Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk
Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk
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DOI：
10.1016/s0277-9536(02)00363-5
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发表时间：
2003-07-01
影响因子：
5.4
通讯作者：
Chapman, RR
中科院分区：
文献类型：
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作者：
Chapman, RR
尽管婴儿和孕产妇死亡率很高，但许多获得产前服务的莫桑比克妇女却推迟了产前门诊咨询，限制了预防和治疗可预防的妊娠并发症的机会。在莫桑比克中部进行了人种学研究、卫生服务提供者访谈以及对 83 名妇女的纵向妊娠案例研究，以调查孕妇未充分利用诊所产前服务的情况。研究发现，怀孕信念和产前实践反映了女性在多个层面的脆弱条件下影响生育的尝试。妇女报告说，孕产妇生殖发病率很高，经常流产，并且在整个育龄期承受着巨大的生育压力。在经济紧缩、土地短缺以及社会冲突和不平等加剧的时期，贫穷以及城市周边贫困女农民在家庭生存和持续生育方面承受的沉重负担，加剧了生殖脆弱性。在这种因拥挤的生活条件而加剧的经济不安全环境中，妇女报告说要争夺稀缺资源，包括男性的支持和收入。这种脆弱性使妇女更加认识到她们和未出生的婴儿将成为嫉妒的邻居和亲戚巫术或巫术的目标。他们的反应是隐瞒怀孕情况并推迟产前护理。在妇女意识到生殖风险的背景下，延迟产前护理可以被视为保护怀孕免受有目的的人类和精神伤害的策略。妇女调动有限的资源在正规诊所之外获得产前护理。结论是，提供临床产前服务不足以降低社会和经济最边缘群体的生殖风险，因为她们的脆弱性阻碍了妇女利用现有服务。建议提供保密的产妇服务和社会安全网以提高经济安全。 (C) 2003 Elsevier Science Ltd. 保留所有权利。
Despite high infant and maternal mortality rates, many Mozambican women with access to prenatal services delay prenatal clinic consultations, limiting opportunity for prevention and treatment of preventable pregnancy complications. Ethnographic research, interviews with health providers and longitudinal pregnancy case studies with 83 women were conducted in Central Mozambique to examine pregnant women's underutilization of clinic-based prenatal services. The study found that pregnancy beliefs and prenatal practices reflect women's attempts to influence reproduction under conditions of vulnerability at multiple levels. Women reported high maternal reproductive morbidity, frequent pregnancy wastage, and immense pressure to bear children throughout their reproductive years. Reproductive vulnerability is intensified by poverty and an intense burden placed on poor, peri-urban women farmers for family subsistence and continuous fertility in a period of economic austerity, land shortages, and increasing social conflict and inequality. In this environment of economic insecurity exacerbated by congested living conditions, women report competing for scarce resources, including male support and income. This vulnerability heightens women's perceptions that they and their unborn infants will be targets of witchcraft or sorcery by jealous neighbors and kin. They respond by hiding pregnancy and delaying prenatal care. Within the context of women's perceived reproductive risks, delayed prenatal care can be seen as a strategy to protect pregnancy from purposeful human and spirit harm. Women mobilized limited resources to acquire prenatal care outside the formal clinic setting. It is concluded that provision of clinical prenatal services is insufficient to reduce reproductive risks for the most socially and economically marginal since it is their vulnerability that prevents women from using available services. Confidential maternity services and social safety nets for greater economic security are recommended. (C) 2003 Elsevier Science Ltd. All rights reserved.