Use of biomedical obstetric care in rural Tanzania: the role of social and material inequalities.
Use of biomedical obstetric care in rural Tanzania: the role of social and material inequalities.
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DOI：
10.1016/j.socscimed.2010.05.025
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发表时间：
2010-08-01
期刊：
影响因子：
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通讯作者：
Bloom, Shelah S
中科院分区：
文献类型：
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作者：
Spangler, Sydney A;Bloom, Shelah S
尽管20多年来一直在努力改善产妇保健，但在撒哈拉以南非洲的许多国家，妊娠和分娩并发症继续威胁着妇女的生命。为了降低产妇死亡率和实现千年发展目标五，致力于安全孕产的机构致力于使妇女在分娩期间更容易获得生物医学产科护理。然而，由于不能很好地理解的原因，这一战略的实施没有惠及社会经济谱中较低端的妇女。这项研究利用2007年9月至2008年6月期间进行的实地调查数据，调查了坦桑尼亚中南部两个农村地区妇女使用生物医学产科护理的情况，在那里提供了这种护理。具体地说，它试图解释社会和物质不平等如何影响与分娩有关的决定和行为。为了达到这个目的，我们采用了混合方法的研究设计。社会人口学特征对产科护理利用的影响采用Logistic回归分析(n=1150)，育龄妇女的观点和经历采用参与式观察和深度访谈(n=48)。定量研究和定性研究的结果被相互解释。与护理使用有关的统计上显著的社会和物质因素包括种族、教育、平等和家庭资产。定性主题涉及获得卫生设施的物质、经济和社会机会，以及风险认知和自我认同问题。总体研究结果表明，产科护理的使用受到与家庭和社区的相对地位密切相关的各种因素的复杂相互作用的影响。由于个体代理人通过多个权力标志而处于不同的位置，女性在广泛的威慑和激励因素中务实地谈判，以确保她们能得到最好的照顾。为了更好地利用生物医疗产科护理，旨在增加这些服务可获得性的干预措施应侧重于改善处境不利的妇女获得这些服务的机会。
Despite over 20 years of efforts to improve maternal health, complications of pregnancy and childbirth continue to threaten women's lives in many countries of sub-Saharan Africa. To reduce maternal mortality levels and achieve Millennium Development Goal Five, institutions working for safe motherhood are committed to making biomedical obstetric care more available to women during childbirth. However, implementation of this strategy is not reaching women at the lower end of the socioeconomic spectrum for reasons that are not well understood. Using data from fieldwork conducted between September 2007 and June 2008, this study examines women's use of biomedical obstetric care in two rural districts of south-central Tanzania where this care was being supplied. Specifically, it seeks to explain how social and material inequalities affect decisions and behaviors related to childbirth. In addressing this aim we employed a mixed-methods study design. Effects of sociodemographic characteristics on obstetric care use were examined with logistic regression analysis (n = 1150), while perspectives and experiences of childbearing women were explored with participant observation and in-depth interviews (n = 48). The results from quantitative and qualitative study components were interpreted in light of each other. Statistically significant social and material factors related to use of care included ethnicity, education, parity, and household assets. Qualitative themes involved physical, economic, and social access to health facilities as well as issues of risk perception and self-identity. The overall findings suggest that use of obstetric care is influenced by a complex interplay of factors closely tied to relative status in family and community. As individual agents differentially positioned by multiple markers of power, women pragmatically negotiate amidst a wide array of deterrents and motivators to secure the best care they can. In order to improve use of biomedical obstetric care, interventions aimed at increasing availability of these services should focus on improving access for women who are disadvantaged.