The value of grounded theory for disentangling inequalities in maternal-child healthcare in contexts of diversity: A psycho-sociopolitical approach

Abstract

Adopting a psycho-sociopolitical approach, the present paper describes the results of a community-based participatory needs assessment focusing on the perceived needs of women of reproductive age as users of primary healthcare in contexts of migration-driven diversity and socioeconomic vulnerability in the Metropolitan Area of Lisbon. The investigation comprised 64 in-depth interviews with women, including natives and immigrants to Portugal from the main origin countries in the context under study (Brazil, Cape Verde, and other Portuguese-speaking African countries) and a survey of 125 women, again natives and immigrants from these countries. The central role of qualitative methodology and grounded theory, in the framework of a multi-method research, allowed understanding the needs of women as embedded in contexts characterized by asymmetrical power relations, in terms of unequal opportunities and resources, at multiple interrelated ecological levels (personal, relational, organizational, community, socioeconomic, health system/policy, cultural/migration). The priority perceived needs of women were primarily related to socioeconomic disadvantage, severely aggravated in the current contexts of crisis; and factors at the health system level, mainly unequal access to family doctors, excessive waiting lists, and increases in the direct costs of healthcare. Results allow questioning the adequacy of cultural competence approaches for the reduction of inequalities in maternal-child healthcare in the context under study, showing the critical and innovative value of qualitative methodology and grounded theory in research on social justice and health in contexts of diversity characterized by unequal power dynamics.

Dinámicas sociales en salud materna con énfasis en la Morbilidad Materna Extrema y aportes de la bioética en su comprensión

“…Un ejemplo particular de vulnerabilidad específica es la pertenencia a un grupo étnico, pues en estos casos es necesario reorientar los servicios de salud materna para responder a sus necesidades culturales: brindar apoyo a los partos domiciliarios, invertir en generar confianza con la comunidad y preservar las prácticas tradicionales beneficiosas (21). La adecuación de los enfoques de competencia cultural es fundamental para la reducción de las desigualdades en la atención materno-infantil (22).…”

Necesidades percibidas en el trabajo doméstico y de cuidados: un estudio cualitativo

“…El método concreto utilizado ha sido el método lingüístico, ya que permite obtener información sobre cómo las personas interpretan los acontecimientos en los que participan o presencian, cómo elaboran aquello que es relevante para ellos o para los demás, cómo dan sentido a sus experiencias y vivencias y cómo construyen los significados compartidos y los evalúan y valoran. Para la selección de los participantes se utilizó la técnica de bola de nieve, lo que permitió acceder a una muestra con mayor diversificación (Plaza, Padilla, Ortiz y Rodrigues, 2014). Esta técnica consiste en contactar y conocer a algunos informantes y conseguir que pongan en contacto a los investigadores con otros posibles participantes (Taylor y Bogdan, 1984).…”

Fertility, Migration and Acculturation (FEMINA): a research protocol for studying intersectional sexual and reproductive health inequalities

“…The scarce public policies and strategic frameworks addressing migrants’ health fail to address the several intertwined SRH areas, providing a narrow focus only on HIV screening and on perinatal care [20]. The broader conceptualization of sexual health and its linkages to reproductive health also seems to be less visible in the existing research in Portugal [21–23], though with some important contributions to the construction of immigration policies to promote social inclusion and well-being of migrant populations [24, 25]. The need for such actions is in compliance with the 2030 Agenda for Sustainable Development which includes a goal on gender equality and empowerment (Goal 5) as well as a goal on reduction on inequality within and among countries (Goal 10).…”