背景:97%的土著人民生活在中低收入国家。先前对2000年至2017年间发表的文章进行了系统的综合审查,确定了低收入国家土著妇女在获得孕产妇保健服务方面的许多障碍。考虑到在六年内实现全民健康覆盖的目标,这是及时的,到2030年,进行另一次审查。本文更新了先前的评论,探讨了有关LMICs中土著妇女获得孕产妇保健服务的最新文献,以确定服务障碍。
方法:对2018年至2023年发表的文献进行了综合回顾。本审查遵循了使用Whittemore和Knafl的综合审查五步框架以及系统审查和荟萃分析(PRISMA)指南的系统过程。总共从六个数据库中确定了944篇文章:学术搜索Premier,MEDLINE,心理学与行为科学合集,APAPsycInfo,CINAHLPlus与全文和APAPsycarticles(通过EBSCOhost)。搜索于2023年1月16日进行。在使用纳入和排除标准筛选标题/摘要和全文后,确定了26篇文章。批判性评估导致24篇文章被纳入审查。数据是使用由Penchansky和Thomas\的分类法提供的矩阵提取的,由Saurman扩展,重点关注获得医疗保健的六个方面:可负担性,可访问性,可用性,住宿,可接受性和意识。在亚洲进行了十项研究,10项研究来自美洲,4项研究在非洲地区进行。17篇文章是定性的,两种是定量方法,五种是混合方法。综合审查的方法在方案中预先指定,在开放科学框架注册。
结果:确定的障碍包括可负担性;社区对服务的认识,包括提供者与妇女之间的沟通不良;服务的可用性,设施中经常缺少工作人员;服务质量差,没有考虑到土著人民的文化和精神需求;过度依赖生物医学模式;缺乏能够提供适当产妇护理的设施;服务不能满足妇女的日常需求,包括工作和家庭责任;卫生专业人员对土著文化缺乏了解;以及产科暴力和虐待土著妇女的证据。
结论:土著妇女获得孕产妇保健服务的障碍是土著人民的社会排斥和边缘化的基础。需要增强中低收入国家的土著妇女和社区的权能,并采取举措来挑战她们面临的污名化和边缘化。需要社区参与支持土著人民政治和人权的设计和干预措施的重要性。这项审查的局限性包括遗漏文章的可能性,因为有时从文章中不清楚某个特定群体是否来自土著社区。在产后获得服务方面仍需进行更多研究,以及质量定量研究。也缺乏对北非土著群体的研究,以及在撒哈拉以南非洲-特别是狩猎-采集群体-以及COVID-19对获得服务的影响。
BACKGROUND: Ninety-seven per cent of Indigenous Peoples live in low-and middle-income countries (LMICs). A previous systematic integrative
review of articles published between 2000 and 2017 identified numerous barriers for Indigenous women in LMICs in accessing maternal healthcare services. It is timely given the aim of achieving Universal Health Coverage in six years\' time, by 2030, to undertake another
review. This article updates the previous
review exploring the recent available literature on Indigenous women\'s access to maternal health services in LMICs identifying barriers to services.
METHODS: An integrative
review of literature published between 2018 and 2023 was undertaken. This review followed a systematic process using Whittemore and Knafl\'s five-step framework for integrative reviews and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A total of 944 articles were identified from six databases: Academic Search Premier, MEDLINE, Psychology and Behavioral Sciences Collection, APA PsycInfo, CINAHL Plus with Full Text and APA PsycArticles (through EBSCOhost). The search was undertaken on 16 January 2023. After screening of the title/abstract and the full text using inclusion and exclusion criteria 26 articles were identified. Critical appraisal resulted in 24 articles being included in the
review. Data were extracted using a matrix informed by Penchansky and Thomas\'s taxonomy, extended by Saurman, which focused on six dimensions of access to health care: affordability, accessibility, availability, accommodation, acceptability and awareness. Ten studies took place in Asia, 10 studies were from the Americas and four studies took place in the African region. Seventeen articles were qualitative, two were quantitative and five were mixed methods. The methods for the integrative review were prespecified in a protocol, registered at Open Science Framework.
RESULTS: Barriers identified included affordability; community awareness of services including poor communication between providers and women; the availability of services, with staff often missing from the facilities; poor quality services, which did not consider the cultural and spiritual needs of Indigenous Peoples; an overreliance on the biomedical model; a lack of facilities to enable appropriate maternal care; services that did not accommodate the everyday needs of women, including work and family responsibilities; lack of understanding of Indigenous cultures from health professionals; and evidence of obstetric violence and mistreatment of Indigenous women.
CONCLUSIONS: Barriers to Indigenous women\'s access to maternal health services are underpinned by the social exclusion and marginalisation of Indigenous Peoples. Empowerment of Indigenous women and communities in LMICs is required as well as initiatives to challenge the stigmatisation and marginalisation that they face. The importance of community involvement in design and interventions that support the political and human rights of Indigenous Peoples are required. Limitations of this review include the possibility of missing articles as it was sometimes unclear from the articles whether a particular group was from an Indigenous community. More research on access to services in the postnatal period is still needed, as well as quality quantitative research. There is also a lack of research on Indigenous groups in North Africa, and in sub-Saharan Africa - especially hunter-gatherer groups - as well as the impact of COVID-19 on access to services.