Editorial: Addressing Health Inequities in Women Care

In the 1980s, I was working on a health and nutrition program for the inhabitants of coffee plantations (fincas) in the highlands of the west coast of Guatemala. One night, around 8 p.m., a nurse in charge of one of these fincas called me with an emergency. When we entered the dwelling, in a unique room where the family would eat, cook and sleep, I saw a table placed in the centre of the room, with a boy lying on this table surrounded by candles. The boy was around 8 years old, thin, with impressive beautiful black eyes, breathing slowly. Seated on the floor in silence, forming a circle around the table, were some women and men dressed in colourful indigenous clothing. Any new person coming into the room lit a candle and took a seat in the same way. We could not convince the parents to allow us to take care of the child, to take him to the hospital and treat him. Their refusal was based on accumulated experiences in the community: the child would die anyway in the hostile hospital, and in order to receive his dead body and bury him, the family would need to pay to a mortuary company a sum of money unaffordable for them. Allowing the child to die at home would give them the opportunity to bury their child in a family cemetery without costs. Coming out of this dwelling with our hearts destroyed, we could see the mansion where the owner of the finca lived—the windows were lit, and we could hear the sound of soft music and the noise of knives and forks, which were sometimes interrupted by laughs. The next day, the nurse reported to us that the child had died around 2 a.m. Health workers around the world are faced with different aspects of health inequities as the one described above. The role of social and economic situation on health deliver and outcome is a well-known situation for health providers. Recent epidemiological research has shown that fetal growth has long term implications on the quality of life of an individual. Two articles in this issue show the implications of fetal life. Prater article describes the effect of maternal nutrition on long term outcomes of the progeny and Maritz article shows the long-term effect on lung integrity of the offspring of maternal nicotine exposure. Again, another contribution on how inequities could influence quality of life since it is expected that low income populations would have poorer fetal growth and low possibility to receive preventive interventions to improve maternal habits. Hallam article shows an initiative from a high income country to address health inequities during pregnancy. It is an interesting approach since the author has look for evidence based interventions that can be applied in a high income country and could ameliorate the differences in outcome due to inequities. In middle and low income countries a set of evidence based interventions could have a great impact on maternal survival and the challenge is how to improve the implementation of such interventions. Implementation science is a young science promoting research looking for mechanisms to scale-up well known interventions of benefit. Such approach is described in Chersich article testing a simple intervention to improve the access to HIV testing for women. It is highly encouraging to see the effort of the medical scientific community to ameliorate the consequences of health inequities and to improve survival and quality of life of those with major needs.