Racismo y discriminación en la atención a mujeres totonacas en Veracruz, México: la necesidad de competencias interculturales
Resumen
Objetivo. El racismo es una desigualdad en la salud que ha sido desatendida. El objetivo es examinar la salud materna en México rural con respecto a las diferentes formas de discriminación. Material y métodos. La investigación está basada en un trabajo de campo antropológico llevado a cabo en la región Sierra del Totonacapan en Veracruz, México. Resultados. Distinguimos y documentamos empíricamente omisiones y violaciones a los derechos humanos, antes de analizar las fuentes del racismo desde una perspectiva interseccional, según la cual género, clase y raza constituyen fuentes de discriminación estrechamente enlazadas. Conclusiones. Finalmente proponemos un enfoque de competencia intercultural para enfrentar el racismo en su confluencia con otras ideologías. Este enfoque está dirigido a los profesionales como actores conscientes, reflexivos y transformadores de las interacciones interculturales.
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Williams DR, Mohammed SA. Discrimination and racial disparities in health: evidence and needed research. J Behav Med 2009;32(1):20–47. doi: 10.1007/s10865-008-9185-0.
Johnstone M-J, Kanitsaki O. The Neglect of Racism as an Ethical Issue in Health Care. J Immigr Minor Heal 2010;12(4):489–95. doi: 10.1007/s10903-008-9210-y.
Horton R. Offline: Racism-the pathology we choose to ignore. Lancet 2017;390(10089):14. [Consultado 2020 agosto 8]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/28677545.
Bhopal RS. Intertwining migration, ethnicity, racism, and health. Lancet 2017;390(10098):932. doi: 10.1016/S0140-6736(17)32143-8.
Barnes LL, De Leon CFM, Wilson RS, Bienias JL, Bennett DA, Evans DA. Racial Differences in Perceived Discrimination in a Community Population of Older Blacks and Whites. J Aging Health 2004;16(3):315–37. doi: 10.1177/0898264304264202.
Karlsen S, Nazroo JY. Relation between racial discrimination, social class, and health among ethnic minority groups. Am J Public Health 2002;92(4):624–31. [Consultado 2020 agosto 8]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/11919063.
Larson A, Gillies M, Howard PJ, Coffin J. It’s enough to make you sick: the impact of racism on the health of Aboriginal Australians. Aust N Z J Public Health 2007;31(4):322–9. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/17725009.
Harris R, Tobias M, Jeffreys M, Waldegrave K, Karlsen S, Nazroo J. Racism and health: The relationship between experience of racial discrimination and health in New Zealand. Soc Sci Med 2006;63(6):1428–41. doi: 10.1016/j.socscimed.2006.04.009.
Kung H-C, Hoyert DL, Xu J, Murphy SL. Deaths: final data for 2005. Natl Vital Stat Rep 2008;56(10):1–120. [Consultado 2020 agosto 8]. Disponible en: https://www.cdc.gov/nchs/data/nvsr/nvsr56/nvsr56_10.pdf.
Osorio RM. Eduardo L. Menéndez (2002), La parte negada de la cultura. Relativismo, diferencias y racismo. Región y Soc 2008;20:337–45. [Consultado 2020 agosto 8]. Disponible en: http://www.scielo.org.mx/scielo.php?script=sci_arttext&pid=S1870-39252008000400012.
Menéndez EL. De racismos, esterilizaciones y algunos otros olvidos de la antropología y la epidemiología mexicanas. Salud Colect 2009;5(2):155. [Consultado 2020 agosto 8]. Disponible en: http://revistas.unla.edu.ar/saludcolectiva/article/view/258.
Pan American Health Organization. Ethnicity and Health. 132nd session of the executive committee. Wasinghton (DC): PAHO; 2003. [Consultado 2020 agosto 8]. Disponible en: http://www.paho.org/English/gov/ce/ce132-16-e.pdf
Roldán JA, Álvarez MA, Carrasco M, Guarneros N, Ledesma J, Cuchillo-Hilario M, et al. Marginalization and health service coverage among Indigenous, rural, and urban populations: A public health problem in Mexico. Rural Remote Health 2017;17(4). [Consultado 2020 agosto 8]. Disponible en: https://www.rrh.org.au/journal/article/3948.
Perreira KM, Telles EE. The color of health: skin color, ethnoracial classification, and discrimination in the health of Latin Americans. Soc Sci Med 2014;116:241–50. doi: 10.1016/j.socscimed.2014.05.054.
Freyermuth G and Sesia P. La Muerte Materna. Acciones y estrategias hacia una maternidad segura: Comité Promotor por una Maternidad sin Riesgo en México. México Ciudad: CIESAS; 2009.
Jones CP. Levels of racism: a theoretic framework and a gardener’s tale. Am J Public Health 2000;90(8):1212–5. [Consultado 2020 agosto 8]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/10936998.
CESCR: General comment No. 14. The right to the highest attainable standard of Health. Art. 12. Committee on Economic, Social and Cultural Rights. Geneva; 2000. [Consultado 2020 agosto 8]. Disponible en: https://www.refworld.org/pdfid/4538838d0.pdf.
Valderrama Rouy P. The Totonac. En: Sandstrom AR, García Valencia EH, editors. Native Peoples of the Gulf Coast of Mexico. Tucson: The University of Arizona Press; 2005:187–210.
Atkinson R., Flint J. Accessing Hidden and Hard-to-Reach Populations: Snowball Research Strategies. Social Research Update 2001;(33). [Consultado 2020 agosto 8]. Disponible en: http://sru.soc.surrey.ac.uk/SRU33.html.
Glaser BG, Strauss AL. The discovery of grounded theory : strategies for qualitative research. New York City: Routledge; 1999.
Dietz G. Towards a Doubly Reflexive Ethnography: A proposal from the anthropology of interculturality. AIBR. Revista de Antropología Iberoamericana 2011;11(1):3-26. [Consultado 2020 agosto 8]. Disponible en: http://www.aibr.org/antropologia/netesp/numeros/0601/060102e.pdf
Geertz C. Thick Description: Towards and Interpretive Theory of Culture. En: The Interpretation of Culture: Selected Essays; 1973:310–23.
Smith-Oka V. Unintended consequences: Exploring the tensions between development programs and indigenous women in Mexico in the context of reproductive health. Soc Sci Med 2009;68(11):2069-77. doi: 10.1016/j.socscimed.2009.03.026.
Ali MM, Sadler RK, Cleland J, Ngo T, Shah IH. Long-term contraceptive protection, discontinuation and switching behaviour. Intrauterine device (IUD) use dynamics in 14 developing countries. London: WHO, Marie Stopes International, USAID; 2011.
Kleinman A, Benson P. Anthropology in the Clinic: The Problem of Cultural Competency and How to Fix it. PLoS Med 2006;3(10):1673–6. doi: 10.1371/journal.pmed.0030294.
Dixon LZ, El Kotni M, Miranda V. A Tale of Three Midwives: Inconsistent Policies and the Marginalization of Midwifery in Mexico. J Lat Am Caribb Anthropol 2019;24(2):351–69. doi: 10.1111/jlca.12384
Foucault M. The Birth of the Clinic: An Archaeology of Medical Perception. Vintage; 1994.
Jenkins GL. Burning bridges: policy, practice, and the destruction of midwifery in rural Costa Rica. Soc Sci Med 2003;56(9):1893–909. doi: 10.1016/S0277-9536(02)00212-5.
Maine D. Detours and shortcuts on the road to maternal mortality reduction. Lancet 2007;370(9595 ):1380–2. doi: 10.1016/S0140-6736(07)61580-3.
Hartmann K, Viswanathan M, Palmieri R, Gartlehner G, Thorp Jr J, Lohr KN. Outcomes of Routine Episiotomy. A Systemativ Review. JAMA 2005;293(7):2141–7. doi: 10.1001/jama.293.17.2141
Dietz G. From Indigenismo to Zapatismo: the struggle for indigenous rights in twentieth century Mexico. In: Zamosc L, Grey Postero N, editors. The Struggle for Indian Rights in Latin America. Brighton: Sussex Academic Press; 2004:32–80.
Saldivar Tanaka E. Prácticas cotidianas del Estado: una etnografía del indigenismo. Mexico City: Universidad Iberoamericana; 2008.
Cortina A. Aporofobia, el rechazo al pobre : un desafío para la democracia. Paidós Ibérica; 2017.
Moreno Figueroa MG, Saldívar Tanaka E. ‘We Are Not Racists, We Are Mexicans’: Privilege, Nationalism and Post-Race Ideology in Mexico. Crit Sociol 2016;42(4–5):515–33. doi: 10.1177/0896920515591296.
Hunt P, Backman G. Health systems and the right to the highest attainable standard of health. Health Hum Rights 2008;10(1):81–92. [Consultado 2020 agosto 8]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/20845831.
Iturriaga, E. Las élites de la Ciudad Blanca: discursos racistas sobre la Otredad. Mérida: Universidad Nacional Autónoma de México; 2016.
Walker D, DeMaria LM, Suarez L, Cragin L, Evaluating Alternative Models of Obstetric Care in Mexico Research Team. Skilled Birth Attendants in Mexico: How Does Care During Normal Birth by General Physicians, Obstetric Nurses, and Professional Midwives Compare With World Health Organization Evidence-Based Practice Guidelines? J Midwifery Womens Health 2012;57(1):18–27. doi: 10.1111/j.1542-2011.2011.00075.x.
Heart MYHB, Chase J, Elkins J, Altschul DB. Historical trauma among Indigenous Peoples of the Americas: concepts, research, and clinical considerations. J Psychoactive Drugs 2011;43(4):282–90. doi: 10.1080/02791072.2011.628913.
Flores Albornoz, D. La clínica rural en el contexto indígena: alcances y desafíos. Desacatos 2020;63(1):59-69.
Crenshaw, K. Demarginalizing the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum 1989;(1):139-167. [Consultado 2020 agosto 8]. Disponible en: http://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8.
Crenshaw K. Mapping the Margins: intersectionality, identity politics and violence against women of color. En: M. Fineman & R. Mykitiuk (eds.): The Public Nature of Private Violence. New York, NY: Routledge; 1994:93-118.
Molyneux M. Mothers at the Service of the New Poverty Agenda: Progresa/Oportunidades, Mexico's Conditional Transfer Programme. Social Policy & Administration 2006;40(4):425–49.doi: 10.1111/j.1467-9515.2006.00497.x.
Barber SL. Mexico's conditional cash transfer programme increases cesarean section rates among the rural poor. Eur J Public Health 2009;20(4):383–8. doi: 10.1093/eurpub/ckp184.
Lahoz Gómez D, Vázquez García V, Zapata Martelo E. Programa Oportunidades: ¿superación de la pobreza con perspectiva de género? En: E. Montero Mendoza (coord.): Género y etnicidad en los programas de salud pública: tuberculosis pulmonar en la Sierra de Santa Marta, Veracruz. Xalapa, Editorial Universidad Veracruzana; 2013:63-101.
Hogan VK, de Araujo EM, Caldwell KL, Gonzalez-Nahm SN, Black KZ. “We black women have to kill a lion everyday”: An intersectional analysis of racism and social determinants of health in Brazil. Soc Sci Med 2018;199:96–105. doi: 10.1016/j.socscimed.2017.07.008.
Hankivsky O, Reid C, Cormier R, Varcoe C, Clark N, Benoit C, et al. Exploring the promises of intersectionality for advancing women’s health research. Int J Equity Health 2010;9(5). [Consultado 2020 agosto 8]. Disponible en: http://equityhealthj.biomedcentral.com/articles/10.1186/1475-9276-9-5.
Castro R, Frías SM. Obstetric Violence in Mexico: Results From a 2016 National Household Survey. Violence Against Women, SAGE. 2019. doi: 10.1177/1077801219836732.
Tobasía-Hege C, Pinart M, Madeira S, Guedes A, Reveiz L, Valdez-Santiago R, et al. [Disrespect and abuse during childbirth and abortion in Latin America: systematic review and meta-analysis Desrespeito e maus-tratos durante o parto e o aborto na América Latina: revisão sistemática e meta-análise]. Rev Panam Salud Publica 2019;43:e36. [Consultado 2020 agosto 8]. Disponible en: http://www.ncbi.nlm.nih.gov/pubmed/31093260.
DallaPiazza M, Padilla-Register M, Dwarakanath M, Obamedo E, Hill J, Soto-Greene M. Exploring Racism and Health: An Intensive Interactive Session for Medical Students. MedEdPORTAL 2018;14:10783. [Consultado 2020 agosto 8]. Disponible en: https://www.mededportal.org/publication/10783.
Lerín-Piñón S. Antropología y salud intercultural: desafíos de una propuesta. Desacatos Rev Ciencias Soc 2004 ;0(16):111–25. [Consultado 2020 agosto 8]. Disponible en: http://desacatos.ciesas.edu.mx/index.php/Desacatos/article/view/1074.
Miller S, Cordero M, Coleman AL, Figueroa J, Brito-Anderson S, Dabagh R, et al. Quality of care in institutionalized deliveries: The paradox of the Dominican Republic. Int J Gynecol Obstet 2003;82(1):89–103. doi: 10.1016/S0020-7292(03)00148-6.
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Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.