**5. How to reduce the consequences of social inequality on the results of reproductive health in socially vulnerable women's?**

It has already been noted that income inequalities contribute to health inequality, regardless of universal access to health systems. In addition, it has been noted that Chile has one of the greater concentrations of wealth and one of the higher levels of inequality the world [77]. Social, economic, cultural and politic determinants had allowed to understand the mechanism underlying the production processes of these

health inequalities. Therefore, estimating that reducing the adverse consequences of reproductive health could be remedied through the distribution of wealth is a true possibility, but for a very long term and practically utopian in the developing countries.

The mitigation of the poor results in reproductive health in poor communities, must focus on the changes required by the segmented and fragmented health practice, both in health programs as well as in social programs. The best practices for an integrated management are reached through the articulation of activities and fluid relations between disciplines, professions, departments, institutions, and organizations [78]. Thus, it is overcome the ambivalence of the responsibilities and the institutional segmentation in the execution of the reproductive health policy, among other [79].

Reality shows that the construction of disciplinary knowledge has been performed through activities governed by models and/or paradigms that organize the thinking and mutilated vision of reality. In Chile, midwives working in primary health care recognize poor skills to address complex social problems that affect women's healthy [80, 81]. The health practice has been developed excessively segmented and without communication, which is a culture of fragmented work that just benefits to those who apply specific perspectives and do not solve collective issues of greater social complexity. The fragmentation is the heart of ineffectiveness because it determines a poor link between health systems and social systems [79]. To achieve an approximation to what people, require an accurate diagnosis is needed, which must necessarily represent the psychosocial reality of the groups with which we will work and, have as much knowledge as possible of the forms of solution from people's own perspectives, of what they recognize as problems and what they want as a solution.

For this reason, the opportunity to take on the task is an ethical and social responsibility imperative. Today it is required to assume a transdisciplinary approach as a form of cooperation among the different disciplines, since health problems are extraordinarily complex, and their study can just be performed through the convergence and combination of different perspectives [82]. The interaction between the disciplines results on an intercommunication and mutual enrichment with a transformation of research methodologies, fundamental concepts and terminologies modification. There is a balance of power in the established relations, where the teamwork negotiation facilitates all sorts of clarifications and debates about methodological, conceptual, and ideological issues [83]. Transdisciplinary promotes the development of skills related to complex thinking, divergent thinking, adaptability, sensitivity to other people, risk acceptance, acceptance of diversity and new roles in integrated management networks.

In this scenario, the challenge for the professional empowerment for midwifery is related to changes in the pre- and postgraduate training of midwives. It begins in a transformative process with innovations and relevance in the design of educational practices linked to behaviors and social changes, for the generation of competencies and capacities of human capital with a gender and transdisciplinary perspective [84, 85]. The gender perspective allows work teams to eliminate stereotypes as a substrate of gender inequality, stigma and prejudice and the transdisciplinary perspective facilitates the understanding of the entire network of interactions and contradictions that occur between the different phenomena, where the complexity and uncertainty of the results of an action prevail [84, 85]. The observation and analysis of the social reality of health through transdiscipline breaks with the barriers of static and intolerant professional profiles, to rethink knowledge from a cognitive continuum in which one dialogs and constructs collectively, to overcome disparities and inequality in reproductive health among socially vulnerable women [86].

In short, both for public policy managers and in the health and social sciences academia, the biomedical and medicalized model must be complemented by the psychosocial model by the complexity of interactions between biological,

#### *Poverty, Reproductive Health and Public Health Policies in Chile DOI: http://dx.doi.org/10.5772/intechopen.96100*

psychological, and socio-cultural components that health problems have. The optimization of qualitative results at the primary level of health care requires examining and reflecting on how problems are constituted, contextualizing the individual and collective social reality, defining its territoriality, and then building, together with the care subjects, a collective strategy that enhances the assets and strategies of action of women, families, households, and community group. For the systemic resolution of complex problems, the formation of competencies and skills of a relevant and effective health practice using a sequenced combination in three strategic axes is essential: a) selection of critical cases that induce critical, reflective, and creative thinking with integrative work methodologies. Creativity is the ability to think, produce and act innovatively in the various fields of social action; b) Case study with advice and monitoring of inclusive and simultaneous work with students of careers in Health, Law, Informatics, Sociology and Anthropology, among others, to incorporate methodological procedures that allow them to recognize the assets and liabilities of women-families-households and communities and to define territorial areas with vulnerability and social exclusion and, c) Training academics in problem-based learning methodologies, problem solving, evidence-based medicine and communication and expression implemented in an educational practice focused on learning. This strategy generates synergy in the social and cultural construction of knowledge, improves understanding from the perspective of the other and achieves learning situated in the social reality where the experiences of life and health of women are realized. Also, the ability to tolerate diversity, appreciate the points of view of others (intellectual empathy), collaborate in a productive way in a group, and communicate their thinking will be strengthened in future professionals. In this way, the resolution capacity of transdisciplinary teams is improved, which is the way to overcome the segmentation and fragmentation of public management in reproductive health, and, as a result, to ensure the delivery of timely and relevant support to the vulnerable population.
