1
|
Lunda P, Minnie CS, Lubbe W. Factors influencing respectful perinatal care among healthcare professionals in low-and middle-resource countries: a systematic review. BMC Pregnancy Childbirth 2024; 24:442. [PMID: 38914945 PMCID: PMC11194958 DOI: 10.1186/s12884-024-06625-6] [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] [Received: 10/16/2023] [Accepted: 06/06/2024] [Indexed: 06/26/2024] Open
Abstract
BACKGROUND This review aimed to provide healthcare professionals with a scientific summary of best available research evidence on factors influencing respectful perinatal care. The review question was 'What were the perceptions of midwives and doctors on factors that influence respectful perinatal care?' METHODS A detailed search was done on electronic databases: EBSCOhost: Medline, OAlster, Scopus, SciELO, Science Direct, PubMed, Psych INFO, and SocINDEX. The databases were searched for available literature using a predetermined search strategy. Reference lists of included studies were analysed to identify studies missing from databases. The phenomenon of interest was factors influencing maternity care practices according to midwives and doctors. Pre-determined inclusion and exclusion criteria were used during selection of potential studies. In total, 13 studies were included in the data analysis and synthesis. Three themes were identified and a total of nine sub-themes. RESULTS Studies conducted in various settings were included in the study. Various factors influencing respectful perinatal care were identified. During data synthesis three themes emerged namely healthcare institution, healthcare professional and women-related factors. Alongside the themes were sub-themes human resources, medical supplies, norms and practices, physical infrastructure, healthcare professional competencies and attributes, women's knowledge, and preferences. The three factors influence the provision of respectful perinatal care; addressing them might improve the provision of this care. CONCLUSION Addressing factors that influence respectful perinatal care is vital towards the prevention of compromised patient care during the perinatal period as these factors have the potential to accelerate or hinder provision of respectful care.
Collapse
Affiliation(s)
- Petronellah Lunda
- School of Nursing, North-West University, NuMIQ Research Focus Area, Potchefstroom, South Africa.
| | - Catharina Susanna Minnie
- School of Nursing, North-West University, NuMIQ Research Focus Area, Potchefstroom, South Africa
- School of Nursing, University of the Western Cape, Bellville, Cape Town, South Africa
| | - Welma Lubbe
- School of Nursing, North-West University, NuMIQ Research Focus Area, Potchefstroom, South Africa
| |
Collapse
|
2
|
Hawkes S. Commercial co-opting of feminist health narratives. BMJ 2024; 384:q314. [PMID: 38355156 DOI: 10.1136/bmj.q314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Affiliation(s)
- Sarah Hawkes
- Institute for Global Health, University College London, London, UK
| |
Collapse
|
3
|
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.
Collapse
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.
| |
Collapse
|
4
|
Ross T, de Maria de Albuquerque C, Chaves J, Carneiro Rolim KM, Albuquerque Frota M, Surkan PJ. COVID-19 threatens the progress of humanised childbirth: a qualitative study of giving birth during the pandemic in Brazil. Sex Reprod Health Matters 2023; 31:2152548. [PMID: 36825627 PMCID: PMC9970195 DOI: 10.1080/26410397.2022.2152548] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Abstract
The stressful nature of the early months of the COVID-19 pandemic severely impacted the quality of maternity care. The purpose of this study was to understand and explore the labour and delivery experiences for women who were diagnosed with COVID-19 in Brazil during this time. Between July and October 2020, we conducted 28 semi-structured interviews with postpartum women who tested positive for COVID-19 prior to delivering at a tertiary hospital in Fortaleza, Brazil. Interview transcripts were coded, and we carried out a thematic analysis using three domains of the World Health Organization's model of intrapartum care for a positive childbirth experience as a framework. During labour and delivery, women experienced varying levels of respect, with many women reporting feeling mistreated by their healthcare team because of their COVID-19 diagnosis. Due to COVID-19 hospital protocols that denied companions or visitors, women reported feeling unsupported and isolated, especially during the mandatory quarantine. Women also experienced varying levels of effective communication, with some women citing they felt the staff were often fearful, and either avoidant or disrespectful. A minority of women reported that the staff appeared to be respectful and receptive to their needs. Our findings provide preliminary evidence that the strain of the COVID-19 pandemic on health professionals potentially results in ineffective communication and mistreatment during labour and delivery. Embedding respectful and humanised childbirth principles into emergency maternal healthcare protocols may improve the childbirth experience for women with COVID-19, as well as for women during future public health emergencies.
Collapse
Affiliation(s)
- Tamia Ross
- MSPH Student, Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Conceição de Maria de Albuquerque
- PhD Student, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Jessica Chaves
- MS Student, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Karla Maria Carneiro Rolim
- Professor, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Mirna Albuquerque Frota
- Professor, Centro de Ciências de Saúde, Programa de Pós-graduação em Saúde Coletiva, Universidade de Fortaleza, Fortaleza, Ceará, Brazil
| | - Pamela J. Surkan
- Professor, Social and Behavioral Intervention Program, Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, E5523, Baltimore, MD, USA. Correspondence:
| |
Collapse
|
5
|
Downe S, Nowland R, Clegg A, Akooji N, Harris C, Farrier A, Gondo LT, Finlayson K, Thomson G, Kingdon C, Mehrtash H, McCrimmon R, Tunçalp Ö. Theories for interventions to reduce physical and verbal abuse: A mixed methods review of the health and social care literature to inform future maternity care. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001594. [PMID: 37093790 PMCID: PMC10124898 DOI: 10.1371/journal.pgph.0001594] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2023]
Abstract
Despite global attention, physical and verbal abuse remains prevalent in maternity and newborn healthcare. We aimed to establish theoretical principles for interventions to reduce such abuse. We undertook a mixed methods systematic review of health and social care literature (MEDLINE, SocINDEX, Global Index Medicus, CINAHL, Cochrane Library, Sept 29th 2020 and March 22nd 2022: no date or language restrictions). Papers that included theory were analysed narratively. Those with suitable outcome measures were meta-analysed. We used convergence results synthesis to integrate findings. In September 2020, 193 papers were retained (17,628 hits). 154 provided theoretical explanations; 38 were controlled studies. The update generated 39 studies (2695 hits), plus five from reference lists (12 controlled studies). A wide range of explicit and implicit theories were proposed. Eleven non-maternity controlled studies could be meta-analysed, but only for physical restraint, showing little intervention effect. Most interventions were multi-component. Synthesis suggests that a combination of systems level and behavioural change models might be effective. The maternity intervention studies could all be mapped to this approach. Two particular adverse contexts emerged; social normalisation of violence across the socio-ecological system, especially for 'othered' groups; and the belief that mistreatment is necessary to minimise clinical harm. The ethos and therefore the expression of mistreatment at each level of the system is moderated by the individuals who enact the system, through what they feel they can control, what is socially normal, and what benefits them in that context. Interventions to reduce verbal and physical abuse in maternity care should be locally tailored, and informed by theories encompassing all socio-ecological levels, and the psychological and emotional responses of individuals working within them. Attention should be paid to social normalisation of violence against 'othered' groups, and to the belief that intrapartum maternal mistreatment can optimise safe outcomes.
Collapse
Affiliation(s)
- Soo Downe
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Rebecca Nowland
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Naseerah Akooji
- Lancashire Clinical Trials Unit, University of Central Lancashire, Preston, United Kingdom
| | - Cath Harris
- Synthesis, Economic Evaluations and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, United Kingdom
| | - Alan Farrier
- Healthy and Sustainable Settings Unit, University of Central Lancashire, Preston, United Kingdom
| | | | - Kenny Finlayson
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Gill Thomson
- Maternal and Infant Nurture and Nutrition Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Carol Kingdon
- Research in Childbirth and Health Group, THRIVE Centre, University of Central Lancashire, Preston, United Kingdom
| | - Hedieh Mehrtash
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| | - Rebekah McCrimmon
- School of Community Health and Midwifery, University of Central Lancashire, Preston, United Kingdom
| | - Özge Tunçalp
- UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction, Department of Sexual and Reproductive Health and Research, World Health Organization, Geneva, Switzerland
| |
Collapse
|
6
|
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.
Collapse
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
| |
Collapse
|
7
|
Cantor AR. " Yo trato de no llorar": Rethinking Obstetric Violence in Costa Rica. Med Anthropol 2023; 42:163-176. [PMID: 36692941 DOI: 10.1080/01459740.2023.2166410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Obstetric violence is an emergent paradigm that uses gender-based violence to frame traumatic childbirth. Despite its growing popularity in the literature, it may not adequately address the nuanced ways that all actors experience these interactions. While Costa Rica adopted a nationally endorsed humane birthing policy, the semi-structured interviews on which I draw in this article show that health care personnel continue to dehumanize and objectify women; experiences considered characteristic of obstetric violence. However, women's own interpretations of their experiences are not aligned with definitions of obstetric violence. This lacuna in praxis highlights the need to critically reevaluate how birth trauma is conceptualized within a contemporary context.
Collapse
Affiliation(s)
- Allison R Cantor
- Department of Anthropology, New Mexico State University, Las Cruces, New Mexico, USA
| |
Collapse
|
8
|
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.
Collapse
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
| |
Collapse
|
9
|
Rodrigues AP, de Oliveira DCC, Gomes ML, de Azevedo Nicida LR, Torres JA, da Trindade Dias Coutinho A, de Souza Cravo BDSS, Dantas JG, Oliveira TB, Domingues RMSM. Women's voice on changes in childbirth care practices: a qualitative approach to women's experiences in Brazilian private hospitals participating in the Adequate Childbirth Project. Reprod Health 2023; 20:19. [PMID: 36694218 PMCID: PMC9872282 DOI: 10.1186/s12978-022-01539-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2022] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND In Brazil, childbirth practices are strongly marked by surgical events and particularly in the private sector cesarean sections reach rates above 80%. The National Supplementary Health Agency proposed the Adequate Childbirth Project (PPA), a quality improvement project developed at Brazilian hospitals with the aim of changing the current model of childbirth care and reducing unnecessary cesarean sections. The objective of this study is to assess how the participation of women in the process of improving quality childbirth care occurred in two hospitals participating in the PPA. METHOD Qualitative study, based on interviews with 102 women attended at two hospitals that took part in the first and second stages of the "Healthy Birth", an evaluative hospital-based research, conducted in 2017-2018, that assessed the degree of implementation and the effects of PPA. After thematic content analysis, supported by MaxQda software, three categories emerged: (1) how women gathered knowledge about the PPA, (2) how women perceived it, and (3) which are their suggestions for the PPA improvement. RESULTS The PPA was unknown to most women before delivery. A polysemy of terms, including adequate childbirth, promotes recognition of the "new" model of care. Visits to the maternity hospital and antenatal care groups for pregnant women are opportunities for contacts that change the perception of what childbirth can be. Women have expectations of a relationship with maternity that is not limited to the moment of delivery. The listening channels established between hospitals and women are fragile and not systematized. By increasing the supply of listening spaces, one can also increase the request to leave their suggestions and contributions, and thus gain more allies in improving the project. Women are not yet included as PPA agents and their voices are silenced. CONCLUSIONS Women's participation to improve childbirth care is relevant and necessary. The women's voice in the PPA is still incipient, and maternity hospitals and health plan operators should create strategies to insert and engage them. Women's voices should be listened to not only during but also before and after childbirth.
Collapse
Affiliation(s)
- Andreza Pereira Rodrigues
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro (UFRJ), Rua Afonso Cavalcanti, 275. Cidade Nova, Rio de Janeiro, RJ CEP: 20211-130 Brazil
| | - Débora Cecília Chaves de Oliveira
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro (UFRJ), Rua Afonso Cavalcanti, 275. Cidade Nova, Rio de Janeiro, RJ CEP: 20211-130 Brazil
| | - Maysa Luduvice Gomes
- Faculty of Nursing, Rio de Janeiro State University (UERJ), Rio de Janeiro, RJ Brazil
| | | | | | - Amanda da Trindade Dias Coutinho
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro (UFRJ), Rua Afonso Cavalcanti, 275. Cidade Nova, Rio de Janeiro, RJ CEP: 20211-130 Brazil
| | - Beatriz da Silva Soares de Souza Cravo
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro (UFRJ), Rua Afonso Cavalcanti, 275. Cidade Nova, Rio de Janeiro, RJ CEP: 20211-130 Brazil
| | - Juliana Guimarães Dantas
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro (UFRJ), Rua Afonso Cavalcanti, 275. Cidade Nova, Rio de Janeiro, RJ CEP: 20211-130 Brazil
| | - Thays Basílio Oliveira
- Escola de Enfermagem Anna Nery, Universidade Federal do Rio de Janeiro (UFRJ), Rua Afonso Cavalcanti, 275. Cidade Nova, Rio de Janeiro, RJ CEP: 20211-130 Brazil
| | - Rosa Maria Soares Madeira Domingues
- Laboratory of Clinical Research in STD/AIDS, Evandro Chagas National Institute of Infectology, Oswaldo Cruz Foundation (Fiocruz), Rio de Janeiro, RJ Brazil
| |
Collapse
|
10
|
Diniz CSG, Cabral CDS. Reproductive health and rights, and public policies in Brazil: revisiting challenges during covid-19 pandemics. Glob Public Health 2022; 17:3175-3188. [PMID: 34710333 DOI: 10.1080/17441692.2021.1995463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
We revisit the debates on reproductive health and rights (RHR) and public policies in Brazil, with focus on contraception, abortion and maternity care. These were part of a broader political agenda for re-democratisation, and for health sector reform, with the creation of the Women's Integral Health Program (PAISM) in 1983, and of the Universal Health System (SUS) in 1988. The momentum created by ICPD in Cairo (1994) was essential to institutionalise the language of RHR. Not without resistance and organised activism, recent years of right-wing governments brought a disinvestment in most public policies for women's rights. Some components of the RHR agenda are more mainstreamed, such as fertility regulation, especially hormonal and long term-methods. The limited legal rights to abortion are poorly institutionalised and constantly threatened. Maternal care tends to be highly medicalised and frequently abusive. The covid-19 pandemic accelerated social and public health disruption. The article addresses notions such as reproductive justice and institutional violence, present in the early days of women's health movement, in order to highlight important premises that were diluted in the debate on reproductive rights and autonomy. The historical analysis of how these concepts evolved locally and globally can allow a better understanding of present challenges.
Collapse
|
11
|
Fabbro MRC, Wernet M, Baraldi NG, de Castro Bussadori JC, Salim NR, Souto BGA, dos Reis Fermiano A. Antenatal care as a risk factor for caesarean section: a case study in Brazil. BMC Pregnancy Childbirth 2022; 22:731. [PMID: 36154888 PMCID: PMC9509577 DOI: 10.1186/s12884-022-05008-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Accepted: 08/08/2022] [Indexed: 12/03/2022] Open
Abstract
Background Antenatal care is an important tool to prevent complications and decrease the incidence of maternal and antenatal morbidity and mortality. In Brazil, quality, access, and coverage of antenatal care are described as insufficient. Consequently, high rates of caesarean section, congenital morbidities such as syphilis, maternal and early neonatal mortality occur, as well as obstetric violence and dissatisfaction with healthcare. It is important to reflect on health disparities in antenatal care. This study aimed to carry out a critical analysis of antenatal care in one city of São Paulo state in Brazil. Methods A case study was performed, structured in a descriptive cross-sectional epidemiological study and two qualitative studies. Data for the epidemiological study was obtained from the Informatics Department of the Unified Health System (DATASUS) of Brazil, which was processed in the Epi-info v software 7.2. and treated descriptively and by the Mantel–Haenszel or Fisher's exact tests. Qualitative data was collected through semi-structured interviews with 30 pregnant women and 8 nurses in the primary healthcare service of one city in São Paulo. The qualitative data analysis was based on thematic content analysis. Results The data revealed a limited quality of antenatal care. More than six antenatal visits increased the probability of a caesarean section by 47% and babies born vaginally had a lower Apgar score. There was little participation of nurses in antenatal care and women described it as “a quick medical appointment”, limited by protocols, based on procedures and insufficient in dialogue. Antenatal care appeared to be fragmented and permeated by challenges that involve the need for change in management, performance, and ongoing training of professionals, as well as in the guarantee of women’s rights. Conclusions Caesarean section was statistically related to the number of antenatal care visits. Interactions between professionals and pregnant women were poor and resulted in dissatisfaction. There is an urgent need to connect health indicators with the findings from professionals and women’s experiences to improve the quality of antenatal care.
Collapse
|
12
|
da Silva SS, Fortuna CM, Monceau G, Soulière M, Pilotti A. The Feminine Condition and Women's Sexual and Reproductive Health in Brazil and France. Front Psychol 2022; 13:862431. [PMID: 35586244 PMCID: PMC9108480 DOI: 10.3389/fpsyg.2022.862431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Accepted: 03/28/2022] [Indexed: 11/13/2022] Open
Abstract
Introduction Elements mark the reality of reading the female body in symbolic constructions and social symbols in the exercise of their reproductive health. The study aims to identify elements that characterize the female condition while analyzing the reproductive health of Brazilian and French women. Materials and Methods A qualitative, multicenter, international study was conducted in Brazil and in France between 2016 and 2019. Data were produced through the use of semi-structured scripts. Focus group discussions and individual interviews were conducted with women who gave birth, hetero-female couples who lived the experience of gestation and birth of a baby, and professionals of maternal and childcare services or members of the associations concerned with the health of mothers and babies. It was guided by the theoretical-methodological framework of institutional analysis in line with the French Institutional Socioclinics. Results Sexual and reproductive health in the realities researched in Brazil and France are sometimes close and sometimes far apart. In what involves the Brazilian health system, abortion is criminalized and often performed illegally. Furthermore, pregnancy, childbirth, and the postpartum period are highly medicalized. In addition, childbirth is not assured as an experience for a woman and her family. This aspect is confirmed by high numbers of cesarean sections performed or by maternal and infant mortality indicators. The French health system prioritizes vaginal deliveries and seems to assure more autonomy to women, but at the same time, it is worn out by the logic of profit, the efficiency of actions, and the rationalization of practices. In association with these, there are other intrinsic elements in the functioning of the institution that delineates the format of each country: notion of women's rights, violence against women, and discussion regarding the oppression markers of race, gender, sexuality, and social class. Conclusions Both countries reveal aspects related to the social role of women's bodies. The established logic reflects in the decision to have children, motherhood, women's autonomy over their own bodies, and in the core values linked to the termination of pregnancy and the professional practices developed in prenatal care, childbirth, and postpartum.
Collapse
Affiliation(s)
- Simone Santana da Silva
- Department of Ed2ucation, State of Bahia University, Senhor do Bonfim, Brazil
- Ribeirão Preto College of Nursing, Universityof São Paulo, Ribeirão Preto, Brazil
| | | | - Gilles Monceau
- Laboratoire École, Mutations, Apprentissages (EMA), CY Cergy Paris Université, Cergy, France
| | | | - Anne Pilotti
- Laboratoire École, Mutations, Apprentissages (EMA), CY Cergy Paris Université, Cergy, France
| |
Collapse
|
13
|
Santos MPDS, Capelanes BCS, Rezende KTA, Chirelli MQ. Humanization of childbirth: challenges of the Apice On Project. CIENCIA & SAUDE COLETIVA 2022. [DOI: 10.1590/1413-81232022275.23602021en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Abstract The movement aimed at the humanization of childbirth has found resistance to the implementation of a new care model. This article aims to analyze the challenges experienced in the implantation and implementation of the Apice On Project in a large hospital in Brazil. A study was carried out with a qualitative approach, through interviews with health professionals using content analysis, thematic modality. An ineffective management was verified when conducting health work, as well as a biomedical care model and insufficient training to promote changes in health practices. It is important to review the implementation strategies of the Apice On Project proposals, incorporating Permanent Education in Health as a strategy for the reflection and reconstruction of health practices. Expanding the investigation beyond the hospital service, contemplating the perspective of other scenarios, such as, for instance, assistance in primary health care, are recommended.
Collapse
|
14
|
Santos MPDS, Capelanes BCS, Rezende KTA, Chirelli MQ. Humanização do parto: desafios do Projeto Apice On. CIENCIA & SAUDE COLETIVA 2022; 27:1793-1802. [DOI: 10.1590/1413-81232022275.23602021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/03/2021] [Indexed: 12/23/2022] Open
Abstract
Resumo O movimento de humanização do parto enfrenta resistências para a implementação de um novo modelo de cuidado. O objetivo deste artigo é analisar os desafios vividos na implantação e implementação do Projeto Apice On em um hospital de grande porte no Brasil. Pesquisa com abordagem qualitativa, por meio de entrevista com profissionais de saúde e análise de conteúdo, modalidade temática. Constatou-se a gestão ineficaz na condução do trabalho em saúde, modelo de atenção biomédico e formação insuficiente para promoção de mudança nas práticas em saúde. É importante rever as estratégias de implementação das propostas do Projeto Apice On, incorporando a educação permanente em saúde como estratégia de reflexão e reconstrução das práticas em saúde. Sugere-se ampliar a investigação para além do serviço hospitalar, contemplando a perspectiva de outros cenários, como o cuidado na atenção primária à saúde.
Collapse
|
15
|
Schaaf M, Boydell V, Topp SM, Iyer A, Sen G, Askew I. A summative content analysis of how programmes to improve the right to sexual and reproductive health address power. BMJ Glob Health 2022; 7:bmjgh-2022-008438. [PMID: 35443940 PMCID: PMC9021801 DOI: 10.1136/bmjgh-2022-008438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/27/2022] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Power shapes all aspects of global health. The concept of power is not only useful in understanding the current situation, but it is also regularly mobilised in programmatic efforts that seek to change power relations. This paper uses summative content analysis to describe how sexual and reproductive health (SRH) programmes in low-income and middle-income countries explicitly and implicitly aim to alter relations of power. METHODS Content analysis is a qualitative approach to analysing textual data; in our analysis, peer-reviewed articles that describe programmes aiming to alter power relations to improve SRH constituted the data. We searched three databases, ultimately including 108 articles. We extracted the articles into a spreadsheet that included basic details about the paper and the programme, including what level of the social ecological model programme activities addressed. RESULTS The programmes reviewed reflect a diversity of priorities and approaches to addressing power, though most papers were largely based in a biomedical framework. Most programmes intervened at multiple levels simultaneously; some of these were 'structural' programmes that explicitly aimed to shift power relations, others addressed multiple levels using a more typical programme theory that sought to change individual behaviours and proximate drivers. This prevailing focus on proximate behaviours is somewhat mismatched with the broader literature on the power-related drivers of SRH health inequities, which explores the role of embedded norms and structures. CONCLUSION This paper adds value by summarising what the academic public health community has chosen to test and research in terms of power relations and SRH, and by raising questions about how this corresponds to the significant task of effecting change in power relations to improve the right to SRH.
Collapse
Affiliation(s)
- Marta Schaaf
- Independent Consultant, Brooklyn, New York, USA
- Department of Sexual and Reproductive Health and Research, WHO, Geneva, Switzerland
| | - Victoria Boydell
- School of Health and Social Care, University of Essex Faculty of Science and Health, Colchester, UK
| | - Stephanie M Topp
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Aditi Iyer
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Gita Sen
- Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | | |
Collapse
|
16
|
Mayra K, Sandall J, Matthews Z, Padmadas SS. Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India. BMC Pregnancy Childbirth 2022; 22:318. [PMID: 35421943 PMCID: PMC9009281 DOI: 10.1186/s12884-022-04503-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 02/01/2022] [Indexed: 11/29/2022] Open
Abstract
Background Evidence on obstetric violence is reported globally. In India, research shows that almost every woman goes through some level of disrespect and abuse during childbirth, more so in states such as Bihar where over 70% of women give birth in hospitals. Objective 1) To understand how women experience and attach meaning to respect, disrespect and abuse during childbirth; and 2) document women’s expectations of respectful care. Methods ‘Body mapping’, an arts-based participatory method, was applied. The analysis is based on in-depth interviews with eight women who participated in the body mapping exercise at their homes in urban slums and rural villages. Analysis was guided by feminist relational discourse analysis. Findings Women reported their experiences of birthing at home, public facilities, and private hospitals in simple terms of what they felt ‘good’ and ‘bad’. Good experiences included being spoken to nicely, respecting privacy, companion of choice, a bed to rest, timely care, lesser interventions, obtaining consent for vaginal examination and cesarean section, and better communication. Bad experiences included unconsented interventions including multiple vaginal examinations by different care providers, unanesthetized episiotomy, repairs and uterine exploration, verbal, physical, sexual abuse, extortion, detention and lack of privacy. Discussion The body maps capturing birth experiences, created through a participatory method, accurately portray women’s respectful and disrespectful births and are useful to understand women’s experience of a sensitive issue in a patriarchal culture. An in-depth understanding of women’s choices, experiences and expectations can inform changes practices in and policies and help to develop a culture of sharing birth experiences. Supplementary Information The online version contains supplementary material available at 10.1186/s12884-022-04503-7.
Collapse
|
17
|
Gélinas É, Mallé Samb O. [The impact of a humanized childbirth intervention on women's experience of care in Senegal]. SANTE PUBLIQUE (VANDOEUVRE-LES-NANCY, FRANCE) 2022; Vol. 33:695-704. [PMID: 35485126 DOI: 10.3917/spub.215.0695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Violence against women during institutional childbirth is recognized as a major barrier to the quality of care. In recent years, several countries have implemented interventions aimed at improving the childbirth experience of women through humanized care. However, the literature on the effectiveness of these interventions remains weak. PURPOSE OF RESEARCH The aim of this study is therefore to analyze the experience of care of women regarding the intervention of humanized childbirth in Senegal. Qualitative research based on a multiple case study was done. Three collection methods were used: observation, individual interview, and document analysis. Individual interview were carried out with 20 women. RESULTS In general, women who gave birth following the intervention appreciated their experience due to changes such as the opportunity to eat and drink, to be accompanied by a trusted person and to choose their position during childbirth. However, it was the way in which women were received at the health facility and the attitude of health professionals that were decisive in their level of satisfaction with care. Few women benefited from all the components of the intervention. The difficulties encountered in the implementation such as non-functional delivery rooms, the lack of qualified human resources and the lack of awareness of the intervention explain this. CONCLUSIONS Our results therefore suggest that improving the quality of care at birth, for a “humanized” (or natural, respectful) birth, is only possible when certain materials and medical conditions are met and prepared in advance, during the prenatal period.
Collapse
|
18
|
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.
Collapse
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
| | | | | |
Collapse
|
19
|
Loreto TM, Kuhn dos Santos JF, Nomura RMY. Understanding the opinion of doctors on obstetric violence in Brazil to improve women's care. Midwifery 2022; 109:103294. [DOI: 10.1016/j.midw.2022.103294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 10/19/2022]
|
20
|
Leite TH, Marques ES, Esteves-Pereira AP, Nucci MF, Portella Y, Leal MDC. Desrespeitos e abusos, maus tratos e violência obstétrica: um desafio para a epidemiologia e a saúde pública no Brasil. CIENCIA & SAUDE COLETIVA 2022; 27:483-491. [DOI: 10.1590/1413-81232022272.38592020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 01/29/2020] [Indexed: 11/22/2022] Open
Abstract
Resumo Estudos sobre desrespeitos e abusos/maus tratos/violência obstétrica durante gestação, parto e puerpério têm aumentado nas últimas décadas. Entretanto, os pesquisadores interessados na temática se deparam com muitas dificuldades teóricas e metodológicas. Nesse sentido, o objetivo do presente estudo consiste em discutir e refletir sobre como questões relacionadas a definição e terminologia, mensuração e políticas públicas no Brasil têm dificultado a pesquisa da temática, assim como a mitigação desses atos. O primeiro problema abordado foi a falta de consenso em relação a terminologia e definição desse construto. Essa situação provoca um efeito em cascata, com a utilização de instrumentos de aferição não validados que implicam falta de precisão e comparabilidade entre os estudos. Outra questão mencionada é a falta de estudos explorando as consequências desses atos na saúde da mulher e do recém-nascido, configurando uma das principais lacunas sobre o tema atualmente. A ausência de estudos causais impacta a tomada de decisão em saúde, prejudicando a elaboração de políticas públicas específicas.
Collapse
|
21
|
da Silva SS, Fortuna CM, Monceau G. Cesarean childbirth: an institutional socio-clinical study of the professional practices and discourses. Rev Lat Am Enfermagem 2021; 29:e3508. [PMID: 34816877 PMCID: PMC8616173 DOI: 10.1590/1518-8345.4756.3508] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 09/10/2021] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE to analyze how the social, historical, economic and professional elements influence the institutionalization process of cesarean childbirth in Brazil and France. METHOD a qualitative study grounded on the theoretical framework of the institutional socioclinic. The data were produced through focus groups and individual interviews, supported by semi-structured scripts, with health professionals, mothers and fathers and a research diary. The study had 83 participants. The analysis was based on the theoretical framework and thematic analysis. Cross analysis was developed between the different types of data, services and groups, as well as between countries. RESULTS the participants were characterized in terms of schooling, employment, level of training and workplace. The countries researched have their own peculiar health and educational structure and are marked by a social-historical-economic construction outlined by patriarchy. The New Public Management influences both contexts and makes health care precarious. The technical and organizational dimensions reinforce an intellectual and social division of work and knowledge in health. CONCLUSION the institutionalization process of childbirth in the countries is marked by social, economic and professional aspects. Practices and speeches of the professionals in their work process influence the occurrence, or not, of cesarean sections.
Collapse
Affiliation(s)
- Simone Santana da Silva
- Universidade do Estado da Bahia, Campus VII, Senhor do Bonfim,
Bahia, BA, Brazil
- Scholarship holder at the Programa de Apoio à Capacitação Docente e
de Técnicos Administrativos da Universidade do Estado da Bahia, Brazil
| | - Cinira Magali Fortuna
- Universidade de São Paulo, Escola de Enfermagem de Ribeirão Preto,
PAHO/WHO Collaborating Centre for Nursing Research Development, Ribeirão Preto, SP,
Brazil
| | | |
Collapse
|
22
|
da Silva Carvalho VK, da Silva EN, Barreto JOM. Public engagement in health technology assessment in Brazil: the case of the public consultation on National Clinical Guidelines for Care in Normal Birth. BMC Public Health 2021; 21:1825. [PMID: 34627182 PMCID: PMC8502292 DOI: 10.1186/s12889-021-11855-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Accepted: 09/24/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND There is a growing body of literature that recognizes the importance of public engagement in health technology assessment. However, there is still uncertainty regarding how the results should be recorded, analyzed, and used by decision makers. OBJECTIVE Synthesize the contributions of the Brazilian public (women, health professionals, managers, educational institutions, and companies) about the implementation of the National Clinical Guidelines for Care in Normal Birth from the public consultation carried out in Brazil. METHOD IRaMuTeQ software was used to organize and summarize the corpus based on three types of analysis: descriptive statistics; descending hierarchical classification; and specificities analysis. The public consultation was conducted in 2016 by the National Committee for Health Technology Incorporation (CONITEC) in the Brazilian public health system as part of the guideline development process. RESULTS The corpus consisted of 303 texts, separated into 1233 text segments, 1081 of which were used, corresponding to retention of 87.67%. Five classes emerged from our analyses: mandatory presence of an obstetrician during labor and delivery in hospital settings; barriers and facilitators for guideline implementation; use of evidence-based practices by health professionals; progression of labor and delivery and women's rights; and mobilization to promote the guideline For each class, the most frequent words and sentences with the highest chi-squared scores were presented. Barriers were associated with lack of financial resources, training and professional motivation, and facilitators with training to change the practices of health professionals. Obstetric nurses emerged as an alternative for supervising normal births as well as the mandatory presence of an obstetrician during childbirth in hospital settings. CONCLUSION Our findings summarize the contributions provided by the Brazilian public and shed some light on the barriers and facilitators of clinical guidelines for care in normal birth. These topics are not typically explored by quantitative studies. Including this information in the decision-making process would not only increase public engagement, but provide greater evidence for implementing the clinical guidelines nationwide.
Collapse
|
23
|
Fisseha S, Sen G, Ghebreyesus TA, Byanyima W, Diniz D, Fore HH, Kanem N, Karlsson U, Khosla R, Laski L, Mired D, Mlambo-Ngcuka P, Mofokeng T, Gupta GR, Steiner A, Remme M, Allotey P. COVID-19: the turning point for gender equality. Lancet 2021; 398:471-474. [PMID: 34280381 PMCID: PMC9752819 DOI: 10.1016/s0140-6736(21)01651-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 07/13/2021] [Indexed: 12/27/2022]
Affiliation(s)
| | - Gita Sen
- Public Health Foundation of India, Bangalore, India
| | | | - Winnie Byanyima
- Joint United Nations Programme on HIV/AIDS, Geneva, Switzerland
| | | | | | | | | | | | - Laura Laski
- Partnership for Maternal, Newborn & Child Health, New York, NY, USA
| | - Dina Mired
- Union for International Cancer Control, Amman, Jordan
| | | | - Tlaleng Mofokeng
- Office of the United Nations High Commissioner for Human Rights, Johannesburg, South Africa
| | | | - Achim Steiner
- United Nations Development Programme, New York, NY, USA
| | - Michelle Remme
- United Nations University International Institute for Global Health, UKM Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia
| | - Pascale Allotey
- United Nations University International Institute for Global Health, UKM Medical Centre, 56000 Cheras, Kuala Lumpur, Malaysia.
| |
Collapse
|
24
|
Zanchetta MS, Santos WS, Souza KVD, Pina VR, Hwu H, Stahl H, Argumedo-Stenner H, Osei-Boateng J, Zimmerman R, Pena ÉD, Cabral IE, Carvalho ALDO, Pereira AV, Vieira BDG, Alves VH, Felipe ICV, Guruge S, Amant OS, Costa E, Escobar HPVD. Ampliando vozes sobre violência obstétrica: recomendações de advocacy para enfermeira(o) obstetra. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivos explorar as demandas das mulheres, bem como do público em geral, para melhorar a qualidade da assistência obstétrica; discutir as mudanças potenciais sugeridas pelos respondentes para tal prática assistencial. Método pesquisa multicêntrica realizada por meio da plataforma Opinio, explorando opiniões dos participantes de três cidades da região Sudeste do Brasil. Tratamento dos dados por estatística descritiva e análise temática. Resultados respondentes (n=414) na faixa etária 33-37 anos (26%), incluindo mulheres (75%) com mais de 15 anos de escolaridade, casadas (45%) e com um filho (35%), revelaram lacuna de conhecimentos sobre a violência obstétrica e os direitos da mulher. Jornal, rádio e televisão são as principais fontes de informação. O enfrentamento da violência obstétrica dar-se-ia por apoio familiar. Para a práxis renovada sugeriu-se a educação coletiva sobre direitos aos cuidados obstétricos (53,1%) e o atendimento humanizado (38,2%) mobilizando o poder profissional para consolidar a humanização. Temas analíticos centrais incluíram situação vivenciada pelas mulheres e contexto idealizado de prática. Conclusão e Implicações para a prática o debate incrementa a humanização e a governança compartilhada. Recomendações propostas para advocacy coadunam com a perspectiva global da promoção de saúde das mulheres e liderança social.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Edwaldo Costa
- Ryerson University, Canada; Marinha do Brasil, Brasil
| | | |
Collapse
|
25
|
Hugues GM, Heilborn ML. “Cesárea? Não, Obrigada!”: ativismo em uma comunidade online na busca pelo parto normal no Brasil. CAD SAUDE PUBLICA 2021. [DOI: 10.1590/0102-311x00047620] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo: Este artigo visa a compreender a organização de uma comunidade online cujo objetivo é contribuir para a conquista do parto normal e humanizado entre mulheres de camadas médias. Realizou-se uma netnografia na comunidade Cesárea? Não, Obrigada! na rede social Facebook, cujas participantes são de diferentes partes do país. A análise enfoca a troca de saberes, apoio mútuo entre as participantes sobre o que denominam de processo de “empoderamento” e mudanças na relação médico/paciente. Categorizou-se quatro perfis de participantes: não iniciadas, iniciadas, paciente informada e profissional de saúde. Nas razões das usuárias para a busca de informações online alinham-se interesse pela autonomia de decisão, cuidado e humanização da assistência. A comunidade contribui para esse processo ao organizar, educar e fornecer ferramentas para transformar as participantes em pacientes informadas.
Collapse
|
26
|
Zanchetta MS, Santos WS, Souza KVD, Viduedo ADFS, Argumedo-Stenner H, Carrie D, Aviv F, Hwu H, Stahl H, Fofie V, d’Souza D, Oliva M, Tadeo J, Costa E, Vilela F, Carvalho A, Escobar HPVD, Felipe ICV. Reflexão metodológica sobre o trabalho de campo de pesquisa internacional multicêntrica Brasil-Canadá. ESCOLA ANNA NERY 2021. [DOI: 10.1590/2177-9465-ean-2020-0390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Resumo Objetivo Apresentar o resultado de uma reflexão metodologicamente estruturada sobre o caminho trilhado em todas as fases de uma pesquisa internacional no Brasil sobre a implementação do Programa de Humanização do Pré-natal e do Nascimento e seus atores sociais. Método Método reflexivo de pesquisa que conduz à percepção modificada de uma dada situação levando a novas ideias, com o potencial de revelar temas de análise e engendrar propostas de possíveis soluções com desenho de um plano de ação. O objeto das reflexões concentrou-se nas participações dos copesquisadores de um estudo etnográfico internacional, multidisciplinar e multicêntrico implantado em Junho/2019-Março/2020. Resultados As reflexões indicam sensibilidade sobre o tema e silêncio imposto em relação à violência obstétrica. Sob múltiplas manifestações da violência institucionalizada, constatou-se ações como resistência ao assunto na rede hospitalar, negligência e questionamentos distorcidos nos espaços políticos de autorização para a anuência institucional. A demora por comitê de ética colocando em risco o calendário de conclusão da condução da pesquisa, exigido por agência estrangeira de fomento. Conclusão e implicação para a prática A reflexão estruturada possibilitou um processo ímpar de aprendizagem para os copesquisadores navegando em distintas culturas universitárias e sociais de pesquisa.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Edwaldo Costa
- Ryerson University, Canadá; Marinha do Brasil, Brasil
| | - Francisco Vilela
- Sindicato dos Agentes Comunitários de Saúde do Estado do Rio de Janeiro, Brasil
| | - Andréa Carvalho
- Sindicato dos Agentes Comunitários de Saúde do Estado do Rio de Janeiro, Brasil
| | | | | |
Collapse
|
27
|
Diniz CSG, Bussadori JCDC, Lemes LB, Moisés ECD, Prado CADC, McCourt C. A change laboratory for maternity care in Brazil: Pilot implementation of Mother Baby Friendly Birthing Initiative. MEDICAL TEACHER 2021; 43:19-26. [PMID: 32672483 DOI: 10.1080/0142159x.2020.1791319] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Disrespectful and abusive treatment of women during childbirth is a worldwide problem. This research aimed to develop and implement a Mother Baby-Friendly Hospital Initiative (MBFHI) in an academic maternity hospital in Brazil and evaluate how change could be sustained. Change Laboratory principles guided a process of action research, which was conducted between 2017 and 2019. Clinicians and managers joined the researchers in discussion sessions to redesign routines and care pathways. Observation, interviews, focus groups, and historical and documentary analysis provided information about the existing activity system, which we analysed qualitatively using MBFHI criteria to identify themes. Evidence of inappropriate obstetric interventions and impersonal interactions between clinicians and patients stimulated us to devise innovative solutions. The challenges identified by this exercise included: poor infrastructure and ambience; difficulty adhering to evidence-based protocols; social and professional hierarchies; and clinicians being poorly educated about women's rights. Although challenges remained, positive changes included a friendlier environment, improved patient privacy, and fewer unnecessary procedures. Resources released by these changes allowed us, collaboratively, to track the further implementation and sustainability of change. We conclude that the Change Laboratory can help motivated clinicians and managers humanise patients' experiences, make care more evidence-based, and expand learning of mother-friendly maternity care. Tensions and contradictions between education and patient care reported here may resonate in settings other than maternity care.
Collapse
Affiliation(s)
| | | | | | - Elaine Christine Dantas Moisés
- Department of Gynecology & Obstetrics, Ribeirão Preto School of Medicine (FMRP), University of São Paulo, Ribeirão Preto, Brazil
| | | | | |
Collapse
|
28
|
Brenes Monge A, Fernández Elorriaga M, Poblano Verástegui O, Valdez Santiago R, Martínez Nolasco MA, Yáñez Álvarez I, Saturno Hernández PJ. Disrespect and Abuse in Obstetric Care in Mexico: An Observational Study of Deliveries in Four Hospitals. Matern Child Health J 2020; 25:565-573. [PMID: 33230682 DOI: 10.1007/s10995-020-03052-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION To identify and describe the frequency and characteristics of disrespect and abuse practices towards women during facility-based delivery in four hospitals in two Mexican states in 2017, using a mixed method of direct observation and women's reports of health care experiences. METHODS A cross-sectional study was performed to describe disrespect and abuse practices in obstetric care (interactions or conditions that are experienced as or intended to be humiliating or undignified) committed by healthcare providers. We included all pregnant women admitted for childbirth (vaginal and cesarean). Semi-structured interviews were also conducted with women, prior to discharge, regarding their experience at delivery. RESULTS 867 deliveries were observed. 18.8% of women (n = 163) experienced at least one disrespect and abuse event, especially at secondary care facilities. There were a total of 493 disrespect and abuse events, which, on average, represents three events per woman (39.4% were verbal abuse, 32% were physical abuse, and 28.6% were discrimination). In the majority of cases (> 50%), women did not give consent to not recommended invasive procedures and were not provided with adequate information to those procedures. CONCLUSIONS FOR PRACTICE Direct observation and interviews was a useful tool to identify disrespectful and abusive practices during delivery care. Our findings provide new evidence of the frequency and characteristics of disrespect and abuse during delivery care in Mexico, which can be used to inform maternal health programs. Additionally, these results encourage the creation of surveillance policies and committees in order to guarantee violence-free and dignified treatment of women during delivery care.
Collapse
Affiliation(s)
- Alexander Brenes Monge
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - María Fernández Elorriaga
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico.
| | - Ofelia Poblano Verástegui
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Rosario Valdez Santiago
- Centro de Investigación en Sistemas de Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Manuel A Martínez Nolasco
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Iraís Yáñez Álvarez
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Pedro J Saturno Hernández
- Centro de Investigación en Evaluación y Encuestas, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| |
Collapse
|
29
|
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.
Collapse
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.)
| |
Collapse
|
30
|
Ma X, Marinos J, De Jesus J, Lin N, Sung CY, Vervoort D. Human rights-based approach to global surgery: A scoping review. Int J Surg 2020; 82:16-23. [PMID: 32828980 DOI: 10.1016/j.ijsu.2020.08.004] [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: 04/28/2020] [Revised: 07/30/2020] [Accepted: 08/05/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health is a basic human right, yet surgery remains a neglected stepchild of global health. Worldwide, five billion people lack access to safe, timely, and affordable surgical and anesthesia care when needed. This disparity results in over 18 million preventable deaths each year and is responsible for one-third of the global burden of disease. Here, we evaluate the role of surgical care in protecting human rights and attempt to make a human rights argument for universal access to safe surgical care. MATERIAL AND METHODS A scoping review was done using the PubMed/MEDLINE, Embase, and Scopus databases to identify articles evaluating human rights and disparities in accessing surgical care globally. A conceptual framework is proposed to implement global surgical interventions with a human rights-based approach. RESULTS Disparities in accessing surgical care remain prevalent around the world, including but not limited to gender inequality, socioeconomic differentiation, sexual stigmatization, racial and religious disparities, and cultural beliefs. Lack of access to surgery impedes lives in full health and economic prosperity, and thus violates human rights. Our normative framework proposes human rights principles to make surgical policy interventions more inclusive and effective. CONCLUSION Acknowledging human rights in the provision of surgical care around the world is critical to attain and sustain the Sustainable Development Goals and universal health coverage. National Surgical, Obstetric, and Anesthesia Planning and wider health systems strengthening require the integration of human rights principles in developing and implementing policy interventions to ensure equal and universal access to comprehensive health care services.
Collapse
Affiliation(s)
- Xiya Ma
- Faculty of Medicine, University of Montreal, 2900, Boul. Edouard-Montpetit, Montreal, QC, H3T 1J4, Canada.
| | - John Marinos
- Faculty of Medicine and Health Sciences, University of Sherbrooke, 3001 12 Ave N, Sherbrooke, QC, J1H 5H3, Canada
| | - Jana De Jesus
- St. George's University School of Medicine, University Centre Grenada, West Indies, Grenada
| | - Nicole Lin
- Miller School of Medicine, University of Miami, 1600 NW 10th Ave #1140, Miami, FL, 33136, United States
| | - Chia-Yen Sung
- Chung Shan Medical University, No. 110, Section 1, Jianguo North Road, South District, Taichung City, 402, Taiwan
| | - Dominique Vervoort
- Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St Suite E8527, Baltimore, MD, 21205, United States
| |
Collapse
|
31
|
Lamy ZC, Gonçalves LLM, Carvalho RHDSBFD, Alves MTSSDBE, Koser ME, Martins MDS, Leal NP, Thomaz EBAF. Labor and childbirth care in maternity facilities in Brazil's North and Northeast regions: perceptions of the evaluators of the Stork Network Program. CIENCIA & SAUDE COLETIVA 2020; 26:951-960. [PMID: 33729350 DOI: 10.1590/1413-81232021263.26572020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 07/31/2020] [Indexed: 11/21/2022] Open
Abstract
This article eevaluates delivery and birth care practices in maternity facilities in Brazil's North and Northeast regions. We conducted a qualitative evaluation of 91 facilities in the North and 181 facilities in the Northeast. The data was collected using systematic observation by a team of 44 previously trained evaluators and recorded in a field diary. A thematic analysis of the collected data was performed, resulting in three core themes: challenges of collegial management; challenges for coping with obstetric violence; and the potential of the evaluation process for driving change. Advances were made in the implementation of good labor and childbirth care practices; however, some maternity facilities still reproduce hierarchical models without spaces for collegial management and accounts of obstetric violence were common. Health professionals used the presence of risk to justify the low level of adoption of good practices. However, the findings reveal progress towards the humanization of care. The results also show the potential of the evaluation process for driving change. Although progress has been made towards the adoption of the good practices recommended by the Stork Network Program both in the area of management and care delivery, many challenges remain in view of the dominance of a hierarchical management model associated with an interventionist approach to health care.
Collapse
Affiliation(s)
- Zeni Carvalho Lamy
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Laura Lamas Martins Gonçalves
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | | | | | - Maria Eduarda Koser
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Matheus de Sousa Martins
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| | - Neide Pires Leal
- Escola Nacional de Saúde Pública, Fiocruz. Rio de Janeiro RJ Brasil
| | - Erika Barbara Abreu Fonseca Thomaz
- Programa de Pós-Graduação em Saúde Coletiva, Departamento de Saúde Pública, Universidade Federal do Maranhão. R. Barão de Itapary 155, Centro. 65020-070 São Luís MA Brasil.
| |
Collapse
|
32
|
Sen G, Iyer A, Chattopadhyay S, Khosla R. When accountability meets power: realizing sexual and reproductive health and rights. Int J Equity Health 2020; 19:111. [PMID: 32635915 PMCID: PMC7341588 DOI: 10.1186/s12939-020-01221-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 06/15/2020] [Indexed: 11/17/2022] Open
Abstract
This paper addresses a critical concern in realizing sexual and reproductive health and rights through policies and programs - the relationship between power and accountability. We examine accountability strategies for sexual and reproductive health and rights through the lens of power so that we might better understand and assess their actual working. Power often derives from deep structural inequalities, but also seeps into norms and beliefs, into what we 'know' as truth, and what we believe about the world and about ourselves within it. Power legitimizes hierarchy and authority, and manufactures consent. Its capillary action causes it to spread into every corner and social extremity, but also sets up the possibility of challenge and contestation.Using illustrative examples, we show that in some contexts accountability strategies may confront and transform adverse power relationships. In other contexts, power relations may be more resistant to change, giving rise to contestation, accommodation, negotiation or even subversion of the goals of accountability strategies. This raises an important question about measurement. How is one to assess the achievements of accountability strategies, given the shifting sands on which they are implemented?We argue that power-focused realist evaluations are needed that address four sets of questions about: i) the dimensions and sources of power that an accountability strategy confronts; ii) how power is built into the artefacts of the strategy - its objectives, rules, procedures, financing methods inter alia; iii) what incentives, disincentives and norms for behavior are set up by the interplay of the above; and iv) their consequences for the outcomes of the accountability strategy. We illustrate this approach through examples of performance, social and legal accountability strategies.
Collapse
Affiliation(s)
- Gita Sen
- Distinguished Professor and Director, Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | - Aditi Iyer
- Senior Research Scientist, Ramalingaswami Centre on Equity and Social Determinants of Health, Public Health Foundation of India, Bangalore, India
| | | | - Rajat Khosla
- Human Rights Advisor for the Human Reproduction Programme at the World Health Organization, Geneva, Switzerland
| |
Collapse
|
33
|
Katz L, Amorim MM, Giordano JC, Bastos MH, Brilhante AVM. Who is afraid of obstetric violence? REVISTA BRASILEIRA DE SAÚDE MATERNO INFANTIL 2020. [DOI: 10.1590/1806-93042020000200017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Abstract Despite being a relatively new term, obstetric violence is an old problem. In 2014, the World Health Organization declared: “Many women experience disrespectful and abusive treatment during childbirth in facilities worldwide. Such treatment not only violates the rights of women to respectful care, but can also threaten their rights to life, health, bodily integrity, and freedom from discrimination”. This problem, named as “abuse”, “disrespect” and/or “mistreatment” during childbirth, has been addressed in several studies. However, there has been no consensus on how to properly name this problem, although its typology has been well described. Considering the magnitude of this problem, it is essential to give the correct terminology to this important health and human rights issue. Naming it as obstetric violence and understanding it as gender-based violence will ensure appropriate interventions to avert this violation of women's rights.
Collapse
Affiliation(s)
- Leila Katz
- Rede Feminista de Ginecologistas e Obstetras, Brazil
| | | | | | | | | |
Collapse
|
34
|
Mena-Tudela D, González-Chordá VM, Soriano-Vidal FJ, Bonanad-Carrasco T, Centeno-Rico L, Vila-Candel R, Castro-Sánchez E, Cervera Gasch Á. Changes in health sciences students' perception of obstetric violence after an educational intervention. NURSE EDUCATION TODAY 2020; 88:104364. [PMID: 32120084 DOI: 10.1016/j.nedt.2020.104364] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/18/2019] [Accepted: 02/07/2020] [Indexed: 06/10/2023]
Abstract
BACKGROUND Obstetric violence is a type of gender-based violence that is presented structurally. This type of violence has physical and psychological consequences for both the women who experience it and health professionals. The World Health Organization adds that health professionals need training to ensure that pregnant women are treated with compassion and dignity. OBJECTIVES The objective of the study was to evaluate health sciences students' perception of obstetric violence and to identify possible changes after an educational intervention. DESIGN A pre-post quasi-experimental study was carried out between January and June 2019. SETTINGS AND PARTICIPANTS Students of medicine and nursing from Jaume I University (Universitat Jaume I) (Spain). METHODS An ad hoc scale comprising 33 items was designed to measure the students' perceptions. In addition, sociodemographic and control variables were collected. Descriptive analyses of the sample and the scale were carried out, and a bivariate analysis was performed. RESULTS Of the students surveyed, 89.7% were women, and the majority was nursing students. Of the 33 items, 28 (84.84%) showed statistically significant changes in the pre-post-intervention measurement. Twenty-five of the 33 items (75.75%) showed a relationship with the sociodemographic variables of gender, field, course and ever having been pregnant. CONCLUSION This study shows the change in health sciences students' perceptions of obstetric violence after an educational intervention. In addition, the normalization of this type of violence was observed with the progression of training and with personal obstetric experience.
Collapse
Affiliation(s)
| | | | - Francisco Javier Soriano-Vidal
- Nursing Department, Universidad de Valencia, Spain; Department of Obstetrics and Gynecology, Hospital Lluis Alcanyis, Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain
| | | | | | - Rafa Vila-Candel
- Nursing Department, Universidad de Valencia, Spain; Department of Obstetrics and Gynecology, Hospital Universitario de la Ribera, Foundation for the Promotion of Health and Biomedical Research in the ValencianRegion (FISABIO), Valencia, Spain
| | - Enrique Castro-Sánchez
- National Institute for Health Research, Health Protection Research Unit (NIHRHPRU) in Healthcare-Associated Infection and Antimicrobial Resistance, Imperial College, London, United Kingdom
| | | |
Collapse
|
35
|
Morton CH, Simkin P. Can respectful maternity care save and improve lives? Birth 2019; 46:391-395. [PMID: 31273848 DOI: 10.1111/birt.12444] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Accepted: 06/09/2019] [Indexed: 01/17/2023]
|
36
|
Kismödi E, Ferguson L. Celebrating the 70th anniversary of the UDHR, celebrating sexual and reproductive rights. REPRODUCTIVE HEALTH MATTERS 2018. [DOI: 10.1080/09688080.2018.1550239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Affiliation(s)
- Eszter Kismödi
- Chief Executive, Reproductive Health Matters, London, UK
| | - Laura Ferguson
- Assistant Professor and Associate Director, Program on Global Health and Human Rights, Institute for Global Health, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|