The current focus on monitoring health inequalities and the complexity around ethnicity requires careful consideration of how ethnic disparities are measured and presented. This paper aims to determine how inequalities in maternal healthcare by ethnicity change according to different criteria used to classify indigenous populations. Nationally representative demographic surveys from Bolivia, Guatemala, Mexico, and Peru (2008–2016) were used to explore coverage gaps across maternal health care by ethnicity using different criteria. Women were classified as indigenous through self-identification (SI), spoken indigenous language (SIL), or indigenous household (IH). We compared the gaps through measuring coverage ratios (CR) with adjusted Poisson regression models. Proportions of indigenous women changed significantly according to the identification criterion (Bolivia:SI-63.1%/SIL-37.7%; Guatemala:SI-49.7%/SIL-28.2%; Peru:SI-34%/SIL-6.3% & Mexico:SI-29.7%/SIL-6.9%). Indigenous in all countries, regardless of their identification, had less coverage. Gaps in care between indigenous and non-indigenous populations changed, for all indicators and countries, depending on the criterion used (e.g., Bolivia CR for contraceptive-use SI = 0.70, SIL = 0.89; Guatemala CR for skilled-birth-attendant SI = 0.77, SIL = 0.59). The heterogeneity persists when the reference groups are modified and compare just to non-indigenous (e.g., Bolivia CR for contraceptive-use under SI = 0.64, SIL = 0.70; Guatemala CR for Skilled-birth-attendant under SI = 0.77, SIL = 0.57). The indigenous identification criteria could have an impact on the measurement of inequalities in the coverage of maternal health care. Given the complexity and diversity observed, it is not possible to provide a definitive direction on the best way to define indigenous populations to measure inequalities. In practice, the categorization will depend on the information available. Our results call for greater care in the analysis of ethnicity-based inequalities. A greater understanding on how the indigenous are classified when assessing inequalities by ethnicity can help stakeholders to deliver interventions responsive to the needs of these groups.

中文翻译：

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种族指标的选择如何影响四个拉丁美洲国家中基于种族的孕产妇保健不平等：谁是土著？

当前对监测健康不平等和种族复杂性的关注要求仔细考虑如何衡量和呈现种族差异。本文旨在根据用于对土著人口进行分类的不同标准，确定按种族划分的孕产妇保健不平等状况如何变化。来自玻利维亚，危地马拉，墨西哥和秘鲁（2008-2016年）的全国代表性人口普查被用于使用不同的标准探讨按种族划分的孕产妇保健覆盖率差距。通过自我识别（SI），口语（SIL）或土著家庭（IH）将妇女分为土著。我们使用调整后的泊松回归模型通过测量覆盖率（CR）比较了差距。根据确定标准（玻利维亚：SI-63.1％/ SIL-37.7％;危地马拉：SI-49.7％/ SIL-28.2％;秘鲁：SI-34％/ SIL-6.3％和墨西哥： SI-29.7％/ SIL-6.9％）。所有国家的土著居民，无论其身份如何，覆盖面都较小。对于所有指标和国家，根据使用的标准，土著和非土著人口之间的照护差距发生了变化（例如，避孕用玻利维亚CR SI = 0.70，SIL = 0.89；熟练出生护理人员危地马拉CR SI = 0.77，SIL = 0.59）。当参考组被修改并仅与非土著人群进行比较时，异质性仍然存在（例如，在SI = 0.64，SIL = 0.70的情况下使用玻利维亚CR避孕；在SI = 0.77，SIL = 0.57的情况下，熟练技术人员的危地马拉CR ）。土著身份确定标准可能会影响孕产妇保健覆盖面中不平等的衡量。考虑到所观察到的复杂性和多样性，不可能就定义土著人口以衡量不平等现象的最佳方法提供明确的指导。在实践中，分类将取决于可用的信息。我们的结果要求对基于种族的不平等进行分析时应更加谨慎。在按种族评估不平等时，对土著人如何分类有更多的了解，可以帮助利益相关者针对这些群体的需求进行干预。不可能就定义土著人口以衡量不平等的最佳方法提供明确的方向。在实践中，分类将取决于可用的信息。我们的结果要求对基于种族的不平等进行分析时应更加谨慎。在按种族评估不平等时，对土著人如何分类有更多的了解，可以帮助利益相关者针对这些群体的需求进行干预。不可能就定义土著人口以衡量不平等的最佳方法提供明确的方向。在实践中，分类将取决于可用的信息。我们的结果要求对基于种族的不平等进行分析时应更加谨慎。在按种族评估不平等时，对土著人如何分类有更多的了解，可以帮助利益相关者针对这些群体的需求进行干预。