探索印度部落社区的母婴健康:生命历程视角

Minal Madankar, Narendra Kakade, Lohitha Basa, Bushra Sabri
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摘要

印度的母婴死亡率和发病率很高,部落社区受到的影响尤为严重。部落人口经常生活在不利的社会经济条件下,社会健康指标不足,最终导致不利的健康后果。这项定性研究从生命历程的角度,探讨了导致印度部落人口母婴健康问题的生命历程风险。此外,该研究还探讨了孕期和产后利用医疗保健服务的障碍。数据收集工作于 2017 年至 2019 年期间进行,通过对印度马哈拉施特拉邦马迪亚-贡德部落妇女的参与观察、关键信息提供者访谈(n = 7)、深度访谈(n = 68)和焦点小组(n = 7)进行。此外,还对该部落三名死亡妇女和五名婴儿的亲属进行了口头尸检。不同社会生态水平和人生发展阶段的多种风险因素与该部落的母婴健康问题有关。这些因素包括坚持传统的有害习俗、获得营养饮食的机会有限、妇女的健康因家务和职业劳动的双重负担而被忽视,以及缺乏方便和设备齐全的医疗设施。无法就医的原因包括极端贫困、地理位置偏僻以及医疗基础设施不完善。有必要制定相关规定,促进医疗服务的可及性,并促进以证据支持的医疗保健为中心的教育和宣传,特别是针对孕妇的教育和宣传。实施营养支持计划可能有助于缓解部落人口中普遍存在的母婴死亡率和发病率高的问题。
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Exploring Maternal and Child Health Among Tribal Communities in India: A Life Course Perspective
India experiences high rates of maternal and infant mortality and morbidity, with tribal communities disproportionately affected. Tribal populations frequently live in unfavorable socio-economic conditions and deficient social health indicators, culminating in adverse health consequences. Using a life course perspective, this qualitative study explored risks over the life course that contribute to maternal and child health problems among tribal populations in India. Additionally, the study examined barriers to utilization of healthcare services during the pregnancy and postpartum periods. Data collection occurred between 2017 and 2019 through participant observation, key informant interviews (n = 7) and in-depth interviews (n = 68) and a focus group (n = 7) with tribal women from the Madia-Gond tribe in the Indian state of Maharashtra. Additionally, verbal autopsies were conducted with relatives of three deceased women and five infants from the tribe. Multiple risk factors operating at different socio-ecological levels and developmental stages of life were associated with maternal and child health problems among the tribe. These included adherence to traditional harmful practices, limited access to nutritional diet, women's health neglected due to the double burden of domestic and professional labor, and a lack of accessible and well-equipped medical facilities. Inaccesibility stemmed from factors including extreme poverty, geographical isolation, and suboptimal healthcare infrastructure. There is need for provisions to promote access to care and to promote education and awareness centered on evidence-supported healthcare, particularly targeted towards expectant mothers. The implementation of nutritional support programs may help mitigate high maternal and child mortality and morbidity rates prevalent among tribal populations.
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