Perceptions of adolescent pregnancy in the rural context and the Colombian armed conflict: a qualitative approach based on social determination of health

Background Adolescent pregnancy in rural areas is a persistent health problem that has still not properly been understood. Studies with qualitative perspectives that address this phenomenon as a complex social process, which involves the recognition of the voices of the actors involved and the analysis of the specific context in which it takes place, are limited. Objective This research explored the perceptions of young people and other social actors (municipalities of Palmira and El Cerrito in Colombia) of the social forces and dimensions of the social determination of adolescent pregnancy in the Amaime river basin. These geographic areas have been scenes of armed violence with various groups in combat within the context of a long-standing political conflict in Colombia. After the 2016 Havana agreements were signed, peacebuilding has been underway in its territories. Methods A qualitative study that implemented focus groups and semi-structured interviews was conducted. The theoretical approach of social determination of health proposed by Breilh was used to study the social process entailed in adolescent pregnancy. Perceptions about social conditions, specific ways of life, and lifestyles were addressed. Galtung and Fischer’s theoretical approach on violence and peacebuilding was also incorporated to enrich the understanding of the Colombian context. The analysis was conducted with approaches from phenomenology. Results Living conditions with strong social stigma and demand for social, political, and cultural opportunities were found. Regarding ways of life, little communication and information about sex education was perceived. As for lifestyles, there are youthful behaviors infused by sociocultural traditions that affect life projects and sexual behavior. Gender relations are precarious, and there are various types of violence that limit effective peacebuilding. Conclusions This study contributes to a priority issue in sexual and reproductive health, with an approach that generates analytical elements to comprehensively expand the social and health interventions required.

Perceptions of Adolescent Pregnancy in Rural Contexts: An Approach based on Social Determination of health inequities

Background: The phenomenon of teen pregnancy as a social process in rural areas within settings of violence and peacebuilding are not well understood. The purpose of this study was to inquire into the perceptions of lived experiences in Colombian rural areas on the social forces and social determination of adolescent pregnancy. Methods: Qualitative study using semi-structured interviews and focus groups. Data triangulation included young people and other social actors from the Amaime river basin (municipalities of Palmira and El Cerrito in Colombia). Perceptions about the social conditions, specific ways of living, and lifestyles, were analyzed with approximations from phenomenology with the theoretical approach of social determination of health inequities. Results: Living conditions with strong social stigma and demand for social, political, and cultural opportunities were found. Regarding the way of living, an isolated young person is perceived with emotional gaps, sanctioned by the social group, and with little communication and information on sexual education. Regarding lifestyles, there are standardized youth behaviors that affect a person’s life plan and sexuality with precarious gender relations and with various types of violence that limit exercising peacebuilding. Conclusions: This study contributes to a pressing topic in sexual and reproductive health, with a novel approach that generates conclusions that contribute to comprehensively expanding the required interventions.

Racial and Ethnic Disparities in COVID-19 Outcomes: Social Determination of Health

As of 18 October 2020, over 39.5 million cases of coronavirus disease 2019 (COVID-19) and 1.1 million associated deaths have been reported worldwide. It is crucial to understand the effect of social determination of health on novel COVID-19 outcomes in order to establish health justice. There is an imperative need, for policy makers at all levels, to consider socioeconomic and racial and ethnic disparities in pandemic planning. Cross-sectional analysis from COVID Boston University’s Center for Antiracist Research COVID Racial Data Tracker was performed to evaluate the racial and ethnic distribution of COVID-19 outcomes relative to representation in the United States. Representation quotients (RQs) were calculated to assess for disparity using state-level data from the American Community Survey (ACS). We found that on a national level, Hispanic/Latinx, American Indian/Alaskan Native, Native Hawaiian/Pacific Islanders, and Black people had RQs > 1, indicating that these groups are over-represented in COVID-19 incidence. Dramatic racial and ethnic variances in state-level incidence and mortality RQs were also observed. This study investigates pandemic disparities and examines some factors which inform the social determination of health. These findings are key for developing effective public policy and allocating resources to effectively decrease health disparities. Protective standards, stay-at-home orders, and essential worker guidelines must be tailored to address the social determination of health in order to mitigate health injustices, as identified by COVID-19 incidence and mortality RQs.

Determination or determinants? A debate based on the Theory on the Social Production of Health

This article aims to discuss the concepts of Social Determination of Health and Social Determinants of Health, by establishing a comparison between each of their guiding perspectives and investigating their implications on the development of health policies and health actions. We propose a historical and conceptual reflection, highlighting the Theory on the Social Production of Health, followed by a debate on the concepts, with a comparative approach among them.