Intersectionality in surgical care in LMICs: A systematic scoping review

Area of Science:

• Global Health
• Surgical Care Equity
• Social Determinants of Health

Background:

• Intersectionality analyzes how overlapping social identities interact with power structures to create inequality.
• In low and middle-income countries (LMICs), this lens can reveal cumulative disadvantages in surgical care.
• Understanding these intersections is crucial for addressing health disparities.

Purpose of the Study:

• To examine the application of intersectionality in surgical care within LMICs.
• To identify how intersecting social dimensions affect surgical access and outcomes.
• To uncover cumulative disadvantages and inequities in LMIC surgical systems.

Main Methods:

• A comprehensive literature search was conducted following PRISMA guidelines across eight databases.
• Studies investigating the intersection of at least two marginalized social dimensions and surgical care in LMICs were identified.
• 31 studies were included from an initial 7325 abstracts.

Main Results:

• No studies explicitly used the term 'intersectionality,' but an average of 4.3 social determinants were analyzed per study.
• The most frequently studied determinants were income (100%), location (87.1%), gender/sex (77.4%), and education (77.4%).
• Beliefs (54.8%) and other factors like insurance, occupation, race/ethnicity, language, and caste were less frequently reported.

Conclusions:

• Applying an intersectional lens is supported by the findings to understand social determinant interactions.
• This approach helps identify the most vulnerable populations within surgical care systems.
• Findings can inform targeted policies to address gaps in surgical care access in LMICs.