Economic and Social Factors are Some of the Most Common Barriers Preventing Women from Accessing Maternal and Newborn Child Health (MNCH) and Prevention of Mother-to-Child Transmission (PMTCT) Services: A Literature Review
Economic and Social Factors are Some of the Most Common Barriers Preventing Women from Accessing Maternal and Newborn Child Health (MNCH) and Prevention of Mother-to-Child Transmission (PMTCT) Services: A Literature Review
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DOI：
10.1007/s10461-014-0756-5
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发表时间：
2014-10-01
影响因子：
4.4
通讯作者：
Bloem, Martin
中科院分区：
文献类型：
--
作者：
HIarlaithe, Micheal O.;Grede, Nils;Bloem, Martin
对卫生规划的支持日益强调加强卫生系统。将预防母婴传播（PMTCT）与孕产妇和新生儿保健（MNCH）服务结合起来，是从孤立的做法转向更加综合的做法的领域之一。抗逆转录病毒治疗的扩大使服务越来越容易获得，同时也使这些服务更接近有需要的人。然而，如果不更明确地关注获取问题，仅在保健中心一级解决围绕护理的可得性和质量的供应方面问题并不能保证取得更好的结果。获得预防母婴传播护理和治疗服务受到一些障碍的影响，这些障碍影响了妇女寻求护理的决定。本文回顾了已发表的关于预防母婴传播服务的需求方障碍的定性和定量研究，并提出了对这些障碍的分类。报告指出，预防母婴传播服务的获得以及预防母婴传播护理的最终接受和保留始于一般的妇幼保健服务的获得。尽管贫穷往往使妇女（无论是否感染艾滋病毒）无法获得母婴服务，但需要预防母婴传播服务的感染艾滋病毒的妇女还面临一系列预防母婴传播障碍。这篇综述提出了四类预防母婴传播障碍：社会规范和知识、社会经济地位、生理状况和心理状况。社会规范、知识和社会经济地位突出。交通是最常被提及的社会经济障碍。在社会规范和知识方面，不披露、污名化和伴侣关系是最常提到的障碍。一些研究还提到了生理障碍。与社会规范和知识、社会经济地位和生理有关的障碍都可以受到个体的精神和心理状态的影响，从而形成心理障碍。如果决策者和规划管理人员更好地了解可能阻碍其潜在目标人群接受和坚持其服务的障碍，就可以扩大预防母婴传播服务的覆盖面和普及程度。本综述中提出的分类提供了对可能存在的障碍类型的进一步了解。
Support to health programming has increasingly placed an emphasis on health systems strengthening. Integration of prevention of mother-to-child transmission (PMTCT) and maternal and newborn child health (MNCH) services has been one of the areas where there has been a shift from a siloed to a more integrated approach. The scale-up of anti-retroviral therapy has made services increasingly available while also bringing them closer to those in need. However, addressing supply side issues around the availability and quality of care at the health centre level alone cannot guarantee better results without a more explicit focus on access issues. Access to PMTCT care and treatment services is affected by a number of barriers which influence decisions of women to seek care. This paper reviews published qualitative and quantitative studies that look at demand side barriers to PMTCT services and proposes a categorisation of these barriers. It notes that access to PMTCT services as well as eventual uptake and retention in PMTCT care starts with access to MNCH in general. While poverty often prevents women, regardless of HIV status, from accessing MNCH services, women living with HIV who are in need of PMTCT services face an additional set of PMTCT barriers. This review proposes four categories of barriers to accessing PMTCT: social norms and knowledge, socioeconomic status, physiological status and psychological conditions. Social norms and knowledge and socioeconomic status stand out. Transport is the most frequently mentioned socioeconomic barrier. With regard to social norms and knowledge, non-disclosure, stigma and partner relations are the most commonly cited barriers. Some studies also cite physiological barriers. Barriers related to social norms and knowledge, socioeconomic status and physiology can all be affected by the mental and psychological state of the individual to create a psychological barrier to access. Increased coverage and uptake of PMTCT services can be achieved if policy makers and programme managers better understand the barriers that may prevent their potential target population from taking up and adhering to their services. The categorisation presented in this review provides further insight into the type of barriers that may exist.