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How the choice of ethnic indicator influences ethnicity-based inequities in maternal health care in four Latin American countries: who is indigenous?

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dc.contributor.authorArmenta-Paulino, Nancy
dc.contributor.authorCastelló, Adela
dc.contributor.authorSandín Vázquez, María
dc.contributor.authorBolúmar, Francisco
dc.date.accessioned2024-06-24T09:16:20Z
dc.date.available2024-06-24T09:16:20Z
dc.date.issued2020-03-12
dc.description.abstractBackground: The current focus on monitoring health inequalities and the complexity around ethnicity requires careful consideration of how ethnic disparities are measured and presented. This paper aims to determine how inequalities in maternal healthcare by ethnicity change according to different criteria used to classify indigenous populations. Methods: Nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008-2016) were used to explore coverage gaps across maternal health care by ethnicity using different criteria. Women were classified as indigenous through self-identification (SI), spoken indigenous language (SIL), or indigenous household (IH). We compared the gaps through measuring coverage ratios (CR) with adjusted Poisson regression models. Results: Proportions of indigenous women changed significantly according to the identification criterion (Bolivia:SI-63.1%/SIL-37.7%; Guatemala:SI-49.7%/SIL-28.2%; Peru:SI-34%/SIL-6.3% & Mexico:SI-29.7%/SIL-6.9%). Indigenous in all countries, regardless of their identification, had less coverage. Gaps in care between indigenous and non-indigenous populations changed, for all indicators and countries, depending on the criterion used (e.g., Bolivia CR for contraceptive-use SI = 0.70, SIL = 0.89; Guatemala CR for skilled-birth-attendant SI = 0.77, SIL = 0.59). The heterogeneity persists when the reference groups are modified and compare just to non-indigenous (e.g., Bolivia CR for contraceptive-use under SI = 0.64, SIL = 0.70; Guatemala CR for Skilled-birth-attendant under SI = 0.77, SIL = 0.57). Conclusions: The indigenous identification criteria could have an impact on the measurement of inequalities in the coverage of maternal health care. Given the complexity and diversity observed, it is not possible to provide a definitive direction on the best way to define indigenous populations to measure inequalities. In practice, the categorization will depend on the information available. Our results call for greater care in the analysis of ethnicity-based inequalities. A greater understanding on how the indigenous are classified when assessing inequalities by ethnicity can help stakeholders to deliver interventions responsive to the needs of these groups.es_ES
dc.description.peerreviewedSíes_ES
dc.format.number1es_ES
dc.format.page31es_ES
dc.format.volume19es_ES
dc.identifier.citationInt J Equity Health. 2020 Mar 12;19(1):31.es_ES
dc.identifier.doi10.1186/s12939-020-1136-6es_ES
dc.identifier.e-issn1475-9276es_ES
dc.identifier.journalInternational journal for equity in healthes_ES
dc.identifier.pubmedID32164717es_ES
dc.identifier.urihttp://hdl.handle.net/20.500.12105/19840
dc.language.isoenges_ES
dc.publisherBioMed Central (BMC)es_ES
dc.relation.publisherversionhttps://doi.org/10.1186/s12939-020-1136-6es_ES
dc.repisalud.centroISCIII::Centro Nacional de Epidemiologíaes_ES
dc.repisalud.institucionISCIIIes_ES
dc.rights.accessRightsopen accesses_ES
dc.rights.licenseAtribución 4.0 Internacional*
dc.rights.urihttp://creativecommons.org/licenses/by/4.0/*
dc.subjectHealth inequalitieses_ES
dc.subjectIndigenouses_ES
dc.subjectMaternal health carees_ES
dc.subjectLACes_ES
dc.subject.meshHealth Equityes_ES
dc.subject.meshIndians, South Americanes_ES
dc.subject.meshIndigenous Peopleses_ES
dc.subject.meshMaternal Health Serviceses_ES
dc.subject.meshAdolescentes_ES
dc.subject.meshAdultes_ES
dc.subject.meshBoliviaes_ES
dc.subject.meshEthnicityes_ES
dc.subject.meshFamily Characteristicses_ES
dc.subject.meshFemalees_ES
dc.subject.meshGuatemalaes_ES
dc.subject.meshHealthcare Disparitieses_ES
dc.subject.meshHumanses_ES
dc.subject.meshLanguagees_ES
dc.subject.meshLatin Americaes_ES
dc.subject.meshMaternal Healthes_ES
dc.subject.meshMexicoes_ES
dc.subject.meshParturitiones_ES
dc.subject.meshPerues_ES
dc.subject.meshPregnancyes_ES
dc.subject.meshQuality Indicators, Health Carees_ES
dc.subject.meshSocial Identificationes_ES
dc.subject.meshYoung Adultes_ES
dc.titleHow the choice of ethnic indicator influences ethnicity-based inequities in maternal health care in four Latin American countries: who is indigenous?es_ES
dc.typeresearch articlees_ES
dc.type.hasVersionVoRes_ES
dspace.entity.typePublication
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