Violência obstétrica e o papel da enfermagem na promoção de um parto humanizado

Objective: The present article is aimed to analyse the phenomenon of obstetric violence as a type of violation of women’s human rights. A great incidence of physical, sexual and psychological offenses against women during pregnancy, childbirth and the puerperium committed by healthcare workers has been documented worldwide. Labelled as ‘obstetric violence’, this offence has been understood as a specific type of human rights violation that hampers women's sexual and reproductive rights and is committed in both public and private healthcare facilities, as well as from poor health system conditions. Nevertheless, obstetric violence is still a poorly understood phenomenon. This article will analyse how obstetric violence has been defined, measured and understood by specialists, by focusing on its concept, formats, and consequences for victims, as well as on the contributing factors that influence its occurrence. Methodology: The applied methodology was the qualitative method through documentary studies, in which primary sources and English, Spanish and Portuguese-language research publications from different fields of study were used, including public health, public international law, and human rights. Results: The paper concludes by suggesting how the international human rights framework can be used to better address obstetric violence. The Convention on the Elimination of all Forms of Discrimination against Women and the Inter-American Convention on the Prevention, Punishment and Eradication of Violence against Women are key treaties that establish for States Parties the obligation to pursue, by all appropriate means and without delay, a policy of eliminating discrimination and gender-based violence against women, including in the field of health. Contribution: The article has as contribution the exposure a little-known subject about obstetric violence as a type of violation of women's human rights.

Understanding the opinion of doctors on obstetric violence in Brazil to improve women's care

Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study

Programme synopsis

ABSTRACTIn Latin America, over the past decade, the term “obstetric violence” has become part of the legal framework. Specific laws against obstetric violence – gender-based violence and the violation of human rights – exist in Venezuela, Argentina, Mexico, Brazil and Uruguay. In Europe, the issue is raised by human rights organizations, social movements and academics, but no country has yet passed legislation on the matter. In this article, I focus on the contribution of Argentina to this international debate, particularly with respect to the implementation of the Obstetric Violence Observatory.

Obstetric violence has not received the same amount of interest as other forms of violence against women (VAW). We assess the prevalence and factors associated with experiences of obstetric violence (obstetric abuse and violence, and nonconsensual care) among women between 15 and 49 years of age in their latest childbirth within the last 5 years by using the 2016 National Survey on Household Relationship Dynamics. (N = 24,126 women). A total of 33.3% of Mexican women experienced obstetrical violence in their last childbirth: 23.6% experienced obstetric abuse and violence and 17.1% nonconsensual care. Gender interacts with other social stratification variables. Obstetric violence is an extended practice in health care services. It is a human rights problem that must be prevented and eradicated.

Obstetric violence refers to certain practices and behaviors carried out by health professionals towards women that belittle, violate and oppress them during pregnancy, childbirth and puerperium, whether in public or private settings. This type of violence is interpreted as a form of gender discrimination and represents a violation of human rights that has a direct impact on women's mental well-being. It manifests itself mainly as an inequality of power between healthcare professionals and pregnant women, whether during childbirth or the puerperium. The World Health Organization has stressed the importance of eliminating these harmful medical practices, urging medical personnel to react appropriately through dialogue and support for pregnant women. A nationally representative sample of women aged 12 years and older from the 2018 National Health and Nutrition Survey was used. Multicollinearity tests were used to avoid redundant information in the models. Next, we used factor analysis to generate an index of obstetric violence and performed linear regressions to observe the correlation between obstetric violence and mental well-being of women in our sample. Finally, we addressed the heterogeneity observed in the proposed relationship by using quantile regression techniques to disentangle the heterogeneous relationship in the distribution of mental well-being and obtain correlation coefficients, with their 95% confidence intervals (95% CI). Based on our findings, we highlight the urgent need to raise awareness and sensitize health professionals about this specific problem, since our main result indicates that there is a misleading correlation between obstetric violence and women's mental well-being. It is crucial to modify those health practices that violate women's rights. Another significant measure to improve the current situation would be the implementation of programs that give visibility to gender violence in the health sector, as well as the promotion of research focused on obstetric violence and the implementation of interventions that strengthen the autonomy of users.

Introduction: Obstetric violence is a major silent and silenced violation of human rights, affecting women’s sexual and reproductive health worldwide. This issue is discussed in this research by portraying the Angolan context, where inhumane practices in health services during pregnancy, childbirth, and the postpartum period by healthcare professionals have been common. Therefore, the study sought to understand how obstetric violence impacts the dignity, autonomy, and human rights of Angolan women, on the one hand, and, on the other, the National Health System (NHS). Methods applied to the research: A qualitative methodology with an exploratory-descriptive approach was used for this study, relying on semi-structured interviews with women and bibliographic research, which consisted of reviewing existing literature on the topic under study. Research results: The results indicate that obstetric violence manifests through practices such as verbal and physical assaults, psychological abuse, inadequate medical follow-up, lack of communication and of free and informed consent in decision-making about any medical procedures performed on women’s bodies, and the denial of companions during childbirth. These practices are often naturalized/normalized and institutionalized in health services. Discussion: The discussion emphasizes the need to reverse this situation through public policies that ensure truly humanized and respectful treatment for women, suggesting that the culture of impunity in institutions must be challenged so that healthcare professionals who commit violence in hospitals are held accountable. Conclusion: It was concluded that obstetric violence is a global public health problem and an alarming reality in Angola that demands immediate attention. Promoting a culture of respect and dignity in health services through the training of professionals, as well as fostering debate about women’s multiple rights within institutions, is crucial to ensure that human rights including women’s rights to health, sexuality, reproduction, equality, and opportunity are truly respected and protected.

Joint response from Latin American, European Obstetric Violence Observatories and others organizations all over Europe to the Joint Position Statement on Substandard and Disrespectful Care in Labour – Because Words Matter

BackgroundThis study explored how gender inequalities in health systems influence women’s experiences of obstetric violence in Ghana. Obstetric violence is recognised as a major public health concern and human rights violation. In particular, it reduces women’s trust and use of health facilities for childbirth, thereby increasing the risks of maternal and neonatal mortality. In Ghana, obstetric violence is pervasive and normalised; yet, little is known about the gendered dynamics of this phenomenon.MethodologyA qualitative study was conducted in eight public health facilities in Ghana. Specifically, semi-structured interviews were conducted with 30 midwives who work in the maternity units and 35 women who have utilised the obstetric services of the hospitals for childbirth. The midwives and women were selected using the purposive sampling technique. The transcripts of the interviews were coded using NVivo qualitative data analysis software and were thematically analysed. Secondary materials such as existing data on the medical profession in Ghana were utilised to complement the primary data.ResultsThe study revealed that there are huge structural inequalities that keep women at the lower cadres of the health system. Five major themes depicting how gender inequalities contribute to women’s experiences of obstetric violence emerged: gender inequality in the medical profession, unequally and heavily tasked, feminisation of midwifery, patriarchal pressures and ideologies, and gender insensitivity in resource provision. These inequalities impact the kind of care midwives provide, which is often characterised by mistreatment and abuse of women during childbirth. The study also discovered that patriarchal ideologies about women and their bodies lead to power and control in the delivery room and violence has become a major instrument of domination and control.ConclusionThe hierarchical structure of the healthcare profession puts the midwifery profession in a vulnerable position, with negative consequences for maternity care (obstetric violence). The study recommends that gender-responsive approaches that address structural inequalities in health systems, women’s empowerment over their bodies and male involvement in women’s reproductive care are crucial in dealing with obstetric violence in Ghana.

ABSTRACTObjective:to analyze the scientific production on obstetric violence by identifying and discussing its main characteristics in the routine care for the pregnant-puerperal cycle. Method:integrative literature review of 24 publications indexed in the Cumulative Index to Nursing and Allied Health Literature, Medical Literature Analysis and Retrieval System Online, SciVerse Scopus, Web of Science and the Scientific Electronic Library Online and Virtual Health Library. Results:the publications are intensified from 2015 onwards and present methodological designs of quantitative and qualitative nature. In the discussion, we first address the concept of obstetric violence and its different forms of occurrence in care. Then, interfaces of the phenomenon are presented with reflections related to the conception of gender, the different actors involved, the institutionalization, and the invisibility and trivialization of the event. Finally, strategies to combat the problem are presented through academic training, women’s awareness, proposals of social mobilization, and creation of public policies and laws. Conclusion:obstetric violence portrays a violation of human rights and a serious public health problem and is revealed in the form of negligent, reckless, omissive, discriminatory and disrespectful acts practiced by health professionals and legitimized by the symbolic relations of power that naturalize and trivialize their occurrence.

Service members and veterans (SM/Vs) with posttraumatic stress disorder (PTSD) can receive significant benefits from social support by a spouse or romantic partner. However, little is known about how providing support impacts partners. This study sought to identify (a) how provision of support is associated with partners' daily negative and positive affect and (b) how SM/Vs' PTSD symptom severity might moderate such associations. In a 14-day daily-diary study that assessed 64 couples in which one member was an SM/V with PTSD symptoms, partners reported nightly on whether or not they provided instrumental support and/or emotional support that day as well as their current negative and positive affect. Multilevel modeling showed that the provision of emotional and instrumental support were both significantly related to partners' lower levels of negative affect, f 2 = 0.09, and higher levels of positive affect, f 2 = 0.03, on that same day but not the next day. The positive same-day effects were seen if any support was given, with no additive effects when both types of support were provided. Severity of SM/V PTSD moderated the association between provision of emotional support and lower same-day negative affect such that the association was significant only when PTSD symptoms were more severe. Overall, these findings indicate that support provision to a partner with PTSD is associated with improved affect for the romantic partner providing support. However, given that only same-day affect was associated with support, the findings may also suggest that positive affect increases the provision of support.

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.

BackgroundEvidence suggests that obstetric violence has been prevalent globally and is finally getting some attention through research. This human rights violation takes several forms and is best understood through the narratives of embodied experiences of disrespect and abuse from women and other people who give birth, which is of utmost importance to make efforts in implementing respectful maternity care for a positive birthing experience. This study focused on the drivers of obstetric violence during labor and birth in Bihar, India.MethodsParticipatory qualitative visual arts‐based method of data collection—body mapping‐assisted interviews (adapted as birth mapping)—was conducted to understand women's perception of why they are denied respectful maternity care and what makes them vulnerable to obstetric violence during labor and childbirth. This study is embedded in feminist and critical theories that ensure women's narratives are at the center, which was further ensured by the feminist relational discourse analysis. Eight women participated from urban slums and rural villages in Bihar, for 2–4 interactions each, within a week. The data included transcripts, audio files, body maps, birthing stories, and body key, which were analyzed with the help of NVivo 12.FindingsWomen's narratives suggested drivers that determine how they will be treated during labor and birth, or any form of sexual, reproductive, and maternal healthcare seeking presented through the four themes: (1) “I am admitted under your care, so, I will have to do what you say”—Influence of power on care during childbirth; (2) “I was blindfolded … because there were men”—Influence of gender on care during childbirth; (3) “The more money we give the more convenience we get”—Influence of structure on care during childbirth; and (4) “How could I ask him, how it will come out?”—Influence of culture on care during childbirth. How women will be treated in the society and in the obstetric environment is determined by their identity at the intersections of age, class, caste, marital status, religion, education, and many other sociodemographic factors. The issues related to each of these are intertwined and cross‐cutting, which made it difficult to draw clear categorizations because the four themes influenced and overlapped with each other. Son preference, for example, is a gender‐based issue that is part of certain cultures in a patriarchal structure as a result of power‐based imbalance, which makes the women vulnerable to disrespect and abuse when their baby is assigned female at birth.DiscussionSensitive unique feminist methods are important to explore and understand women's embodied experiences of trauma and are essential to understand their perspectives of what drives obstetric violence during childbirth. Sensitive methods of research are crucial for the health systems to learn from and embed women's wants, to address this structural challenge with urgency, and to ensure a positive experience of care.

A qualitative study of women's experiences with obstetric violence during childbirth in Turkey