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Healthcare Access Experiences 
Among Indigenous Women in 
Northern Rural Thailand: A 
Focused Ethnographic Study 

 
Onouma Thummapol1, Sylvia 
Barton2, Tanya Park1 

 
1University of Alberta, Canada; 
2University of Northern British Columbia, 
Canada  
 
 
 
 
 
 

 
Vol. 7, No. 1 (2018)   |   ISSN 2166-7403 (online)  
DOI 10.5195/cajgh.2018.328 |   http://cajgh.pitt.edu 

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Central Asian Journal of Global Health 
Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.328|http://cajgh.pitt.edu 

 
 

Abstract 
Introduction: Persistent inequities in health and access to healthcare services for indigenous women living in 
Thailand remain a significant challenge. This study provides narrative accounts of Indigenous women’s experiences 
accessing healthcare in northern and rural Thailand and explores the complexity of culture and its interaction with 
multiple intersecting influences on health behaviours. 

Methods: A focused ethnographic study was conducted to understand and describe the culture of health behaviors 
and other cultural phenomena. We recruited 21 female participants aged 20-41 years between March and April of 
2017. In-depth semi-structured interviews conducted in Thai were used to explore the experiences of the participants 
living in a northern rural village. Data analysis was informed and guided by Roper and Shapira’s framework for 
ethnographic analysis. 

Results: Seven themes presented across three phases of experience (pre-access, making choices, and encountering 
difficulties) revealed an in-depth understanding of the Indigenous women’s lives, the broader sociocultural context in 
which they lived, and the challenges they faced when accessing healthcare. Analysis of data showed that the 
participants did not have equal access to healthcare and often disproportionately experienced discriminatory practices 
and negative attitudes of mainstream healthcare providers. 

Conclusions: This is the only study to date that discusses healthcare access challenges experienced by Indigenous 
women living in a northern rural Thai village. There is an urgent need to focus on citizenship, employment, and general 
health conditions; gender, familial, and labor roles; specific health conditions, wellness, and cultural practices; the 
seeking of healthcare services; healthcare provider relationships; the ability to access needed care; and optimization 
of self-care. Future efforts to improve healthcare access and reduce disease burden might benefit from these findings 
and allow for the development of more effective strategies, programs, and policies. 

Keywords: Indigenous women, Northern Rural Thailand, Ethnic minorities, Healthcare services, Access to healthcare, 
Gender equality, Human rights 

Healthcare Access Experiences 
Among Indigenous Women in 
Northern Rural Thailand: A Focused 
Ethnographic Study 

 
Onouma Thummapol1, Sylvia 
Barton2, Tanya Park1 

 
1University of Alberta, Canada; 
2University of Northern British Columbia, 
Canada  

Research 

Introduction 

Access to healthcare is complex and 
multidimensional. Culturally diverse populations 
experience layers of complexity when accessing 
healthcare. Although access to quality healthcare is 
internationally recognized as a fundamental human 
right,1,2 inequities in health and healthcare access persist 
for many ethnic groups.1 Asian Indigenous women are 
more likely than non-Indigenous women to bear a greater 
burden of disease and have higher rates of suboptimal 

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.328|http://cajgh.pitt.edu 

 
 

health.2 They are less likely to receive appropriate 
healthcare services and face a myriad of obstacles in their 
quest for achieving optimal health.2,3 In Asia, previously 
published studies provide evidence of the significant 
inequities for Indigenous and non-Indigenous 
populations. However, few studies have been published 
to understand healthcare access among Indigenous 
groups; thus Asian Indigenous health research remains 
largely overlooked.2,4-5 The existing literature shows that 
there are significant differences in Asian Indigenous 
women’s access and use of health services in comparison 
to the rest of the population.3,6-8 For example, Indigenous 
women are excluded from sexual and reproductive health 
services and are less likely to seek care when they are 
ill.2,6 The health status of Asian Indigenous women is a 
low priority and is often overlooked by the governments.2 

Approximately 70% of the world’s Indigenous 
people reside in Asia.2 Thailand is a country in Southeast 
Asia, with 3,429 Indigenous villages and an Indigenous 
population of approximately 923,257 people.2,4 

Indigenous peoples of Asia, including Thailand, as 
defined by the United Nations, are those who have a long 
connection with the lands and an experience of 
marginalization or discrimination, largely because they 
have a distinct and different cultural tradition and history 
compared to other groups within the state.2 While 
‘Indigenous’ is a commonly-used international term, its 
use in Asia, particularly Thailand, is limited.4,9 In 
recognition of the right to self-identification declared in 
the United Nations Declaration on the Rights of 
Indigenous Peoples2, this paper primarily uses the term 
‘Indigenous women’ to describe Indigenous women in 
Thailand. 

In Thailand, many different Indigenous groups 
reside in northern rural highland areas. The government 
legally recognizes ten Indigenous groups, leaving almost 
half a million of Indigenous peoples in Thailand 
stateless.4 These stateless people can become subjects of 
discrimination and denial of basic human rights.4 Many 

of these stateless people are ethnic minorities living in 
northern rural areas near the Thai-Myanmar border.10-11  

 Health inequities exist for Indigenous groups in 
Thailand.12 Indigenous peoples often live in northern 
rural areas, where access to healthcare is limited or not 
available and these people are less likely to access public 
health services.4,13 This healthcare access inequity 
between Indigenous and non-Indigenous groups in 
Thailand can lead to negative health consequences. Many 
of the women who are affected by preventable diseases, 
such as cervical cancer14 and HIV/AIDS15, are 
Indigenous. They also experience multiple forms of 
discrimination and often have difficulty obtaining 
healthcare.10,15 This is attributed to the ‘double burden’ of 
Indigenous identity and gender inequalities.12 

Globally, literature on Indigenous peoples’ 
healthcare access is available; however, few studies are 
gender specific.2 The current literature on healthcare 
access for Indigenous women is from countries such as 
Bangladesh16, Canada17-19, Guatemala20, India7-8, and 
Vietnam.6 These studies report on inequitable healthcare 
access and high disease burden; however, there is no 
Thai-specific literature. Furthermore, healthcare access 
experiences among Indigenous women in Thailand have 
not yet been explored. The purpose of this study is to 
understand the healthcare access experiences among 
Indigenous women in northern rural Thailand and to 
explore within these experiences the complexity of 
culture. 

 

Methods 

Institutional Review Board human ethics 
approval of the study protocol was received in both 
Canada and Thailand. Informed written consent was 
obtained prior to conducting all of the interviews, which 
included a request to audio-record, as well as an 
opportunity to check back with participants to confirm 
the credibility of their responses. When obtaining

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Central Asian Journal of Global Health 
Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.328|http://cajgh.pitt.edu 

 
 

 

Figure 1. The study setting 

informed consent, the researcher ensured that 
participants fully understood the purpose of the research, 
and potential risks/benefits associated with research 
participation. Participants were informed that they could 
make a voluntary decision to participate in the study, 
withdraw at any time, and choose not to answer any given 
question.  

The research was a focused ethnographic study 
conducted using purposive sampling and snowball 
strategies guided by Knoblauch’s applied research 
methodology.21 Research questions included: 1) what are 
the experiences of Indigenous women accessing 
healthcare services in northern Thailand?; 2) how do 
cultural beliefs and practices influence access to 
healthcare for these women?; 3) what do Indigenous 
women believe are the facilitators and impediments to 
accessing quality healthcare?; and 4) how do these 

women experience engagement with healthcare 
providers in the healthcare system? 

The study site was a village located in the rural 
highland areas of Mae Hong Son province, one of the 
northern and mountainous provinces of Thailand that 
borders Myanmar (Figure 1). This province is 
approximately 924 kilometers (574 miles) away from the 
national capital, Bangkok. According to the Department 
of Provincial Affairs of Thailand (2014), ethnic groups 
represent approximately 63 % of the Mae Hong Son’s 
population. Participants were from the Tai-Yai group 
(also known as Shan); they have inhabited the rural 
highlands of Mae Hong Son for generations and make up 
the majority of the province’s populations.22 The village 
has a population of 457 Indigenous people and is located 
55 kilometers (34.17 miles) from the closest hospital. It 
has poor road conditions and no access to public 
transportation.  

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CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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Central Asian Journal of Global Health 

Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.328|http://cajgh.pitt.edu 

 
 

Data collection 

Twenty-one women aged 20-41 years 
participated in interviews between March and April of 
2017. We approached twenty-three women; however, 
due to language barriers and a lack of translation 
resources, two women who were not able to fully 
understand and communicate in Thai were excluded. 
Demographic data were collected from each participant 
at the beginning of the interview. The researcher 
identified and recruited participants using purposive and 
snowball sampling, the researcher’s personal networks, 
an Indigenous mentor (identified during a study 
feasibility trip), face-to-face approach, and study 
posters23-27. Data saturation dictated the sample size28-30 

and occurred after 21 interviews. Field notes (e.g., 
observations and information recorded during the 
interviews) and a reflexive journal (e.g., the researcher’s 
thoughts, reactions to people and the setting, or personal 
feelings and emotions) were maintained during the 
course of fieldwork and used for analysis.30 

The first author conducted face to face, in-depth 
interviews in Thai language with 21 women. These 
interviews focused on participants’ past and current 
experiences with the healthcare system. The interviews 
were semi-structured, with questions and probes that 
included: Where do you usually go for healthcare? Can 
you tell me about your last (or last two) healthcare visits? 
What influenced your decision to seek healthcare? How 
was it for you to get needed healthcare services? The 
interviews lasted approximately 45 minutes and were 
transcribed verbatim.  

Data analysis 

Data collection and analysis proceeded 
concurrently after the first interview, with the first author 
transcribing and translating the first three interviews into 
English for review and analysis by the research team. The 
other transcripts were kept in the original language 
(Thai), with analysis completed by the first author. Roper 
and Shapira’s framework for ethnographic analysis 

guided the work using five strategies: a) coding for 
descriptive labels, (b) sorting for patterns, (c) identifying 
outliers or negative cases, (d) generalizing themes, and 
(e) noting reflective remarks (e.g., ideas or insights from 
the research team when collecting data and reviewing 
interview or relevant documents).25 NVivo qualitative 
data analysis software and a manual approach were used 
to organize and code narrative data.  

Written materials compiled from field notes, a 
reflexive journal, and transcribed interviews were read 
and re-read prior to coding. Initial coding was discussed 
and refined by the research team and then grouped into 
meaningful, descriptive categories. These categories 
were then compared, contrasted, and sorted for patterns 
that reflected the similarities and differences between 
interviews, as well as for patterns related to cultural 
beliefs and practices. Following this pattern 
identification and notation, the data was re-read to 
abstract themes that captured the nature of the women’s 
experiences. Finally, this iterative process of data 
analysis resulted in organizing the seven themes across 
three phases of the women’s experiences, which was 
further discussed and refined by the research team, taking 
both emic and etic perspectives into the account.25   

Translation and Back-Translation 

The interviews were conducted in Thai; 
however, English was the language used with the 
research team and reporting of the findings. Therefore, 
translation of the interviews was required. All audiotapes 
were transcribed verbatim in Thai. The first author read 
the transcribed transcripts in conjunction with the 
audiotapes to verify the accuracy of the transcription and 
to correct any transcription errors. The process of 
translation and back-translation began after themes and 
categories had been identified.31-33 Three people were 
involved in the translation and back-translation process: 
1) the first author who conducted all of the interviews in 
Thai, 2) a Thai nurse researcher who conducted research 
in English and Thai, and 3) another Thai nurse researcher 
who conducted research in English and Thai.   

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The translated documents were compared and 
any discrepancies were resolved through discussion 
between the first two translators.31-33 The final English 
version was reached by agreement with the first two 
translators.32  To ensure the accuracy of translation, the 
process of back-translation was conducted by the third 
translator.31-33  To achieve equivalence between original 
and targeted languages, and to avoid misrepresentation of 
participants’ feedback, the first researcher compared the 
back-translated transcript with the original version.31-33 
The translation and back-translation processes were 
repeated multiple times and discussed throughout, in 
order to minimize any discrepancies in meaning.34 

It has been well recognized that achieving 
equivalence between two languages is a challenge.35 
Therefore, working with a bilingual translator who 
possessed an understanding and knowledge of the 
participants’ culture and language, and was familiar with 
medical terminology and research, was an optimal way 
to produce accurate and meaningful data.32-33, 35  

 

Results 

Three phases: pre-access, making choices, and 
encountering difficulties which integrate seven 
overlapping themes exemplify participants’ experiences 
accessing healthcare. Table 1 presents the demographic 
characteristics of the participants and Table 2 lists the 
themes and their definitions.   

Pre-access  

The pre-access phase of healthcare access 
focused on the participants’ experiences of employment 
and income, gender roles and responsibilities, and views 
on health and treatment.  

The majority of participants were self-employed 
(farmers, shop owners, and cooks), while others were 
government-employed schoolteachers. The self-
employed participants reported that they faced additional 
difficulties, such as fear of income loss when taking time 

away from work for medical visits. One participant 
stated, “I was crying in pain at work because I could not 
afford to take my day off to go to see the doctor…The 
employer will only pay me 100-200 Baht [$ 3-6 USD] a 
day and if I take a day off work we will not have money 
to buy food…” (Participant 11). In addition to unpaid 
work in the household, participants also engaged in paid 
work to supplement family income and explained that 
they had little time to think about their own health needs, 
let alone access healthcare. One participant shared, 
“Besides cooking, doing household chores and looking 
after children and the family, I’m also working on the 
farm…I have to do everything and have no time for 
myself” (Participant 4). 

Participants reported that they usually met 
gender expectations related to their domestic and 
reproductive roles. One participant stated, “…cooking, 
washing clothes, and caring for children are our 
responsibility…we work within and outside the home. So 
caring for children and going to the hospital…it’s hard 
for me” (Participant 3). Participants also mentioned 
having to assume unpaid caregiving duties for the ill, 
elderly, and young children had significant impact on 
their decisions to seek healthcare. One participant 
explained, “I have two siblings but they are not here. I 
live with my mom and have to look after her and take 
care of everything…like going to town to fill her 
prescriptions…I will not go to see the doctor unless I’m 
really sick because I don’t want to leave my mom alone” 
(Participant 2). 

During many of the interviews, traditional 
beliefs and practices during the postpartum period were 
described, such as herbal steam baths, keeping the body 
covered from head to toe, and food beliefs. One 
participant stated, “Herbal steam baths made by boiling a 
mixture of herbs such as roots and leaves will promote a 
mother’s perspiration which eliminate residual 
impurities, improve the skin and stimulate breastmilk” 
(Participant 6). Another participant shared, “Keeping the 
body of both, mother and baby covered from head to toe

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Table 1. Demographic Characteristics of the Study Sample of 21 Participants 

for at least a month after delivery is important to prevent 
further cooling. We believe it will give strength and 
protect mother and baby from getting sick” (Participant 
5).  

Making choices  

The making choices phase of healthcare access 
focused on the participants’ experiences of traditional 

and Western medicines, support networks and resources, 
the referral system, and previous experiences.   

All participants used a combination of 
traditional and Western practices, which were largely 
influenced by the perceived nature and severity of health 
conditions. As one participant explained, “If you were 
not feeling well and did not get better after visiting the 

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doctor, you have ‘lom nok’ [physical symptoms for 
which the doctor can find no cause, which was believed 
to be caused by supernatural forces]. I would go to see a 
traditional healer for religious rituals and drink ‘nam 
mon’ [holy water] and then I would get better” 
(Participant 7). Several participants mentioned health 
conditions that they believed to be caused by demons or 
supernatural forces. One participant revealed, “When my 
son was three months old, he cried inconsolably for 
several nights for no apparent reason. I took him to the 
village traditional healer at night for healing, who got him 
to drink ‘nam mon’ [holy water] and put ‘sai sin’ [a white 
holy cord] around his neck. My son got better” 
(Participant 17). 

Positive social support and resources from 
family, neighbors, and community were mentioned as 
important factors contributing to participants’ decisions 
about health and access to healthcare services. Several 
narrative accounts emerged regarding support systems. 
For example, during a crisis, neighbors offered rides to 
the doctor. One participant stated, “I did not make it to 
the hospital to deliver my first child. The village vehicle 
at the community clinic was not available, but luckily one 
of our neighbors drove me to the district hospital. The 
health worker at the community clinic tagged along and 
I gave birth to my child in the car on our way to hospital.” 
(Participant 12). 

All participants discussed healthcare services 
that they accessed inside or outside the village as a 
referral system for sub-district (traditional healer, 
traditional herbs or medicines, and community health 
center), district (private clinics, drug stores, and district 
hospital), and hospitals within and outside the provincial 
areas. The majority of the participants primarily accessed 
the community health centers when experiencing 
symptoms of illness, while some participants bypassed 
the community health centers and directly accessed the 
hospitals, often paying extra for this. The latter group was 
more educated, had a higher income, had experience with 
medical conditions, and/or knew someone working in 

healthcare setting. One participant shared, “I will go to 
the [provincial] hospital when I’m sick because I like the 
quality of services there better, even though I have to pay 
extra for it. I paid 800 baht [equivalent to $23 USD] for 
blood tests because it was not covered by universal 
healthcare when you bypassed the community health 
center and district hospital” (Participant 19). 

Throughout the interviews, it became apparent 
that participants’ opinions of the quality of the healthcare 
they have received was highly dependent on the 
interactions with their healthcare providers. Participants 
reported feeling that they were respected, accepted, and 
cared for, particularly when a strong positive 
relationship/interaction was formed. The presence of 
Indigenous health providers, in particular, was perceived 
as crucial because of the shared cultural and linguistic 
heritage, which created an environment of belonging and 
acceptance. As one participant stated, “I really 
appreciated that I got to see an Indigenous nurse when I 
visited the district hospital. She was very friendly and 
understanding...made me feel at ease” (Participant 3). 

Encountering difficulties 

The encountering difficulties phase of 
healthcare access focused on the participants’ personal 
characteristics and circumstances, transportation and 
distance, as well as racism and discrimination.   

The majority of participants reported having 
Thai citizenship. Participants who had citizenship status 
generally reported that they were able to access basic 
education, healthcare and social services, and had 
freedom of movement and employment opportunities. 
Participants who did not have Thai citizenship reported 
difficulties in achieving the rights and benefits given to 
‘citizens’. The following excerpt illustrates challenges 
undocumented participants faced when attempting to 
obtain essential care, “I took my child to the community 
clinic early in the morning on a weekend because of fever 
and got yelled at by the health worker… she was not 
friendly and refused to provide care, saying, “Come back

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Understanding the lives of the women 

 

Women’s roles in Thai society 

 

Wellness and cultural practices 

 

 

 

 

 

Seeking out healthcare services 

 

 

Engaging with health care providers 

 

Navigating access to quality healthcare 

 

 

Facilitating healthcare access 

Non-citizen women have restricted access to care 

Health-seeking behaviour is influenced by employment  

More disadvantaged and vulnerable to poor health outcomes 

The expected gender roles create ‘double burden’  

Caregiving as a female responsibility 

Unequal distribution of responsibilities  

Reproduction, chronic conditions, and accidents are most common issues 

Traditional herbs/medicines, farm work, and religious rituals used to stay healthy 

Some cultural specific practices and religious beliefs influence health and decisions about 

care  

The provision of services not equally distributed 

Traditional and Western medicines are complementary 

Structural barriers and socioeconomic characteristics identified as  

reasons for avoidance or delayed access 

Having familial connections is described as beneficial 

A sense of belonging and acceptance created by meaningful interactions 

A discriminatory and insensitive behaviours 

A desire to engage enhanced when feeling treated with respect 

Unequal treatment and discrimination based on different characteristics 

Long waiting time viewed as the most challenging  

The complexity of gender and its intersection between social categories 

Strong family and community relationships promoted care seeking and outcomes 

Need for reducing wait times; better healthcare environment; outreach services; and 

transport system  

 

Table 2: List of Themes and Their Definitions 

during the operating hours.” I did not want to go there 
again and would rather treat my son’s symptoms myself” 
(Participant 17). Another undocumented participant 
stated, “I do not have citizenship… I am stuck here, I 
cannot go anywhere I want to” (Participant 16). 

Multiple intersecting influences affecting 
participants’ access to healthcare were identified 
throughout the interviews. These included specific 
transportation and distance challenges due to the rural 
and mountainous geography, contending with time away 
from work, long wait times, financial constraints, family 
responsibilities, severity of symptoms, and cultural 
discrimination.  One participant shared, “I could spend a 
day waiting to see a doctor. It’s a waste of time. I would 

rather not go and suffer, wait for the symptoms to go 
away on their own. It’s difficult, we are living far from 
town and if we are not extremely sick, we won’t go. 
Many of us are poor and do not have a vehicle, asking 
others who have private vehicles to drive us, which cost 
thousands of Baht, not to mention cost of food. 
Transportation alone will cost 1000 Baht [$29 USD]” 
(Participant 5). Several suggestions were made regarding 
how to improve access to healthcare services, and 
included reducing wait times, making the waiting room 
more inviting and welcoming, providing outreach 
services in the village, and establishing a transport 
system, especially in case of emergency. One participant 
shared, “I would like them [health care providers] to 

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come to the village…every once in a while if possible, 
for services like pap smears or physical check-ups for 
those who are ill. We are poor and many do not have 
money to go to the hospital, so they would miss the 
appointment. If they [healthcare providers] brought the 
services to us, it would save us a lot” (Participant 7).  

Many participants reported a lack of trust in 
non-Indigenous healthcare providers resulting from 
firsthand experience of discriminatory and insensitive 
behaviors; such as unfriendliness, lack of attention, and 
negative reactions to Indigenous accent, appearance and 
a lack of education. One participant shared, “The last 
time I was there [district hospital] was when I had an 
ankle sprain from a motorcycle accident. I was not okay 
with the way I was treated. I felt like the doctor did not 
respect me as a patient when he talked to me. I wished he 
knew how to treat patients fairly and not based on how 
we look or how much money we have” (Participant 5). 

 

Discussion 

The findings of this study highlight the 
significance of personal, socioeconomic, 
cultural/geographical contexts, and previous healthcare 
experiences that affect participants’ access/use of 
healthcare services. These experiences provide a window 
into understanding the complexity of culture affecting 
healthcare access inequitties. 

One striking aspect of the findings is related to 
gender inequality. The participants’ accounts of life 
based in traditional and patriarchal norms perpetuate 
their status as subordinate, creating a ‘double burden’ for 
women.36 The unequal distribution of responsibilities 
(within and outside of the home) leads to unequal 
opportunities to seek care, invest in educational and 
vocational skills, and participate in paid work.36-40 These 
unequal opportunities offer an important snapshot into 
how cultural values and gender roles affect health 
inequities. The United Nations Sustainable Development 
Goal 5 (SDGs) provides strong support for the action to 

reduce health inequities for Indigenous women.41 Action 
priorities include the recognition of women’s roles, 
implementation of strategies to change cultural and social 
norms that can form barrier to equal opportunity, and 
better integration of gender perspectives into the 
healthcare system.41-42 This will, in turn, ensure effective 
use of healthcare services and reduce health inequities.    

Understanding women’s unique health needs 
and experiences, the differences in how they view and 
take care of their health, their cultural and religious 
beliefs and practices related to health and decisions-
making, are all critical in identifying appropriate 
strategies and interventions to enhance healthcare access. 
For example, the findings revealed that participants are 
more likely to self-treat or use alternatives (e.g., 
traditional medicines), depending on the perceived cause 
and severity of conditions. Domestic duties prevent 
women from going to the hospital during operating 
hours, resulting in adverse consequences on their health. 
In addition, the findings showed that participants were 
not aware of the benefits and importance of preventive 
health services. This suggests the necessity of providing 
linguistically and culturally appropriate education, in 
order to increase women’s participation in screening and 
early detection.14,18,20 The results also demonstrated that 
women adhered to beliefs and taboos on food during the 
postpartum period. These findings parallel the extensive 
literature suggesting the importance of integrating 
holistic approaches to health into mainstream healthcare 
practices and policies, such as the development of 
culturally appropriate nutritional programs.43 Programs 
that could improve pregnancy outcomes and long-term 
quality of life for this underserved population are needed 
to be implemented.43  

Participants are subject to complex and different 
socioeconomic and cultural influences that impact their 
options for healthcare practices. Our findings indicated 
that healthcare services were not available to the 
participants on an equitable basis due to geographic 
factors. This introduces financial costs associated with 

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access to childcare, transportation, accommodation, and 
etc., which leads to further health inequity for women. 
The literature that has explored this issue among 
Indigenous women supports this view.7,18,44 Although the 
use of traditional and Western medicines is 
commonplace, the findings raise concerns about 
equitable healthcare access and highlight factors 
associated with avoidance or delayed access. 
Understanding why women fail to seek or come late for 
care can inform efforts and interventions to reduce 
treatment delay; which will result in early detection of 
disease, timely care, increased survival, and ultimately, 
desired health outcomes.7,45-46 

This study revealed that structural factors, 
including long wait times and the discriminatory 
behavior of healthcare providers, negatively affect 
participants’ experiences, satisfaction, and decision to 
engage with healthcare. Participants described how 
experiences of unequal treatment, discrimination, and 
long waits discouraged them from seeking healthcare and 
developing trusting relationships with care providers. 
These findings corroborate several studies suggesting 
that strong, respectful and trusting relationships, as well 
as meaningful and familiar connections, are integral for 
encouraging care seeking.47-48 It also highlights the need 
for education and professional development to increase 
the sensitivity, compassion, and reflective practices of 
healthcare providers.3,49-50 

 The three access phases and seven integrated 
themes revealed the intersectionality of influences on the 
participants’ health and access to healthcare. Many 
participants faced additional challenges that interfered 
with the enjoyment of their human rights, particularly in 
relation to the right to healthcare on the basis of factors 
such as ethnicity, gender roles, cultural beliefs and 
practices, socioeconomic status, and geography.51-52 

Participants were further affected by discrimination as 
Indigenous people, and therefore access to healthcare 
was further limited. This study offers insight and 
understanding into Indigenous women’s lives, the 

broader sociocultural context in which they live, and the 
challenges they face when accessing healthcare. 
Intersectionality is particularly useful in informing such 
analyses because it draws attention to multiple 
intersecting social influences and how they shape the 
ways in which healthcare is experienced, received, and 
provided.51-53 Understanding the intersections and taking 
into account women’s perspectives will enable policy 
makers and health care providers to better design context-
specific strategies that will improve equitable access to 
healthcare. 

There are several limitations to this project. The 
first author interviewed a small and select sample of Thai 
speaking participants who had similar backgrounds and 
social levels (educational, geographical, or 
occupational). In particular, the research setting was 
relatively homogeneous with respect to gender and 
ethnicity. As is essential in qualitative research, the 
participants were selected based on their ability to 
provide information in Thai, not on the basis of how they 
represented the general population. It is acknowledged 
that the qualitative research results are not generalizable, 
and that the participants may not be representative of the 
general population. Given the lack of translation 
facilities, participants who did not speak Thai were 
excluded; this may have resulted in the study not 
capturing the healthcare challenges of non-Thai-speaking 
Indigenous participants who may have different 
experiences.  

Future research is needed on healthcare access 
inequalities for Indigenous women in Thailand. It can 
replicate the findings of this study within similar 
contexts, such as northern and rural communities across 
Thailand, supporting the urgent need to improve 
healthcare access for Indigenous women. Another area 
for future research would be on exploring the experiences 
of healthcare providers working with Indigenous 
communities, which may enhance the understanding of 
gaps and inform strategies to remove or minimize 
barriers to access. 

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In this study, we identified the impacts of gender 
and family roles on the cultural understandings and 
experiences in seeking healthcare among Indigenous 
women. It would be interesting to examine in-depth the 
impact of Indigenous women’s illnesses or diseases on 
family function and relationships. Thus, ethnographic 
studies with this focus are recommended. Last, given the 
lack of disaggregated data on Indigenous peoples in 
Thailand and of culturally relevant indicators, research is 
warranted pertaining to Indigenous data collection on 
gender, race/ethnicity, culture, Indigenous identity, 
health status, socioeconomic status, or geography. 
Collecting and using such data is important to advance 
human rights, achieve equal opportunities, redress 
discriminatory disadvantages, and improve Indigenous 
health outcomes.  

This study might potentially have important 
implications for current gender policy discussions. 
Gender equality and women’s rights are increasingly 
recognized by international institutions, such as the 
United Nations Sustainable Development Goal and the 
Convention on the Elimination of Discrimination Against 
Women (CEDAW). Because of disadvantaged position 
in society, women who belong to minority groups suffer 
disproportionately from multiple forms of discrimination 
and are less likely to enjoy the full enjoyment of human 
rights, including equitable access to quality healthcare. 
Thus, the results of this study can assist advocates, policy 
makers, and allied healthcare professionals to understand 
the differences among women with respect to multiple 
influences and contexts (e.g., socioeconomic, cultural, 
ethnic, citizenship, and geographical).  

This is the only study to date that discusses 
healthcare access challenges experienced by Indigenous 
women living in a northern rural Thai village; 
emphasizing an urgent need to enhance non-
discriminatory access to, and quality delivery of, 
healthcare services to Indigenous women in northern 
rural Thailand. Future research should focus on equitable 
healthcare access and disease burden reduction, in order 

to develop effective strategies, culturally sensitive 
programs, and evidenced-based policies.  

 

References  

1. World Health Organization. Health and Human 

Right [Internet]. Geneva: WHO Media Centre; 

2015. Available from: 

http://www.who.int/mediacentre/factsheets/fs3

23/en/. Accessed October 8, 2018. 

2. United Nations. State of the world’s 

Indigenous peoples (2nd volume): Indigenous 

peoples access to health services [Internet]. 

New York: Department of Economic and 

Social Affairs; 2015. Available from: 

https://www.un.org/development/desa/indigeno

uspeoples/publications/2015/09/state-of-the-

worlds-indigenous-peoples-2nd-volume-

health/. Accessed October 8, 2018. 

3. Thummapol O, Park T, Barton S. Exploring 

health services accessibility by Indigenous 

women in Asia and identifying actions to 

improve it: A scoping review. Ethnicity and 

Health. 2018;1-20.  

4. Dhir RK. Indigenous Peoples in the world of 

work in Asia and the Pacific: A status report 

[Internet]. Geneva: International Labour 

Organization; 2015. Available from: 

https://www.ilo.org/global/topics/indigenous-

tribal/publications/WCMS_438853/lang--

en/index.htm. Accessed October 8, 2018. 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://www.who.int/mediacentre/factsheets/fs323/en/
http://www.who.int/mediacentre/factsheets/fs323/en/
https://www.un.org/development/desa/indigenouspeoples/publications/2015/09/state-of-the-worlds-indigenous-peoples-2nd-volume-health/
https://www.un.org/development/desa/indigenouspeoples/publications/2015/09/state-of-the-worlds-indigenous-peoples-2nd-volume-health/
https://www.un.org/development/desa/indigenouspeoples/publications/2015/09/state-of-the-worlds-indigenous-peoples-2nd-volume-health/
https://www.un.org/development/desa/indigenouspeoples/publications/2015/09/state-of-the-worlds-indigenous-peoples-2nd-volume-health/
https://www.ilo.org/global/topics/indigenous-tribal/publications/WCMS_438853/lang--en/index.htm
https://www.ilo.org/global/topics/indigenous-tribal/publications/WCMS_438853/lang--en/index.htm
https://www.ilo.org/global/topics/indigenous-tribal/publications/WCMS_438853/lang--en/index.htm


 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

This work is licensed under a Creative Commons Attribution 4.0 United States License. 
 

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of its D-Scribe Digital Publishing Program and is cosponsored by the University of Pittsburgh Press. 

 
Central Asian Journal of Global Health 

Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.328|http://cajgh.pitt.edu 

 
 

5. United Nations. State of the world’s 

Indigenous peoples (Volume 1) [Internet]. New 

York: Department of Economic and Social 

Affairs; 2010. Available from: 

http://www.un.org/esa/socdev/unpfii/document

s/SOWIP/press%20package/sowip-press-

package-en.pdf. Accessed October 8, 2018. 

6. Dang H-A. Vietnam: A widening poverty gap 

for ethnic minorities [Internet]. In Gillette H, 

Harry, P. (Eds.). Indigenous Peoples, Poverty 

and Development. Cambridge University 

Press, Forthcoming; 2012. Available from: 

https://papers.ssrn.com/sol3/papers.cfm?abstra

ct_id=2346307. Accessed October 8, 2018. 

7. Jose JA, Sarkar S, Kumar S, Kar SS. 

Utilization of maternal health-care services by 

Tribal women in Kerala. Journal of Natural 

Science, Biology & Medicine. 2014;5(1):144-

147. 

8. Shah R, Bélange D. Socioeconomic correlates 

of utilization of maternal health services by 

Tribal women in India. Canadian Studies in 

Population. 2011;38(1/2):83. 

9. Asia Indigenous Peoples Pact. Overview of the 

state of Indigenous peoples in Asia [Internet].  

Chiang Mai: Publications; 2014. Available 

from: http://www.gapeinternational.org/wp-

content/uploads/2011/08/asia-ip-overview-

final.pdf. Accessed October 8, 2018. 

10. Cadchumsang J. People at the rim: A study of 

Thai ethnicity and nationalism in a Thai border 

village [dissertation]. Ontario: University of 

Toronto, Department of Anthropology; 2011.  

11. Spindler W. Thousands of stateless people 

given nationality in Thailand [Internet]. 

Geneva: United Nations High Commissioner 

for Refugees; 2015. Available from: 

http://www.unhcr.org/news/latest/2015/12/565

db8939/thousands-stateless-people-given-

nationality-thailand.html. Accessed October 8, 

2018. 

12. Lutvey T. Gender mainstreaming manual: 

Good practices and lessons learnt of an 

Indigenous Peoples organization [Internet]. 

Chiang Mai: Asia Indigenous Peoples Pact; 

2014. Available from: 

https://aippnet.org/gender-manual-good-

practices-and-lessons-learnt-by-an-indigenous-

peoples-organization/. Accessed October 8, 

2018. 

13. United Nations High Commissioner for 

Refugees. Good practices addressing 

statelessness in South East Asia [Internet]. 

Geneva: Resources and Publications; 2010. 

Available from: 

http://www.unhcr.org/protection/statelessness/

4d7de47f9/good-practices-addressing-

statelessness-south-east-asia-report-

regional.html?query=stateless peoples. 

Accessed October 8, 2018. 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://www.un.org/esa/socdev/unpfii/documents/SOWIP/press%20package/sowip-press-package-en.pdf
http://www.un.org/esa/socdev/unpfii/documents/SOWIP/press%20package/sowip-press-package-en.pdf
http://www.un.org/esa/socdev/unpfii/documents/SOWIP/press%20package/sowip-press-package-en.pdf
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2346307
https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2346307
http://www.gapeinternational.org/wp-content/uploads/2011/08/asia-ip-overview-final.pdf
http://www.gapeinternational.org/wp-content/uploads/2011/08/asia-ip-overview-final.pdf
http://www.gapeinternational.org/wp-content/uploads/2011/08/asia-ip-overview-final.pdf
http://www.unhcr.org/news/latest/2015/12/565db8939/thousands-stateless-people-given-nationality-thailand.html
http://www.unhcr.org/news/latest/2015/12/565db8939/thousands-stateless-people-given-nationality-thailand.html
http://www.unhcr.org/news/latest/2015/12/565db8939/thousands-stateless-people-given-nationality-thailand.html
https://aippnet.org/gender-manual-good-practices-and-lessons-learnt-by-an-indigenous-peoples-organization/
https://aippnet.org/gender-manual-good-practices-and-lessons-learnt-by-an-indigenous-peoples-organization/
https://aippnet.org/gender-manual-good-practices-and-lessons-learnt-by-an-indigenous-peoples-organization/
http://www.unhcr.org/protection/statelessness/4d7de47f9/good-practices-addressing-statelessness-south-east-asia-report-regional.html?query=stateless%20peoples
http://www.unhcr.org/protection/statelessness/4d7de47f9/good-practices-addressing-statelessness-south-east-asia-report-regional.html?query=stateless%20peoples
http://www.unhcr.org/protection/statelessness/4d7de47f9/good-practices-addressing-statelessness-south-east-asia-report-regional.html?query=stateless%20peoples
http://www.unhcr.org/protection/statelessness/4d7de47f9/good-practices-addressing-statelessness-south-east-asia-report-regional.html?query=stateless%20peoples


 
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14. Kritpetcharat O, Sirijaichingkul S, 

Kritpetcharat P, Wutichouy W. Comparison of 

pap smear screening results between Akha hill 

tribe and urban women in Chiang Rai province, 

Thailand. Asian Pacific Journal of Cancer 

Prevention. 2012;13(11): 5501-5504. 

15. Apidechkul T. A 20-year retrospective cohort 

study of TB infection among the hill-tribe 

HIV/AIDS populations, Thailand. BMC 

Infectious Diseases. 2016;16(72):1-14. 

doi:10.1186/s12879-016-1407-4 

16. Chowdhury HE. Framework for tribal peoples 

plan-health sector support program [Internet]. 

Bangladesh: Ministry of Health and Family 

Welfare; 2017. Available from: 

http://documents.worldbank.org/curated/en/397

301492068554569/pdf/SFG3262-IPP-

P160846-Box402901B-PUBLIC-Disclosed-4-

11-2017.pdf. Accessed October 8, 2018. 

17. Denison J, Varcoe C, Browne A. Aboriginal 

women's experiences of accessing health care 

when state apprehension of children is being 

threatened. Journal of Advanced Nursing. 

2014;70(5): 1105-1116. 

18. Morgan L, Wabie J. Aboriginal women’s 

access and acceptance of reproductive health 

care. A Journal of Aboriginal & Indigenous 

Community Health. 2012;10(3):313-325. 

19. Van Herk K, Smith D, Andrew C. Identity 

matters: Aboriginal mothers' experiences of 

accessing health care. Contemporary Nurse. 

2011;37(1):57-68. 

20. Schooley J, Mundt C, Wagner P, Fullerton J, 

O’Donnell M. Factors influencing health care-

seeking behaviours among Mayan women in 

Guatemala. Midwifery. 2009;25411-421. 

21. Knoblauch H. Focused ethnography. Forum 

Qualitative Social Research. 2005;6(3): 1-11p. 

22. Ord M. Shan: Thailand for beginners. The 

Travelfish [Intternet]; 2015. Available from: 

https://www.travelfish.org/beginners_detail/tha

iland/77. Accessed October 8, 2018. 

23. Bonevski B1, Randell M, Paul C, Chapman K, 

Twyman L, Bryant J, Brozek I, Hughes C. 

Reaching the hard-to-reach: A systematic 

review of strategies for improving health and 

medical research with socially disadvantaged 

groups. BMC Med Res Methodol. 2014;14:42.  

24. Liamputtong P. Researching the vulnerable. 

London: SAGE; 2007. 

25. Roper J, Shapira J. Ethnography in nursing 

research. [Electronic resource]. Thousand 

Oaks, Calif: SAGE; 2000.  

26. Sixsmith J, Boneham M, Goldring J. Accessing 

the community: Gaining insider perspectives 

from the outside. Qualitative Health Research. 

2003;13(4): 578-589. 

27. Higginbottom G, Pillay J, Boadu N. Guidance 

on performing focused ethnographies with an 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://documents.worldbank.org/curated/en/397301492068554569/pdf/SFG3262-IPP-P160846-Box402901B-PUBLIC-Disclosed-4-11-2017.pdf
http://documents.worldbank.org/curated/en/397301492068554569/pdf/SFG3262-IPP-P160846-Box402901B-PUBLIC-Disclosed-4-11-2017.pdf
http://documents.worldbank.org/curated/en/397301492068554569/pdf/SFG3262-IPP-P160846-Box402901B-PUBLIC-Disclosed-4-11-2017.pdf
http://documents.worldbank.org/curated/en/397301492068554569/pdf/SFG3262-IPP-P160846-Box402901B-PUBLIC-Disclosed-4-11-2017.pdf
https://www.travelfish.org/beginners_detail/thailand/77
https://www.travelfish.org/beginners_detail/thailand/77


 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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emphasis on healthcare research. Qualitative 

Report. 2013;18(17):1-16. 

28. Cruz EV, Higginbottom G. The use of focused 

ethnography in nursing research. Nurse 

Researcher. 2013;20(4):36-43. 

29. Guest G, Bunce A, Johnson L.  How many 

interviews are enough? An experiment with 

data saturation and variability. Field Methods. 

2006;18(1): 59-82. 

30. Ortlipp M. Keeping and using reflective 

journals in the qualitative research process. 

Qualitative Report. 2008;13(4):695-705. 

31. Al-Amer R, Ramjan L, Glew P, Darwish M, 

Salamonson Y. Translation of interviews from 

a source language to a target language: 

Examining issues in cross-cultural health care 

research. Journal of Clinical Nursing. 

2015;24(9/10): 1151-1162. 

32. Chen H, Boore J. Translation and back-

translation in qualitative nursing research: 

Methodological review. Journal of Clinical 

Nursing. 2010;19(1-2): 234-239. 

33. Nurjannah I, Mills J, Park T, Usher K. 

Conducting a grounded theory study in a 

language other than English. Sage Open. 

2014;4(1):1-10.  

34. Maneesriwongul W, Dixon J. Instrument 

translation process: A methods review. Journal 

of Advanced Nursing. 2004;48(2):175-186. 

35. Squires A. Language barriers and qualitative 

nursing research: methodological 

considerations. International Nursing Review. 

2008;55(3):265-273.  

36. Ferrant G, Pesando GL, Nowacka K. Unpaid 

care work: The missing link in the analysis of 

gender gaps in labour outcomes. Paris: OECD 

Development Centre; 2014. Available from: 

https://www.oecd.org/dev/development-

gender/Unpaid_care_work.pdf. Accessed 

October 8, 2018. 

37. Binder-Finnema P, Lien P, Hoa D, Målqvist 

M. Determinants of marginalization and 

inequitable maternal health care in North-

Central Vietnam: A framework analysis. 

Global Health Action. 2015;8(1).  

38. Munro J, McIntyre L. (Not) getting political: 

Indigenous women and preventing mother-to-

child transmission of HIV in West Papua. 

Culture, Health & Sexuality. 2016;18(2):157-

172. 

39. Norsa'adah B, Wnorlida W. Preventive health 

practices among women at rural villages in 

Malaysia. International Medical Journal. 

2014;21(2):143-145. 

40. Wongwatcharanukul L, Promthet S, Bradshaw 

P, Jirapornkul C, Tungsrithong N. Factors 

affecting cervical cancer screening uptake by 

Hmong hilltribe women in Thailand. Asian 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
https://www.oecd.org/dev/development-gender/Unpaid_care_work.pdf
https://www.oecd.org/dev/development-gender/Unpaid_care_work.pdf


 
THUMMAPOL 

 
This work is licensed under a Creative Commons Attribution 4.0 United States License. 

 
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Pacific Journal of Cancer Prevention. 

2014;15(8):3753-3756. 

41. United Nations Sustainable Development 

Goals. Sustainable development goal 5: 

Achieve gender equality and empower all 

women and girls [Internet]. UN: Department of 

Public Information; 2015. Available from: 

http://www.un.org/sustainabledevelopment/gen

der-equality/. Accessed October 8, 2018. 

42. Sen G, Ostlin P. Unequal, unfair, ineffective 

and inefficient gender inequity in health: Why 

it exists and how we can change it [Internet]. 

WHO: Women and Gender Equity; 2007. 

Available from: 

http://www.who.int/social_determinants/resour

ces/csdh_media/wgekn_final_report_07.pdf?ua

=1. Accessed October 8, 2018. 

43. Riang'a R, Nangulu A, Broerse J. Food beliefs 

and practices among the Kalenjin pregnant 

women in rural Uasin Gishu County, Kenya. 

Journal of Ethnobiology and Ethnomedicine. 

2017;13(29):1-16 

44. Browne A. Issues affecting access to health 

services in northern, rural and remote regions 

of Canada. British Columbia: University of 

Northern British Columbia; 2010. Available 

from: 

https://www.unbc.ca/assets/northern_studies/n

orthern/issues_affecting_access_to_health_serv

ices_in_northern.pdf. Accessed October 8, 

2018. 

45. Lama S, Krishna A. Barriers in utilization of 

maternal health care services: Perceptions of 

rural women in Eastern Nepal. Kathmandu 

University Medical Journal. 2014;12(48):253-

258. 

46. Cameron B, Carmargo Plazas M, Salas A, 

Bourque Bearskin R, Hungler K. 

Understanding inequalities in access to health 

care services for aboriginal people: A call for 

nursing action. Advances in Nursing Science. 

2014;37(3): 1-16.  

47. Askew D, Brady J, Brown A, Cass A, Davy C, 

DeVries J, Fewquandie B, Hackett M, Howard 

M, Ingram S, Liu H, Mentha R, Peiris D, 

Simon P, Rickards B, Togni S. To your door: 

Factors that influence Aboriginal and Torres 

Strait Islanders peoples seeking care. Kanyini 

Qualitative Study Monograph Series. 2008;1:1-

25. 

48. Davy C, Cass A, Brady J, DeVries J, 

Fewquandie B, Ingram S., & ... Brown A. 

Facilitating engagement through strong 

relationships between primary healthcare and 

Aboriginal and Torres Strait Islander 

peoples. Australian & New Zealand Journal Of 

Public Health. 2016;40(6):535-541.  

49. Castro A, Savage V, Kaufman H. Assessing 

equitable care for Indigenous and 

Afrodescendant women in Latin America. 

Revista Panamericana De Salud Publica-Pan 

http://www.library.pitt.edu/
http://www.pitt.edu/
http://www.library.pitt.edu/articles/digpubtype/index.html
http://www.upress.pitt.edu/upressIndex.aspx
http://www.un.org/sustainabledevelopment/gender-equality/
http://www.un.org/sustainabledevelopment/gender-equality/
http://www.who.int/social_determinants/resources/csdh_media/wgekn_final_report_07.pdf?ua=1
http://www.who.int/social_determinants/resources/csdh_media/wgekn_final_report_07.pdf?ua=1
http://www.who.int/social_determinants/resources/csdh_media/wgekn_final_report_07.pdf?ua=1
https://www.unbc.ca/assets/northern_studies/northern/issues_affecting_access_to_health_services_in_northern.pdf
https://www.unbc.ca/assets/northern_studies/northern/issues_affecting_access_to_health_services_in_northern.pdf
https://www.unbc.ca/assets/northern_studies/northern/issues_affecting_access_to_health_services_in_northern.pdf


 
 

CENTRAL ASIAN JOURNAL OF GLOBAL HEALTH 
 

 

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Central Asian Journal of Global Health 

Volume 7, No. 1 (2018) |  ISSN 2166-7403 (online) | DOI 10.5195/cajgh.2018.328|http://cajgh.pitt.edu 

 
 

American Journal of Public Health. 

2015;38(2):96-109. 

50. Sharma B, Ramani K, Christensson K, Giri G, 

Johansson E. The transition of childbirth 

practices among tribal women in Gujarat, India 

- a grounded theory approach. BMC 

International Health and Human Rights. 

2013;13(1).  

51. Hankivsky O, Reid C, Cormier R, Varcoe C, 

Clark N, Brotman S, et al. Exploring the 

promises of intersectionality for advancing 

women's health research. International Journal 

for Equity in Health. 2010;91:15. 

52. Iyer A, Sen G, Östlin P. The intersections of 

gender and class in health status and health 

care. Global Public Health. 2008;313-24. 

  

 

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	Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study
	Abstract
	Keywords: Indigenous women, Northern Rural Thailand, Ethnic minorities, Healthcare services, Access to healthcare, Gender equality, Human rights
	Healthcare Access Experiences Among Indigenous Women in Northern Rural Thailand: A Focused Ethnographic Study
	Research

