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Haseli A, Khosravi S, Hajimirzaie SS, Feli R, Rasoal D. Midwifery students' experiences: Violations of dignity during childbirth. Nurs Ethics 2024; 31:296-310. [PMID: 37650382 PMCID: PMC11181724 DOI: 10.1177/09697330231197703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND The principle of human dignity is woven into the ethical principles of the midwifery profession, noted as both an obligation and a human right. RESEARCH OBJECTIVES The aim of this study is to explore the experiences of midwifery students regarding threats to women's dignity during childbirth. RESEARCH DESIGN This is a qualitative study with explorative design. Participants and Research Context: The research was carried out in 2022 at Kermanshah University of Medical Sciences, involving 32 midwifery students in individual interviews that lasted between 30 and 90 minutes. These participants aged 21 to 28 years, with an average age of 23.5 years, provided their perspectives on the matter. RESULTS Four key themes described the threats to women's dignity during childbirth: 1) professional incompetence, 2) abuse of power imbalance, 3) caring only for physical and not mental health, and 4) structural issues within the healthcare system. Professional incompetence was characterized by outdated practices and lack of adherence to evidence-based medicine. Abuse of power imbalance was demonstrated in instances where the authoritative position of healthcare providers was misused, thereby disrupting the respectful care that women are entitled to receive. The disproportionate emphasis on physical health over mental health was evidenced by the disregard for mothers' psychological well-being during childbirth. Lastly, systemic structural issues emerged as significant impediments, revealing the need for system-wide changes. Ethical considerations: This study was approved by the Ethics Committee of the Research Deputy at Kermanshah University. Participation was voluntary and the confidentiality were maintained. CONCLUSION The findings underscore the role that unprofessional behavior, ethical lapses in medical practices, and systemic challenges play in undermining maternal dignity during childbirth. These threats necessitate urgent attention and must be adequately addressed in policy development and program implementation to safeguard the dignity of mothers during childbirth.
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Affiliation(s)
| | | | | | | | - Dara Rasoal
- School of Health and Welfare, Dalarna University, Sweden
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Unutkan A, Elem E. "Normal in all the rush": A phenomenological study analyzing midwifery students' views on obstetric violence. NURSE EDUCATION TODAY 2024; 132:106014. [PMID: 37948973 DOI: 10.1016/j.nedt.2023.106014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Revised: 10/24/2023] [Accepted: 10/29/2023] [Indexed: 11/12/2023]
Abstract
INTRODUCTION In recent years, obstetric violence, which undermines women's dignity and autonomy, has received increased attention worldwide. Considering the importance of midwives in combating violence in the obstetric field and the significance of the discussed issue, the following question arises: How do future midwives view obstetric violence? OBJECTIVE This study aimed to investigate midwifery students' thoughts about obstetric violence. DESIGN AND METHOD This study was conducted using a phenomenological qualitative research design. This study, which adopted a descriptive approach and used typical case sampling, was conducted in the midwifery department of the Kutahya Health Sciences University. Sixteen midwifery students studying fourth-year in the 2018-2019 academic year, who had participated in childbirth during their studies, and who agreed to participate in the study were included. All students had the experience of repeated monitoring and presence in labor. They had witnessed births in different institutions. Focus group interviews were conducted using an unstructured interview guide to obtain data for the study. Data were collected through four focus group interviews with groups of four students in the classroom environment. The data were evaluated separately by two researchers using the content analysis method in MAXQDA Analytics Pro 2020. The Consolidated Criteria for Reporting Qualitative Studies guidelines were used as a guide in reporting. RESULTS As a result of the analysis, four main themes emerged: defining violence, causes of violence, effects of witnessing violence, and whether can violence be prevented? CONCLUSIONS Midwifery students have an awareness of all visible forms of obstetric violence. However, they were less aware of the invisible structural and policy drivers of obstetric violence. It is invaluable to raise awareness of obstetric violence among midwifery students, who will be the most important defenders of women in childbirth. Studies focused on education and policy will contribute to women receiving quality care at birth.
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Affiliation(s)
- Aysegul Unutkan
- Department of Midwifery, Kutahya Health Sciences University Health Sciences Faculty, PO Box 43700, Kutahya, Turkiye.
| | - Emel Elem
- Department of Midwifery, Kutahya Health Sciences University Health Sciences Faculty, PO Box 43700, Kutahya, Turkiye.
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Garcia LM. Obstetric violence in the United States and other high-income countries: an integrative review. Sex Reprod Health Matters 2023; 31:2322194. [PMID: 38590127 PMCID: PMC11005882 DOI: 10.1080/26410397.2024.2322194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Abstract
Obstetric violence has been documented throughout the world, yet this human rights issue has mostly been investigated in middle- and low-income countries where the intensity and brutality of abuse and mistreatment is more easily recognised as problematic. This integrative review aimed to analyse sources about obstetric violence in high-income countries with the objective of identifying gaps in the research, challenges to the study of obstetric violence, and solutions to framing research that meets those challenges. A systematic search was conducted using the PubMed and CINAHL databases from February to June 2022. Empirical and non-empirical sources, published in English, with no date restrictions, were retrieved. Citation searching was also done. Forty-six sources were included. Identified gaps in the research were: (a) scarce attention to obstetric violence in most high-income countries; (b) most US sources are non-scientific and from outside the healthcare disciplines; (c) inconsistencies in terminology; (d) most studies were conducted with samples of women who had given birth, with scant research about healthcare providers and obstetric violence, and (e) the association between obstetric violence and traumatic birth was under-recognised. Identified challenges to the study of obstetric violence were: (1) factors that enable and perpetuate obstetric violence are multilevel and nonlinear; (2) the phenomenon is contextually complex; and (3) blind spots from routinised harmful practices and normalised mistreatment can prevent healthcare providers and birthing people from recognising obstetric violence. A systems approach and complexity theory are guiding frameworks recommended as solutions to the challenges of studying and correcting obstetric violence.
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Mena-Tudela D, Roman P, González-Chordá VM, Rodriguez-Arrastia M, Gutiérrez-Cascajares L, Ropero-Padilla C. Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study. Women Birth 2023; 36:e219-e226. [PMID: 35922250 DOI: 10.1016/j.wombi.2022.07.169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 10/16/2022]
Abstract
BACKGROUND Obstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women's autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence. AIM To explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students. METHODS A constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data. RESULTS Twenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants' experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans. DISCUSSION Despite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term 'obstetric violence' offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers. CONCLUSIONS Obstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.
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Affiliation(s)
- Desirée Mena-Tudela
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain
| | - Pablo Roman
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria, Spain
| | - Víctor M González-Chordá
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain
| | - Miguel Rodriguez-Arrastia
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain.
| | | | - Carmen Ropero-Padilla
- Faculty of Health Sciences, Pre-Department of Nursing, Jaume I University, Castello de la Plana, Spain
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Dhakal P, Newnham E, Debra K Creedy E, Gamble J. Upskilling nursing students in Nepal: Evaluation of an online education module for promoting respectful maternity care. Midwifery 2023; 117:103576. [PMID: 36527772 DOI: 10.1016/j.midw.2022.103576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Revised: 11/10/2022] [Accepted: 12/05/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To explore Nepalese nursing student...s evaluation of an online education module on respectful maternity care. DESIGN Cross-sectional study. SETTING A medical college in Chitwan, Nepal. PARTICIPANTS Forty third-year undergraduate nursing students. METHODS Over a three-week time frame, students undertook three, two-hour online education sessions about respectful maternity care. Students were then invited to complete a purposely designed evaluation survey with 13 Likert-scale and yes/no items, and eight open-ended questions about the quality, relevance, impact, and areas for improvement of the education module. Responses were analysed using descriptive statistics and qualitative thematic analysis. FINDINGS Students considered the education module to be useful and informative about respectful maternity care. More than half (60%) of the students agreed that the online delivery was more convenient than face-to-face, and learning was equivalent to a traditional class (87.5%). Most students (92.5%) reported that respectful maternity care is not explicitly covered in their degree. Students recommended that respectful maternity care be included in the curriculum and similar education offered to staff and women. Three themes from open-ended questions revealed: 1) empowerment through respectful maternity care; 2) motivation to initiate change; and 3) becoming a respectful clinician. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE Respect is essential in all areas of maternity care for improved experiences and outcomes for women and babies. Participants considered that the brief intervention improved their understanding of respectful maternity care and were inspired to implement change in their own practice to be more respectful to women. Curricula in all Nepalese institutions that offer preregistration education should customarily include respectful maternity care. Further research about respectful maternity care from the standpoint of women, educators, students, and maternity care providers in Nepal is required.
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Affiliation(s)
- Prativa Dhakal
- School of Nursing and Midwifery, Griffith University, Queensland, Australia.
| | - Elizabeth Newnham
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Australia; Transforming Maternity Care Collaborative
| | - Em Debra K Creedy
- School of Nursing and Midwifery, University of Newcastle, New South Wales, Australia; Transforming Maternity Care Collaborative
| | - Jenny Gamble
- Transforming Maternity Care Collaborative; Professor, School of Nursing, Midwifery and Allied Health, Coventry University, United Kingdom
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Schaaf M, Jaffe M, Tunçalp Ö, Freedman L. A critical interpretive synthesis of power and mistreatment of women in maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000616. [PMID: 36962936 PMCID: PMC10021192 DOI: 10.1371/journal.pgph.0000616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Labouring women may be subjected to physical and verbal abuse that reflects dynamics of power, described as Mistreatment of Women (MoW). This Critical Interpretive Synthesis on power and MoW consolidates current research and advances theory and practice through inter-disciplinary literature exploration. The review was undertaken in 3 phases. Phase 1 consisted of topic scoping; phase 2 entailed exploration of key power-related drivers emerging from the topic scoping; and phase 3 entailed data synthesis and analysis, with a particular focus on interventions. We identified 63 papers for inclusion in Phase 1. These papers utilized a variety of methods and approaches and represented a wide range of geographic regions. The power-related drivers of mistreatment in these articles span multiple levels of the social ecological model, including intrapersonal (e.g. lack of knowledge about one's rights), interpersonal (e.g. patient-provider hierarchy), community (e.g. widespread discrimination against indigenous women), organizational (e.g. pressure to achieve performance goals), and law/policy (e.g. lack of accountability for rights violations). Most papers addressed more than one level of the social-ecological model, though a significant minority were focused just on interpersonal factors. During Phase 1, we identified priority themes relating to under-explored power-related drivers of MoW for exploration in Phase 2, including lack of conscientization and normalization of MoW; perceptions of fitness for motherhood; geopolitical and ethnopolitical projects related to fertility; and pressure to achieve quantifiable performance goals. We ultimately included 104 papers in Phase 2. The wide-ranging findings from Phase 3 (synthesis and analysis) coalesce in several key meta-themes, each with their own evidence-base for action. Consistent with the notion that research on power can point us to "drivers of the drivers," the paper includes some intervention-relevant insights for further exploration, including as relating to broader social norms, health systems design, and the utility of multi-level strategies.
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Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, United States of America
| | - Maayan Jaffe
- Independent Consultant, Brooklyn, New York, United States of America
| | - Özge Tunçalp
- Department of Sexual and Reproductive Health and Research, UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), World Health Organization, Geneva, Switzerland
| | - Lynn Freedman
- Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, New York, United States of America
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Scandurra C, Zapparella R, Policastro M, Continisio GI, Ammendola A, Bochicchio V, Maldonato NM, Locci M. Obstetric violence in a group of Italian women: socio-demographic predictors and effects on mental health. CULTURE, HEALTH & SEXUALITY 2022; 24:1466-1480. [PMID: 34463607 DOI: 10.1080/13691058.2021.1970812] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Accepted: 08/17/2021] [Indexed: 06/13/2023]
Abstract
This study had two aims: (1) to explore the types and incidence of obstetric violence (OV) in a group of Italian women, as well as associated socio-demographic factors; and (2) to assess whether OV affects women's mental health (e.g. psychological distress and post-traumatic stress). A web-based cross-sectional study was conducted with 282 Italian women. Women answered questions on socio-demographic factors, childbirth characteristics, OV and mental health. Multiple linear regression analyses assessing the predictive role of socio-demographic and childbirth characteristics on OV were conducted. Additionally, hierarchical multiple linear regression analyses assessing whether OV affected women's mental health were also carried out. More than three quarters of the sample (78.4%) had experienced at least one type of OV (55.5% of non-consented care and 66.4% of abuse and violence). The factors most associated with OV were younger age, low educational level, not having attended a prenatal childbirth preparedness course, and having given birth naturally. The form of OV that most affected women's mental health was that linked to abuse and violence rather than non-consented care. Study findings shed light into addressing OV from a multidimensional perspective.
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Affiliation(s)
- Cristiano Scandurra
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Rosanna Zapparella
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Marilina Policastro
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | | | - Alessandra Ammendola
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Vincenzo Bochicchio
- Department of Humanistic Studies, University of Calabria, Arcavacata di Rende, Italy
| | - Nelson Mauro Maldonato
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
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9
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Respectful Maternity Care Framework and Evidence-Based Clinical Practice Guideline. J Obstet Gynecol Neonatal Nurs 2022; 51:e3-e54. [PMID: 35101344 DOI: 10.1016/j.jogn.2022.01.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Mena-Tudela D, Cervera-Gasch Á, Andreu-Pejó L, Alemany-Anchel MJ, Valero-Chillerón MJ, Peris-Ferrando E, Mahiques-Llopis J, González-Chordá VM. Perception of obstetric violence in a sample of Spanish health sciences students: A cross-sectional study. NURSE EDUCATION TODAY 2022; 110:105266. [PMID: 35051872 DOI: 10.1016/j.nedt.2022.105266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 12/22/2021] [Accepted: 01/08/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Obstetric violence is a problem that has grown worldwide, and a particularly worrying one in Spain. Such violence has repercussions for women, and for the professionals who cause them. Preventing this problem seems fundamental. OBJECTIVE This study evaluated how health sciences students perceived obstetric violence. DESIGN A cross-sectional study conducted between October 2019 and November 2020. PARTICIPANTS A sample of Spanish health sciences students studying degrees of nursing, medicine, midwifery, and psychology. METHODS A validated questionnaire was used: Perception of Obstetric Violence in Students (PercOV-S). Socio-demographic and control variables were included. A descriptive and comparative multivariate analysis was performed with the obtained data. RESULTS 540 questionnaires were completed with an overall mean score of 3.83 points (SD ± 0.63), with 2.83 points (SD ± 0.91) on the protocolised-visible dimension and 4.15 points (SD ± 0.67) on the non-protocolised-invisible obstetric violence dimension. Statistically significant differences were obtained for degree studied (p < 0.001), gender (p < 0.001), experience (p < 0.001), ethnic group (p < 0.001), the obstetric violence concept (p < 0.001) and academic year (p < 0.005). There were three significant multivariate models for the questionnaire's overall score and dimensions. CONCLUSIONS Health sciences students perceived obstetric violence mainly as non-protocolised aspects while attending women. Degree studied and academic year might be related to perceived obstetric violence.
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Affiliation(s)
- Desirée Mena-Tudela
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Spain
| | | | - Laura Andreu-Pejó
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Spain
| | | | | | - Emma Peris-Ferrando
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Spain
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Dhakal P, Creedy DK, Gamble J, Newnham E, McInnes R. Educational interventions to promote respectful maternity care: A mixed-methods systematic review. Nurse Educ Pract 2022; 60:103317. [DOI: 10.1016/j.nepr.2022.103317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/18/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
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Dhakal P, Gamble J, Creedy DK, Newnham E. Development of a tool to assess students' perceptions of respectful maternity care. Midwifery 2021; 105:103228. [PMID: 34954469 DOI: 10.1016/j.midw.2021.103228] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 12/12/2021] [Accepted: 12/14/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To develop and test a tool to measure Bachelor of Nursing students' perceptions towards respectful maternity care in Nepal, a lower-middle income country. DESIGN A cross-sectional design was used. Phases of tool development included item generation, expert review for content validity testing, and psychometric testing. The draft tool had 42 items on a 5-point Likert response scale of 1 = strongly disagree to 5 = strongly agree. Psychometric testing included dimensionality, internal consistency, and test-retest reliability. A t-test assessed mean score differences between students who had witnessed or not witnessed disrespect and abuse. SETTINGS Two medical colleges in Chitwan, Nepal PARTICIPANTS: Undergraduate Bachelor of Nursing students (n = 171) undertaking their midwifery clinical practicum were invited to complete the online survey. FINDINGS Principal component analysis generated three factors: Respectful Care, Safety and Comfort, and Supportive Care and explained 37.44% of the variance. The 18-item tool demonstrated good internal reliability (Cronbach's alpha of 0.81). The mean total scale score was 71.23 (SD 7.47, range 52-88 out of 90). Pearson's correlation coefficient confirmed test-retest reliability at one week (r = 0.91, p <0.001). The magnitude of difference in mean scores between those who had witnessed or not witnessed disrespectful and abusive care was very small (η2 = 0.04). KEY CONCLUSION The new Student Perceptions of Respectful Maternity Care tool is the first valid and reliable measure of students' perceptions of respectful maternity care. Validation of the newly developed tool in other low- and middle-income countries is recommended. IMPLICATIONS FOR PRACTICE Measuring students' perceptions provides information to educators on how best to enhance students' understanding and provision of respectful care to women.
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Affiliation(s)
- Prativa Dhakal
- School of Nursing and Midwifery, Griffith University, Queensland, Australia; Department of Nursing, Chitwan Medical College, Chitwan, Nepal.
| | - Jenny Gamble
- Professor Emeritus, School of Nursing and Midwifery, Transforming Maternity Care Collaborative, Griffith University, Queensland, Australia
| | - Debra K Creedy
- Professor Emeritus, Professor of Perinatal Mental Health, School of Nursing and Midwifery, Transforming Maternity Care Collaborative, Griffith University, Queensland, Australia
| | - Elizabeth Newnham
- School of Nursing and Midwifery, Transforming Maternity Care Collaborative, Griffith University, University Drive, Meadowbrook, Queensland, 4131, Australia
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Mtaita C, Likindikoki S, McGowan M, Mpembeni R, Safary E, Jahn A. Knowledge, Experience and Perception of Gender-Based Violence Health Services: A Mixed Methods Study on Adolescent Girls and Young Women in Tanzania. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:8575. [PMID: 34444324 PMCID: PMC8392576 DOI: 10.3390/ijerph18168575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/11/2021] [Accepted: 08/11/2021] [Indexed: 12/03/2022]
Abstract
Many adolescent girls and young women (AGYW) experience gender-based violence (GBV) in Tanzania and only few seek GBV health services following violence. The objectives of our study are (1) to evaluate knowledge of gender-based violence among AGYW, (2) to explore their perceptions of and experiences with GBV health service quality and (3) to evaluate access to comprehensive GBV services. This study employed an explanatory, sequential mixed methods design in two districts of Dar es Salaam, Tanzania (Kinondoni and Temeke). A quantitative cross-sectional survey among AGYW (n = 403) between 15-24 years old was performed to assess their knowledge of GBV as well as perceptions of and experiences with GBV health services. The quantitative data was complemented by 20 semi-structured in-depth interviews with participants. Out of 403 study participants, more than three quarters (77.9%) had moderate to good knowledge of how GBV is defined and what constitutes gender-based violence. However, few participants (30.7%, n = 124) demonstrated knowledge of GBV health services offered at local health facilities. For example, only 10.7% (n = 43) of participants reported knowledge of forensic evidence collection. Additionally, of 374 participants (93% of total participants) who reported to have received GBV education sessions, only 66% accessed GBV health services (n = 247) and about half of these (52.7%, n = 130) were satisfied with these services. The study indicated that-despite good knowledge about what constituted GBV-knowledge about the roles and availability of GBV health services was limited and utilization of GBV health services remained low. Coordinated actions need to be strengthened to reach AGYW who remain unaware of GBV health services offered at health facilities by improving GBV service quality, bettering interventions aimed at reducing GBV among AGYW in Tanzania, and scaling-up integrated service models, such as GBV one-stop centers.
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Affiliation(s)
- Caroline Mtaita
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
| | - Samuel Likindikoki
- Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65001, Tanzania;
| | - Maureen McGowan
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
| | - Rose Mpembeni
- Department of Epidemiology, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, Dar es Salaam 65015, Tanzania;
| | - Elvis Safary
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
| | - Albrecht Jahn
- Heidelberg Institute of Global Health, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (M.M.); (E.S.); (A.J.)
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Mena-Tudela D, Iglesias-Casás S, González-Chordá VM, Cervera-Gasch Á, Andreu-Pejó L, Valero-Chilleron MJ. Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 18:E199. [PMID: 33383862 PMCID: PMC7794951 DOI: 10.3390/ijerph18010199] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/18/2020] [Accepted: 12/24/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND obstetric violence can partially be represented by the high number of interventions and medicalization rates during the birthing process. The objective of the present study was to determine the interventionism and medicalization levels during childbirth in Spain. METHODS a descriptive, retrospective, and cross-sectional study was conducted between January 2018 and June 2019. RESULTS the intervention percentages were 34.2% for Kristeller maneuver and 39.3% for episiotomy. Differences appeared in public, private, and mixed healthcare settings (p < 0.001). The mean satisfaction, with healthcare in the different settings, was estimated at 6.88 points (SD ± 2.146) in public healthcare, 4.76 points (SD ± 3.968) in private healthcare, and 8.03 points (SD ± 1.930) in mixed healthcare (p < 0.001). No statistically significant differences were found in Spanish autonomous communities. CONCLUSIONS births in Spain seem to be highly intervened. In this study, a certain equity criterion was found concerning interventionism during childbirth in Spain. Healthcare influenced female intervention, satisfaction, and perception levels for obstetric violence; this evidences that female empowerment plays an important role.
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Affiliation(s)
- Desirée Mena-Tudela
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, 12071 Castellón, Spain; (V.M.G.-C.); (Á.C.-G.); (L.A.-P.); (M.J.V.-C.)
| | - Susana Iglesias-Casás
- Department of Obstetrics, Hospital do Salnés, Villgarcía de Aurousa, 36619 Pontevedra, Spain;
| | - Víctor Manuel González-Chordá
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, 12071 Castellón, Spain; (V.M.G.-C.); (Á.C.-G.); (L.A.-P.); (M.J.V.-C.)
| | - Águeda Cervera-Gasch
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, 12071 Castellón, Spain; (V.M.G.-C.); (Á.C.-G.); (L.A.-P.); (M.J.V.-C.)
| | - Laura Andreu-Pejó
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, 12071 Castellón, Spain; (V.M.G.-C.); (Á.C.-G.); (L.A.-P.); (M.J.V.-C.)
| | - María Jesús Valero-Chilleron
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, 12071 Castellón, Spain; (V.M.G.-C.); (Á.C.-G.); (L.A.-P.); (M.J.V.-C.)
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Mena-Tudela D, Cervera-Gasch A, Alemany-Anchel MJ, Andreu-Pejó L, González-Chordá VM. Design and Validation of the PercOV-S Questionnaire for Measuring Perceived Obstetric Violence in Nursing, Midwifery and Medical Students. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E8022. [PMID: 33143368 PMCID: PMC7662790 DOI: 10.3390/ijerph17218022] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 10/27/2020] [Accepted: 10/27/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Obstetric violence could be defined as the dehumanized treatment or abuse of health professionals towards the body or reproductive process of women. Some practices associated with obstetric violence have been routinely standardized and do not include the woman in decision making. This type of violence has consequences for the health of both the mother and the baby and that of the professionals who practice or observed it. METHODS A questionnaire consisting of 33 items that measured perception through a Likert scale was developed. Some sociodemographic variables were collected. The instrument was applied to a sample of nursing, medicine and midwifery students to determine its psychometric properties. RESULTS The final sample consisted of 153 students. The Kaiser-Meyer-Olkin (p = 0.918) and Barlett tests (p ≤ 0.001) allowed for factor analysis, which explained 54.47% of the variance in two factors called protocolized-visible obstetric violence and non-protocolized-invisible obstetric violence. CONCLUSIONS The PercOV-S (Perception of Obstetric Violence in Students) instrument was validated. The distribution and content of the two factors are closely related to obstetric violence against women. The existence of statistically significant relationships between the sociodemographic variables collected and the global measurements, domains and items of the PercOV-S scale highlight the normalization of obstetric violence as a central factor for future studies.
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Affiliation(s)
- Desirée Mena-Tudela
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Avda. Sos I Baynat s/n, 12071 Castellón, Spain; (A.C.-G.); (L.A.-P.); (V.M.G.-C.)
| | - Agueda Cervera-Gasch
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Avda. Sos I Baynat s/n, 12071 Castellón, Spain; (A.C.-G.); (L.A.-P.); (V.M.G.-C.)
| | | | - Laura Andreu-Pejó
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Avda. Sos I Baynat s/n, 12071 Castellón, Spain; (A.C.-G.); (L.A.-P.); (V.M.G.-C.)
| | - Víctor Manuel González-Chordá
- Department of Nursing, Faculty of Health Sciences, Universitat Jaume I, Avda. Sos I Baynat s/n, 12071 Castellón, Spain; (A.C.-G.); (L.A.-P.); (V.M.G.-C.)
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