Nouvelles des membres du Réseau Conférence internationale: Using fuzzy cognitive mapping to build soft models of indigenous knowledge about safe motherhood

 

Une présentation d'Iván Sarmiento, lauréat du concours de soutien à la participation à des conférences internationale 2019-2020, 47th NAPCRG 2019 Annual Meeting, 16-20 Novembre 2019, Toronto, Canada. 

Co-auteursSergio Paredes-Solís, Anne Cockcroft, Neil Andersson

Résumé

Context: A pregnant woman living in the South of Guerrero (Mexico) is ten times more likely to die than a woman in any other region of the State. Attenuated health care services and cultural barriers hamper proper care. Ineffective methodologies hinder understanding and incorporation of indigenous perspectives in the provision of adequate services.  Objective: To explore indigenous perspectives on risks and protective factors for safe motherhood among indigenous communities in the South of Guerrero.  Study Design: Participatory research involves people affected by an issue in creating the knowledge to solve it. We listened key informants in discussions group and used fuzzy cognitive mapping to produce soft models of their knowledge.  Setting: Two municipalities in Guerrero (Xochistlahuaca and Acatepec) populated by indigenous people who subsist mainly on migrant labour, small-scale agriculture and cattle; Population Studied: We worked with twenty-nine indigenous elders from the Me’phaa and Nancue ñomndaa people whose communities recognized them as traditional midwives.  Instrument: Participants created fuzzy cognitive maps listing risk and protective factors associated with maternal health and indicating the importance of the relationships between those factors. The analysis calculated fuzzy transitive closure to rank the influence of each factor while considering all other factors and the relationships between them and to determine optimal paths for intervention.  Outcome Measures: Weight of the net influence of each factor after calculating transitive closure and synthesizing the maps from all the communities.  Results: The maps identified a complex concept of maternal health that involves, beyond lower morbidity, women’s well-being, the condition of the offspring and even the health condition of the husband. Participants identified as risk factors a complex network of diseases, abandonment of health care traditions, women’s mental health and gender violence. Protective factors included increased male involvement in maternal health, receiving support from traditional healers, following protective rituals, and better nutrition.  Conclusions: Fuzzy cognitive mapping offers a tool meaningful participation where stakeholders from different cultural backgrounds engage to increase mutual understanding. This information can help to inform adjustments in health services to the needs of indigenous women and bridge the cultural gap with Western-based services.