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Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review.

ABSTRACT: INTRODUCTION:Indigenous mothers often receive culturally unsafe services that do not fully respond to their needs. The objective of this scoping review is to collate and assess evidence that identifies factors, including the role and influence of traditional midwives, that affect maternal health in indigenous communities in the Americas. The results will map Western perspectives reflected in published and unpublished literature to indicate the complex network of factors that influence maternal outcomes. These maps will allow for comparison with local stakeholder knowledge and discussion to identify what needs to change to promote culturally safe care. METHODS AND ANALYSIS:A librarian will search studies with iterative and documented adjustments in CINAHL, Scopus, Latin American and Caribbean Health Sciences Literature (LILACS), MEDLINE, Embase and Google Scholar without any time restrictions, and use Google search engine for grey literature. Included studies will be empirical (quantitative, qualitative or mixed); address maternal health issues among indigenous communities in the Americas; and report on the role or influence of traditional midwives. Two researchers will independently screen and blindly select the included studies. The quality assessment of included manuscripts will rely on the Mixed Methods Appraisal Tool (MMAT). Two independent researchers will extract data on factors promoting or reducing maternal health in indigenous communities, including the role or influence of traditional midwives. Fuzzy cognitive mapping will summarise the findings as a list of relationships between identified factors and outcomes with weights indicating strength of the relationship and the evidence supporting this. ETHICS AND DISSEMINATION:This review is part of a proposal approved by the ethics committees at McGill University and the Centro de Investigación de Enfermedades Tropicales in Guerrero. Participating indigenous communities in Guerrero State approved the study in 2015. The results of the scoping review will contribute to the field of cultural safety and intercultural dialogue for the promotion of maternal health in indigenous communities.

SUBMITTER: Sarmiento I

PROVIDER: S-EPMC7592283 | biostudies-literature | 2020 Oct

REPOSITORIES: biostudies-literature

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Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review.

Sarmiento Iván I Paredes-Solís Sergio S Morris Martin M Pimentel Juan J Cockcroft Anne A Andersson Neil N

BMJ open 20201027 10

<h4>Introduction</h4>Indigenous mothers often receive culturally unsafe services that do not fully respond to their needs. The objective of this scoping review is to collate and assess evidence that identifies factors, including the role and influence of traditional midwives, that affect maternal health in indigenous communities in the Americas. The results will map Western perspectives reflected in published and unpublished literature to indicate the complex network of factors that influence ma ...[more]

PMID: 33109651

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Project description:ObjectivesCollate published evidence of factors that affect maternal health in Indigenous communities and contextualise the findings with stakeholder perspectives in the Mexican State of Guerrero.DesignScoping review and stakeholder fuzzy cognitive mapping.Inclusion and exclusionThe scoping review included empirical studies (quantitative, qualitative or mixed methods) that addressed maternal health issues among Indigenous communities in the Americas and reported on the role or influence of traditional midwives before June 2020. The contextualisation drew on two previous studies of traditional midwife and researcher perspectives in southern Mexico.ResultsThe initial search identified 4461 references. Of 87 selected studies, 63 came from Guatemala and Mexico. Three small randomised trials involved traditional midwives. One addressed the practice of traditional midwifery. With diverse approaches to cultural differences, the studies used contrasting definitions of traditional midwives. A fuzzy cognitive map graphically summarised the influences identified in the scoping review. When we compared the literature's map with those from 29 traditional midwives in Guerrero and eight international researchers, the three sources coincided in the importance of self-care practices, rituals and traditional midwifery. The primary concern reflected in the scoping review was access to Western healthcare, followed by maternal health outcomes. For traditional midwives, the availability of hospital or health centre in the community was less relevant and had negative effects on other protective influences, while researchers conditioned its importance to its levels of cultural safety. Traditional midwives highlighted the role of violence against women, male involvement and traditional diseases.ConclusionsThe literature and stakeholder maps showed maternal health resulting from complex interacting factors in which promotion of cultural practices was compatible with a protective effect on Indigenous maternal health. Future research challenges include traditional concepts of diseases and the impact on maternal health of gender norms, self-care practices and authentic traditional midwifery.

Project description:ObjectiveThe objective of this review protocol is to map the available evidence regarding all the oral health surveys of Traditional Peoples and Communities (TPCs) in Brazil.Methods and analysisThe review question of the protocol is: 'What evidence is available on the oral health surveys of Traditional Peoples and Communities in Brazil?'. Observational studies that report oral health surveys of TPC in Brazil will be included. The protocol considered the Problem, Concept and Context strategy to guide data collection, as established by the Joanna Briggs Institute. The search strategy will consider Medical Subject Headings terms, synonyms and relevant free terms about epidemiological surveys in oral health and TPC in Brazil, with no limits to data, language, subject or search type, in the databases Medical Literature Analysis and Retrieval System Online (MEDLINE/PubMed), Literatura Latino-americana e do Caribe em Ciências da Saúde (LILACS), Scopus, Web of Science and Embase. Bibliographic searches will be updated until June 2023. The selection will be carried out by two independent, blinded reviewers, following the eligibility criteria, based on the title and abstract identified in the initial search. Potentially eligible studies will be fully read to confirm eligibility and collect relevant information. The categorisation of the studies will consider the author and year of publication, the traditional group studied, the study design, geographic location, age group, sample size, data collection method and the main oral health problem evaluated and its outcome. The data obtained and extracted will be presented in table format and text and presented using the visualisation of similarities method.Ethics and disseminationThe present study does not need ethical approval. The protocol title was registered in the Open Science Framework (DOI 10.17605/OSF.IO/BQ5J3). A final article will be prepared presenting the results of the scoping review, and will be submitted for publication in a peer-reviewed journal. The findings of this review will be presented at national conferences and scientific meetings.

Project description:BackgroundMany Indigenous communities across the USA and Canada experience a disproportionate burden of health disparities. Effective programs and interventions are essential to build protective skills for different age groups to improve health outcomes. Understanding the relevant barriers and facilitators to the successful dissemination, implementation, and retention of evidence-based interventions and/or evidence-informed programs in Indigenous communities can help guide their dissemination.PurposeTo identify common barriers to dissemination and implementation (D&I) and effective mitigating frameworks and strategies used to successfully disseminate and implement evidence-based interventions and/or evidence-informed programs in American Indian/Alaska Native (AI/AN), Native Hawaiian/Pacific Islander (NH/PI), and Canadian Indigenous communities.MethodsA scoping review, informed by the York methodology, comprised five steps: (1) identification of the research questions; (2) searching for relevant studies; (3) selection of studies relevant to the research questions; (4) data charting; and (5) collation, summarization, and reporting of results. The established D&I SISTER strategy taxonomy provided criteria for categorizing reported strategies.ResultsCandidate studies that met inclusion/exclusion criteria were extracted from PubMed (n = 19), Embase (n = 18), and Scopus (n = 1). Seventeen studies were excluded following full review resulting in 21 included studies. The most frequently cited category of barriers was "Social Determinants of Health in Communities." Forty-three percent of barriers were categorized in this community/society-policy level of the SEM and most studies (n = 12, 57%) cited this category. Sixteen studies (76%) used a D&I framework or model (mainly CBPR) to disseminate and implement health promotion evidence-based programs in Indigenous communities. Most highly ranked strategies (80%) corresponded with those previously identified as "important" and "feasible" for D&I The most commonly reported SISTER strategy was "Build partnerships (i.e., coalitions) to support implementation" (86%).ConclusionD&I frameworks and strategies are increasingly cited as informing the adoption, implementation, and sustainability of evidence-based programs within Indigenous communities. This study contributes towards identifying barriers and effective D&I frameworks and strategies critical to improving reach and sustainability of evidence-based programs in Indigenous communities.Registration numberN/A (scoping review).

Project description:BackgroundMaternal Mortality Ratio (MMR) in Indonesia is still high, 305, compared to 240 deaths per 100,000 in South East Asian Region. The use of Traditional Birth Attendance (TBA) as a cascade for maternal health and delivery, suspected to be the pocket of the MMR problem. The study aimed to assess the influence of traditional practices on maternal health services in Indonesia.MethodsWe used two data sets of national surveys for this secondary data analysis. The samples included 14,798 mothers whose final delivery was between January 2005 and August 2010. The dependent variables were utilization of maternal healthcare, including receiving antenatal care (ANC≥4), attended by skilled birth attendance (SBA), and having a facility-based delivery (FBD). The independent variables were the use of traditional practices, type of family structure, and TBA density. We run a Multivariate logistic regression for the analysis by controlling all the covariates.ResultsTraditional practices and high TBA density have significantly inhibited the mother's access to maternal health services. Mothers who completed antenatal care were 15.6% lost the cascade of facility-based delivery. The higher the TBA population, the lower cascade of the use of Maternal Health Services irrespective of the economic quintile. Mothers in villages with a high TBA density had significantly lower odds (AOR = 0.30; CI = 0.24-0.38; p<0.01) than mothers in towns with low TBA density. Moreover, mothers who lived in an extended family had positively significantly higher odds (AOR = 1.33, CI = 1.17-1.52; p<0.01) of using maternal health services.DiscussionNot all mothers who have received proper antenatal delivered the baby in health care facilities or preferred a traditional birth attendance instead. Traditional practices influenced the ideal utilization of maternal health care. Maternal health care utilization can be improved by community empowerment through the maternal health policy to easier mothers get delivery in a health care facility.

Project description:Traditional knowledge about the use of medicinal plants for herbal drinks (HDs) is not well documented in the Azad Kashmir region despite their widespread use. This study highlights the taxonomic diversity and traditional knowledge on medicinal plants used for HDs while examining the diversity of diseases treated with HDs in the study area.Individual discussions were conducted with 255 informants (84 women and 171 men). Data gathered included (i) informant age and gender, (ii) HD species and respective plant parts used, (iii) health disorders treated, and (iv) mode of preparation and utilizations. Quantitative ethnobotanical indices including relative frequency of citation (RFC), informant consensus factor (ICF), and use value (UV) were used for data analyses.Altogether, 73 medicinal plants belonging to 40 families and 66 genera were reported to be used in HD preparations, with Asteraceae being the richest family. The average number of HD species cited was 9.09?±?0.17 per informant and did not vary either by age or gender. In addition, men and women, and adults and the young used the same pool of species (dissimilarity nearly zero). The most used plant parts were leaves (20.00%), roots (17.25%), and fruits (16.47%). Based on UV, the top five most used species were Valeriana jatamansi, Isodon rugosus, Onopordum acanthium, Acacia nilotica, and Viola canescens; and the UV was similar among gender and age categories too. The most utilized herbal preparation forms included decoctions, infusions, and tea. One hundred and eleven diseases grouped into 13 ailment categories were reported to be cured using HDs. The main category of disease treated with HDs was gastrointestinal (GIT) disorders (RFC?=?17.43%). Relatively few species were used by a large proportion of informants for each category of ailment (ICF???0.60). Only one species was used for "glandular disorders" and "eye diseases" (ICF?=?1). A novelty of about 22% (16 species) was recorded for HD species in the present work.The diversity of medicinal plant species used as HDs and the associated traditional knowledge are of considerable value to the indigenous communities of the Azad Kashmir region. Therefore, there is a need for conservation and preservation of medicinal HD species as well as the wealth of indigenous knowledge. The conservation effort should be high for species in the ailments categories glandular disorders and eye diseases. The therapeutic uses of HDs have provided basic data for further research focused on phytochemical and pharmacological studies and conservation of the most important species.

Project description:BackgroundMidwives are strong advocates for vaginal births. However, their visibility and accessibility are poorly perceived by women in Romania. Consequently, the women's options are limited to a single direction when pregnancy occurs, involving the family doctor, the obstetrician, and often an interventional technical approach at the time of birth. The aim of this research is to identify specific variables that affect the perceptions and attitudes of pregnant women towards the care provided by midwives. This knowledge could contribute to the development of more effective education and information strategies within maternal health services.MethodsA cross-sectional observational analytical survey was conducted in Romania among pregnant women from the general population. Data were collected through a self-administered questionnaire, with informed consent obtained from each participating pregnant woman. The questionnaire was administered online using the cloud-based Google Forms platform and was available on the internet for seven months, from January to July 2023. The questionnaire was distributed through various media channels, both individually and in communication groups, in the form of a link. All questions were mandatory, and the questionnaire could only be submitted after answering all questions.ResultsA total of 1301 individual responses were collected. The analysis of the socio-demographic and obstetrical profile of the pregnant women revealed that approximately half, 689 (52.95%), of the participants were aged between 18-29 years, and 1060 (81.47%) of the participants were married. Among our group of 1301 pregnant women, 973 (74.78%) had higher education, and 987 (75.86%) had a regular job. A majority of the survey participants, 936 (71.94%), lived in an urban geographic area, while 476 (36.58%) had attended childbirth education courses, and 791 (60.79%) were in the third trimester of pregnancy. A total of 298 (22.9%) respondents did not want to give birth in a hospital, and one-third, 347 (26.67%), did not place significant importance on control over the childbirth process.ConclusionsThe main factors influencing women's decisions regarding perinatal care and the importance of midwives as a component of the maternal-infant care team are modifiable, and thorough educational and psychological preparation would reduce the increasing predominance of preference for cesarean section, thereby promoting healthier and more woman- and child-centered perinatal care.

Project description:Improving sexual, reproductive, maternal, newborn, and adolescent health outcomes necessitates greater commitment to, and investments in, midwifery. To identify future research priorities to advance and strengthen midwifery, we conducted a scoping review to synthesise and report areas of midwifery that have been explored in the previous 10 years in the 11 countries of the World Health Organization's South-East Asia region. Electronic peer-reviewed databases were searched for primary peer-reviewed research published in any language, published between January 2012 and December 2022 inclusive. A total of 7086 citations were screened against the review inclusion criteria. After screening and full text review, 195 sources were included. There were 94 quantitative (48.2%), 67 qualitative (34.4%) and 31 mixed methods (15.9%) studies. The majority were from Indonesia (n = 93, 47.7%), India (n = 41, 21.0%) and Bangladesh (n = 26, 13.3%). There were no sources identified from the Democratic People's Republic of Korea or the Maldives. We mapped the findings against six priority areas adapted from the 2021 State of the World's Midwifery Report and Regional Strategic Directions for Strengthening Midwifery in the South-East Asia region (2020-2024): practice or service delivery (n = 73, 37.4%), pre-service education (n = 60, 30.8%), in-service education or continuing professional development (n = 51, 26.2%), workforce management (n = 46, 23.6%), governance and regulation (n = 21, 10.8%) and leadership (n = 12, 6.2%). Most were published by authors with affiliations from the country where the research was conducted. The volume of published midwifery research reflects country-specific investment in developing a midwifery workforce, and the transition to midwifery-led care. There was variation between countries in how midwife was defined, education pathways, professional regulation, education accreditation, governance models and scope of practice. Further evaluation of the return on investment in midwifery education, regulation, deployment and retention to support strategic decision-making is recommended. Key elements of leadership requiring further exploration included career pathways, education and development needs and regulatory frameworks to support and embed effective midwifery leadership at all levels of health service governance.

Project description:ObjectiveCultural safety is an Indigenous concept that can improve how healthcare services are delivered to both Indigenous and non-Indigenous peoples in Canada. This study explored how Indigenous and non-Indigenous clients at an urban, Indigenous-focused midwifery practice in Toronto, Canada (Seventh Generation Midwives Toronto, SGMT) conceptualised and experienced culturally safe care.Design and settingInterviews were conducted with former clients of SGMT as a part of a larger evaluation of the practice. Participants were purposefully recruited. Interviews were transcribed and analysed thematically using an iterative, consensus-based approach and a critical, naturalistic, and decolonising lens.ParticipantsSaturation was reached after 20 interviews (n=9 Indigenous participants, n=11 non-Indigenous participants).ResultsThree domains of cultural safety emerged. Each domain included several themes: Relationships and Communication (respect and support for choices; personalised and continuous relationships with midwives; and being different from past experiences); Sharing Knowledge and Practice (feeling informed about the basics of pregnancy, birth, and the postpartum period; and having access to Indigenous knowledge and protocols), and Culturally Safe Spaces (feeling at home in practice; and having relationships interconnected with the physical space). While some ideas were shared across groups, the distinctions between the Indigenous and non-Indigenous participants were prominent.ConclusionThe Indigenous participants conceptualised cultural safety in ways that highlight the survival and resurgence of Indigenous values, understandings, and approaches in cities like Toronto, and affirm the need for Indigenous midwives. The non-Indigenous participants conceptualised cultural safety with both congruence, illuminating Black-Indigenous community solidarities in cultural safety, and divergence, demonstrating the potential of Indigenous spaces and Indigenous-focused midwifery care to also benefit midwifery clients of white European descent. We hope that the positive impacts documented here motivate evaluators and healthcare providers to work towards a future where 'cultural safety' becomes a standard of care.

Dataset Information

Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review.

Publications

Factors influencing maternal health in indigenous communities with presence of traditional midwifery in the Americas: protocol for a scoping review.

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