Activity Post – Week 6

Social determinants in a society can play a direct role in an individual’s health. According to the World Health Organization, prominent examples of social determinants may be the social gradient, stress, social exclusion, social support, addiction, and transport (WHO, 2003). In my chosen country of Guatemala, maternal mortality has improved, but still happens in great numbers. Indigenous women in Guatemala are three times more likely to experience maternal mortality than non-indigenous women (Colombara et al., 2016). Social determinants that may contribute to this instance are the social gradient and social exclusion.

The social gradient is having to do with social and economic circumstances which places a person in a certain area of the social ladder. Poor social and economic circumstances can affect health as shorter life expectancy and disease are more common with individuals toward the bottom of the social ladder (WHO, 2003). Economic and social standing are directly related to a person’s health outcome. Secondly, social exclusion can result from discrimination, particularly about ethnic background and economic status in this case. Social exclusion can lead to worse health and risk of premature death (WHO, 2003). In my research, indigenous Guatemalans, which make up almost half of the population, experience greater socioeconomic disadvantages than non-indigenous Guatemalans fueling discrimination against them. In knowing this and the lack of value put on women in the country, indigenous women are one of the most at-risk and vulnerable groups in Guatemala.

Maternal mortality is higher in indigenous women than non-indigenous women having to do with the reality that indigenous people, especially women, are seen as “lower value” to society based on their underprivileged factors that associate them being lower in the social ladder than other groups. These factors include being more likely to be illiterate, uneducated, and have a low wealth index (Colombara et al., 2016). With these economic stereotypes that fuel discrimination against them, there is also great ethnic disparity with indigenous women in healthcare facilities as these women are subject to discrimination by predominantly ladino (mixed Spanish and indigenous) people. This can be explained by the lack of understanding from the two ethnic groups since there is presence of a large language barrier with the ladinos who speak Spanish and the largely Mayan indigenous people that could speaker various indigenous languages and dialects. The discrimination of these women is prevalent at best as a survey conducted that indigenous women’s most common complaint of hospitals in the lack of quality in care during their stay (Kanako et al., 2012). Indigenous women’s hesitancy to visit hospitals because of the possible discrimination is shown by the statistic regarding birth arrangements. In a Guatemalan study analyzing 2008-2009 birthing statistics, around 36% of indigenous women delivered in medical institutions, while a much larger 73% of ladina women gave birth in medical facilities (Kanako et al., 2012). The instance of birth in medical facilities or hospitals are associated with decreased maternal death inevitably giving indigenous women disproportionately high maternal mortality rates and being less likely to give birth in a medical institution by show of their commonly underprivileged economic and education background.

Social gradient and social exclusion being key social determinants in influencing health for Guatemalan mothers is justified. Indigenous women being associated towards the lower end of the social gradient or “ladder” is factual as they are more likely to be poor, uneducated, and illiterate (Colombara et al., 2016). These women also experience a more difficult time if they do decide to visit a hospital during their pregnancy or birth, whether it is because of the discrimination they face or lack of understanding because of a prominent language barrier (Kanako et al., 2012). This, in turn, explains the statistically significant maternal mortality rate of indigenous women that is two to three fold greater than the national Guatemalan average (Colombara et al., 2016). Social determinants like social gradient and social exclusion affecting indigenous women in Guatemala is blindingly prominent as shown by the excessive rate of maternal mortality in indigenous communities.

Activity PDF 6.3 WHO (2003) – “Social Determinants of Health: The Solid Facts.” https://drive.google.com/file/d/1ubK2nSOuNnZS9X5vvt7C7rwqQq370tnh/view.

Colombara, Danny, et al. “Institutional Delivery and Satisfaction among Indigenous and Poor Women in Guatemala, Mexico, and Panama.” (PLoS ONE) Public Library of Science, vol. 11, no. 4, 27 Apr. 2016, doaj.org/article/05ebf2bd048a46029ace7607396e9a29.

Kanako, Ishida, et al. “Ethnic Inequality in Guatemalan Women’s Use of Modern Reproductive Health Care.” Journal of International Perspectives on Sexual and Reproductive Health, vol. 38, no. 2, June 2012, www.jstor.org/stable/41585364?seq=1#page_scan_tab_contents.

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