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Intersectionality in surgical care in LMICs: A systematic scoping review
Ayla Gerk1, Shreenik Kundu1, Elena Guadagno2
1McGill University Faculty of Medicine and Health Sciences, Montreal, Quebec, Canada; Harvey E. Beardmore Division of Pediatric Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Background:
This review examines the application of intersectionality in surgical care within low and middle-income countries (LMICs). Intersectionality is an analytic lens that examines how overlapping social identities intersect within structural systems of power and inequality. In the context of health, it helps explain how these intersections shape people's exposure to risk, access to care, and overall outcomes. Applying this lens can help uncover cumulative disadvantages and inequities within surgical systems in LMICs.
Methods:
Following PRISMA guidelines, we conducted a comprehensive search across eight databases to identify studies examining the relationship between the intersection of at least two marginalized social dimensions and surgical care in LMICs.
Results:
From 7325 identified abstracts, 31 were included. While none explicitly mentioned intersectionality, an average of 4.3 social determinants were analyzed per study. The most frequently examined were income (100.0 %), location (87.1 %), gender/sex (77.4 %), and education (77.4 %). Beliefs were included in 54.8 % of studies. Other determinants, such as insurance, occupation, race/ethnicity, language, and caste, were less frequently reported.
Conclusion:
Our findings support applying an intersectional lens to understand how social determinants interact, identify the most vulnerable groups, and inform targeted policies that address gaps in access to surgical care.
