Reframing goals and strategies for delivering humanized obstetric care in Brazil

Abstract

Introduction: Despite the long-lasting efforts to promote the quality of obstetric care, Brazil requires robust changes in the care practices throughout the prenatal-labour-postpartum continuum. The ongoing National Program for the Humanization of Prenatal and Childbirth (PHPN) efforts address the fight against obstetric violence (OV), the improvement in the quality of obstetric care, but its implementation has faced obstacles and difficulties, such as responding to cultural values and operating with a weak infrastructure. This research explored Brazilian health and social service professionals’ perceptions of the PHPN’s recommendations regarding innovation, policy and practice changes necessary to respect women’s human rights to receive a high quality, dignifying obstetric care. Methods: An online multi-site survey in which data were collected (Jun 2019-Mar 2020) from health professionals working in the public health system in Brazil. Data analysis used descriptive statistics and thematic analysis. Analytical themes were Perceptions of Program effectiveness to minimize obstetric violence and Program’s gaps, inadequacies and needed changes. Results: Respondents (n=369) disclosed their perceptions about the Program’s nature, utility, and gaps towards an improved implementation. Key issues were rooted in the outdated university education, reduced accountability, and governance in services’ management; unfavourable work conditions and climate; professional power-imbalance; population’s lack of information about the Program; underutilization of obstetric nurses’ and midwives’ skills; neglect of professional development; no denunciation & re-education, and culture of quality improvement. Conclusions: Firmness, hope and determination will be needed to transform society’s culture of silence about OV, awakening the public awareness and mobilizing to enhance collective health and political literacy to ensure professional accountability while protecting women and newborns. There is a need for a realignment of work processes, an investment in professional education, and education within women’s social networks for women to become partners in the active process of improvement of quality of obstetric care.