RESUMO
BACKGROUND: Colombia has high numbers of internally displaced people, forced to migrate due to the conflict. 1 in 3 displaced women undergo pregnancy during adolescence, compared to around 1 in 5 in the non-displaced population, alongside health and resource inequalities between these groups. There is limited qualitative information available from the perspectives of displaced women experiencing adolescent pregnancy. This research explores how structural violence may feature in their experiences. METHODS: Qualitative methods were used. Participants were recruited with purposive sampling, using key informants and snowball sampling technique. 14 semi-structured interviews were conducted in Ciudad Bolívar, Bogotá, involving 11 displaced women who began childbearing age 15-19 in the past 10 years, and 4 participants' mothers. Data was analysed using the theoretical framework of structural violence, and emergent themes categorised using thematic analysis. RESULTS: Pregnancy was considered advantageous in many ways, but this was contradicted by resulting disadvantages that ensued. Structural violence was embedded in life stories, manifesting in poverty and difficulties accessing reliable income, poor access to healthcare and education following pregnancy. Institutional and interpersonal discrimination confounded these challenges. CONCLUSIONS: Pregnancy during adolescence was a contradictory experience, representing both a safety net and a trap due to a complex interplay of structural and cultural violence in everyday survival. Policymakers must consider the importance of the context surrounding adolescent pregnancy and address systematic disadvantages affecting women in these positions.
The violent conflict in Colombia has left many people forced to leave their homes and become 'internally displaced'. Internally displaced women are more likely to become pregnant during their adolescence than non-displaced women. This work tries to understand more about the everyday lives of displaced women who experience adolescent pregnancy, through interviews. The interviews were analysed and results interpreted using the theory of 'structural violence'. Structural violence describes how social structures such as racism, sexism, war and poverty determine life choices, leading to suffering and inequality. The work found that pregnancy and motherhood in adolescence for displaced women was positive in many ways by bringing purpose, status and companionship. However, these women also experienced many challenges after pregnancy, such as exclusion from education and secure employment and difficulty accessing healthcare. This demonstrated that structural violence features in multiple interconnected forms in the daily lives of displaced adolescent mothers. The work urges policymakers to appreciate the complexity of context surrounding adolescent pregnancy and motherhood, and to address the structural disadvantages facing women in these situations.
Assuntos
Gravidez na Adolescência , Pesquisa Qualitativa , Humanos , Feminino , Adolescente , Gravidez , Gravidez na Adolescência/psicologia , Colômbia , Adulto Jovem , Refugiados/psicologia , Violência/psicologia , Adulto , Acessibilidade aos Serviços de SaúdeRESUMO
Research has shown that neighborhood disadvantage has an effect on BMI that is independent of individual disadvantage, much more pronounced in women than in men. The mechanisms that explain this gender-specific effect are not yet clear. Since women's body size dissatisfaction is closely linked to gender differences in BMI inequalities, the independent effect of neighborhood disadvantage on female BMI may relate to a local culture of acceptance of female large bodies, that could influence women's parameters for body size dissatisfaction. This study explored how the relation between female BMI, neighborhood income, individual income and education is influenced by body size dissatisfaction in a random sample of 882 women aged 20-60 that reside in two Chilean Municipalities. Data have a two level structure (women nested in 17 neighborhoods); it was collected by direct survey, height and weight were measured with portable instruments. Disadvantaged neighborhoods house mainly poor and low educated women, whereas the wealthier ones were inhabited mostly by affluent women with postsecondary education. The proportion of women without a husband/partner and with more than three children in disadvantaged neighborhoods was higher than better off areas. Multilevel linear regression showed that neighborhood disadvantage had an effect on female BMI that was independent of women's income and education, which was explained by body size dissatisfaction. The mean BMI for body size satisfaction among women in disadvantaged neighborhoods was 2 kg/m2 higher than in affluent areas, which suggests that a 'culture of plus-size women' would emerge in urban clusters of poverty. The findings signal that neighborhood effects on BMI would relate to the socioeconomic polarization of urban areas, with marked concentrations of poverty and wealth, and might be explained by the psychosocial pathways associated to social disadvantage that act in addition to the effects of material conditions to influence people's health.
Assuntos
Características de Residência , Índice de Massa Corporal , Criança , Chile , Cidades , Estudos Transversais , Feminino , Humanos , Masculino , Fatores SocioeconômicosRESUMO
BACKGROUND: Pregnancy in adolescence is higher among internally displaced women in Colombia than non-displaced women. It is defined as a problem with significant negative outcomes by both biomedical and epidemiological approaches. However, little is known about pregnancy during adolescence from the perspective of women who experienced this in the specific context of armed conflict and displacement. AIM: This article focuses on how internally displaced women understand their experiences of pregnancy in adolescence in the context of armed conflict through an ethnographic approach in a receptor community of internally displaced women in Bogotá, Colombia. METHODS: Based on 10 years of experience in the community, we conducted 1 year of fieldwork, using an ethnographic approach. We collected life stories of 20 internally displaced women through in-depth interviews and ran 8 workshops with them and other women from the community. We used thematic analysis to analyse the responses of internally-displaced women and understand how they made meaning around their experiences of adolescent pregnancy in the context of displacement. RESULTS: The main themes that emerged from participants' experiences include rural violence, early family life (characterized by violence and mistreatment at home), meanings of pregnancy at an early age (including being challenged and feelings of love), and reactions to their pregnancies during adolescence (such as stigmatization) from their families and partners. CONCLUSION: Our analysis of the in-depth interviews and the workshops suggests that adolescent pregnancy among women who are internally displaced has complex dynamics, characterized by the violent context of the rural areas, but primarily by the violence experienced during their childhood. The experience of pregnancy during adolescence brings feelings of ownership and also challenges, together with the forced displacement. This understanding will provide insights for policy makers and healthcare providers on how to work with this specific population who have experienced pregnancy in adolescence.
Assuntos
Gravidez na Adolescência/etnologia , Refugiados/psicologia , Adolescente , Antropologia Cultural , Colômbia , Feminino , Humanos , Gravidez , Gravidez na Adolescência/psicologiaRESUMO
Obesity in Chile disproportionately affects women of low socioeconomic status (SES). Research has shown that ideals of body size and differences in perceived social pressure for being slim across socioeconomic strata contribute to the social stratification of body size among women in modern societies. Thinness is most valued by high SES women, following western standards of ideal body size. Aiming to understand the link between ideals of body size and SES, this qualitative study explored how 36 Chilean women construct their bodily ideals according to their social position. A purposive sample of women with different profiles with regard to educational attainment, nutritional status and body size (dis)satisfaction was defined, aiming to cover a diverse spectrum of bodily perceptions. Data were collected through semi-structured interviews and approached through a thematic and narrative analysis. Drawing on Bourdieu's concepts of habitus, field, capital and embodiment of the social context, this study explains how ideals of body size and appearance are strongly linked to class-dependent gender roles and social roles. The existing gender and class inequalities in the Chilean social structure have been literally embodied by these women through a 'gendered class habitus'. Compliance with the thin ideal confers women different degrees of power according to their social position in different fields, such as in marriage and on the labour market, which turns thinness into an embodied form of capital. The societal dynamic behind obesity rates cannot be disregarded when approaching possible solutions. Promoting obesity-related lifestyle modification at an individual level might appear an over-simplistic and individualistic approach to a complex social issue. Context-oriented interventions that take cultural constructions of gender and social class into account might yield better results in the long term, while advocating for a more equitable society and social justice as a public health concern.
Assuntos
Imagem Corporal/psicologia , Identidade de Gênero , Disparidades nos Níveis de Saúde , Obesidade/epidemiologia , Capital Social , Magreza , Adulto , Chile/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa Qualitativa , Distribuição por Sexo , Classe Social , Adulto JovemRESUMO
BACKGROUND: In the Caribbean, mosquito-borne diseases are a public health threat. In Sint Eustatius, dengue, Chikungunya and Zika are now endemic. To control and prevent mosquito-borne diseases, the Sint Eustatius Public Health Department relies on the community to assist with the control of Aedes aegypti mosquito. Unfortunately, community based interventions are not always simple, as community perceptions and responses shape actions and influence behavioural responses Objective: The aim of this study was to determine how the Sint Eustatius population perceives the Aedes aegypti mosquito, mosquito-borne diseases and prevention and control measures and hypothesized that increased knowledge of the virus, vector, control and prevention should result in a lower AQ1 prevalence and incidence of mosquito-borne diseases. METHODS: This study was conducted in Sint Eustatius island in the Eastern Caribbean. We combined qualitative and quantitative designs. We conducted interviews and focus groups discussions among community member and health professional in 2013 and 2015. We also conducted cross-sectional survey to assess local knowledge on the vector, virus, and control and prevention. RESULTS: The population is knowledgeable; ©however, mosquito-borne diseases are not the highest health priority. While local knowledge is sometimes put into action, it happens on the 20 household/individual level as opposed to the community level. After the 2014 CHIK outbreak, there was an increase in knowledge about mosquito control and mosquito-borne diseases. DISCUSSION: In the context of Sint Eustatius, when controlling the Aedes population it may be a strategic option to focus on the household level rather than the community and build collaborations with households by supporting them when they actively practice mosquito 25 control. To further increase the level of knowledge on the significance of mosquito-borne diseases, it may also be an option to contextualize the issue of the virus, vector, prevention and control into a broader context. CONCLUSION: As evidenced by the increasing number of mosquito-borne diseases on the island, it appears that knowledge amongst the lay community may not be transferred into 30 action. This may be attributed to the perception of the Sint Eustatius populations that mosquitoes and the viruses they carry are not a high priority in comparison to other health concerns.
Assuntos
Febre de Chikungunya/prevenção & controle , Dengue/prevenção & controle , Controle de Mosquitos , Infecção por Zika virus/prevenção & controle , Adulto , Aedes/virologia , Idoso , Animais , Países Baixos Caribenhos/epidemiologia , Febre de Chikungunya/epidemiologia , Estudos Transversais , Dengue/epidemiologia , Surtos de Doenças/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Mosquitos Vetores/crescimento & desenvolvimento , Mosquitos Vetores/virologia , Pesquisa Qualitativa , Adulto Jovem , Zika virus , Infecção por Zika virus/epidemiologiaRESUMO
This paper reports on an ethnographic study in Cartagena, Colombia. Over a seven-month fieldwork period, 35 men and 35 women between 15 and 60 years of age discussed the social context of HIV/AIDS through in-depth interviews, life histories and drawing. Participants considered the transgression of traditional gender roles as prescribed by machismo a major risk factor for HIV infection. In addition, they integrated public-health concepts of risk groups with these long-standing constructions of gender roles and sexuality-related stigma to create the notion of 'AIDS carriers'. The bricolage between machismo, public health and sexuality-related stigma that participants created and consequent preventive measures (based on an avoidance of sex with people identified as 'AIDS carriers') was a dynamic process in which participants were aware that changes in this particular interpretation of risk were necessary to confront the local epidemic.
Assuntos
Características Culturais , Infecções por HIV/psicologia , Saúde Pública , Estigma Social , Estereotipagem , Adolescente , Adulto , Colômbia , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Fatores de RiscoRESUMO
OBJECTIVE: To obtain a thorough understanding of the complexity and dynamics of the social determination of HIV infection among inhabitants of Cartagena, Colombia, as well as their views on necessary actions and priorities. METHODS: In a five-year ethnography of HIV/AIDS in collaboration with 96 citizens of Cartagena, different methods and data collection techniques were used. Through 40 in-depth interviews and 30 life histories of inhabitants, the scenario of HIV vulnerability was summarized in a diagram. This diagram was evaluated and complemented through group discussions with key representatives of local governmental and nongovernmental organizations and with people who were interested in the epidemic or affected by it. RESULTS: The diagram illustrates the dynamic and complex interrelationships among structural factors (i.e., social determinants) of HIV infection, such as machismo; lack of work, money, and social services; local dynamics of the performance of the state; and international dynamics of the sexual tourism industry. On the basis of the diagram, groups of key representatives proposed prioritizing structural actions such as reducing socioeconomic inequalities and providing access to health care and education. CONCLUSIONS: The social determinants displayed in the diagram relate to historic power forces that have shaped vulnerable scenarios in Cartagena. Collaboration between participants and researchers generates conceptual frameworks that make it possible to understand and manage the complexity of HIV's social determination. This way of understanding effectively connects local inequalities with international flows of power such as sexual tourism and makes evident the strengths and limitations of current approaches to HIV prevention.
Assuntos
Infecções por HIV/prevenção & controle , Meio Social , Saúde da População Urbana , Adulto , Antropologia Cultural , Atitude Frente a Saúde , Colômbia/epidemiologia , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Prioridades em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Liderança , Masculino , Pacientes/psicologia , Pobreza , Pesquisa Qualitativa , Fatores de Risco , Estudos de Amostragem , Profissionais do Sexo , Comportamento Sexual , Fatores Socioeconômicos , Populações VulneráveisRESUMO
OBJECTIVE: To obtain a thorough understanding of the complexity and dynamics of the social determination of HIV infection among inhabitants of Cartagena, Colombia, as well as their views on necessary actions and priorities. METHODS: In a five-year ethnography of HIV/AIDS in collaboration with 96 citizens of Cartagena, different methods and data collection techniques were used. Through 40 in-depth interviews and 30 life histories of inhabitants, the scenario of HIV vulnerability was summarized in a diagram. This diagram was evaluated and complemented through group discussions with key representatives of local governmental and nongovernmental organizations and with people who were interested in the epidemic or affected by it. RESULTS: The diagram illustrates the dynamic and complex interrelationships among structural factors (i.e., social determinants) of HIV infection, such as machismo; lack of work, money, and social services; local dynamics of the performance of the state; and international dynamics of the sexual tourism industry. On the basis of the diagram, groups of key representatives proposed prioritizing structural actions such as reducing socioeconomic inequalities and providing access to health care and education. CONCLUSIONS: The social determinants displayed in the diagram relate to historic power forces that have shaped vulnerable scenarios in Cartagena. Collaboration between participants and researchers generates conceptual frameworks that make it possible to understand and manage the complexity of HIV's social determination. This way of understanding effectively connects local inequalities with international flows of power such as sexual tourism and makes evident the strengths and limitations of current approaches to HIV prevention.
OBJETIVO: Explorar la comprensión de los habitantes sobre la determinación social de la infección por el VIH en Cartagena, Colombia, y sus criterios sobre las medidas necesarias y las prioridades. MÉTODOS: Se usaron diferentes métodos y técnicas de recolección de datos en una investigación etnográfica quinquenal de la infección por el VIH/sida en colaboración con 96 ciudadanos de Cartagena. Se resumió en un diagrama la situación de vulnerabilidad al VIH tras analizar la información obtenida en 40 entrevistas a profundidad y 30 historias de vida de los habitantes. Este diagrama se evaluó y se complementó por medio de análisis grupales con representantes clave de organizaciones gubernamentales y no gubernamentales locales y con personas interesadas en la epidemia o afectadas por ella. RESULTADOS: El diagrama ilustra las interrelaciones dinámicas y complejas que existen entre los factores estructurales (es decir, determinantes sociales) de la infección por el VIH, como el machismo; la falta de trabajo, dinero y servicios sociales; la dinámica local de la función del estado; y la dinámica internacional de la industria del turismo sexual. Sobre la base del diagrama, los grupos de representantes clave propusieron medidas estructurales prioritarias, como reducir las desigualdades socioeconómicas y proporcionar acceso a la atención de salud y la educación. CONCLUSIONES: Los determinantes sociales que se muestran en el diagrama se relacionan con las fuerzas de poder que históricamente han configurado situaciones de vulnerabilidad en Cartagena. La colaboración entre los participantes y los investigadores genera marcos conceptuales que permiten comprender y gestionar la complejidad de la determinación social de la infección por el VIH. Este enfoque permite relacionar las desigualdades locales con los flujos internacionales de poder, como el turismo sexual, y pone de manifiesto las ventajas y las limitaciones de los métodos actuales para la prevención de la infección por el VIH.
Assuntos
Humanos , Masculino , Feminino , Adulto , Infecções por HIV/prevenção & controle , Meio Social , Saúde da População Urbana , Antropologia Cultural , Atitude Frente a Saúde , Colômbia/epidemiologia , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Infecções por HIV/transmissão , Conhecimentos, Atitudes e Prática em Saúde , Prioridades em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Liderança , Pacientes/psicologia , Pobreza , Pesquisa Qualitativa , Fatores de Risco , Estudos de Amostragem , Profissionais do Sexo , Comportamento Sexual , Fatores Socioeconômicos , Populações VulneráveisAssuntos
Infecções por HIV , Síndrome da Imunodeficiência Adquirida , Antropologia Cultural , Meio Social , Pesquisa Qualitativa , Colômbia , HIV , Síndrome da Imunodeficiência Adquirida , Antropologia Cultural , Meio Social , Meio Social , Antropologia Cultural , Colômbia , Liderança , Pacientes , Pobreza , Pesquisa Qualitativa , Estudos de Amostragem , Comportamento Sexual , Infecções por HIV , Saúde da População Urbana , Atitude Frente a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Prioridades em Saúde , Acessibilidade aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde , Fatores de Risco , Profissionais do Sexo , Fatores Socioeconômicos , Populações VulneráveisRESUMO
The objective of this study was to describe and understand gender roles and the relational context of sexual decision-making and safe sex negotiation among Afro-Surinamese and Dutch Antillean women in the Netherlands. Twenty-eight individual in-depth interviews and eight focus group discussions were conducted. In negotiating safe sex with a partner, women reported encountering ambiguity between being respectable and being responsible. Their independence, autonomy, authority and pride inherent to the matrifocal household give them ample opportunity to negotiate safe sex and power to stand firm in executing their decisions. The need to be respectable burdens negotiation practices, because as respectable, virtuous women there would not be the need to use condoms. Respectable women will only participate in serious monogamous relationships, which are inherently safe. Women's desire to feel like a woman, 'to tame the macho-man' and constrain him into a steady relationship, limits negotiation space because of emotional dependency. Respectability seems to enforce not questioning men's sexual infidelity. In developing STI/HIV prevention programmes this ambiguity due to cultural values related to gender roles should be considered. Raising awareness of power differences and conflicting roles and values may support women in safe-sex decision-making.
Assuntos
População Negra/psicologia , Emigrantes e Imigrantes/psicologia , Identidade de Gênero , Responsabilidade Social , Adulto , Preservativos , Características da Família , Feminino , Infecções por HIV/etnologia , Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Hierarquia Social , Humanos , Negociação , Países Baixos , Antilhas Holandesas/etnologia , Poder Psicológico , Sexo Seguro/psicologia , Abstinência Sexual/psicologia , Valores Sociais , Suriname/etnologiaRESUMO
Bibliography for those who are interested in the developments in the area of health and health care in Suriname. It serves as a support and inelutive for medical antropological and sociological research in Suriname. The literature is categorized in 5 themes, namely: western health care in general, medical mission, nutrition, mother and child care, and also popular medicine and religion