Sex And Gender Research Articles

Artificial Intelligence for Education and Research: Pilot Study on Perception of Academic Staff

Artificial Intelligence (AI) tools have been used across various sectors of the global economy. The use of AI has been associated with both benefits and drawbacks, which is why the goal of this research was to identify the attitudes of academic staff of higher education institutions (HEIs) towards using AI for both academic and research purposes. To attain the goal, there was designed a questionnaire, which was distributed to members of academic staff of different biological genders and ages from 10 European countries. Irrespective of biological gender, age, or country, responses were similar. First, academic staff emphasized the importance of having AI-related regulations at HEIs. Second, academic staff were positive about using AI for information searchers and preparation of teaching materials. Third, academic staff were concerned about AI-related plagiarism issues, which is why they were reluctant to approve the AI use for research and thesis writing. Fourth, slightly more than 40% of the respondents indicated the use of AI. This points to the lack of AI skills among academic staff, which was further supported by a set of basic purposes for which AI was claimed to have been used. One implication of this research relates to the organization of the study process. Managers of HEIs should introduce institutionalized training in AI for academic and research purposes for academic staff to promote digital equality. Another implication of the study relates to the areas of AI training for academic staff. It should cover the topics of AI for the design of teaching materials, formative and summative assessment, and plagiarism check.

“The Rosa Parks of the trans bathroom debate”: Gavin Grimm and the racialization of transgender civil rights

ABSTRACT Gavin Grimm, a white transgender boy from Virginia, successfully sued his school board in Grimm v. Gloucester County School Board and helped secure the right for trans and gender nonconforming students to use public school bathrooms that correspond to their gender identities. His 2021 victory was the culmination of a long legal battle that began in 2014, when the Gloucester County School Board (GCSB) passed a resolution that segregated bathrooms on the basis of “biological gender.” This essay considers the two GCSB meetings at which this resolution was debated as instances of “ordinary democracy,” where local practices of deliberation not only set policy but also sustain community and produce shared opinion. Drawing on Black trans scholarship that proposes the transitivity of Blackness and demonstrates how Blackness is made present in the service of whiteness, I examine how the discussions at the GCSB meetings strategically mobilized civil rights rhetoric and histories of racial segregation to debate Gavin’s entitlement to public space. Blackness, I argue, is invoked and disavowed as a condition of possibility for modern white trans identities and a resource for vernacular articulations of the scope of trans rights.

Gender-specific associations between mixture of polycyclic aromatic hydrocarbons and telomere length.

Evidence shows the relationships of individual environmental PAHs by their urinary metabolites with relative telomere length (RTL), which may be affected by biological gender differences. Since plasma parent PAHs are not metabolized, it may reflect human exposure to PAHs more realistically in daily life. Thus, exploring joint associations between plasma parent PAHs and RTL is urgent, which may identify the major contributor to its adverse effect. In this study,2577 participants were obtained from the Henan Rural Cohort. The level of PAHs in blood samples was detected by gas chromatography coupled with tandem mass spectrometry. RTL in blood samples was detected by quantitative polymerase chain reaction. Generalized linear models or quantile g-computation were performed to evaluate the associations between the individual or a mixture of PAHs and RTL. Results from generalized linear models showed that each unit increment in BghiP value corresponded to a 0.098 (95%CI: 0.067, 0.129) increment in RTL for men; each unit increment in BaP, BghiP and Flu value corresponded to a 0.041 (95%CI: 0.014, 0.068), 0.081 (95%CI: 0.055, 0.107) and 0.016 (95%CI: 0.005, 0.027) increment in RTL for women. Results from quantile-g computation revealed that each one-quantile increment in the mixture of 10 PAHs corresponded to a 0.057 (95%CI: 0.021, 0.094) and 0.047 (95%CI: 0.003, 0.091) increment in RTL valuesof women and men, but these associations were mainly ascribed to three PAHs for women (BaP, Flu and BghiP) and men (BaP, BghiP and Pyr), respectively. Similar results were found in smoking men and cooking women without smoking. Our study foundthat exposure to 10 PAHs mixture was positively associated with RTL across gender, mainly attributed to Flu, BaP and BghiP, implicating that gender-specific associations may be ascribed to tobacco and cooking smoke pollution. The findings provided clues for effective measures to control PAHs pollutants-related aging disease.Clinical trial registration The Henan Rural Cohort Study has been registered at the Chinese Clinical Trial Register (Registration number: ChiCTR-OOC-15006699). Date of registration: 06 July 2015. http://www.chictr.org.cn/showproj.aspx?proj=11375 .

Abstract IA03: Head and Neck Cancer Takes a Nerve, Cancer neuroscience: emerging hallmark of cancer

Abstract Over the past decade, emerging technologies have enabled investigators to begin to bridge the gap between cancer and neuroscience research to unveil the interactive roles of nerves in cancer. We are now beginning to define how the nervous system contributes to cancer initiation, growth, spread, recurrence, and even resistance to oncologic therapeutic strategies. Indeed, neuromodulation with both genetic and pharmacological approaches has been shown to affect not only tumor growth but also antitumor immune response. Collectively, studies have demonstrated a significant and pressing need to recognize cancer neuroscience interplay as a hallmark of cancer to 1) establish the neoneurogenic process as a highly relevant therapeutic target for both the prevention and treatment of cancer, 2) foster interdisciplinary cross-talk among experts in cancer biology and neuroscience, which have traditionally progressed along parallel paths, and 3) integrate human variables such as biological sex, age, race, and gender as underlying factors that can impact cancer neuroscience. Citation Format: Moran Amit. Head and Neck Cancer Takes a Nerve, Cancer neuroscience: emerging hallmark of cancer [abstract]. In: Proceedings of the AACR-AHNS Head and Neck Cancer Conference: Innovating through Basic, Clinical, and Translational Research; 2023 Jul 7-8; Montreal, QC, Canada. Philadelphia (PA): AACR; Clin Cancer Res 2023;29(18_Suppl):Abstract nr IA03.

Analysis of the Importance of Gender Identity Information and Sex Education in Social Media and School

Rose adolescents are a group of people with different behaviors that differ from their biological gender identity. But few people in society pay attention to this group. This is inseparable from the role played by the media in communication and the education of sexual knowledge. Biased general cognition will harm this group physically and psychologically, leading to social problems, such as school bullying. They need to be understood by the public, and the physical and mental health of young people also need to be protected and given attention from multiple dimensions. So, the paper will use three theories related to gender, media, and diversity, analyzing public stereotypes of gender diversity and, the social impact behind it. How does the media play an essential role in guiding public comments? What can sex education do to help? In the end, the article believes that when mass media is widespread and biased in disseminating social information, the resulting erroneous or misleading information needs to be managed and guided by the press and the family, school, and society for the mental health of young people.

The intersection of biological sex and gender in adverse events following seasonal influenza vaccination in older adults

BackgroundWomen/females report more adverse events (AE) following immunization than men/males for many vaccines, including the influenza and COVID-19 vaccines. This discrepancy is often dismissed as a reporting bias, yet the relative contributions of biological sex and gender are poorly understood. We investigated the roles of sex and gender in the rate of AE following administration of the high-dose seasonal influenza vaccine to older adults (≥ 75 years) using an AE questionnaire administered 5–8 days post-vaccination. Participant sex (male or female) was determined by self-report and a gender score questionnaire was used to assign participants to one of four gender categories (feminine, masculine, androgynous, or undifferentiated). Sex steroid hormones and inflammatory cytokines were measured in plasma samples collected prior to vaccination to generate hypotheses as to the biological mechanism underpinning the AE reported.ResultsA total of 423 vaccines were administered to 173 participants over four influenza seasons (2019-22) and gender data were available for 339 of these vaccinations (2020-22). At least one AE was reported following 105 vaccinations (25%), by 23 males and 82 females. The majority of AE occurred at the site of injection, were mild, and transient. The odds of experiencing an AE were 3-fold greater in females than males and decreased with age to a greater extent in females than males. The effects of gender, however, were not statistically significant, supporting a central role of biological sex in the occurrence of AE. In males, estradiol was significantly associated with IL-6 and with the probability of experiencing an AE. Both associations were absent in females, suggesting a sex-specific effect of estradiol on the occurrence of AE that supports the finding of a biological sex difference.ConclusionsThese data support a larger role for biological sex than for gender in the occurrence of AE following influenza vaccination in older adults and provide an initial investigation of hormonal mechanisms that may mediate this sex difference. This study highlights the complexities of measuring gender and the importance of assessing AE separately for males and females to better understand how vaccination strategies can be tailored to different subsets of the population.

Association between dietary acid load and the odds of ulcerative colitis: a case–control study

Ulcerative colitis (UC) is one of the two types of inflammatory bowel disease (IBDs), which have a pivotal role in weakening the quality of lives of suffering patients. According to some recent studies, significant changes in dietary patterns may have contributed to the increased prevalence of UC. Potential renal acid load (PRAL) is an index used to estimate dietary acid load of the diet. The aim of the current study is to investigate the association between PRAL and odds of UC. The current case–control study included 62 newly diagnosed cases of UC and 124 healthy controls. Dietary habits of participants in the last year were collected with a valid food frequency questionnaire (FFQ). Thereafter, PRAL score was calculated based on a formula containing the dietary intake of protein, phosphorus, potassium, calcium, and magnesium. Participants were categorized according to quartiles of PRAL. Multivariable logistic regression models were used to estimate the odds' ratio (OR) with 95% confidence intervals (CIs) of UC across quartiles of PRAL. The results of the current study indicated that in the crude model, participants in the fourth quartile of PRAL had 2.51 time higher odds of UC compared with those in the first quartile of the PRAL [(OR 2.51; 95% CI 1.03–6.14), (P = 0.043)]. After adjustment for age and biological gender, this positive association remained significant [(OR 2.99; 95% CI 1.16–7.72), (P = 0.023)]. In the final model, after further adjustment for BMI, current smoking, education, Helicobacter pylori infection, and dietary intakes of total energy, omega-3 fatty acids, trans-fatty acids, and total dietary fiber, the odds of UC in the highest quartile of PRAL was significantly higher compared to the lowest quartile [(OR 3.08; 95% CI 1.01–9.39), (P = 0.048)]. So, we observed that higher dietary acid load assessed by PRAL score is associated with greater odds of UC.

Health inequities in the modulator era.

To discuss the existing health inequities in people with cystic fibrosis (CF) and how the recent development of cystic fibrosis transmembrane regulator (CFTR) modulators may impact these inequities. People with CF (pwCF) from low socioeconomic status (SES) have more pulmonary exacerbations, worse nutritional status, lower pulmonary function, and an increased mortality rate with less access to lung transplantation. pwCF who identify as racial and ethnic minorities have earlier mortality, lower lung function, are less likely to be detected on newborn screening resulting in a delayed diagnosis, are underrepresented in clinic trials, and less likely to be eligible for a CFTR modulator. Female sex is associated with more pulmonary exacerbations and earlier mortality. Sexual gender minorities are a vulnerable population with worse health outcomes, and more research is needed in CF. CFTR modulators are inaccessible to low to middle-income countries due to significant cost burden. People with CF from low SES, racial and ethnic minorities, female sex, and sexual gender minorities face health inequities. CFTR modulator use will further widen existing health inequities given the unequal access to modulators based on nonqualifying genetics and exorbitant cost restricting use both on an individual and global level.

Insights into Sex and Gender Differences in Brain and Psychopathologies Using Big Data.

The societal implication of sex and gender (SG) differences in brain are profound, as they influence brain development, behavior, and importantly, the presentation, prevalence, and therapeutic response to diseases. Technological advances have enabled speed up identification and characterization of SG differences during development and in psychopathologies. The main aim of this review is to elaborate on new technological advancements, such as genomics, imaging, and emerging biobanks, coupled with bioinformatics analyses of data generated from these technologies have facilitated the identification and characterization of SG differences in the human brain through development and psychopathologies. First, a brief explanation of SG concepts is provided, along with a developmental and evolutionary context. We then describe physiological SG differences in brain activity and function, and in psychopathologies identified through imaging techniques. We further provide an overview of insights into SG differences using genomics, specifically taking advantage of large cohorts and biobanks. We finally emphasize how bioinformatics analyses of big data generated by emerging technologies provides new opportunities to reduce SG disparities in health outcomes, including major challenges.

“The Loved Home” and Other Exclusionary Care Discourses

Based on a conceptualization of heteroactivism as a transnational phenomenon manifesting in local contexts to spread and express resistance to gender and sexual rights, this article aims to illuminate new dimensions of heteroactivism beyond a sole focus on gender and sexuality by bringing its specificities in the Swedish context to the fore. Drawing on digital ethnography with members of the neo-conservative, far-right thinktank Oikos and the ethnonationalist political party the Sweden Democrats (SD), the article shows how heteroactivist forms of resistance seek to reshape the state and the nation through the gender–sexuality nexus and how these resistances enter into negotiation with spatiohistorically established notions of gender equality and sexual rights. Through a multiscalar transnational approach, the article brings forth how heteroactivism connects several levels horizontally—from the local to the national and the transnational—and vertically and establishes linkages among gender, sexuality, the state and the nation. The analysis reveals how care, love and gratitude for the shared home are core elements used in heteroactivist negotiations, with contextually established notions of gender equality and sexual rights as national values. It also demonstrates how the home, which these actors seek to cherish and protect, takes shape as an exclusive and exclusionary space.

The Impact of Biological Gender Exploring on L1 Negative Transfer in English Preposition Learning

This study investigates the influence of biological gender on L1 negative transfer in learning English prepositions. Interviews were conducted with 12 English language learners, revealing that males performed better in spatial prepositions but struggled with other types. A mixed-methods approach was used, combining qualitative and quantitative research. Female participants demonstrated higher performance, and the study was conducted in Luxembourg, a multilingual country. Ethical considerations were addressed, achieving a 91.08% response rate. Results indicated females generally outperformed males in prepositional accuracy. Language transfer from L1 impacted preposition acquisition, with replacement errors being common. Females showed greater syntactic maturity, while males exhibited advanced linguistic skills. Stylistic differences in writing styles were observed. The study highlights the influence of gender in language acquisition and contributes to understanding gender disparities in second language learning.

Seasonal influence on respiratory tract infection severity including COVID-19 quantified through Markov Chain modelling.

Respiratory tract infections (RTI) are a burden to global health, but their characterisation is complicated by the influence of seasonality on incidence and severity. The Re-BCG-CoV-19 trial (NCT04379336) assessed BCG-(re)vaccination for protection from COVID-19 and recorded 958 RTIs in 574 individuals followed over one year. We characterized the probability of RTI occurrence and severity using a Markov model with health scores for four states of symptom severity. Covariate analysis on the transition probability between health scores explored the influence of demographics, medical history, SARS-CoV-2 or influenza vaccinations which became available during the trial, SARS-CoV-2 serology, and epidemiology-informed seasonal influence of infection pressure represented as regional COVID-19 pandemic waves, as well as BCG (re)vaccination. The infection pressure reflecting the pandemic waves increased the risk of RTI symptom development, while the presence of SARS-CoV-2 antibodies protected against RTI symptom development and increased the probability of symptom relief. Higher probability of symptom relief was also found in participants with African ethnicity and with male biological gender. SARS-CoV-2 or influenza vaccination reduced the probability of transitioning from mild to healthy symptoms. Model diagnostics over calendar-time indicated that COVID-19 cases were underreported during the first wave by an estimated 2.76-fold. This trial was performed during the initial phase of the COVID-19 pandemic in South Africa and the results reflect that situation. Using this unique clinical dataset of prospectively studied RTIs over the course of one year, our Markov Chain model was able to capture risk factors for RTI development and severity, including epidemiology-informed infection pressure.

Buffering masculinity’s impact on binge drinking: the femininity effect

Background Across most developmental periods, males tend to drink at a higher frequency and at a higher intensity than females. In identifying the mechanism responsible for these differences, biological factors have been a prevalent focus; however, gender expression is also highlighted. The purpose of this paper is to decipher how differences in binge drinking are attributed to sex differences and gendered traits. Method Using data from Wave III of the National Longitudinal Study of Adolescent to Adult Health (ADD Health) (n = 8,882), we conducted a multiple group moderation analysis to examine how differences in biological sex and gender roles in emerging adulthood predicted binge drinking. Results We found that binge drinking in emerging adulthood was most strongly predicted by high levels of masculinity and low levels of femininity in emerging adulthood. As masculinity decreased, alcohol use decreased. Femininity significantly moderated masculinity’s association with binge drinking, primarily when masculinity was high, and this did not vary across sex after controlling for gender roles. Conclusions Our findings expand sex and gender research surrounding alcohol use. For both males and females, the higher the masculinity the more frequent alcohol use, an effect of which was buffered by higher levels of femininity. Clinicians should take into consideration gender role ascription of their clients when determining the risk profile during assessment.

FARKLI YAŞ GRUPLARINDA ÇAĞRIŞIMSAL CİNSİYET ALGISI-TÜRKÇE BAĞLAMINDA

Turkish has no noun classes or grammatical gender. However, in terms of biological gender, it can be said that lexical/semantic gender is reflected to nouns lexically. Although Turkish has no grammatical gender, it does have various means based on semantic system in which nouns are assigned to a gender according to its referent’s biological sex to recognize gender. It can also be said that there is a covert gender marking that denotes some person reference words as masculine or feminine. The aim of this study is to describe the phenomenon of associative gender, which carries the social-psychological context, in the case of certain categories (colour, animal, vegetable/fruit, clothing, body, transportation, sports, profession, material and natural features/plants). Also it was aimed at see the current associative gender perceptions of the lexicalized covert words (e.g., hemşire ‘nurse’, gömlek ‘shirt’) based on the assumption that the associative gender perception of sociocultural context may change in parallel with social changes. For this aim, how participants from different age groups (N 400) perceive the gender in Turkish is researched. A survey consisting of close-ended questions with 3 rating scale (masculine, feminine, neutral) for each category was conducted. The most general conclusion in this study is that in the associative gender assignment, neutral is dominant. This is followed by male and female dominance. In terms of the context of database, gender bias varies from masculine-feminine to neutral when the process from childhood to adulthood is looked at. In other words, while the children's perspective in marking gender is more towards masculine-feminine, the characteristics of the language appear more prominently and the tendency to assign gender decreases with age. Another consequence is male participants marked more masculine than female participants. This may be identified with the social gender perception.

Pan-immune-inflammation value in FMF patients

Objective: Familial Mediterranean fever (FMF) is the most common disease that leads to secondary amyloidosis related to persistent subclinical inflammation in Turkish patients. Pan-immune-inflammation value (PIIV), a recently-developed index validated to predict prognoses of several malignancies. We investigated PIIV in FMF patients. Material and Methods: We included 100 FMF patients with regular follow-ups, defined as at least two visits yearly. Demographic characteristics, prominent attack features, and treatment choices of the patients were noted. We also calculated PIIV and other inflammation-related laboratory results at attack-free periods. In the comparative analysis of quantitative data, Student's t-test (for normal distribution) and the Mann-Whitney U test (for non-normally distribution) were used. P <0.05 was accepted as a statistically significant value. Results: A total of 100 patients were included in the study. Forty-two patients were male, whereas fifty-eight patients were female. The patients were between 18 and 69 years old, and the mean age of the study group was 39.65 ± 13.83 years. MEFV mutation analyses of eighty-six patients were present in the medical record system. Exon 10 mutations were detected in 67 (77.9%) patients, whereas non-exon 10 mutations (exon 2 and 3) were in 8 (9.3%) patients. Homozygous Exon 10 mutations were detected in 19 patients (22.1%). Although acute phase reactants, including erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and serum amyloid A (SAA), were significantly higher in patients with homozygous exon 10 mutations, there was no statistical difference in PIIV between groups. Conclusion: The results were also similar to the recent literature in the northern part of the country. The need for biological agents and male gender was significantly higher in patients with homozygous exon 10 mutations compared to other groups.

Canon, Catechism, and Curriculum: GSAs and Student Mental Health in Ontario Catholic Schools

The permissibility of student GSA (Gender Sexuality Alliance) clubs in Ontario has been heavily disputed, with Catholic schools showing particular resistance. With a history of opposing same-sex rights, Canada’s Catholic Church holds great social, economic, and political power. This institution-level power generates extensive structural stigma that harms the LGBTQ community, including adolescents. Stigmatization provokes emotional, cognitive, behavioural, and physiological responses that compound each other, altering one’s health. Through the use of accepted socio-epidemiological guidelines for establishing causal inference along with data from a Canadian report on homophobia and transphobia in both Catholic and public schools, it is evident that structural stigma, expressed through prejudice against GSAs in Ontario Catholic schools, is harmful to the health of LGBTQ students. LGBTQ students, who are structurally stigmatized in Ontario Catholic schools, experience inferior emotional health compared to their nonstigmatized cisgender and heterosexual peers. Literature reviewed demonstrates confidence in a causal relationship; due to the structural stigma that Catholic schools in Ontario perpetuate against the LGBTQ community, LGBTQ students attending these schools experience greater risks to their mental health. It is imperative that LGBTQ youth are protected in schools, and solutions must be considered to balance Catholic religious rights in education with the health and social needs of students.

Exploring the nature of the gender-congruency effect: implicit gender activation and social bias.

The aim of the study was to explore the nature of the gender-congruency effect, characterized by a facilitation on the processing of congruent words in grammatical gender. Moreover, we explored whether resemblances between gender identities and gender attitudes with grammatical gender modulated lexical processing. We designed a gender-priming paradigm in Spanish, in which participants decided the gender of a masculine or feminine pronoun preceded by three different primes: biological gender nouns (mapping biological sex), stereotypical nouns (mapping biological and stereotypical information), and epicene nouns (arbitrary gender assignment). We found faster processing of gender congruent pronouns independently of the type of prime, showing that the grammatical gender feature is active even when processing bare nouns that are not conceptually related to gender. This indicates that the gender-congruency effect is driven by the activation of the gender information at the lexical level, which is transferred to the semantic level. Interestingly, the results showed an asymmetry for epicene primes: the gender-congruency effect was smaller for epicene primes when preceding the feminine pronoun, probably driven by the grammatical rule of the masculine being the generic gender. Furthermore, we found that masculine oriented attitudes can bias language processing diminishing the activation of feminine gender, which ultimately could overshadow the female figure.

Female Recruitment Into Cardiovascular Disease Trials

Female Recruitment Into Cardiovascular Disease Trials

Quality of diet and odds of metabolic syndrome in Iranian adults: Baseline results from the PERSIAN Kavar cohort study (PKCS)

Background and aimsMetabolic Syndrome (MetS) is a major risk factor for cardiovascular diseases and type 2 diabetes mellitus. Diet quality has been associated with multiple chronic diseases. We aimed to investigate the association between the quality of diet and the odds of being diagnosed with MetS. Methods and resultsThis study was conducted cross-sectionally on baseline data of 2225 individuals from the PERSIAN Kavar Cohort Study (PKCS). The quality of diet was measured based on the Diet Quality Index – International (DQI-I), using Food Frequency Questionnaires. The association between DQI-I and MetS and its components was measured via logistic regression models in crude and adjusted models. We did not observe any association between DQI-I and MetS in the overall population. However, after adjustment for potential confounders, we found that male participants with higher DQI-I scores had a lower risk of MetS [adjusted odds ratio (OR) 95% confidence interval CI) = 0.62 (0.42–0.93)]. Moreover, analogous trends were observed with respect to some components of MetS, including elevated triglyceride (TG) [crude OR (95% CI) = 0.89 (0.70–0.98); adjusted OR = 0.82 (0.65–0.93)], lowered high-density lipoprotein cholesterol (HDL-c) [crude OR (95% CI) = 0.79 (0.57–0.99); adjusted OR = 0.76 (0.55–0.97)], and abnormal glucose homeostasis [crude OR (95% CI) = 0.80 (0.55–0.94); adjusted OR = 0.73 (0.51–0.91)] only in male participants, both before and after adjustment for potential confounders. ConclusionIn this study, we showed that higher adherence to a high-quality diet was associated with a lower chance of developing MetS in men. Biological gender might be responsible for the observed discrepancies.

Synthesis of Qualitative Evidence on Malaria in Pregnancy, 2005–2022: A Systematic Review

Qualitative research on malaria in pregnancy (MiP) is incipient, therefore its contextual, experiential and symbolic associated factors are unknown. This study systematizes the qualitative research on MiP, describes knowledge, perceptions and behaviors about MiP, and compiles individual, socioeconomic, cultural and health system determinants of MiP through a meta-synthesis in 10 databases. A total of 48 studies were included with 2600 pregnant women, 1300 healthcare workers, and 2200 relatives or community members. Extensive knowledge was demonstrated on ITN and case management, but it was lacking on SP-IPTp, risks and consequences of MiP. Attitudes were negative towards ANC and MiP prevention. There were high trustfulness scores and preference for traditional medicine and distrust in the safety of drugs. The main determinants of the Health System were rationing, copayments, delay in payment to clinics, high out-of-pocket expenses, shortage, low workforce and work overload, shortcomings in care quality, low knowledges of healthcare workers on MiP and negative attitude in care. The socioeconomic and cultural determinants were poverty and low educational level of pregnant women, distance to the hospital, patriarchal-sexist gender roles, and predominance of local conceptions on maternal-fetal-neonatal health. The meta-synthesis demonstrates the difficulty to detect MiP determinants and the importance of performed qualitative research before implementing MiP strategies to understand the multidimensionality of the disease.