Background
Methods
Study design and data sources
Coverage indicators
Identification of ethnicity
Ethnicity identification Questions | Categorizing | ||
---|---|---|---|
Indigenous | Reference Group | ||
Self- identification (SI) | SI | Non-SI | |
Bolivia | Do you consider yourself a member of an indigenous people such as quechua, aymara, guarani, or other? | Quechua, aymara, guaraní, other | None |
Guatemala | Do you consider yourself as indigenous or non-indigenous? | Indigenous | Non-indigenous |
Do you consider yourself: maya, ladina/mestiza, garifuna, xinca, or other ethnia? | Maya, xinca or other ethnia | Ladina/mestiza, garifuna | |
Mexico | According to your culture, do you consider yourself as indigenous? | Yes | No |
Peru | According to your ancestors and traditions, do you consider yourself as: Quechua?, Aymara?, Native or Amazonia’s indigenous?, Black, mulatto, afro Peruvian?, White?, Mestizo?, other? | Quechua, aymara, native or Amazonia’s indigenous | Black, mulatto, afro peruvian, White, Mestizo |
Spoken indigenous language (SIL) | SIL | Non-SIL | |
Bolivia | What languages do you speak? | Quechua, Aymara, Guaraní, another native | Spanish, foreign language |
Guatemala | Usually, what language do you speak at home? | Kaqchiquel, Q’eqchi, K’iche, Mam, Poqomchi’, Tzu’utujil, Q’anjob’al, Ch’orti’, Pocomam, Achi, Akateko, Awakateko, Chalchiteko, Chuj, Itza’, Ixil, Jakatelteko (Popti’), Mopan, Sakapulteko, Sipakapense, Tektiteko, Usapanteko | Spanish |
Mexico | Do you speak any indigenous language? | Yes | No |
Peru | Usually, what language or dialect do you speak at home? | Quechua, Aymara, another native | Spanish, foreign language |
Indigenous household (IH) | IH | Non-IH | |
Bolivia | If the head of household said to speak an indigenous language | Indigenous household: Quechua, Aymara, Guaraní, another native | Non-indigenous household: Spanish, foreign language |
Mexico | If the head of household said to speak an indigenous language | Indigenous household: Yes | Non-indigenous household: No |
Statistical analysis
Measurement of maternal health care inequalities
Differences in the inequalities by ethnic identification criterion used
Approach | Comparison groups | Specifications | |
---|---|---|---|
A1. Direct references | • The simplest way to measure gaps by ethnicity. We identify as indigenous those who report the specific ethnic criterion and non-indigenous as who do not report it. • Otherwise, if women did not meet these criteria, they were considered as non-indigenous. A woman who self-identified as indigenous but does not speak an indigenous language would be classified as non-indigenous under the SIL criterion. • This could be a unique way to measure inequalities when you only have information on any of the ethnic identification criteria. | ||
SI vs Non- SI SIL vs Non- SIL IH vs Non- IH | |||
A2. Adjusted reference groups | SI vs Non- Indigenous SIL vs Non- Indigenous IH vs Non- indigenous | • We only included in the reference group women who did not report any of the attributes of ethnic identification (self-identification, language or living in an indigenous household) • Under this approach, we avoid including in the reference group women with similar sociocultural factors because under other criteria they are identified as indigenous. | |
A3. Integrate indigenous population | Indigenous if: SI or SIL or IH | vs Non- Indigenous | • We identified as indigenous women those who reported any of the ethnic identification criteria. • Under this strategy, we can identify a higher number of women as indigenous. • We considered that women identified through any of the different criteria could share with the rest some cultural factors related to motherhood or suffer discrimination and have language barriers, all of which may affect maternal health care. |
Results
Indigenous women
Inequalities in the continuum of care for maternal health
Ethnicity Identification criteria | Approach | ||||||
---|---|---|---|---|---|---|---|
A1. Direct references | A2. Adjusted reference groups | A3. Integrate indigenous population | |||||
Coverage ratio | SI vs Non-SI | SIL vs Non-SIL | IH vs Non-IH | SI vs Non-Indigenous | SIL vs Non-Indigenous | IH vs Non- Indigenous | SI or SIL or IH vs Non-Indigenous |
Bolivia | |||||||
Before and during pregnancy | |||||||
Contraceptive use | 0.70 (0.64;0.77) 0.000 | 0.89 (0.81;0.98) 0.013 | 0.61 (0.55;0.67) 0.000 | 0.64 (0.58;0.71) 0.000 | 0.59 (0.52;0.67) 0.000 | 0.59 (0.53;0.65) 0.000 | 0.69 (0.63;0.76) 0.000 |
Antenatal care (skilled provider) | 0.97 (0.95;0.98) 0.000 | 0.99 (0.98;1.01) 0.531 | 0.96 (0.95;0.98) 0.000 | 0.97 (0.95;0.98) 0.000 | 0.97 (0.95;0.99) 0.001 | 0.96 (0.95;0.98) 0.000 | 0.97 (0.96;0.99) 0.000 |
First antenatal care visit in 1st trimester | 0.95 (0.91;0.99) 0.014 | 0.98 (0.93;1.03) 0.433 | 0.92 (0.87;0.96) 0.000 | 0.96 (0.91;1.01) 0.120 | 0.94 (0.89;1.00) 0.067 | 0.94 (0.89;0.99) 0.017 | 0.97 (0.93;1.02) 0.311 |
Four or more antenatal care visits | 0.90 (0.87;0.93) 0.000 | 1.00 (0.96;1.04) 0.900 | 0.90 (0.87;0.93) 0.000 | 0.90 (0.87;0.94) 0.000 | 0.91 (0.87;0.95) 0.000 | 0.90 (0.87;0.94) 0.000 | 0.92 (0.89;0.96) 0.000 |
Birth and postpartum period | |||||||
Skilled birth atendant | 0.90 (0.88;0.93) 0.000 | 0.97 (0.94;1.01) 0.145 | 0.90 (0.87;0.92) 0.000 | 0.91 (0.88;0.93) 0.000 | 0.89 (0.86;0.93) 0.000 | 0.91 (0.88;0.93) 0.000 | 0.93 (0.90;0.95) 0.000 |
Postpartum care visit | 0.95 (0.94;0.97) 0.000 | 0.99 (0.97;1.02) 0.589 | 0.95 (0.93;0.96) 0.000 | 0.96 (0.94;0.98) 0.000 | 0.95 (0.93;0.98) 0.000 | 0.95 (0.94;0.97) 0.000 | 0.97 (0.95;0.98) 0.000 |
Mexico | |||||||
Before and during pregnancy | |||||||
Contraceptive use | 0.96 (0.91;1.02) 0.213 | 0.86 (0.74;0.99) 0.037 | 0.92 (0.83;1.02) 0.114 | 0.97 (0.91;1.03) 0.270 | 0.88 (0.76;1.01) 0.078 | 0.94 (0.85;1.05) 0.255 | 0.98 (0.92;1.04) 0.517 |
Antenatal care (skilled provider) | 0.98 (0.96;1.00) 0.094 | 0.94 (0.88;1.01) 0.084 | 0.95 (0.90;1.01) 0.099 | 0.98 (0.96;1.00) 0.086 | 0.93 (0.88;1.00) 0.038 | 0.95 (0.90;1.00) 0.052 | 0.98 (0.96;1.01) 0.140 |
First antenatal care visit in 1st trimester | 0.99 (0.92;1.07) 0.857 | 0.95 (0.86;1.05) 0.330 | 0.93 (0.83;1.05) 0.243 | 0.99 (0.92;1.06) 0.711 | 0.95 (0.85;1.06) 0.362 | 0.94 (0.83;1.06) 0.322 | 0.98 (0.91;1.06) 0.647 |
Four or more antenatal care visits | 0.98 (0.94;1.01) 0.159 | 0.85 (0.77;0.95) 0.003 | 0.89 (0.81;0.96) 0.005 | 0.97 (0.94;1.00) 0.053 | 0.85 (0.77;0.93) 0.001 | 0.88 (0.82;0.96) 0.002 | 0.97 (0.94;1.00) 0.027 |
Birth and postpartum period | |||||||
Skilled birth atendant | 0.98 (0.96;0.99) 0.011 | 0.88 (0.80;0.96) 0.004 | 0.92 (0.85;0.98) 0.012 | 0.98 (0.96;0.99) 0.008 | 0.87 (0.80;0.95) 0.002 | 0.91 (0.85;0.97) 0.005 | 0.98 (0.96;1.00) 0.022 |
Postpartum care visit | 0.98 (0.96;1.01) 0.149 | 0.91 (0.85;0.98) 0.009 | 0.95 (0.89;1.00) 0.052 | 0.98 (0.96;1.01) 0.144 | 0.91 (0.86;0.98) 0.008 | 0.95 (0.90;1.00) 0.043 | 0.98 (0.96;1.01) 0.160 |
Ethnicity Identification criteria | Approach | ||||
---|---|---|---|---|---|
A1. Direct references | A2. Adjusted reference groups | A3. Integrate indigenous population | |||
Coverage ratio | SI vs Non-SI | SIL vs Non-SIL | SI vs Non-Indigenous | SIL vs Non-Indigenous | SI or SIL or IH vs Non-Indigenous |
Guatemala | |||||
Before and during pregnancy | |||||
Contraceptive use | 0.78 (0.74;0.83) 0.000 | 0.66 (0.60;0.73) 0.000 | 0.78 (0.73;0.83) 0.000 | 0.64 (0.58;0.71) 0.000 | 0.78 (0.73;0.83) 0.000 |
Antenatal care (skilled provider) | 0.98 (0.96;1.00) 0.022 | 0.97 (0.94;1.00) 0.023 | 0.98 (0.96;1.00) 0.022 | 0.96 (0.93;0.99) 0.012 | 0.98 (0.96;1.00) 0.022 |
First antenatal care visit in 1st trimester | 0.91 (0.87;0.94) 0.000 | 0.91 (0.87;0.96) 0.000 | 0.91 (0.87;0.94) 0.000 | 0.89 (0.84;0.93) 0.000 | 0.91 (0.87;0.94) 0.000 |
Four or more antenatal care visits | 1.00 (0.98;1.02) 0.959 | 1.02 (0.99;1.05) 0.233 | 1.00 (0.98;1.02) 0.985 | 1.02 (0.99;1.05) 0.260 | 1.00 (0.98;1.02) 0.985 |
Birth and postpartum period | |||||
Skilled birth atendant | 0.77 (0.74;0.80) 0.000 | 0.59 (0.54;0.64) 0.000 | 0.77 (0.73;0.80) 0.000 | 0.57 (0.52;0.62) 0.000 | 0.76 (0.73;0.80) 0.000 |
Postpartum care visit | |||||
Peru | |||||
Before and during pregnancy | |||||
Contraceptive use | 0.91 (0.87;0.96) 0.000 | 0.76 (0.70;0.83) 0.000 | 0.91 (0.87;0.95) 0.000 | 0.76 (0.69;0.83) 0.000 | 0.91 (0.87;0.95) 0.000 |
Antenatal care (skilled provider) | 1.00 (1.00;1.01) 0.357 | 0.94 (0.90;0.98) 0.005 | 1.00 (0.99;1.01) 0.542 | 0.96 (0.92;1.00) 0.038 | 1.00 (0.99;1.01) 0.797 |
First antenatal care visit in 1st trimester | 0.94 (0.92;0.97) 0.000 | 0.91 (0.87;0.95) 0.000 | 0.94 (0.92;0.97) 0.000 | 0.90 (0.86;0.94) 0.000 | 0.94 (0.92;0.97) 0.000 |
Four or more antenatal care visits | 0.99 (0.99;1.00) 0.284 | 0.96 (0.94;0.98) 0.001 | 1.00 (0.99;1.00) 0.331 | 0.97 (0.95;1.00) 0.025 | 1.00 (0.99;1.00) 0.309 |
Birth and postpartum period | |||||
Skilled birth atendant | 1.03 (1.02;1.05) 0.000 | 0.97 (0.91;1.03) 0.331 | 1.03 (1.01;1.04) 0.000 | 1.00 (0.94;1.07) 0.990 | 1.03 (1.01;1.04) 0.000 |
Postpartum care visit | 1.01 (1.00;1.02) 0.016 | 0.97 (0.93;1.01) 0.117 | 1.01 (1.00;1.02) 0.029 | 0.98 (0.94;1.02) 0.407 | 1.01 (1.00;1.02) 0.049 |