1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
First generation: Health disparities between indigenous and non-indigenous Guatemalan women are evident in country-wide data on adverse birth outcomes such as maternal mortality. Guatemala has one of the highest maternal mortality ratios in Latin America and 70% of maternal deaths occur among women of indigenous communities [1].
Second generation: Understanding why disparities exist is essential for moving into the third and fourth generation of the framework. With adverse birth outcomes several factors and socioeconomic correlates are identified by the literature such as access barriers of poverty, malnutrition, education, language as well as cultural factors with interfacing with the health care facility. My research focuses in on discrimination during maternity care as a barrier to health care utilization which directly affects adverse birth outcomes. Discrimination during childbirth, disrespectful maternity care, person-centered maternity care and respectful maternity care are all terms trying to define a concept and terminology around this research. Because the “why” of discrimination during childbirth is still being measured and defined, I think the research currently lies in the second generation.
To move forward into 3rd generation, the research community needs to agree on the terminology and quantitative measurement of the concept. Then we can move forward into planning interventions to address the health disparities. In order to progress to the fourth generation critical race theory serves as a lattice to structure the research, theory and practical application in the community.
1. van Dijk, M., Ruiz, M.J., Leona, D., & Garcia, S.G. (2013). Ensuring intercultural maternal health care for Mayan women in Guatemala: a qualitative assessment. [Supplement]. Culture, Health & Sexuality. 15 (3): S365-82
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
Referencing the three dimensional cliff in the article by Jones, differences in access to care can exacerbate health inequities. Within maternal health care services in Guatemala, there are many access barriers for indigenous women to deliver within a health facility. In order to mitigate adverse birth outcomes, the WHO recommends all births to be assisted by a skilled birth attendant. One major access barrier for many indigenous women is language. Spanish is the primary language spoken in Guatemala and within the medical system. Women without Spanish proficiency are less likely to deliver in a health facility controlling for other confounding factors (Ishida et al, 2012). One intervention to address this heal equity barrier, is obstetric care navigators or community health workers that serves as patient advocates, interpreters and guides to moving through maternal health care services. Perhaps this intervention can address the social determinant of poverty related to education attainment for rural, indigenous women.
Ishida, K., Stupp, P., Turcios-Ruiz, R., William, D., Espinoza, E. (2012). Ethnic inequality in Guatemalan women’s use of modern reproductive health care. International Perspectives on Sexual and Reproductive Health. 38(2):99-108.
3. Please respond to one other classmate's responses to this assignment – post this response as a separate post in the forum.
I replied to another student’s post through the forum.