Qualitativa , Tradução , Adulto Jovem
3.
Health Policy Plan ; 35(1): 115-121, 2020 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-31691791

RESUMO

Cultural consensus analysis (CCA) is a quantitative method for determining cohesion in a specified cultural domain and cultural modelling (CM) is a method for designing and testing connections within a cultural domain based on qualitative data collection. After a description of the methods, and examples of their application, we provide a description of three main points in the programme planning, implementation and evaluation cycle at which the method can best be utilized to plan, contextualize or evaluate programmes and policies. In addition, the use of CCA and CM is not constrained to one point in time though, in order to maximize its ability to help with programme design or evaluation, it ought to be done as early as possible in the process. Through examples from research, and a broader description of the methods of CM and analysis, we provide another tool for global public health practitioners, planners and policymakers. We argue these tools can be used to great effect in a short period of time to maximize the local suitability, acceptability and quality of proposed and implemented interventions, building on existing local strengths, not just in maternal health but, more broadly.


Assuntos
Consenso , Cultura , Desenvolvimento de Programas/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Antropologia Cultural/métodos , Feminino , Identidade de Gênero , Humanos , Masculino , Pessoa de Meia-Idade , Tocologia , Parto/etnologia , Gravidez/etnologia , Complicações na Gravidez , Inquéritos e Questionários , Tanzânia
4.
Health Care Women Int ; 40(12): 1302-1335, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31600118

RESUMO

First Nations women who live on rural and remote reserves in Canada leave their communities between 36 and 38 weeks gestational age to receive labor and birthing services in large urban centers. The process and administrative details of this process are undocumented despite decades of relocation as a routine component of maternity care. Using data from 32 semistructured interviews and information from peer-reviewed literature, grey literature, and public documents, I constructed a descriptive map and a visual representation of the policy. I present new and detailed information about Canada's health policy as well as recommendations to address the health care gaps identified.


Assuntos
Política de Saúde , Acesso aos Serviços de Saúde , Serviços de Saúde do Indígena/organização & administração , Índios Norte-Americanos , Tocologia/métodos , Parto/etnologia , Gestantes/psicologia , Canadá , Feminino , Humanos , Entrevistas como Assunto , Manitoba , Serviços de Saúde Materna/organização & administração , Área Carente de Assistência Médica , Gravidez , Gestantes/etnologia , Pesquisa Qualitativa , População Rural
5.
Women Birth ; 32(5): 427-436, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31326382

RESUMO

BACKGROUND: The urban-based Malabar Community Midwifery Link Service integrates multidisciplinary wrap-around services along-side continuity of midwifery care for Aboriginal and Torres Strait Islander mothers and babies. AIM: To evaluate the Malabar Service from 1 January 2007 to 31 December 2014. METHODS: A mixed method design. Outcomes for mothers of Aboriginal and/or Torres Strait Islander babies cared for at an urban Australian referral hospital by the Malabar Service were compared to mainstream. Primary outcomes are rates of low birth weight; smoking >20 weeks gestation; preterm birth; and breastfeeding at discharge. Malabar outcomes are also compared to national and state perinatal outcomes. RESULTS: The Malabar Service (n = 505) demonstrated similar rates of preterm birth (aOR 2.2, 95% CI 0.96-4.97); breastfeeding at discharge (aOR 1.1, 95% CI 0.61-1.86); and a higher rate of low birth weight babies (aOR 3.6, 95% CI 1.02-12.9) than the comparison group (n = 201). There was a 25% reduction in smoking rates from 38.9% to 29.1%. Compared to national and state populations, Malabar outcomes were better. Women experienced greater psychosocial complexity but were well supported. Malabar Mothers (n = 9) experienced: accessibility, preparedness for birth and cultural safety. Staff (n = 13) identified going 'above and beyond' and teamwork to provide culturally safe care counterbalanced with concerns around funding and cultural support. CONCLUSIONS: Dedicated integrated continuity of midwifery care with wrap-around services for Aboriginal and/or Torres Strait Islander mothers is highly valued and is culturally safe. The service is as safe as main stream services and promotes better clinical outcomes compared to national and state outcomes.


Assuntos
Continuidade da Assistência ao Paciente , Serviços de Saúde do Indígena , Serviços de Saúde Materna/organização & administração , Bem-Estar Materno/etnologia , Tocologia/organização & administração , Grupo com Ancestrais Oceânicos/psicologia , Parto/etnologia , Adulto , Austrália , Características Culturais , Feminino , Humanos , Obstetrícia , Gravidez , Fumar
6.
Women Birth ; 32(5): 391-403, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31345660

RESUMO

BACKGROUND: Birth on Country is often assumed as relevant to Aboriginal women in rural/remote locations and not usually associated with urban environments. In Western Australia, one third of the Aboriginal population live in the greater metropolitan area. We wanted to know Aboriginal women's experiences of on Country urban births. METHODS: Indigenous qualitative data collection and analysis methods were used to learn about Aboriginal women's stories of contemporary and past experiences of maternity care and cultural practices associated with Birth on Country. RESULTS: Aboriginal Birthing, Senior and Elder women consistently reported ongoing cultural practices associated with childbirth including knowledge sharing across generations and family support, observance of extended family present at the time of or shortly after birth, and how their cultural security was improved when Aboriginal staff were present. Also noted, were the inflexibility of health systems to meet their needs and midwives lack of cultural awareness and understanding of the importance of Aboriginal kinship. CONCLUSION: The Birthing on Noongar Boodjar project Aboriginal women's data represents four generations of women's stories, experiences and expressions of childbearing, which highlighted that maternity care changes across time have failed to acknowledge and support Aboriginal women's cultural needs during childbearing. In terms of on Country urban birth, the women collectively expressed a strong desire to maintain cultural practices associated with childbirth, including birthing close to home (on Country); having family acknowledged and included throughout the perinatal period; and, having access to Aboriginal midwives, nurses, doctors, and other health care workers to support their cultural security.


Assuntos
Parto Obstétrico/métodos , Grupo com Ancestrais Oceânicos/psicologia , Parto/psicologia , Adulto , Idoso , Parto Obstétrico/estatística & dados numéricos , Feminino , Grupos Focais , Pessoal de Saúde , Humanos , Tocologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Parto/etnologia , Gravidez , Pesquisa Qualitativa , População Rural , Austrália Ocidental
7.
BMC Pregnancy Childbirth ; 19(1): 217, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248386

RESUMO

BACKGROUND: In many Western countries, higher rates of cesarean have been described among migrant women compared to natives of receiving countries. We aimed to estimate this difference comparing women originating from France and Sub-Saharan Africa (SSA), identify the clinical situations explaining most of this difference and assess whether maternal origin was independently associated with cesarean risk. METHODS: The PreCARE prospective multicenter cohort study was conducted in 2010-2012 in the north Paris area. Our sample was restricted to 1500 women originating from Sub-Saharan Africa and 2206 from France. Profiles of cesarean section by maternal origin were described by the Robson classification. Independent associations between maternal origin and 1) cesarean before labor versus trial of labor, then 2) intrapartum cesarean versus vaginal delivery were assessed by logistic regression models to adjust for other maternal and pregnancy characteristics. RESULTS: Rates of cesarean for women originating from France and SSA were 17 and 31%. The Robson 5A category "unique uterine scar, single cephalic ≥37 weeks" was the main contributor to this difference. Within this category, SSA origin was associated with cesarean before labor after adjustment for medical risk factors (adjusted odds ratio [aOR] = 2.30 [1.12-4.71]) but no more significant when adjusting on social deprivation (aOR = 1.45 [0.63-3.31]). SSA origin was associated with cesarean during labor after adjustment for both medical and social factors (aOR = 2.95 [1.35-6.44]). CONCLUSIONS: The wide difference in cesarean rates between SSA and French native women is mainly explained by the Robson 5A category. Within this group, medical factors alone do not explain the increased risk of cesarean in SSA women.


Assuntos
Cesárea/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adulto , África ao Sul do Saara/etnologia , Cesárea/classificação , Feminino , França/epidemiologia , França/etnologia , Humanos , Trabalho de Parto/etnologia , Modelos Logísticos , Razão de Chances , Parto/etnologia , Gravidez , Estudos Prospectivos , Fatores de Risco
9.
Med Anthropol ; 38(4): 342-355, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30883239

RESUMO

When a new biomedical hospital was built in Chuuk, women were encouraged to forgo home births and seek obstetric care. Chuuk's infrastructure deteriorated over time, however, and the hospital became known as the place of death. Women maintained faith in obstetric technology despite these conditions; they simply sought better technology in Guam or a US state. Yet, even upon migrating, women continued to suffer disproportionately poor birth outcomes. In this article, I explore how Chuukese women maintained faith in obstetric technology, elucidating the power of the "obstetric imaginary" in the context of neocolonial development, migration, and stratified reproduction.


Assuntos
Grupo com Ancestrais Oceânicos/etnologia , Parto/etnologia , Gravidez/etnologia , Adulto , Antropologia Médica , Feminino , Guam , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Migração Humana , Humanos , Segurança do Paciente
10.
MCN Am J Matern Child Nurs ; 44(2): 94-99, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30640727

RESUMO

PURPOSE: To explore the reasons why some Chinese women travel to the United States on a tourist visa specifically to give birth, also known as birth tourism. STUDY DESIGN: Qualitative, exploratory design. METHODS: Using convenience and snowball sampling, Chinese women were recruited from the waiting rooms of obstetricians known to care for birth tourists. Participants completed demographic data and provided answers to questions about their reasons for traveling to give birth and their birth experience while in the United States. Qualitative content analysis methods were used to extract themes from participant narratives. RESULTS: Twelve married, college-educated women, aged between 26 and 39 years, self-identifying as birth tourists from China participated in this study. Content analysis revealed two themes: (1) positive perceptions of childbirth in the United States; and (2) securing a future for their child. CLINICAL IMPLICATIONS: Study findings suggest Chinese birth tourists come to the United States for a better childbirth experience, and to secure future opportunities for their children. Nurses should be aware of the current political climate on immigration and birth tourism in order to promote a safe and judgment-free environment when providing care to this unique population of women.


Assuntos
Turismo Médico/psicologia , Responsabilidade Social , Adulto , China/etnologia , Feminino , Humanos , Turismo Médico/tendências , Parto/etnologia , Gravidez , Pesquisa Qualitativa , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos
11.
Women Birth ; 32(6): e560-e566, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30591304

RESUMO

BACKGROUND: Increasingly, pregnant women, as active online media users, incorporate media driven values on childbirth that may not agree with professional midwifery values. In Dutch midwifery practice, online searching for other women's stories is often discouraged. However, online birth stories attract women as a means to learn from one another's experiences of childbirth. AIM: This study aims to explore Dutch women's use of an online social media platform (Instagram) to represent childbirth by analyzing their narrative strategies. METHOD: A collection of 110 Instagram-linked childbirth narratives (2015-2017) were analyzed applying an approach of interpretative repertoires. FINDINGS: The Dutch women in this study linked birth stories on their Instagram accounts that represented impactful experiences of childbirth. In their narratives, three interconnected repertoires are played out: sharing your story, going into details, and doing it yourself. This study highlights that narrative details of the online birth stories illustrate the physical and procedural obstacles that women overcame in giving birth. DISCUSSION: Reporting their emotional experiences in detail, women's online sharing of birth stories puts a focus on their personal preferences and decision making, and may ease the way for medical interventions. Without giving explicit advice, personal online birth stories could be instrumental in reformulating the standards of what childbirth is, or should be, like. CONCLUSION: Social media networks allow women to exchange stories that structure narrating women's childbirth experiences and offer a structure for the lived or future experiences of others. This may have an impact on women's decision-making during pregnancy and childbirth.


Assuntos
Narração , Parto , Mídias Sociais , Apoio Social , Feminino , Humanos , Países Baixos , Parto/etnologia , Parto/fisiologia , Parto/psicologia , Gravidez
12.
Birth ; 46(3): 500-508, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-30198111

RESUMO

BACKGROUND: Routine use of medical interventions during labor has been identified as a clinical area for concern, since such routinized practice is not consistent with an evidence-based approach to care and continues to increase despite efforts to encourage normal childbirth. Therefore, the aim of our study was to explore maternity health professionals' use of interventions during the second stage of labor in two hospitals in Jeddah, Saudi Arabia, to understand what influences their decision-making and practices. METHODS: This was an exploratory study using an ethnographic approach. Data collection methods included participant observations of 19 labors and births (n = 8 at City Hospital and n = 11 at King's Hospital) and semi-structured interviews with 29 health care professionals. In addition, the hospital labor and delivery ward policies and guidelines from those hospitals were collected. Data were analyzed thematically. RESULTS: Medical interventions were used during the second stage of labor routinely, regardless of clinical indication. Three core influences that shaped the clinical decision-making were identified as follows: (a) organizational culture, (b) a medical concept of birth, and (c) a hierarchical system of control. We suggest that the clinical decision-making and routine practice in this setting arises out of the interface between these three core influences whereby hierarchical control and clinicians' exercise of power and feelings of powerlessness are fundamental drivers for an organizational culture of medicalized childbirth, despite the differing models of childbirth which professionals described. CONCLUSIONS: Clinical decisions relating to the use of interventions during childbirth are both complex and socially negotiated. The findings reflect the complexity of the use of interventions during the second stage of labor and the multiple influences on professionals' practices. We have shown how three key influences interact to shape clinical decision-making during the second stage of labor in this cultural setting and how the use of medical interventions can be analyzed as an illustration of the power dynamic in the maternity health care system. We suggest that written policies are insufficient to bring about evidence-based practice and approaches to change need to take into account these different levels of influence.


Assuntos
Parto Obstétrico/métodos , Segunda Fase do Trabalho de Parto/efeitos dos fármacos , Medicalização , Parto/etnologia , Antropologia Cultural , Atitude do Pessoal de Saúde/etnologia , Tomada de Decisões , Feminino , Humanos , Segunda Fase do Trabalho de Parto/etnologia , Gravidez , Arábia Saudita
13.
Med Anthropol ; 38(7): 560-573, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-30521376

RESUMO

In this article, I analyze the birth stories of Black women living in the United States. Their birth stories describe various forms of racism during medical encounters while they were pregnant or during labor and delivery. In the global women's health arena, the issues raised are viewed as obstetric violence. However, obstetric racism-as both an occurrence and analytic-best captures the particularities of Black women's reproductive care during the pre- and post-natal period. Obstetric racism is a threat to positive birth outcomes. I argue that birth workers including midwives and doulas, mediate obstetric racism and stratified reproductive outcomes.


Assuntos
Afro-Americanos/etnologia , Trabalho de Parto/etnologia , Parto/etnologia , Racismo/etnologia , Adulto , Antropologia Médica , Feminino , Acesso aos Serviços de Saúde , Humanos , Política , Gravidez , Estados Unidos , Saúde da Mulher
14.
Health Care Women Int ; 40(2): 138-157, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30526416

RESUMO

Maternal mortality is unacceptably high in developing countries, and maternal health care service utilization is associated with improved maternal outcomes. We shed light on conditions that influence women's preferences for childbirth location. Based on a qualitative descriptive design, 25 interviews were conducted with women of childbearing age in Southern Ethiopia in 2015. Previous experience of complications was the most common reason for using skilled attendants at the next childbirth. In addition, women's limited decision-making authority and knowledge, as well as the quality of health care services and infrastructure, influenced childbirth location preferences. Home birth is still the norm, but there is growing interest in using health facilities and skilled attendants.


Assuntos
Parto Obstétrico , Acesso aos Serviços de Saúde , Parto Domiciliar , Serviços de Saúde Materna/estatística & dados numéricos , Parto , Preferência do Paciente , Adolescente , Adulto , Etiópia , Feminino , Humanos , Entrevistas como Assunto , Parto/etnologia , Parto/psicologia , Gravidez , Pesquisa Qualitativa , Fatores Socioeconômicos , Adulto Jovem
15.
Med Anthropol ; 38(2): 137-151, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30462518

RESUMO

The institutionalization of Mexican midwifery has a long history. Despite global recommendations moving away from training traditional midwives, training courses still continue. Based on fieldwork in the State of Chiapas, I argue that while ongoing trainings offered to traditional midwives in Mexico aim at teaching them best practices, they also limit midwives' autonomy and keep poor women's reproductive behaviors under control. I demonstrate how midwives and medical personnel mobilize discourses of reproductive risk, women's rights and indigenous cultural rights to reinforce or contest mechanisms of reproductive governance.


Assuntos
Atitude do Pessoal de Saúde/etnologia , Tocologia/normas , Direitos Sexuais e Reprodutivos , Antropologia Médica , Feminino , Humanos , México/etnologia , Tocologia/organização & administração , Parto/etnologia , Gravidez
19.
J Perinat Med ; 47(1): 22-29, 2018 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-29870393

RESUMO

Background Anthropometric parameters such as birth weight (BW) and adult body height vary between ethnic groups. Ethnic-specific percentile charts are currently being used for the assessment of newborns. However, due to globalization and interethnic families, it is unclear which charts should be used. A correlation between a mother's height and her child's BW (1 cm accounts for a 17 g increase in BW) has been observed. The study aims to test differences in small for gestational age (SGA) and large for gestational age (LGA) rates, employing BW percentile charts based on maternal height between ethnic groups. Methods This retrospective study of 2.3 million mother/newborn pairs analyzed BW, gestational age, sex, maternal height and ethnicity from the German perinatal survey (1995-2000). These data were stratified for maternal height (≤157, 158-163, 164-169, 170-175, ≥176 cm) and region of origin (Germany, Central and Northern Europe, North America, Mediterranean region, Eastern Europe, Middle East and North Africa, and Asia excluding Middle East). Percentile charts were calculated for each maternal height group. Results The average BW and maternal height differ significantly between ethnic groups. On current percentile charts, newborns of taller mothers (≥176 cm) have a low rate of SGA and a high rate of LGA, whereas newborns of shorter mothers (≤157 cm) have a high rate of SGA and a low rate of LGA. When the BW data are stratified based on the maternal height, mothers of similar height from different ethnic groups show similar average BWs, SGA and LGA rates. Conclusion Maternal body height has a greater influence on BW than maternal ethnicity. The use of BW percentile charts for maternal height should be considered.


Assuntos
Peso ao Nascer , Estatura , Parto/etnologia , Adulto , Grupos Étnicos , Feminino , Alemanha/epidemiologia , Idade Gestacional , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional/fisiologia , Gravidez , Resultado da Gravidez/etnologia , Estudos Retrospectivos
20.
BMC Pregnancy Childbirth ; 18(1): 243, 2018 Jun 18.
Artigo em Inglês | MEDLINE | ID: mdl-29914405

RESUMO

BACKGROUND: Preventable maternal and infant mortality continues to be significantly higher in Latin American indigenous regions compared to non-indigenous, with inequalities of race, gender and poverty exacerbated by deficiencies in service provision. Standard programmes aimed at improving perinatal health have had a limited impact on mortality rates in these populations, and state and national statistical data and evaluations of services are of little relevance to the environments that most indigenous ethnicities inhabit. This study sought a novel perspective on causes and solutions by considering how structural, cultural and relational factors intersect to make indigenous women and babies more vulnerable to morbidity and mortality. METHODS: We explored how structural inequalities and interpersonal relationships impact decision-making about care seeking during pregnancy and childbirth in Wixarika communities in Northwestern Mexico. Sixty-two women were interviewed while pregnant and followed-up after the birth of their child. Observational data was collected over 18 months, producing more than five hundred pages of field notes. RESULTS: Of the 62 women interviewed, 33 gave birth at home without skilled attendance, including 5 who delivered completely alone. Five babies died during labour or shortly thereafter, we present here 3 of these events as case studies. We identified that the structure of service provision, in which providers have several contiguous days off, combined with a poor patient-provider dynamic and the sometimes non-consensual imposition of biomedical practices acted as deterrents to institutional delivery. Data also suggested that men have important roles to play supporting their partners during labour and birth. CONCLUSIONS: Stillbirths and neonatal deaths occurring in a context of unnecessary lone and unassisted deliveries are structurally generated forms of violence: preventable morbidities or mortalities that are the result of systematic inequalities and health system weaknesses. These results counter the common assumption that the choices of indigenous women to avoid institutional delivery are irrational, cultural or due to a lack of education. Rather, our data indicate that institutional arrangements and interpersonal interactions in the health system contribute to preventable deaths. Addressing these issues requires important, but achievable, changes in service provision and resource allocation in addition to long term, culturally-appropriate strategies.


Assuntos
Atitude Frente a Saúde/etnologia , Parto/etnologia , Morte Perinatal/prevenção & controle , Qualidade da Assistência à Saúde/estatística & dados numéricos , Violência/etnologia , Adolescente , Adulto , Antropologia Cultural , Tomada de Decisões , Grupos Étnicos , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Relações Interpessoais , México , Assistência Perinatal/estatística & dados numéricos , Morte Perinatal/etiologia , Gravidez , Fatores Socioeconômicos , Adulto Jovem
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