10 Best resources on… intersectionality with an emphasis on low- and middle-income countries

Abstract

Intersectionality has emerged as an important framework for understanding and responding to health inequities by making visible the fluid and interconnected structures of power that create them. It promotes an understanding of the dynamic nature of the privileges and disadvantages that permeate health systems and affect health. It considers the interaction of different social stratifiers (e.g. 'race'/ethnicity, indigeneity, gender, class, sexuality, geography, age, disability/ability, migration status, religion) and the power structures that underpin them at multiple levels. In doing so, it is a departure from previous health inequalities research that looked at these forms of social stratification in isolation from one another or in an additive manner. Despite its potential use and long history in other disciplines, intersectionality is uncommonly used in health systems research in low- and middle-income countries (LMICs). To orient readers to intersectionality theory and research, we first define intersectionality and describe its role in public health, and then we review resources on intersectionality. We found that applications in public health mostly increased after 2009, with only 14 out of 86 articles focused on LMICs. To arrive at 10 best resources, we selected articles based on the proportion of the article that was devoted to intersectionality, the strength of the intersectionality analysis, and its relevance to LMICs. The first four resources explain intersectionality as a methodology. The subsequent six articles apply intersectionality to research in LMIC with quantitative and qualitative analysis. We provide examples from India, Swaziland, Uganda and Mexico. Topics for the studies range from HIV, violence and sexual abuse to immunization and the use of health entitlements. Through these 10 resources, we hope to spark interest and open a needed conversation on the importance and use of intersectional analysis in LMICs as part of understanding people-centred health systems.

‘You’re disabled, why did you have sex in the first place?’ An intersectional analysis of experiences of disabled women with regard to their sexual and reproductive health and rights in Gujarat State, India

“…Existing studies tend to apply intersectionality as an analytical lens [20,21]. The few studies that apply intersectionality principles to wider study design focus on the identification of social categories as an entry point for sampling and analysis, whilst simultaneously prioritising heterogeneity across multiple axes within and across such categories [20,21]. In line with this approach, within our study sample heterogeneity was prioritised across the ‘entry point’ social categories of gender and disability.…”

“…While health disparities have typically been explored by disaggregating vulnerabilities, prioritising one category over another, or assuming a cumulative effect of multiple vulnerabilities, an intersectional analysis acknowledges the likely complexity of these interactions [19]. It demands a deeper exploration of social processes and structures and how they interrelate at both macro and micro level to shape lived experiences [20–23]. Critiques of intersectional analysis have identified potential risks of losing feminist insight or of presenting individual characteristics as ‘fixed’ ‘tiers’ of vulnerability, rather than fluid and mutually constituting positionalities in social power relations [21,23].…”

“…Critiques of intersectional analysis have identified potential risks of losing feminist insight or of presenting individual characteristics as ‘fixed’ ‘tiers’ of vulnerability, rather than fluid and mutually constituting positionalities in social power relations [21,23]. An effective intersectional approach is one that is non-additive, resists essentialising, and is concerned with implications for social action [20–22]. Whilst we aim to move away from the dominance of one social category [22–25], we prioritise gender as an analytical entry point in relation to disabled women’s SRH [18].…”

A qualitative study to explore the barriers and enablers for young people with disabilities to access sexual and reproductive health services in Senegal

“…The approach helps us to explore the convergence of different social identifiers, types of exclusion and marginalisation within a population or an individual. 5 Originally coined by Kimberlé Crenshaw in the USA in response to the exclusion of black women from feminist theory, the intersectionality framework is a useful starting-point for analysing the overlapping identities, external social expectations, vulnerabilities and means of accessing health services, such as those given by age, gender and a disability. Intersectionality needs to be contextualised.…”

Assessing geographical inequity in availability of hospital services under the state-funded universal health insurance scheme in Chhattisgarh state, India, using a composite vulnerability index

“…Recognizing the multi-dimensional nature of vulnerability and its frequent geographical clustering, the aim of this study was to assess geographical inequity in availability of hospital services under the publicly-funded universal health insurance scheme in the state of Chhattisgarh [8,40]. …”