Abstract
Latin America and the Caribbean still have high maternal mortality rates and access to health care is very uneven in some countries. Indigenous women, in particular, have poorer maternal health outcomes than the majority of the population and are less likely to benefit from health-care services. Therefore, inequities in maternal health between different ethnic groups should be monitored to identify critical factors that could limit health-care coverage. In adopting the United Nations’ sustainable development goals, governments have committed to providing equitable and universal health coverage. It is, therefore, the right time to assess ethnic disparities in maternal health care. However, finding a standard method of identifying ethnicity has been difficult, because ethnicity involves several features, such as language, religion, tribe, territory and race. In this study, spoken indigenous language was used successfully as a proxy for ethnicity to detect inequities in maternal health-care coverage between indigenous and non-indigenous populations in four Latin American countries: Guatemala, Mexico, Peru and the Plurinational State of Bolivia. Although, quantifying ethnic inequities in health care is just a starting point, this quantification can help policy-makers and other stakeholders justify the need for monitoring these inequities. This monitoring is essential for designing more culturally appropriate programmes and policies that will reduce the risks associated with maternity among indigenous woman. As long as inequities persist, identifying them is an important step towards their elimination.
Highlights
Countries in Latin America and the Caribbean have some of the highest adolescent pregnancy rates in the world and adolescent pregnancies are more common among uneducated, poor and indigenous women
An ethnic group is defined as a collectively that identifies itself, and it is identified by others, with regard to certain common elements, such as language, religion, tribe, nationality, race or a combination thereof, and whose members share a common feeling of identity.[16,24,25]
The presence of a language barrier has been closely linked to the limited access to health care that results from being unable to communicate with health-care personnel
Summary
Countries in Latin America and the Caribbean have some of the highest adolescent pregnancy rates in the world and adolescent pregnancies are more common among uneducated, poor and indigenous women. (i) pregnant women with private insurance had more antenatal consultations and received higherquality services than women with public or no insurance; (ii) a low educational level increased a woman’s risk of dying from eclampsia or haemorrhage; and (iii) women with pregnancy complications experienced delays because of ineffective triage (i) the maternal mortality ratio in some mainly indigenous regions was more than six times higher than in the national capital; (ii) the difference between the poorest and richest quintiles in the proportion of women who had a skilled birth attendant was 32 percentage points; and (iii) in some areas, the advanced equipment needed for emergency obstetric care was available only in provincial capitals.
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