{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T11:40:33Z","timestamp":1791891633223,"version":"4.3.4"},"reference-count":8,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T00:00:00Z","timestamp":1609977600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"IDRC under Innovating for Maternal and Child Health in Africa initiative","award":["108547"],"award-info":[{"award-number":["108547"]}]}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Arch Public Health"],"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Vulnerability at the individual, family, community or organization level affects access and utilization of health services, and is a key consideration for health equity. Several frameworks have been used to explore the concept of vulnerability and identified demographics including ethnicity, economic class, level of education, and geographical location. While the magnitude of vulnerable populations is not clearly documented and understood, specific indicators, such as extreme poverty, show that vulnerability among women is pervasive. Women in low and middle-income countries often do not control economic resources and are culturally disadvantaged, which exacerbates other vulnerabilities they experience. In this commentary, we explore the different understandings of vulnerability and the importance of engaging communities in defining vulnerability for research, as well as for programming and provision of maternal newborn and child health (MNCH) services.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methodology<\/jats:title>\n                <jats:p>In a recent community-based qualitative study, we examined the healthcare utilization experiences of vulnerable women with MNCH services in rural southwestern Uganda. Focus group discussions were conducted with community leaders and community health workers in two districts of Southwestern Uganda. In addition, we did individual interviews with women living in extreme poverty and having other conventional vulnerability characteristics.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Findings and discussion<\/jats:title>\n                <jats:p>We found that the traditional criteria of vulnerability were insufficient to identify categories of vulnerable women to target in the context of MNCH programming and service provision in resource-limited settings. Through our engagement with communities and through the narratives of the people we interviewed, we obtained insight into how nuanced vulnerability can be, and how important it is to ground definitions of vulnerability within the specific context. We identified additional aspects of vulnerability through this study, including: women who suffer from alcoholism or have husbands with alcoholism, women with a history of home births, women that have given birth only to girls, and those living on fishing sites.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusion<\/jats:title>\n                <jats:p>Engaging communities in defining vulnerability is critical for the effective design, implementation and monitoring of MNCH programs, as it ensures these services are reaching those who are most in need.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s13690-020-00523-x","type":"journal-article","created":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T18:04:01Z","timestamp":1610042641000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Context matters in understanding the vulnerability of women: perspectives from southwestern Uganda"],"prefix":"10.1186","volume":"79","author":[{"given":"Neema","family":"Murembe","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Teddy","family":"Kyomuhangi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Manalili","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Florence","family":"Beinempaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Primrose","family":"Nakazibwe","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Kyokushaba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basil","family":"Tibanyendera","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Brenner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0462-8762","authenticated-orcid":false,"given":"Eleanor","family":"Turyakira","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2021,1,7]]},"reference":[{"issue":"2","key":"523_CR1","first-page":"32","volume":"14","author":"M Barnes","year":"2016","unstructured":"Barnes M, Schmitz P. Community engagement matters (now more than ever). Stanf Soc Innov Rev. 2016;14(2):32\u20139.","journal-title":"Stanf Soc Innov Rev"},{"key":"523_CR2","doi-asserted-by":"publisher","unstructured":"Hoddinott, J., & Quisumbing, A. (2010). Methods for microeconometric risk and vulnerability assessment. In Risk, shocks, and human development (pp. 62\u2013100). Springer.\u00a0London:\u00a0Palgrave Macmillan.\u00a0https:\/\/doi.org\/10.1057\/9780230274129_4.","DOI":"10.1057\/9780230274129_4"},{"key":"523_CR3","unstructured":"Kidd, S., Gelders, B., & Bailey-Athias, D. (2017). Exclusion by design: An assessment of the effectiveness of the proxy means test poverty targeting mechanism (ESS \u2013 Working Paper No. 56). Geneva: International Labour Organization."},{"issue":"11","key":"523_CR4","doi-asserted-by":"publisher","first-page":"1067","DOI":"10.1016\/j.trstmh.2008.04.023","volume":"102","author":"SN Kiwanuka","year":"2008","unstructured":"Kiwanuka SN, Ekirapa EK, Peterson S, Okui O, Rahman MH, Peters D, Pariyo GW. Access to and utilisation of health services for the poor in Uganda: a systematic review of available evidence. Trans R Soc Trop Med Hyg. 2008;102(11):1067\u201374.","journal-title":"Trans R Soc Trop Med Hyg"},{"issue":"1","key":"523_CR5","doi-asserted-by":"publisher","first-page":"150","DOI":"10.9745\/GHSP-D-17-00291","volume":"6","author":"WM Moret","year":"2018","unstructured":"Moret WM. Let\u2019s stop trying to quantify household vulnerability: the problem with simple scales for targeting and evaluating economic strengthening programs. Glob Health. 2018;6(1):150\u201360. https:\/\/doi.org\/10.9745\/GHSP-D-17-00291.","journal-title":"Glob Health"},{"key":"523_CR6","volume-title":"Women\u2019s empowerment and decision-making at the household level: A case study of Ankore families in Uganda","author":"M Neema","year":"2015","unstructured":"Neema, M. (2015). Women\u2019s empowerment and decision-making at the household level: A case study of Ankore families in Uganda [Doctoral Thesis, Tilburg University]. https:\/\/research.tilburguniversity.edu\/en\/publications\/."},{"key":"523_CR7","unstructured":"United Nations. The world\u2019s women 2015: Trends and statistics. 6th ed: United Nations; 2015. http:\/\/www.myilibrary.com?id=1012011.\u00a0Accessed 1 July 2019."},{"key":"523_CR8","series-title":"(Poverty Assessment No. 36996-UG).","volume-title":"Uganda- Poverty and Vulnerability Assessment","author":"World Bank","year":"2006","unstructured":"World Bank. (2006). Uganda- Poverty and Vulnerability Assessment (Poverty Assessment No. 36996-UG). World Bank Group. http:\/\/documents.worldbank.org\/curated\/en\/558621468115759328\/Uganda-Poverty-and-vulnerability-assessment."}],"container-title":["Archives of Public Health"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-020-00523-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/article\/10.1186\/s13690-020-00523-x\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/link.springer.com\/content\/pdf\/10.1186\/s13690-020-00523-x.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,7]],"date-time":"2021-01-07T20:17:41Z","timestamp":1610050661000},"score":1,"resource":{"primary":{"URL":"https:\/\/archpublichealth.biomedcentral.com\/articles\/10.1186\/s13690-020-00523-x"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,1,7]]},"references-count":8,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2021,12]]}},"alternative-id":["523"],"URL":"https:\/\/doi.org\/10.1186\/s13690-020-00523-x","relation":{},"ISSN":["2049-3258"],"issn-type":[{"value":"2049-3258","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,1,7]]},"assertion":[{"value":"15 July 2020","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"21 December 2020","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 January 2021","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"The community-based qualitative study was done under a larger project examining Barriers and Enablers to Gender, Equity and Scale-Up of MNCH interventions in Tanzania and Uganda. Ethical clearance was obtained through Catholic University of Health and Allied Sciences Research & Ethical Committee (CREC\/201\/2017), National Institute for Medical Research Lake Zone Institutional Review Board (MR\/53\/100\/493), Mbarara University of Science and Technology Research Ethics Committee (MUREC #04\/06\u201317), Uganda National Council for Science and Technology (SS 4386), and the University of Calgary Conjoint Health Research Ethics Board (REB17-1741). The District Health Offices were informed about the study and provided written permission to collect data.","order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare that they have no competing interests.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"4"}}