全球衛生中非／單一伴侶研究的範疇界定回顧

Abstract

背景：近年來，在親密關係研究中出現了一波批判性思維，尤其是在親密與伴侶關係數量方面。此類研究跨越眾多學科與專業領域，批判單偶正典制度——即認為單偶伴侶為唯一有效和可接受的連結形式。在全球衛生領域，這種批評主要問題化「同時發生之多重伴侶關係」（multiple concurrent partnership）之範式，其將非單偶關係界定為衛生介入的對象，而新的研究要求對全球衛生中的非/單偶關係進行更細緻的考慮。 目標：此範疇界定審查旨在通過描述並定義相關重要概念、突出限制並追蹤未來研究方向，以全面地論述並分析全球衛生領域中逐漸興起之非單偶伴侶研究。透過批判話語分析和反思分析，範疇界定審查方法變得更加多元，從而試圖對抗學院內的系統性且僵化之權力動態。 方法：本研究在三個資料庫中系統性蒐索了將「非單偶關係」與人類健康及福祉連結起來之所有相關研究。符合條件的來源包括從2012年開始以英語發表之通過同儕審查的文獻及灰色科學文獻。研究者一自158個文獻，勾勒資料圖景，必要時由研究者二（及本論文指導教授）協助。研究人員的反身性被用來分析系統性的權力動態，並提高研究過程的透明度（包括所有審查決定）。 結果：量化趨勢顯示，近來與健康相關之非/單偶研究之出版物顯著增加，表明人們越來越認識到伴侶數量對健康的作用。這些結果還揭示了若干重要的健康落差，包括缺乏關於跨性別者、與女性發生性關係的女性，以及種族和族群對非/單偶伴侶健康之作用的資訊。使用批判性話語分析，出現了四個質性主題：性健康、生育健康、心理健康以及污名和歧視。這些主題在臨床照護理之可及性與可接受性方面尤為突出，突顯肯定非單偶親密關係之健康及保健選項之必要性。 結論：此範疇界定審查增加了關於親密關係對健康作用之新興討論。研究結果表明，非/單偶親密關係在個人與社群層面，對健康系統有明顯的影響，這通常需要與通過單偶霸權之啟發式想像的解決方案不同的解決方案。展望未來，在設計全球衛生研究和介入措施時，應更通盤考慮親密關係的動態性——尤其是非/單偶伴侶關係。由於這些考量必然會導致全球衛生領域之基礎發生劇變，因此這項研究最終主張，要求解殖並酷兒化相關研究。

Background: Recent years have seen a wave of critical thought applied to intimacy studies, particularly in the realm of relational numeracy. Such research critiques mononormativity—the viewpoint that monogamy is the only valid and acceptable form of relating—across a range of academic disciplines. In global health, this critique primarily problematizes the “multiple concurrent partnership” (MCP) paradigm, which has positioned non-monogamy as the site of health intervention. New research calls for more nuanced considerations of non/monogamies in global health. Objectives: This scoping review aims to provide an overview of emerging non-monogamies research in global health by mapping key concepts, highlighting limitations, and tracking future directions. Using critical discourse analysis and reflexivity, the scoping review methodology is made polyqueer, thereby attempting to confront systematic power dynamics within the academy. Methods: Three databases were searched for studies linking non-monogamies to human health and wellbeing. Eligible sources included peer-reviewed and gray scientific literature published in English, starting in 2012. A single reviewer charted data from N=158 sources, with assistance from a secondary reviewer when necessary. Researcher reflexivity was employed to analyze systematic power dynamics and improve transparency in the research process. Results: Quantitative trends point to a recent significant increase in health-related non/monogamies publications, indicating growing recognition of the role of relational numeracy on health. These results also revealed several gaps, including a lack of information on trans+ folks, women who have sex with women, and the role of race and ethnicity on health within non/monogamies. Using critical discourse analysis, four qualitative themes emerged: sexual health, reproductive health, mental health, and stigma and discrimination. These themes were particularly salient in terms of accessibility and acceptability of clinical care, highlighting a need for non-monogamy affirming health and wellness options. Conclusions: This scoping review adds to an emergent discussion regarding the role of intimate relationships on health. The findings suggest that non/monogamies have a distinct impact on individual and community level systems of health, which often require different solutions than those imagined through the heuristics of hegemonic monogamy. Moving forward, intimate relationship dynamics—non/monogamies in particular—should be considered more thoroughly when designing global health research and interventions. Since such considerations will necessarily result in an upheaval of the foundations of the global health field, this research eventually calls for a decolonization and queerification of the academy.