Thanatchaporn Mulikaburt1, Tawatchai Apidechkul2,3,4, Pilasinee Wongnuch1,5, Siwarak Kitchanapaibul1,5, Anusorn Udplong1, Peeradone Srichan1,5, Panupong Upala5, Chalitar Chomchoei5, Fartima Yeemard5, Ratipark Tamornpark1,5, Onnalin Singkhorn5,6. 1. School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand. 2. School of Health Sciences, Mae Fah Luang University, Chiang Rai, Thailand. Tawatchai.api@mfu.ac.th. 3. Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand. Tawatchai.api@mfu.ac.th. 4. School of Health Science, Mae Fah Luang University, 333 Moo 1, Ta Sud Subdistrict, Muang District, 57100, Chiang Rai Province, Thailand. Tawatchai.api@mfu.ac.th. 5. Center of Excellence for Hill Tribe Health Research, Mae Fah Luang University, Chiang Rai, Thailand. 6. School of Nursing, Mae Fah Luang University, Chiang Rai, Thailand.
Abstract
BACKGROUND: Maternal and child health (MCH) is crucial to the well-being of mothers and children. Stigma regarding access to MCH services is a major challenge, especially for hill tribe people in Thailand. The study aimed to understand the components of stigma and its impact on MCH service and outcomes including experiences and expectations to address the stigma in perspective of Akha hill tribe women in Thailand. METHODS: A phenomenological qualitative approach was used to gather information from Akha women who had attended MCH service one year prior and had an experience with stigma. A validated question guide was used in the study. The interview was conducted in private and confidential rooms in the Akha hill tribe villages between June and September 2021. A thematic analysis was used to extract the major and minor themes and develop the findings. RESULTS: A total of 61 Akha postdelivery participants were recruited to provide information; the average age was 28.9 years, 32.8% had no Thai ID card, and 93.4% were married. Language, traditional clothing, poverty, and name were identified as drivers of stigma, while health care providers' background, gender differences between clients and health care providers, and knowledge gaps facilitated the stigma. Being a member of a hill tribe acted as the stigma marker. Stigma manifestation was presented in the forms of verbal or physical abuse, refusal to provide treatment, and intentional disclosure of personal information to the public. Accepting the situation with no better option, defending oneself to receive better care and services, and using a private care service were experiences in addressing the stigma. Gender matching, active MCH service, mobile emergency clinics, and appropriate, permanent medical equipment in health care facilities located in their villages were the expectations. CONCLUSION: Akha women face a variety of stigmas in access to MCH services, with substantial impacts on health outcomes, especially the rate of services in women and child health. Creating laws to prevent the occurrence of any forms of stigma and implementing gender matching in MCH services should be considered.
BACKGROUND: Maternal and child health (MCH) is crucial to the well-being of mothers and children. Stigma regarding access to MCH services is a major challenge, especially for hill tribe people in Thailand. The study aimed to understand the components of stigma and its impact on MCH service and outcomes including experiences and expectations to address the stigma in perspective of Akha hill tribe women in Thailand. METHODS: A phenomenological qualitative approach was used to gather information from Akha women who had attended MCH service one year prior and had an experience with stigma. A validated question guide was used in the study. The interview was conducted in private and confidential rooms in the Akha hill tribe villages between June and September 2021. A thematic analysis was used to extract the major and minor themes and develop the findings. RESULTS: A total of 61 Akha postdelivery participants were recruited to provide information; the average age was 28.9 years, 32.8% had no Thai ID card, and 93.4% were married. Language, traditional clothing, poverty, and name were identified as drivers of stigma, while health care providers' background, gender differences between clients and health care providers, and knowledge gaps facilitated the stigma. Being a member of a hill tribe acted as the stigma marker. Stigma manifestation was presented in the forms of verbal or physical abuse, refusal to provide treatment, and intentional disclosure of personal information to the public. Accepting the situation with no better option, defending oneself to receive better care and services, and using a private care service were experiences in addressing the stigma. Gender matching, active MCH service, mobile emergency clinics, and appropriate, permanent medical equipment in health care facilities located in their villages were the expectations. CONCLUSION: Akha women face a variety of stigmas in access to MCH services, with substantial impacts on health outcomes, especially the rate of services in women and child health. Creating laws to prevent the occurrence of any forms of stigma and implementing gender matching in MCH services should be considered.
Authors: Anne L Stangl; Valerie A Earnshaw; Carmen H Logie; Wim van Brakel; Leickness C Simbayi; Iman Barré; John F Dovidio Journal: BMC Med Date: 2019-02-15 Impact factor: 8.775
Authors: Patrícia Marques; Ana Gama; Mário Santos; Bruno Heleno; Heleen Vermandere; Sónia Dias Journal: Int J Environ Res Public Health Date: 2021-07-06 Impact factor: 3.390