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Violence against Women in Health-Care Institutions: An Emerging Problem
Abstract
Maternal morbidity and mortality in childbirth is a matter of utmost importance in public health. In this article, we argue that part of the problem lies in violence committed by health workers in childbearing or abortion services, which affects health-service access, compliance, quality, and effectiveness. We analysed rigorous research from the past decade and discuss four forms of violent abuse by doctors and nurses: neglect and verbal, physical, and sexual abuse. These forms of violence recur, are often deliberate, are a serious violation of human rights, and are related to poor quality and effectiveness of health-care services. This abuse is a means of controlling patients that is learnt during training and reinforced in health facilities. Abuse occurs mainly in situations in which the legitimacy of health services is questionable or can be the result of prejudice against certain population groups. We discuss ways to prevent violent abuse.
... São descritas situações de abandono https://doi.org/10.17566/ciads.v12i1.990 dentro de instituições de saúde ou de agressões físicas ou verbais associadas ao atendimento por profissionais de saúde (18). ...
... No outro extremo, as situações de agressão física ou verbal, descritas por muitas pacientes, caracterizam intencionalidade, ou seja, não é um erro ou um descuido, mas sim ações deliberadas e inadequadas (18). Essas situações devem ser coibidas pelas instituições e pela própria sociedade, por meio do seu enquadramento deontológico e legal, quando devidamente estabelecido (19). ...
... O dolo é caracterizado pela intencionalidade. São conhecidos casos de abusos sexuais praticados durante a realização de exames e procedimentos, que podem ser caracterizados por manipulações indevidas, por exemplo (18). Essas situações de dolo são agressões e como tal devem ser tratadas. ...
Objetivo: discutir diferentes abordagens éticas, na perspectiva do Modelo Bioética Complexa (MBC), sobre as questões da saúde da mulher. O MBC é uma reflexão que tem por finalidade verificar a adequação das ações envolvidas com os aspectos biológicos e biográficos, em uma perspectiva interdisciplinar, amparada por referenciais teóricos diversos e considerando também situações individuais e sociais. Metodologia: revisão narrativa de literatura, considerando múltiplas perspectivas bioéticas e éticas em relação aos temas de saúde da mulher. Resultados: os resultados de pesquisa envolvem a referência de 37 textos e considerações dos autores, fruto de pesquisas envolvendo o MBC há mais de 17 anos, em ambiente de saúde. Conclusão: a reflexão da adequação de avaliações e decisões na área da saúde da mulher deve envolver uma multiplicidade de aspectos e perspectivas, neste sentido é necessário que está visão complexa permeie o desenho de políticas de assistência à saúde.
Submissão: 21/12/22 | Aprovação: 09/02/23
... Existen suficiente evidencia que indica que la VO tiene un profundo impacto en la salud física y psíquica de las mujeres (22)(23)(24)(25), ya que muchas de las prácticas que se consideran VO redundan en incisiones y cortes en el cuerpo que alteran la fisonomía, dejan marcas y cicatrices, y pueden derivar en relaciones sexuales dolorosas, incontinencia urinaria, problemas de autoestima y depresión, entre otros (13,24,25). Para muchas de las mujeres, la atención ginecológica puede llegar a constituir una experiencia traumática, ya que en ella se establece una relación asimétrica y donde las retóricas del cuidado (10,22) hacen que el daño infringido por quienes se suponen que deberían cuidarlas pueda llegar a tener un efecto más profundo. ...
... Existen suficiente evidencia que indica que la VO tiene un profundo impacto en la salud física y psíquica de las mujeres (22)(23)(24)(25), ya que muchas de las prácticas que se consideran VO redundan en incisiones y cortes en el cuerpo que alteran la fisonomía, dejan marcas y cicatrices, y pueden derivar en relaciones sexuales dolorosas, incontinencia urinaria, problemas de autoestima y depresión, entre otros (13,24,25). Para muchas de las mujeres, la atención ginecológica puede llegar a constituir una experiencia traumática, ya que en ella se establece una relación asimétrica y donde las retóricas del cuidado (10,22) hacen que el daño infringido por quienes se suponen que deberían cuidarlas pueda llegar a tener un efecto más profundo. Se trataría de un tipo de trauma relacional (26) que opera mediante la falta de reconocimiento y la invisibilización de las mujeres. ...
... Manifestations of disrespect and abuse during pregnancy and childbirth can be varied, with emphasis on pilgrimages to various services in the search for care, mistreatment of women and their companions by professionals, and lack of appropriate material for childbirth and assistance to the newborn. 1,2,6,8 There are also other forms of disrespect and abuse, such as cesarean sections without medical indication, use of practices not supported by scientific evidence and nonconsensual sterilization. 8 Difficulty in accessing and low quality of reproductive health services related to economic, geographic, and cultural aspects are also common forms of structural violence during childbirth, often linked to other types of maltreatment in health institutions. ...
... 8 Difficulty in accessing and low quality of reproductive health services related to economic, geographic, and cultural aspects are also common forms of structural violence during childbirth, often linked to other types of maltreatment in health institutions. 8,9 There is great heterogeneity in the terminology used for abuse during childbirth in health institutions, such as "obstetric violence," "institutional violence," and "disrespect and abuse." 10 In 2010, Bowsen and Hill proposed seven broad categories to measure institutional obstetric violence: lack of confidentiality, nonconsented care, physical abuse, neglect, institutional detention, undignified care, and discriminatory care. 11 Although these categories served as a conceptual basis for the WHO document, 6 some limitations have been pointed out, such as the lack of operational definitions and the difficulty in differentiating between situations arising from individual behavior and structural deficiencies in the health system. ...
Objectives
To assess the prevalence and associated factors of disrespect and abuse during childbirth in Piauí, Brazil.
Methods
A cross‐sectional study was performed with 698 postpartum women in 21 maternity hospitals in 14 municipalities between August 2018 and September 2019. Face‐to‐face interviews were performed at least 6 h after birth, with an assessment of disrespect and abuse during childbirth. Robust Poisson regression was used, with calculation of the adjusted prevalence ratio (aPR) and 95% confidence intervals (95% CIs).
Results
There was evidence that 19.8% of women experienced at least one type of disrespect and abuse during childbirth, with verbal abuse (12.6%), noncompliance with professional standards (11.6%), and health service restrictions being more common (8.3%). There was an association of disrespect and abuse during childbirth with women aged 10 to 19 years (aPR, 1.97; 95% CI, 1.58–2.44), absence of companions (aPR, 2.43; 95% CI, 1.85–2.89), cesarean sections after labor (aPR, 2.19; 95% CI, 1.64–3.59), public hospitals (aPR, 1.87; 95% CI, 1.42–2.85), and in the countryside (aPR, 2.29; 95% CI, 1.81–3.98).
Conclusion
There was a high prevalence of disrespect and abuse during childbirth in Piauí, Brazil, associated with structural conditions of the services, care practices, and characteristics of women.
... Existen suficiente evidencia que indica que la VO tiene un profundo impacto en la salud física y psíquica de las mujeres (22)(23)(24)(25), ya que muchas de las prácticas que se consideran VO redundan en incisiones y cortes en el cuerpo que alteran la fisonomía, dejan marcas y cicatrices, y pueden derivar en relaciones sexuales dolorosas, incontinencia urinaria, problemas de autoestima y depresión, entre otros (13,24,25). Para muchas de las mujeres, la atención ginecológica puede llegar a constituir una experiencia traumática, ya que en ella se establece una relación asimétrica y donde las retóricas del cuidado (10,22) hacen que el daño infringido por quienes se suponen que deberían cuidarlas pueda llegar a tener un efecto más profundo. ...
... Existen suficiente evidencia que indica que la VO tiene un profundo impacto en la salud física y psíquica de las mujeres (22)(23)(24)(25), ya que muchas de las prácticas que se consideran VO redundan en incisiones y cortes en el cuerpo que alteran la fisonomía, dejan marcas y cicatrices, y pueden derivar en relaciones sexuales dolorosas, incontinencia urinaria, problemas de autoestima y depresión, entre otros (13,24,25). Para muchas de las mujeres, la atención ginecológica puede llegar a constituir una experiencia traumática, ya que en ella se establece una relación asimétrica y donde las retóricas del cuidado (10,22) hacen que el daño infringido por quienes se suponen que deberían cuidarlas pueda llegar a tener un efecto más profundo. Se trataría de un tipo de trauma relacional (26) que opera mediante la falta de reconocimiento y la invisibilización de las mujeres. ...
Objetivo
El objetivo del presente artículo es reportar los resultados de la primera encuesta sobre violencia obstétrica en Chile, de modo de hacer visible una realidad más frecuente de lo que creemos y comparar su ocurrencia según tipo de servicio (público o privado) en que se ha atendido el parto.
Métodos
Se trata de un estudio descriptivo y de tipo transversal conducido entre los meses de diciembre de 2019 y mayo de 2020. La muestra quedó compuesta por 2105 mujeres de todas las regiones de Chile.
Resultados
Los análisis de los datos indican que un 79,3% de las mujeres cree haber experimentado alguna forma de violencia obstétrica. A pesar de la gran cantidad de informes de violencia en centros de salud públicos y privados, se detectan diferencias estadísticas significativas entre ambos, y son más frecuentes en los centros públicos. Del mismo modo, se detectan más informes de violencia obstétrica en mujeres jóvenes (18-29 años), en quienes se identifican con pueblos originarios y entre quienes tienen una orientación sexual no heterosexual.
Conclusiones
La violencia obstétrica es parte del continuo de violencia hacia las mujeres e informada de modo sistemático por quienes atienden sus partos tanto en servicios públicos como privados de salud. Es una forma de violencia tiene graves consecuencias en las mujeres debido tanto a la posición del equipo médico y a la relevancia del evento de parto en la vida de cualquier mujer.
... Por último, a violência sexual se caracteriza pelo assédio sexual e pelo estupro (D'Oliveira; Diniz;Schraiber, 2002) além de falas coercitivas e moralistas de conteúdo sexual no momento do parto (Martins;Barros, 2016) e, ainda, o chamado "ponto do marido". Este último procedimento consiste em dar um ponto na sutura final da vagina de forma a deixá-la menor e estreita, em prol do prazer do cônjuge; em contrapartida, pode causar mais dor para a mulher durante a relação sexual e o risco de infecção (Parto do Princípio, 2012). ...
A violência obstétrica constitui uma violência institucional e de gênero que afeta milhares de mulheres no mundo. Assim, apresenta-se como uma urgente questão de saúde pública em relação à promoção de melhores condições a todas as gestantes, independentemente de sua etnia, condições socioeconômicas, demográficas, raciais, de crença religiosa e escolaridade, cuja necessidade de discussão está na experiência positiva ao gestar e dar à luz, respeitando os direitos humanos tanto em relação às mulheres que gestam quanto aos recém-nascidos. O presente artigo visa ao debate sobre o conceito de “violência obstétrica”, suscitando reflexões sobre suas origens, definições e tipologia. Além disso, objetivamos abordar inicialmente, o parto em uma perspectiva histórica. Em seguida, intencionando compreender como emerge o tema da violência obstétrica, retoma-se o movimento pela humanização do parto e do nascimento. Posteriormente, faz-se uma tentativa de conceituar a violência obstétrica, os tipos de agressões nas quais ela se manifesta e seus principais problemas. Por fim, tendo por base os estudos de pesquisadores relacionados à perspectiva foucaultiana, objetiva-se compreender esse tipo de violência a partir de uma hegemonia de saber/poder. Metodologicamente, optamos por realizar uma revisão narrativa de estudos sobre o tema, compreendendo a literatura acadêmica, os documentos institucionais, nacionais, internacionais e a legislação disponível no Tempo Presente.
... Ableism is as powerful as the racist, sexist, and classist structures fed by patriarchal logic dehumanizing black, peripheral, poor, and disabled women. This objectification fosters expressions of violence, which in childbirth scenes are translated as obstetric violence 92 . Obstetric violence is an expression of gender violence, shedding light on the experiences of a woman when dealing with the institutions providing prenatal, childbirth, and postpartum care. ...
This review aims to disclose the gaps and needs for acknowledging the rights to experience motherhood of women with disabilities. To do so, we map how much is known about these women’s experience with motherhood, shedding light on their sexual and reproductive rights. The present work followed the scoping review by the Joanna Briggs Institute (JBI). This research is structured by elaborating the question, identifying the relevant studies, selecting the studies, extracting the data, sorting, summarizing, and creating reports based on the results. Results: we found 1050 articles, of which 53 were selected for the analysis. considering the different themes, we generated three axes: (1) infantilization, dehumanization, and discredit in the experience of motherhood; (2) obstetric ableism - an expression of violence in obstetrics; (3) reproductive justice - politicize motherhood and care. The study showed the urgent need to regard women with disabilities as people having the right to make sexual and reproductive health choices. Health professionals need permanent education to acknowledge and guarantee such a need as interweaving relationships to reach decision-making and autonomy.
... Subsequently, there has been a progressive tendency to privilege the psychological and social aspects of the abuse along with the identification of taboos and social discrimination of the victims (14). Since the 2000s, attention has shifted toward the issues of abortion and economic violence (15), also noting the profiles of more violent partners (16), the low tendency to report to law enforcement (17), and helpful support from services (18). From 2007, there is a tendency evident to make the concept of gender violence more generic (19), to deal with violence in psychiatric contexts, and against female workers (20). ...
Children, women, and older people suffer different types of violence, which appears to have been exacerbated during the COVID-19 pandemic and the relative lockdown. The aim of this study is to analyze the literature about gender violence and abuse in the different ages of life and during the COVID-19 lockdown. Data were obtained from an electronic literature search using various online sources such as PubMed, Google Scholar, Science Direct and Web of Science. The terms “child abuse” were the most frequently used, followed in frequency by “gender violence,” “femicide,” and, lastly, “elderly abuse.” The first studies considered gender-based violence as a purely physical problem, then, progressively, the analysis focused on the psychological point of view of the issue. There was a greater number of studies in 2020 about violence in comparison with previous years. The social and scientific attention to gender-based violence appeared to be very poor, especially in the case of older people abuse. It is necessary to increase general attention to the topic to correctly identify each form of abuse and to be able to take care of the subjects most at risk.
... 12 The widespread use of these practices has contributed to a negative perception among some birthing people of their childbirth experience, in many cases including what has been identified as mistreatment on a systemic level, which includes and goes beyond interpersonal treatment by healthcare professionals. 13 These experiences of childbirth are familiar to people living in Latin America. Of countries belonging to the Organization for Economic Cooperation and Development (OECD), Chile has the third highest rate of caesarean delivery. ...
The medicalisation of childbirth has diminished the role of labouring people. We conducted an exploratory phenomenological qualitative study, using purposive sampling, and then conducted 17 semi-structured interviews between December 2016 and October 2017 with people who had recently given birth in a public hospital in the Northern Metropolitan area of Santiago, Chile. The sufficiency of the study group was determined according to saturation criteria. Triangulated content analysis was applied to explore the clinical relationship and processes of autonomy and decision-making. The predominant clinical relationship observed was paternalism. The participation of labouring people in decision-making is scarce, with no evidence of ethically valid processes of informed consent.
... A VO pode se manifestar de diferentes maneiras: negligência (omissão de atendimento), violência psicológica e verbal (ameaças, humilhação, ironias, coerção, julgamentos, xingamentos, comentários desrespeitosos, culpabilização da mulher), violência moral (associada à conduta profissional, como não reconhecer a mulher como protagonista do parto), violência física (negar alívio da dor, manipular e expor o corpo da mulher excessivamente, litotomia, amniotomia, episiotomia para fins de treino, manobra de Kristeller, enemas, medicalização excessiva), violência institucional (peregrinação por serviços de saúde, ausência de estrutura adequada, proibição de acompanhante, falta de privacidade) e violência sexual (assédio e estupro) SCHRAIBER, 2002;WOLFF;WALDOW, 2008;SANTOS;SOUZA, 2015;MARTINS;BARROS, 2016;ZANARDO et al., 2017). ...
Resumo No Brasil, a violência obstétrica vem sendo pesquisada desde os anos 1980. Na década de 90, no entanto, o fenômeno passou a receber maior destaque. A forma de violência analisada neste trabalho refere-se a uma violência velada, chamada de “violência perfeita”. Este ensaio reflete sobre a ocorrência da violência perfeita na obstetrícia, especialmente no que concerne às sutilezas do discurso médico, que pode travestir essa agressão numa forma de cuidado. A violência perfeita pode soar como preocupação da parte do médico com a saúde da gestante, que pode se submeter às recomendações médicas de forma passiva, por acreditar que deve ser o melhor para ela ou para o bebê. Ao praticar a violência perfeita, o obstetra pode interferir no desfecho do parto. A “epidemia” de cesarianas no Brasil tem sido justificada pelos médicos como preferência da mulher, mas pesquisas refutam essa hipótese e provocam a reflexão: quem está de fato escolhendo a modalidade de parto? O presente ensaio nos mostra que observar as sutilezas do discurso médico pode ajudar a responder essa pergunta.
... "A violência contra mulheres e meninas é uma pandemia global" (1). A afirmação de António Guterres, secretário-geral da Organização das Nações Unidas, em data significativa, como o Dia Internacional pela Eliminação da Violência contra a Mulher, está em sintonia com o que mostram as pesquisas em todo o mundo: mulheres têm sido vítimas de negligência, violência física, violência verbal e violência sexual dentro das instituições de saúde -em especial ao dar à luz (2,3). Pelo menos uma em cada quatro mulheres refere ter vivenciado um dessas situações durante o atendimento ao parto no Brasil (4). ...
Esta pesquisa traz uma abordagem qualitativa exploratória, com objetivo de identificar a percepção dos estudantes da área da saúde sobre a violência obstétrica e sua relação com a bioética. Para esse fim, foi aplicado questionário eletrônico a 102 estudantes da área da saúde, cujo perfil majoritário era do sexo feminino, de até 25 anos, residentes no Distrito Federal, que não possuem filhos. Através das respostas, pode-se perceber que o conhecimento sobre violência obstétrica não necessariamente se deu no contexto formal acadêmico, tendo o debate entre alunos e outras fontes de informação, como a internet e a mídia, considerável importância. Conclui-se que há uma lacuna significativa na formação ética de profissionais de saúde, e que a comunidade acadêmica deve estimular o desenvolvimento do pensamento crítico de seus alunos, ao invés de coibi-lo.
... Thus, Gynecological violence involves practices conducted by healthcare providers and that manifest as acts of negligence as well as verbal, physical, or sexual abuse [4]. The victims of such violence may feel powerless, ignored, or invalidated [5]. ...
Objective:
This study aims to investigate the presence of gynecological violence within the health system in Chile, quantify the magnitude of this problem, define its general contours, and shed light on a phenomenon that has long been silenced. Additionally, we are interested in detecting differences between public and private health services, as well as exploring the role played by variables such as sexual orientation, ethnicity, age, and educational level in contributing to the prevalence of gynecological violence.
Methods:
This study employed a cross-sectional and not probabilistic sampling approach. It included a sample of 1503 women from all regions of Chile, who were of legal age and who had attended gynecological services. A questionnaire was applied between January 2021 and April 2022 using the online platform SurveyMonkey®. Data were collected through the second national survey on obstetric and gynecological violence (GinObs 2021). The study adheres to activist research methodologies and was conducted in collaboration with activists and academic researchers.
Results:
57.9% of the women participants reported having experienced violence. Such violence appears to occur most frequently in the public health system, although not exclusively, and the victims are often people who belong to native ethnic groups, who identify as of African descent, whose sexual orientation is lesbian, who are elderly, and who have a lower level of education.
Conclusion:
Gynecological violence is an integral part of the continuum of violence against women and is consistently reported in both public and private health services. This form of violence has serious consequences for women's health and constitutes a significant public health problem.
... 16,17 As a result, these D&A care practices have had negative consequences. 18 According to the WHO data, the consequences of D&A care practices are present globally. 3 However, no literature review has been done to look at these impacts at the LMIC level. ...
This review article explored the impacts of disrespectful care and abusive care practices and the potential interventions to eliminate those practices. Respectful maternity care is a fundamental right for all women. It ensures that women are able to exercise their rights in maternity care. However, research studies have shown the recent prevalence of poor‐quality care for women in maternity units in low‐ and middle‐income countries. The literature on this topic was searched on PubMed, Medline, Google Scholar, Cochrane, Science Direct/ Elsevier, and SCOPUS. A total of 24 qualitative and quantitative research articles were included. Thematic analysis was conducted by using the six steps. Impacts are coded on topics including psychological impacts due to disrespectful and abusive care practices, impact on the care process, normalization of the absence of care, suppression of knowledge regarding the labor process, and poor obstetric outcomes. Interventions are coded on topics including programs for health professionals to improve care, education and empowerment programs targeting the women and community, enacting policies and guidelines regarding disrespectful and abusive care practices and improving the facilities in the healthcare system. The majority of the evidenced‐based interventions were multi‐component and tailored to the needs of a particular setting. More research evidence is needed to inform the healthcare authorities and policymakers to transform these potential interventions into practice. Future research should clearly document the effectiveness of various combinations of interventions, feasibility, cost‐effectiveness, and outcomes.
... Comprende, además, aquellas acciones directas de violencia psicológica o física dirigidas al cuerpo de las mujeres (comentarios o acciones impertinentes con respecto al cuerpo, medicalización excesiva, uso de procedimientos intencionalmente dolorosos, etc.), incluida cualquier forma de abuso y violencia sexual (obligación de desvestirse sin relación con el motivo de consulta, tocar indebidamente el cuerpo o genitales, abuso sexual, violación, etc.) (1). la confianza en el sistema de salud (5,6). Lo anterior puede redundar que las consultas y exámenes no se realicen en los tiempos esperados, o que muchas mujeres abandonen definitivamente los cuidados de salud ginecológicos. ...
RESUMEN
Objetivo: El objetivo fue analizar un conjunto de resultados sobre violencia ginecológica y relacionarlos con su impacto en la percepción del cuerpo, la sexualidad, la autoimagen y autoestima. Métodos: Se realizó un estudio descriptivo de tipo transversal. Se analizaron 812 relatos de mujeres de diversas regiones de Chile. Resultados: Se detectaron tres clases de consecuencias de la violencia: adopción de medidas de protección y resguardo, impacto en la experiencia de sí mismas y sus cuerpos y secuelas físicas y emocionales de la violencia en sus vidas. Adicionalmente, se presentan algunas experiencias de recuperación de autonomía en el cuidado de la salud ginecológica. Conclusión: La violencia ginecológica es parte de la experiencia común de las mujeres y puede constituir un grave problema de salud pública y erigirse en una barrera en el acceso de las mujeres a servicios de salud. Palabras clave: Violencia ginecológica, Violencia contra la mujer, Centros de salud, Barreras de acceso a los servicios de salud.
SUMMARY
Objective: The objective was to analyze a set of results on gynecological violence and relate them to their impact on the perception of the body, sexuality, self-image and self-esteem. Methods: A descriptive cross-sectional study was carried out. 812 stories of women from different regions of Chile were analyzed. Results: Three kinds of consequences of violence were detected: adoption of protection and shelter measures, impact on the experience of themselves and their bodies, and physical and emotional consequences of violence in their lives. Additionally, some experiences of autonomy recovery in gynecological health care are presented. Conclusion: Gynecological violence is part of the common experience of women and can constitute a serious public health problem and become a barrier to women's access to health services.
... In this sense, it is an essential theme to address in Madagascar given the near invisibility of the gender issue [27]. As many authors have pointed out, to discuss obstetric violence, it is necessary to acknowledge the unequivocal existence of violence against women which is part of the wider structure of gender inequity that produces, and normalizes, all types of gender violence [24,[28][29][30]. By depriving women of their autonomy, states could be found accountable for violating numerous human rights, that is why it is important to understanding the human rights dimension of mistreatment of women during obstetric care [31]. ...
In Madagascar, a country where maternal mortality remains high, the quality of obstetric care as perceived by users has been little explored. In this paper, we examine the perception of the quality of care in rural areas, by identifying women's experiences and expectations for basic and emergency obstetric care and how providers are meeting them. Data were collected in 2020, in three rural regions (Fenerive-Est, Manakara and Miandrivazo). 58 semi-structured interviews were conducted with women who had given birth in basic health centers or at home, and with other key informants including caregivers, birth attendants (known as matrones), grandmothers and community agents. 6 focus groups took place with mothers who had given birth at home and at a basic health centers and 6 observations took place during prenatal consultations. This article highlights the major dysfunctions perceived in the services offered and their influence on healthcare use. The women highlighted a lack of consideration of their expectations in obstetric care, with a defective caregiver/patient relationship, unforeseen costs and inadequate infrastructures incapable of guaranteeing intimacy. The women also complained of a lack of consideration of their fady (cultural prohibitions that can lead to misfortune) that surround pregnancy. These local practices conflict with the medical requirements of priority interventions in maternal care, and the respect of these practices by the women leads to reprimands and humiliation from caregivers. This obstetric violence, which emanates from the structure of society, gender relations and the biomedical practices governing pregnancy and childbirth in health facilities in Madagascar, constitutes an obstacle to the use of obstetric services. We hope that this description of the various dimensions of obstetric violence in Madagascar will make it possible to identify the structural obstacles limiting the capacity to provide quality care and to engender positive improvements in obstetric care in Madagascar.
... It is characterized by disrespect to women's rights and has multiple aspects such as: omission, negligence, physical and psychological violence, sexual abuse, interventions and medications without scientific evidence and other situations that generate suffering to women and may harm their children. 5,3,6 Many professionals involved in the gravidic-puerperal cycle may be responsible for obstetric violence, but mainly physicians and nursery team, since they are responsible for the care offered to the mother-fetus binomial. The violence is present regardless of the type of delivery taken, as it may occur in vaginal delivery or cesarean delivery. ...
Objectives: to know the perception of obstetric violence for professionals who assist in labor and delivery. Methods: the research was qualitative. Research participants were 22 professionals providing or assisting women during labor and delivery. The sample was defined by data saturation. The analysis of the data collected was performed using the proposed content analysis of Bardin. Results: five categories were identified, professionals highlighted the existence of a process of change in childbirth care and the importance of respecting physiology and intervening when necessary. It was evident that verbal violence is one of the most recurrent forms of obstetric violence. The factors identified as determinants for the existence of violence were the interaction between the parturient and the team, the professional’s lack of preparation and institutional problems. Even with several statements about obstetric violence, some professionals stressed not experiencing it in practice. Conclusions: the need to invest in strategies to inhibit obstetric violence and humanize care is perceived through training professionals and guiding women on their rights.
... Este problema comenzó a ser tópico de investigación de académicas feministas desde la década del '70, quienes denunciaban la apropiación médica del parto, amparada en una ideología de género que define a los cuerpos femeninos como patológicos por naturaleza y en constante necesidad de intervención médica, y a las mujeres como incapaces de lidiar con sus procesos reproductivos por su supuesta debilidad psíquica y física (Davis-Floyd, 1992;Martin, 1987;Rothman, 1982) 1 . En Latinoamérica, desde la década de los '80 y desde un enfoque explícito de género, diversos grupos de estudio y organizaciones de mujeres comenzaron a denunciar los abusos cometidos por el sistema de salud durante el parto como manifestaciones de violencia reproductiva y de violencia de género (CLADEM y CRLP, 1998;Diniz y D'Oliveira, 1998;D'Oliveira, Diniz y Schraiber, 2002;Castro y Erviti, 2003). Ello impulsó el movimiento latinoamericano por la "humanización" del nacimiento, en un intento por comprometer a las partes involucradas en la mejora de la calidad de la atención, desde un lenguaje que no generase reacciones hostiles desde el sector salud (Diniz, Rattner, d'Oliveira, de Aguiar y Niy, 2018 Temática que se desarrolla con mayor profundidad en el capítulo "De la ciencia androcéntrica hacia la construcción de un modelo sanitario con enfoque de género" de este mismo volumen, de las autoras Alexandra Obach y Alejandra Carreño. ...
Si bien durante las últimas décadas se ha avanzado en la visibilización de múltiples formas de violencia de género, hay una que ha presentado particular resistencia a ser nombrada y reconocida. Se trata de la violencia obstétrica, que se ejerce principalmente al interior de los establecimientos de salud, y que constituye un grave problema de salud pública y de violación a los derechos sexuales, reproductivos, y humanos de las mujeres. A diferencia de otros tipos de violencia en que es (más) fácil apuntar a victimarios, en este caso la responsabilidad se sitúa en niveles estructurales de la sociedad: en ideologías de género que despojan a las mujeres de la capacidad de decisión sobre sus propios procesos vitales; y en las bases paradigmáticas del sistema biomédico, un sistema androcéntrico y reduccionista que ha propiciado una visión fragmentada y patológica de los procesos reproductivos femeninos. En las siguientes páginas presento los debates que llevaron a visibilizar este tipo de violencia en el mundo y en Chile, los conceptos en uso para referirse a ella, y describo algunos indicadores de atención del parto en el país que
ilustran el escenario actual de este problema. Espero con ello mostrar la urgencia de abordar la calidad de la atención obstétrica como problema de salud pública, y contribuir a la reflexión y puesta en práctica de formas de cuidado integral.
... Este problema comenzó a ser tópico de investigación de académicas feministas desde la década del '70, quienes denunciaban la apropiación médica del parto, amparada en una ideología de género que define a los cuerpos femeninos como patológicos por naturaleza y en constante necesidad de intervención médica, y a las mujeres como incapaces de lidiar con sus procesos reproductivos por su supuesta debilidad psíquica y física (Davis-Floyd, 1992;Martin, 1987;Rothman, 1982) 1 . En Latinoamérica, desde la década de los '80 y desde un enfoque explícito de género, diversos grupos de estudio y organizaciones de mujeres comenzaron a denunciar los abusos cometidos por el sistema de salud durante el parto como manifestaciones de violencia reproductiva y de violencia de género (CLADEM y CRLP, 1998;Diniz y D'Oliveira, 1998;D'Oliveira, Diniz y Schraiber, 2002;Castro y Erviti, 2003). Ello impulsó el movimiento latinoamericano por la "humanización" del nacimiento, en un intento por comprometer a las partes involucradas en la mejora de la calidad de la atención, desde un lenguaje que no generase reacciones hostiles desde el sector salud (Diniz, Rattner, d'Oliveira, de Aguiar y Niy, 2018). ...
... Este problema comenzó a ser tópico de investigación de académicas feministas desde la década del '70, quienes denunciaban la apropiación médica del parto, amparada en una ideología de género que define a los cuerpos femeninos como patológicos por naturaleza y en constante necesidad de intervención médica, y a las mujeres como incapaces de lidiar con sus procesos reproductivos por su supuesta debilidad psíquica y física (Davis-Floyd, 1992;Martin, 1987;Rothman, 1982) 1 . En Latinoamérica, desde la década de los '80 y desde un enfoque explícito de género, diversos grupos de estudio y organizaciones de mujeres comenzaron a denunciar los abusos cometidos por el sistema de salud durante el parto como manifestaciones de violencia reproductiva y de violencia de género (CLADEM y CRLP, 1998;Diniz y D'Oliveira, 1998;D'Oliveira, Diniz y Schraiber, 2002;Castro y Erviti, 2003). Ello impulsó el movimiento latinoamericano por la "humanización" del nacimiento, en un intento por comprometer a las partes involucradas en la mejora de la calidad de la atención, desde un lenguaje que no generase reacciones hostiles desde el sector salud (Diniz, Rattner, d'Oliveira, de Aguiar y Niy, 2018). ...
En tiempos actuales, donde la salud y las políticas sanitarias son objeto de discusión diaria a nivel mediático y personal, en planos nacionales como internacionales, el repensar o remirar el rol que tiene la salud pública resulta crucial. La pandemia por COVID-19 ha dado pie para cuestionarnos sobre el diseñoo y adecuación de ciertas políticas públicas; hoy m.s que nunca los sistemas de salud y la política sanitaria han debido responder a la inmediatez del curso de la pandemia con facilidad de adaptación y versatilidad para hacer frente a este fenómeno que pocos creemos poder vivir. Es en este contexto donde el presente libro y las valiosas contribuciones de sus autores resultan más valorables, por cuanto problematizan el rol de la salud pública frente a una diversidad de temas actuales que invitan a la reflexión y discusión. El documento se encuentra organizado en cuatro secciones. La primera de ellas se orienta a la discusión sobre el quehacer de la salud pública y alberga los primeros tres capítulos del libro.
... A tipificação permaneceu exatamente como registradas nas denúncias. 18 . Em um dos casos, suspeita-se que a vítima tenha sido torturada dentro da unidade de saúde, caso seja considerada a tipificação da Lei nº 9.455/1997 19 , que no art. ...
Resumo Introdução Trata-se de estudo sobre as denúncias formalizadas de violência obstétrica, registradas no primeiro Inquérito Civil Público da Região Norte sobre o tema. Objetivo Analisar as denúncias de violência obstétrica registradas no Ministério Público Federal do Amazonas, a fim de mapear as instituições de saúde do Amazonas envolvidas em violência obstétrica; as técnicas que são consideradas, pelas mulheres, como violentas; e realizar levantamento das categorias profissionais que foram denunciadas como autoras de violência obstétrica. Método Trata-se de um estudo quantitativo, exploratório e documental, realizado de janeiro a abril de 2018 no Ministério Público Federal do Amazonas. Os dados foram analisados por estatística descritiva, sendo apresentadas em frequências absolutas e relativas. Resultados Foram analisadas 43 denúncias sobre violência obstétrica protocoladas entre 2008 e 2018, detectaram-se 12 maneiras diferentes de realizar a denúncia; 13 instituições de saúde, 29 técnicas consideradas violentas; além de identificar 8 especialidades profissionais denunciadas. Conclusão tem-se que a violência obstétrica identificada ocorreu tanto em instituições públicas como em privadas; por diferentes profissionais de saúde, com destaque para médicos e enfermeiros; com diversas técnicas, ações e/ou atitudes, com destaque para aquelas que se situam no campo da relação profissional-usuário. Desse modo, identificou-se que as denúncias realizadas não se remetem apenas à categoria de violência institucional, abrangendo práticas de violência no âmbito da relação profissional-usuário.
... Ela se manifesta de forma tão natural e silenciosa que nem é percebida como tal, principalmente quando não gera danos físicos. Na saúde, apresenta-se como negligência, agressões verbais, tratamento grosseiro, repreensão, ameaças, violência física, incluindo o não alívio da dor e o abuso sexual 29,30 . ...
Este artigo toma as manifestações de violência em um Centro de Atenção Psicossocial Álcool e outras Drogas de Salvador, Bahia, Brasil, como analisadoras da produção do cuidado com as pessoas em situação de rua usuárias desse serviço. Utilizou-se a abordagem qualitativa, em uma perspectiva cartográfica, seguindo pistas que apareceram no acompanhamento do serviço por um semestre, registradas em diário cartográfico, e em quatro encontros mensais com a equipe para discussão sobre cenas de violência. Os resultados apontam para deslocamentos do sentido sobre a violência como desdobramento natural da vulnerabilidade e do uso de drogas, tornando visíveis outros elementos envolvidos na sua produção, como os racismos estrutural e institucional vividos por essas pessoas. Reforçam a necessidade de estratégias de educação permanente que tomem as violências e o racismo nos serviços de saúde como matéria-prima da formação dos trabalhadores de saúde.
... It manifests itself so naturally and silently that it is not even perceived as such, especially when it does not generate physical harm. In health, it presents itself as neglect, verbal aggression, rude treatment, reprimands, threats, physical violence (including the non-relief of pain), and sexual abuse 29,30 . ...
This study takes the manifestations of violence in a Psychosocial Care Center for Alcohol and Other Drugs in Salvador, Bahia, Brazil, as analyzers of the production of care for homeless people who use this service. It used a qualitative approach in a cartographic perspective, following clues which appeared in the monitoring of the service for a semester, recorded in a cartographic diary, and in four monthly meetings with the service care team to discuss scenes of violence. Results point to a shift in the view of violence as a natural unfolding of vulnerability and drug use, making visible other elements involved in its production, such as the structural and institutional racism experienced by these people. They reinforce the need for permanent education strategies which take violence and racism in health services as raw material for the training of health workers.
... AUTHOR: "D'Oliveira, A., Diniz, S., and Schraibe, L. (2002)" has not been cited in the text. Please indicate where it should be cited; or delete from the Reference List. ...
Resumo Nesta revisão, buscamos identificar lacunas e necessidades para o reconhecimento do direito das mulheres com deficiência ao exercício da maternidade. Objetivamos mapear o conhecimento referente às experiências com a maternidade dessas mulheres, ressaltando a produção de conhecimento relacionada aos direitos sexuais e reprodutivos. Realizamos uma revisão de escopo conforme o Joanna Briggs Institute (JBI). A pesquisa se sustentou na: formulação da questão; identificação dos estudos relevantes; seleção dos estudos; extração de dados; separação, sumarização e relatório dos resultados. Resultados: identificamos 1.050 artigos e selecionamos 53 para análise. A separação dos temas convergentes gerou três eixos: (1) infantilização, desumanização e descrédito na experiência da maternidade; (2) capacitismo obstétrico: uma expressão da violência obstétrica; (3) justiça reprodutiva: politizar a maternidade e o cuidado. Concluímos pela urgência de considerar as mulheres com deficiência com direitos de escolhas nas questões referentes à sua saúde sexual e reprodutiva. Os profissionais de saúde precisam de educação permanente para reconhecer e garantir as necessidades como relações de interdependência para decisões e autonomia.
Las mujeres en situación de vulnerabilidad, en México, que acuden a los servicios públicos de salud por causas obstétricas experimentan diversas barreras para el acceso a la atención, aun en las propias unidades médicas, contribuyendo a que 85% de las muertes maternas ocurran al interior de los establecimientos de salud.
Study background
Gender-based violence is a global concern. The perinatal period is a crucial time for early identification of the harmful impact of violence on the well-being of both mothers and infants. However, it has been observed that many women choose not to disclose their experiences to their healthcare providers.
Purpose
To gain insight into this issue, a study was conducted to explore the perspectives of both survivors and healthcare providers regarding the barriers to disclosure.
Methods
Through the utilization of a thematic analysis approach, a total of 28 interviews were conducted, involving 12 survivors and 16 healthcare providers.
Results
Data analysis revealed barriers to disclosure at the individual, community, and healthcare system levels.
Conclusion
Health-care providers have a pivotal role in creating an atmosphere where women are encouraged to break the silence and a paradigm shift in the health system approach towards GBV is necessary.
Understanding and promoting agency are crucial to addressing urgent social problems of our time. Through agency, we can take transformative steps toward the future that ought to be. This book shows how contemporary conceptualizations from cultural-historical activity theory can inform research and practice that fosters positive change. At the core of this book's novel approach to agency and transformation are three motifs: motives, mediation, and motion. These take inspiration from the original work of Vygotsky and subsequent generations of scholarship, enabling us to understand agency in ways that recognize the social and cultural aspects of agency without losing sight of individuals' contributions to changing their own lives and the lives of others. Referring to connections between learning, pedagogy, and agency, the chapters address power, freedom, and the future in contexts including adolescence, school exclusion, children's activism, Indigenous communities, environmental activism, homelessness, childbirth, and young people during the COVID-19 pandemic.
Resumo A violência obstétrica é a apropriação do corpo e dos processos reprodutivos das mulheres por profissionais de saúde. Expressa-se por meio do tratamento desumanizado, do abuso da medicalização e da patologização dos eventos do parto. O objetivo da presente pesquisa é mapear a jurisprudência nacional sobre violência obstétrica para, então, analisar em profundidade as decisões judiciais do sul do Brasil, de modo a identificar como são mobilizadas as “definições persuasivas” e os “estereótipos normativos” nos discursos das sentenças. Trata-se de pesquisa qualitativa, exploratória, indutiva, com utilização de técnica documental. O estudo analisou 12 julgados em seu inteiro teor. Como resultados, foram identificados nos discursos “estereótipos normativos” referentes a quatro eixos: “literatura especializada”, “prova pericial”, “obrigação de meio” e “perícia, prontuário e testemunhas”, e “definições persuasivas” relativas a dois eixos: “medicina” e “gestante”. Além disso, foram identificados silêncios quanto a princípios bioéticos e direitos fundamentais. A partir dos resultados, a pesquisa infere que a racionalidade e a argumentação jurídica das decisões que envolvem violência contra a mulher gestante aqui analisadas carecem de especificidade, de metafundamentação e pecam ao não permitir controle sobre os provimentos decisórios, dificultando o seu contraste, maculando, por fim, a característica dialógica do Direito e a garantia do direito à saúde.
Plain language summary Access to abortion is legally restricted and socially reproved in Kenya. Therefore, women requiring abortion in such restrictive contexts resort to unsafe methods that result in complications, often requiring treatment in health facilities. Nevertheless, there is limited evidence on the quality of care provided in public health facilities in Kenya to patients treated for abortion complications. This paper is drawn from a qualitative study targeting 66 women treated for abortion complication in a sample of primary, secondary and tertiary public health facilities in Kenya between November 2018 and February 2019. The interviews focused on the women’s perceptions around the quality of care they received. Our findings show that while the majority of participants stated in first instances that they received “good care” because they left the facility with their medical problem resolved, half of them, when probed, reported delays in receiving care, yet their condition was seen as an emergency since they were bleeding and experiencing pain. Participants also reported instances of abuse (verbal and physical) or lack of privacy during care and inadequate involvement in decisions on the type of care they were to receive. Our findings also point out that providers treated patients differently based on their attributes (spontaneous versus induced abortion, single versus married, young versus older), with women who experienced miscarriages receiving supportive care while women suspected to have induced their abortion being stigmatized. In conclusion, our findings have far reaching implications on efforts to improve post-abortion seeking behaviors and on how to assess quality of abortion care.
Le point de vue des soignants a été encore peu investigué dans le cadre des « violences obstétricales ». Nous avons interrogé des gynécologues-obstétricien.ne.s, assistant.e.s en gynécologie-obstétrique et étudiant.e.s en médecine de dernière année à l’aide d’un questionnaire en ligne. Deux cent cinquante-huit questionnaires ont été complétés et montrent que la problématique est une réalité, les médecins en sont conscients, et leur définition du phénomène rejoint celle des patientes. Une divergence existe cependant entre les points de vue théorique et pratique.
O presente livro aborda questões sobre saúde da mulher e da criança, trazendo conceitos das políticas públicas, discutindo a política de atenção à saúde da mulher no contexto da promoção da saúde, relata ações de promoção a atenção integral à saúde das mulheres e de crianças em todos os ciclos de vida, enfatizando o binômio mãe e filho. A importância desta publicação está evidentemente associada a questões culturais e sociais abordando temas como a violência contra a mulher na sociedade. Nesse processo de troca as autoras trazem discussões à saúde da mulher e da criança no campo dos Direitos Reprodutivos e Direitos Sexuais, sociais e assistência em saúde.
Considerando a relevância do desenvolvimento na primeira infância, dada sua incomparável plasticidade neuronal e impacto nas fases de vida subsequentes, avaliar e intervir nesse processo implicam um compromisso social de primeira ordem. Este trabalho, que se enquadra num projeto de investigação mais vasto, visa avaliar o status da literatura atual sobre a construção de escalas / instrumentos de screening/rastreio do desenvolvimento infantil, numa versão para professores da educação infantil (creche e pré-escola). O estudo foi realizado em duas etapas: I - Verificação na literatura das publicações sobre o tema, tendo como base de dados a CAPES Periódicos e CAPES Teses e Dissertações, entre 2000 e 2020, e os descritores "Construção, validação de conteúdo, avaliação do desenvolvimento infantil", "Avaliação do desenvolvimento infantil", "Rastreio, atraso de desenvolvimento infantil", em português e inglês, tendo sido incluídos 24 artigos; II - Análise das escalas de desenvolvimento infantil existentes e mais utilizadas, com adaptação no Brasil, Portugal e/ou Espanha, totalizando 17 instrumentos. Os resultados demonstram a escassez de estudos sobre o tema. As escalas são, em sua maioria, usadas por profissionais da saúde. Professores da educação infantil precisam ser habilitados e autorizados a analisar o desenvolvimento infantil de maneira padronizada, pois configuram-se como bons informantes.
Palavras-chaves: screening/rastreio; desenvolvimento infantil; professores da educação infantil
Neste volume são reunidos 17 trabalhos relativos a comunicações que integraram o programa
científico do I Congresso Internacional de Investigação e Intervenção em Psicologia Escolar e da Educação.
Este congresso decorreu no Instituto de Educação da Universidade do Minho (Campus de Gualtar, Braga)
entre 8 e 10 de setembro de 2022, integrando num único evento a 4ª Conferência Internacional da
Associação para o Desenvolvimento da Investigação em Psicologia da Educação (ADIPSIEDUC), o V Colóquio
Internacional de Psicologia Escolar (UnB), o XIV Colóquio de Psicologia Escolar (UnB), e o XV Colóquio
Psicologia e Educação (ISPA-Instituto Universitário). O objetivo principal deste evento centrou-se na
divulgação de projetos e resultados de investigações e de intervenções em Psicologia Escolar e da
Educação.
O objetivo deste artigo é discutir as formas pelas quais algumas entidades representativas da classe médica brasileira operam o conceito de violência obstétrica e apresentar as controvérsias em torno deste conceito. Pautando-me na proposta teórica de Ilana Löwy, busco refletir sobre como violência obstétrica se coloca como um conceito fronteira, cuja imprecisão demonstra a força de seu efeito. Ou seja, são as controvérsias em torno do conceito que fazem com que ele ganhe proeminência nas arenas públicas de debate em torno dos direitos sexuais e reprodutivos das mulheres. Para isso, analiso alguns pareceres e resoluções de conselhos federal e regionais de medicina, em diálogo com outros eventos etnográficos que persegui no processo de pesquisa. Mostro como o conceito de violência obstétrica ganha diferentes contornos na voz das entidades representativas de médicos no Brasil e concluo com a ideia de que o parto se tornou um evento público, em que as controvérsias são não apenas científicas, mas também morais e políticas.
Background
France is somewhat behind other countries in its consideration of the issue of violence in perinatal care. Its consequences on maternal, but also neonatal and infant health are recognised internationally. Nonetheless, research and data measuring its frequency and its determinants are inadequate, and the relevant definitions are not always consensual. In this context, we, as midwives and researchers in public health and as members of the National College of French Midwives, seek to propose a scientific and clinical contribution to this debate.
Aim
We propose avenues for measuring and characterising violence in in perinatal care. Our objective is to quantify and characterise the situations of violence in perinatal care in population-based studies and based on the perceptions of each woman questioned.
Discussion
This proposal for questions, simplified compared with those currently in use in the international scientific literature, has the advantage of focusing reflection around three categories: inappropriate medical care, inappropriate human behaviours in care, and sexual abuse. It should also allow the identification of the contexts of care during which violence may be experienced, as well as the categories of health-care workers concerned.
Conclusion
It seems important to us to distinguish these situations, causal and context, for they require different responses if we hope to reduce the frequency and the effects of violence in perinatal care in the future. We propose questions that could also be used in clinical situations by midwives and other clinicians.
With their widespread use in the Global South, mobile phones are attracting growing interest from international aid actors and local authorities alike, who are positioning mobile technology as a growth driver and a solution to many social problems. Initiated by giants of the digital industry, these policies are reviving old questions about technological development, the relationship between the market sector and States, and the role of technology in the inequalities between the Global North and Global South. Through a multi-sited ethnography on maternal care in Ghana and India, this Element provides a first-hand look at initiatives that promise to improve poor women's health in the Global South through the use of mobile phones; a field known as Mobile Health or mHealth. Attentive to the way in which these technical objects modify power relations at both international and local levels, this Element also discusses how mHealth transforms care practices and healthcare.
Objective: This study aimed at assessing the components of obstetric violence of women in receiving care during labor and postnatal period.
Material and methods: This research was designed as a web-based descriptive study. The study was conducted with 556 women who had a vaginal delivery were within the first 6 weeks after delivery. The data of the research were collected between November-December 2021.
Results: The mean age of women was 27.33±5.75, and the mean gestational week was 38.96±1.42. It was determined that while 95% of the women who underwent the intervention had a vaginal examination for less than 4 hours, 86.9% of them had no freedom of positioning at birth, and information was not provided to 41.2% of them before shaving, 22.2% of them before the amniotomy, 6.3% of them before oxytocin administration, 7.8% of them before episiotomy administration, 23.6% of them before fundal pressure, and 88.9% of them before vacuum support. It was found that 69.8% of the women did not have a companion during the delivery process, 67.1% of them were not involved in the decisions during the delivery process, and 93.9% of them asked for getting permission and providing information in the interventions during the delivery process. Additionally, the difference between the distributions of exposure to obstetric violence according to some sociodemographic and obstetric characteristics of the women was not statistically significant (p<0.05).
Conclusion: According to the result of the study, it was determined that women were subjected to some types of obstetric violence during labor and the delivery process.
A violência obstétrica é o termo utilizado para descrever as diversas formas de violência ocorridas na assistência à gravidez, ao parto, ao pós-parto e ao abortamento. Pode ser manifestada por meio de maus-tratos físicos, psicológicos e verbais além de práticas intervencionistas desnecessárias, como a episiotomia. As mulheres em situação de vulnerabilidade social e discriminação, como as mulheres negras, são mais acometidas pela violência obstétrica. O presente estudo teve como objetivo analisar a repercussão da violência obstétrica nas mulheres negras brasileiras a partir de trabalhos presentes na literatura. Trata-se de uma revisão integrativa, na qual utilizou-se a estratégia PICO e um instrumento validado para direcionamento do estudo nas bases de dados da Biblioteca Virtual em Saúde, do PubMed e do Google Acadêmico, a partir de trabalhos publicados entre 2011 e 2021. Houve a seleção de 06 artigos após os critérios de inclusão e exclusão. Os estudos demonstraram que a violência obstétrica mostrou-se mais frequente em mulheres negras durante todo o ciclo gravídico puerperal, tendo como principais repercussões o atendimento desigual e as consequências negativas associadas à saúde mental. Percebeu-se a necessidade de políticas educativas para desnaturalizar o racismo institucional e ampliar o debate sobre as iniquidades raciais na saúde.
La preocupación en torno al abuso de las tecnologías médicas y el maltrato a las mujeres en el contexto de la atención del embarazo, el parto y el posparto tiene antecedentes históricos y aún está presente en el debate público. Ya en 1985 la Organización Mundial de la Salud recomendó el uso apropiado de estas tecnologías y el respeto de la autonomía de las mujeres. Así mismo, en 2014 reforzó el reconocimiento de este tema como un problema de salud pública y derechos humanos, y señaló la falta de consenso internacional sobre cómo definir y medir este fenómeno. En este marco, en el presente capítulo destacamos y analizamos las diversas conceptualizaciones de la violencia obstétrica que se encuentran en los artículos científicos desde el surgimiento de este concepto y hasta 2019. Para ello, realizamos una revisión narrativa en seis bases electrónicas a partir de una sintáxis que combinó tanto términos estructurados como ad hoc. En este capítulo nos enfocamos en la producción académica en cinco líneas de indagación para dar cuenta del proceso de disputa por el sentido de la “violencia obstétrica”: a) enfoque de las tipologías; b) enfoque legal; c) enfoque de las ciencias sociales y humanas; d) enfoque de la percepción de las mujeres, y e) enfoque de la percepción de los/as profesionales de la salud. mostramos el estado actual del conocimiento sobre este fenómeno, y destacamos las bifurcaciones, confluencias, diferencias y reconfiguraciones que tiene este término en la literatura científica.
Background:
With maternal mortality ratio of 2,000/100,000 live births and perinatal mortality rate of 40/1,000 total births, Cross River State is one of the states with the highest maternal and perinatal deaths in Nigeria. One of the causes of these poor health indices is low utilization of facility-based maternal and child healthcare services during pregnancy and childbirth. The objective of this study was to assess the predictors of utilization of antenatal care and delivery services in Akpabuyo, a rural community in Cross River State of Nigeria.
Method:
This was an analytical cross-sectional survey. Data were collected from 370 pregnant women between June and July, 2013 and analyzed using SPSS version 25.
Results:
Binary logistic regression showed that compared with women with tertiary education, women with non-formal education were less likely to attend antenatal clinic (AOR=0.510, 95% CI=0.219-1.188) although the difference was not statistically significant. Also, compared with farmers, full-time housewives were less likely to deliver in a health facility (AOR=0.650, 95% CI=0.305-1.389) while civil servants were nearly five times more likely to deliver in the health facility (AOR=4.750, 95%CI=1.616-13.962).
Conclusion:
The predictors of antenatal care and facility delivery services utilization identified by the study were educational status and occupation. This raises the need for policies and programmes to ensure girl child education and the economic empowerment of women.
Introdução. Desde a década de 1990, os regulamentos nacionais sobre ética em pesquisa envolvendo seres humanos asseguram aos participantes os benefícios resultantes do projeto (Res. CNS 1996/96) de forma gratuita e por tempo indeterminado (Res. CNS 466/12). Entretanto, em 2017, Conselho Nacional de Saúde (CNS) limitou, ao prazo de cinco anos contados da definição do preço, o acesso dos participantes com doenças ultrarraras aos melhores métodos profiláticos, diagnósticos e terapêuticos comprovados. Objetivo. Esta pesquisa tem como objetivo analisar a limitação ao fornecimento de medicamento pós-estudo em doenças ultrarraras regulamentada pela Resolução CNS 563/2017. Método. Trata-se de estudo descritivo-exploratório que utilizou as técnicas do estudo de caso e da pesquisa bibliográfica para o levantamento de artigos em base de dados. Como referencial teórico, utilizou-se a abordagem internacional da bioética e dos direitos humanos. Resultados. Os resultados revelaram que a Resolução CNS 563/17 restringiu o fornecimento de medicamento pós-estudo no caso de doenças ultrarraras e, ao contrário de representar avanços, foi fruto de uma enorme pressão e influência da indústria e de algumas entidades representativas dos pacientes. Discussão. A harmonização dos procedimentos estabelecidos pelas Boas Práticas Clínicas (BPC) entre centros de pesquisa de vários países contribuiu para que patrocinadores de ensaios clínicos optassem por conduzir pesquisas em regiões menos desenvolvidas, como os países sul-americanos, devido ao menor custo e maior disponibilidade de pacientes. Com isso, a exigência de fornecimento de medicamento pós-estudo torna-se fator decisivo para a escolha do local onde será realizada a pesquisa clínica, como demonstra estudo que constatou percentuais mais elevados de ensaios clínicos envolvendo populações vulneráveis de países de baixa e média renda sem planos de acesso pós-estudo. Tal cenário evidencia que os interesses econômicos das indústrias farmacêuticas buscam a flexibilização da garantia do acesso pósestudo. Conclusão. Considerando que: i) na perspectiva da Declaração Universal sobre Bioética e Direitos Humanos (2005), acordos prévios à pesquisa acerca dos benefícios dela decorrentes são imprescindíveis à promoção da justiça social; ii) na perspectiva dos direitos humanos, a aplicação do direito à saúde deve ser progressiva, segundo Comentário Geral n. 14 do Comitê de Direitos Econômicos, Sociais e Culturais (2000), conclui-se que a falta de transparência dos dados econômicos da indústria farmacêutica e da declaração de ausência de conflitos de interesses das associações de pacientes e outros atores responsáveis por essa inovação regulatória torna ética e juridicamente questionável a limitação temporal do acesso pós-estudo para participantes com doenças ultrarraras.
Introduction:
Brazilian legislation restricts the practice of abortion. In Brazil, abortion is a major public health problem due to the morbidity, mortality and hospitalization caused by the practice of unsafe abortions. Complications related to induced abortion and miscarriages are treated in “maternity wards”, where obstetric violence can be perpetrated.
Purpose of research:
To analyse, based on ethnographic data, the practices of biomedical technologies and their relation to practices of gynecological and obstetrical violence.
Results:
Three main practices are systematized for didactic purposes: treatment of complications from abortion in maternity wards; ultrasound; and curettage. Despite the existence of national standards – due to the advances of the brazilian health and feminist movement – and international standards, there is still institutional resistance to the adoption of practices that prioritize women’s well-being.
Conclusions:
The way in which the ward is organized and materialized and the adoption of certain practices and technologies (and the omission of others) contribute to reproducing obstetric violence. The daily practices in the hospital do not escape the moralization of abortion, and the strong economic, racial and gender inequalities that go beyond the institutional space of the hospital. The analysis allows us to understand that the practice of biomedical technologies shapes and is shaped in a symbolic and situated way and can serve as an instrument for practices of embodied violence. Finally, it is necessary to review the model of post-abortion care.
Le concept de "violences gynécologiques et obstétricales" a émergé au début des années 2000 en Amérique latine dans les milieux militants et scientifiques. Il a été repris à partir des années 2010 dans les débats féministes et politiques français et européens. Les militantes féministes, notamment à travers les réseaux sociaux et les médias, ont joué un rôle important dans la construction de cette question de santé publique. Ce concept est aujourd'hui mobilisé dans l'espace public, politique et académique, en France et à l'international. Il recouvre des réalités et des pratiques médicales diverses et permet de rendre compte des expériences, à la fois objectives et subjectives, des femmes. Les travaux en sciences sociales qui mobilisent cette nouvelle approche conceptuelle sont de plus en plus nombreux. Ils portent cependant majoritairement sur l'accouchement, alors que le domaine de la gynécologie reste plus largement à explorer.
Context Although the Turkish Medical Association has deemed "virginity examinations"
a form of gender-based violence, women in Turkey are often subjected to such
examinations by forensic physicians for both legal and social reasons. Little
is known about these physicians' role and attitudes in this practice.
Objectives To assess forensic physicians' experiences and attitudes regarding virginity
examinations in Turkey and suggest potential solutions to the problems identified.
Design Cross-sectional self-administered survey.
Setting Surveys were completed during the Forensic Science Congress held in
Kusadasi in April 1998 as well as in urban academic and medical practice settings
between April and October 1998.
Participants Of 158 physicians who practice, are formally trained in, or are in training
for forensic medicine, 118 completed the survey (response rate, 74.7%).
Main Outcome Measures Frequency and circumstances of conducting virginity examinations, opinions
regarding beneficial and adverse consequences of these examinations, and recommendations
for changing the practice, as measured by a 100-item questionnaire.
Results Overall, survey respondents reported conducting 5901 examinations in
the previous 12 months; 4045 were conducted because of alleged sexual assault
and 1856 for social reasons. Although 68% of forensic physicians indicated
that they believed virginity examinations are inappropriate in the absence
of an allegation of sexual assault, 45% had conducted examinations for social
reasons. The majority of the respondents (93%) agreed that the examinations
are psychologically traumatic for the patient. In addition, more than half
(58%) reported that at least 50% of patients undergo examinations against
their will.
Conclusions Nearly half of forensic physicians in Turkey conduct virginity examinations
for social reasons despite beliefs that such examinations are inappropriate,
traumatic to the patient, and often performed against the patient's will.
Physicians' participation in such practices is inconsistent with principles
of bioethics and international human rights.
Objectives: To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables.Design: Descriptive and ecological study.Setting: 19 Latin American countries.Main outcome measures: National estimates of caesarean section rates in each country.Results: Seven countries had caesarean section rates below 15%. The remaining 12 countries had rates above 15% (range 16.8% to 40.0%). These 12 countries account for 81% of the deliveries in the region. A positive and significant correlation was observed between the gross national product per capita and rate of caesarean section (rs=0.746), and higher rates were observed in private hospitals than in public ones. Taking 15% as a medically justified accepted rate, over 850 000 unnecessary caesarean sections are performed each year in the region.Conclusions: The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets.
Key messages12 of the 19 Latin American countries studied had caesarean section rates above 15%, ranging from 16.8% to 40%These12 countries account for 81% of the deliveries in the regionBetter socioeconomic conditions were associated with higher caesarean section ratesOver 850 000 unnecessary caesarean sections are performed each year in Latin AmericaReduction of caesarean section rates will need concerted action from public health authorities, medical associations, medical schools, health professionals, the general population, and the media
This essay deals with the theme of violence from the standpoint of violence against women. It discusses the historical precedence of taking violence against women as a Legal issue and as an object of Justice, outlining parallels with the emergence of the problem as a Healthcare issue, as well as one of the targets of the Public Health area and of medical and sanitation practices. KEY WORDS: violence, women's health; women's right; women. Este ensaio procurará tratar do tema violência sob o recorte da violência contra mulheres. Discute a precedência histórica da tomada da violência contra a mulher como questão do Direito e objeto da Justiça, traçando paralelos na emergência do problema como questão de Saúde e alvo da Saúde Pública e das práticas médico-sanitárias. PALAVRAS-CHAVE: violência; saúde da mulher; direito da mulher; mulheres.
Neste trabalho analisou-se a assistência ao parto, caracterizando o perfil das principais maternidades e o deslocamento da clientela, ou seja, o fluxo entre residência e local de nascimento. Os indicadores utilizados foram construídos a partir do Sistema de Informação sobre Nascidos Vivos (SINASC) em 1995 e da Pesquisa sobre Assistência Médico-Sanitária (AMS), com dados para 1992. Através de classificação multivariada foram identificados dois tipos de maternidades: um com grande número de partos cesáreos, boas condições da parturiente e recém-nato; e outro com maior proporção de partos espontâneos e indicadores que apontam riscos do recém-nascido. As proporções de: mães com escolaridade igual ou superior ao ensino médio, mães adolescentes e partos cesáreos são os indicadores que melhor caracterizaram os grupos. Identificou-se grande heterogeneidade na distribuição espacial das maternidades, concentrados nas regiões mais ricas da cidade, determinando, conseqüentemente, longos trajetos das gestantes na busca da assistência ao parto.
Sexual harassment has been identified as a universal factor that can affect nursing performance and work productivity in any type of health care facility. Few studies in the area of sexual harassment have been conducted in developing countries, and this is the first study of its type to be conducted in the country of Turkey. The general purpose of this study is to examine whether the problem of sexual harassment truly is "universal' and to begin to address whether it exists among female nurses in Turkey. Translated surveys were distributed to selected nurses in Ankara, Turkey, asking about their experiences of sexual harassment during their nursing practice. With a response rate of 58% (n = 229), 75% of the respondents reported having been sexually harassed during their nursing practice. The most commonly reported forms of sexual harassment included sexual testing, jokes, remarks or questions and pressure for dates. Harassment by physicians (44%), by patients (34%), by relatives of patients (14%) and others (9%) were noted. Further, a significant relationship was found between sexual harassment of nurses who work in inpatient or outpatient clinics. In general, these findings suggest that sexual harassment of female nurses remains a disturbing problem in this developing country. Based on the findings, implications for policy and further study are suggested.
Although the Turkish Medical Association has deemed "virginity examinations" a form of gender-based violence, women in Turkey are often subjected to such examinations by forensic physicians for both legal and social reasons. Little is known about these physicians' role and attitudes in this practice.
To assess forensic physicians' experiences and attitudes regarding virginity examinations in Turkey and suggest potential solutions to the problems identified.
Cross-sectional self-administered survey.
Surveys were completed during the Forensic Science Congress held in Kusadasi in April 1998 as well as in urban academic and medical practice settings between April and October 1998.
Of 158 physicians who practice, are formally trained in, or are in training for forensic medicine, 118 completed the survey (response rate, 74.7%).
Frequency and circumstances of conducting virginity examinations, opinions regarding beneficial and adverse consequences of these examinations, and recommendations for changing the practice, as measured by a 100-item questionnaire.
Overall, survey respondents reported conducting 5901 examinations in the previous 12 months; 4045 were conducted because of alleged sexual assault and 1856 for social reasons. Although 68% of forensic physicians indicated that they believed virginity examinations are inappropriate in the absence of an allegation of sexual assault, 45% had conducted examinations for social reasons. The majority of the respondents (93%) agreed that the examinations are psychologically traumatic for the patient. In addition, more than half (58%) reported that at least 50% of patients undergo examinations against their will.
Nearly half of forensic physicians in Turkey conduct virginity examinations for social reasons despite beliefs that such examinations are inappropriate, traumatic to the patient, and often performed against the patient's will. Physicians' participation in such practices is inconsistent with principles of bioethics and international human rights.
To explore the circumstances and factors that explain the association between private health insurance cover and a high rate of caesarean sections in Chile.
Qualitative analysis of audiotaped in-depth interviews with obstetricians and pregnant women; quantitative analysis of data from face to face semistructured interview survey conducted postnatally (with women who had given birth in the previous 24-72 hours), and of a review of medical notes at a public hospital, a university hospital, and a private clinic.
Santiago, Chile. Participants: Qualitative arm: 22 obstetricians, 21 pregnant women; quantitative arm: 540 postnatal women.
Rates of caesarean section in different types of institutions; consultants' views on private practice; work patterns in private practice; women's reasons for choosing private care; women's preferences on method of delivery.
Private health insurance cover requires the primary maternity care provider to be an obstetrician. In the postnatal survey, women with private obstetricians showed consistently higher rates of caesarean section (range 57-83%) than those cared for by midwives or doctors on duty in public or university hospitals (range 27-28%). Only a minority of women receiving private care reported that they had wanted this method of delivery (range 6-32%). With the diversification in the healthcare market, most obstetricians now have demanding peripatetic work schedules. Private maternity patients are a lucrative source of income. The obstetrician is committed to attend these private births in person, and the "programming" (or scheduling) of births is a common time management strategy. The rate of elective caesarean sections was 30-68% in women with private obstetricians and 12-14% in women not attended by private obstetricians.
Policies on healthcare financing can influence maternity care management and outcomes in unforeseen ways. The prevailing business ethos in health care encourages such pragmatism among those doctors who do not have a moral objection to non-medical caesarean section.
Although there have been significant improvements in post-abortion care programmes around the world, improvingpain managementhas remained a significant challenge. The introduction of manual vacuum aspiration (MVA) has led to many positive changes in programmes, but the guidelines for pain control have generallybeen vague. Women are often treated with no pain control or in some cases receive too much pain medication. There are many factors contributing to this situation, including: the belief that women who have induced an abortion should be punished, the idea thatpain control is unnecessary, the lack of availability of drugs and inadequate training and/or skills of providers. This paper argues for a greater focus on this important element of quality of care and for clearer guidelines on pain management during treatment of incomplete abortion with MVA. This includes the provision of analgesics immediately before the procedure, counselling and reassurance during the procedure and local anaesthesia when necessary.
Résumé
Bien que les services de soins après avortement aient été sensiblement améliorés, le traitement de la douleur demeure un défi important. L'introduction de (aspiration manuelle par le vide a abouti a de nombreux progrès clans les soins, mais les directives pour soulager la douleur demeurent généralement vagues. Fréquemment, les femmes ne reçoivent pas d'analgésique ou clans certains cas en reçoivent trop. De nombreux facteurs contribuent a cette situation, notamment : l'idée qu'il faut punir les femmes qui avortent ou qu'il est inutile de soulager la douleur,l'absence de medicaments et l'insuffisance de la formation et/ou des compétences des prestataires de soins. Cet article préconise d'accorder plus d'attention a cet élément important de la qualité des soins et demande des directives plus claires sur le traitement de la douleur pendant la prise en charge des avortements incomplets par aspiration manuelle. Cela suppose d'administrer des analgésiques immédiatement avant l'opération, de conseiller et rassurer les femmes pendant l'opération et de réaliser une anesthésie locale si nécessaire.
Resumen
Si bien los programmas de servicios postaboroto se han mejorado alrededor del mundo, todavía hace falta mejorar el manejo del dolor. La introducción de la aspiration manual endouterina (AMEU) ha llevado a muchos cambios positivos en los programas, pero los protocolos para el control del dolor han sido vagos en general. Es frecuente que las mujeres no reciben ningún tratamiento para controlar el dolor, o en algunos casos reciben demasiada medicina contra el dolor. Contribuyen a esta situación muchos factores, entre ellos la creencia de que las mujeres que se han inducido un aborto deben ser castigadas, la idea de que el control del dolor es innecesario, la falta de drogas disponibles, y la falta de capacitación y/o capacidad de los proveedores. El presente trabajo recomienda mayor atención a este elemento importante de la calidad de servicios, además de protocolos más claros para el manejo del dolor durante el. tratamiento de aborto incompleto con AMEU, los cuales incluirian la provisión de analgésicos inmediatamente antes de la intervención, consejería y un trato tranquilizante durante la intervención, y el uso de una anestesia local cuando sea necesario.
PIP
This is a report on a hospital gang rape of a 16-year-old female patient in Swabi, Pakistan. The patient had been admitted for surgical treatment of renal colic when the tragic incident occurred. The hospital's medical superintendent, deputy medical superintendent, and the staff in charge of the ward were all accused and suspended. The patient, who was from a very poor socioeconomic background, suffered vaginal tears. Hearing the news, elders of the Swabi district denounced the incident by making intensive protests on loudspeakers. Rape cases are increasing in Pakistan¿s hospitals, but most of them go unreported because of the stigma attached to such abuse.
Maternal mortality rates are very high in developing countries. In Niamey, the capital of Niger, maternal mortality rate is 280/100,000, in spite of a high concentration of health services and of health personnel. Several studies demonstrated that the efficiency of maternal health services was low, both because the quality and the quantity of work were insufficient. The usual response to the poor performances of health services in developing countries in mainly technical. If improvement of the training of health personnel and re-organization of health services are necessary, they are not sufficient. A good effectiveness of care cannot be achieved without a mutual confident relationship between providers and patients. Focus group discussions were held in Niamey with women users of maternal health services, with student midwives and experienced midwives. Sources of complaints between providers and patients appeared to be numerous. However, they are centered around two themes, delivery techniques and cultural requirements, which correspond to two types of constraints: technical constraints and social representations and practices of the population. A description of traditional practices and beliefs related to delivery were obtained through discussion groups with old women and traditional birth attendants (TBAs). Both women and midwives are tied up by the same social rules (e.g. linguistic taboos, respect and shame) but technical constraints force midwives to violate those rules, making the application of their technical skills very difficult. Thus, the mutual relationship between users and providers is source of dissatisfaction, which often degenerates into an open confrontation. Midwives must learn how to implement obstetrical techniques within specific cultural environments.
Analysis of the current organization and delivery of maternity care in Jamaica profits not only from an assessment of recent health issues but from consideration of the development of maternity services over the past century. Historical analysis indicates that a critical element in public health policy has been the effort to encourage use of biomedical obstetrical care and to eliminate the lay midwife. However, while women increasingly patronize hospitals, the delivery of services has deteriorated, resulting in widespread client dissatisfaction. Economic contingencies have contributed to the decline in maternity services, but health personnel manifest the ideology prevalent throughout the colonial era equating social irresponsibility with health complications. The cultural construction of illegitimacy and maternity is shown to be a dimension of class relations having an impact on health policy throughout Jamaica's history.
Satisfaction is an important element of the quality of health care, often determining patient willingness to comply with treatment and influencing the effectiveness of care. However, few specific assessments of patient satisfaction in developing countries have been undertaken. This paper presents findings from such a study, carried out in Tanzania and primarily undertaken through the use of qualitative interviewing techniques. The study illustrates the perceived problems of the care available, such as structural and inter-personal skill failings, both of which were seen to influence drug availability and maternal services--key weaknesses of the available care. Health centres were perceived to be little better than dispensaries. Although church health care was generally perceived to be better than government care, there was considerable variation in community judgements and clear signs of poor quality church care. The use of villagers' own words and experiences brought into sharp focus the problems they experience in relation to health care and allow planning lessons are identified.
To determine obstetrician-gynecologists' (ob-gyns') awareness of and experience with sexual abuse of patients and former patients and their opinions about appropriate consequences.
Mailed survey.
Canada.
All 792 members of the Society of Obstetricians and Gynaecologists of Canada (SOGC); 618 (78%) responded. Approximately half of all ob-gyns in Canada belong to the SOGC.
Knowledge of sexual involvement by an ob-gyn colleague with a patient or former patient (as defined by the respondents and by the College of Physicians and Surgeons of Ontario [CPSO]), self-report of such involvement, attitudes toward physician sexual abuse, desirable length of time a physician should wait before seeing a former patient in a situation that could lead to a sexual encounter, suggested consequences of sexual abuse.
Overall, 10% of the respondents indicated that they knew about another ob-gyn who at some time had been sexually involved with a patient. In all, 3% of the male respondents and 1% of the female respondents reported sexual involvement with a patient; the corresponding proportions of those who reported having been accused of sexual abuse by a patient were 4% and 2%. Significantly more of the female ob-gyns than of their male counterparts (37% v. 19%) reported awareness of a colleague's sexual involvement with a patient that would meet the CPSO's definition of sexual impropriety, transgression or violation. Most of the respondents felt that the consequence of proven sexual impropriety should be reprimand and fine (chosen by 33%) or rehabilitation without loss of licence (28%). Most of the physicians supported loss of licence for proven sexual transgression (57%) or proven sexual violation (74%), but fewer felt that loss of licence should be permanent for these types of abuse (4% and 24% respectively). The female ob-gyns supported stronger sanctions against sexual transgression and sexual violation than the male ob-gyns. A wide range of opinion was seen regarding the propriety of sexual relationships with former patients.
Ob-gyns have varied opinions about how sexual abuse of patients should be defined and how it should be sanctioned. There is a discrepancy between proposed public policy and the beliefs of physicians to whom the policy is to be applied.
Female genital mutilation is a more appropriate name for female circumcision. About 18 million females in more than 30 countries have undergone genital mutilation. Most of these women are from Africa the Middle East and Southeast Asia. Pharaonic circumcision is the most extensive form. It occurs between 12 months and puberty. It involves removal of the clitoris and the labia minora and majora and closing the opposing sides by either suturing them together or binding the legs together. A small opening for urination and menstruation is left. Sunna circumcision leaves the clitoris but the vaginal opening and the clitoris are covered by sewing the labia together. A third form involves the removal of the clitoris. Nonmedical people who tend to use unsterilized objects usually perform female genital mutilation. Mutilation generally results in complications such as infection recurrent cystitis recurrent vaginitis chronic pelvic inflammatory disease and mental trauma. The girls suffer pain. Subsequent hemorrhage and infection may kill them. Nonmedical problems include sexual dysfunction and marital strife. Neither the Bible nor the Koran support female genital mutilation yet many people claim that it is a religious practice. It has been incorporated into the culture because a girls mother grandmother and other female relatives have had to undergo it and many think it makes girls pure. In 1985 the UK Parliament passed the Prohibition of Female Circumcision Act which calls for female genital mutilators to be either fined or imprisoned. A woman who has given birth or her family may put pressure on an obstetrician to reinfibulate that woman. The surgeon should do only the least amount of reparative surgery to allow the labia to heal and to leave the vagina opening intact. Laws are not enough to prevent female genital mutilation. Education for women men mothers husbands community leaders and communities is also needed. A Royal College of Obstetricians and gynaecologists statement support groups condemning female mutilation.
In an examination of the health security of women, sexual exploitation of women patients when the perpetrators hold the trusted position of care provider, merits some considerable attention. Availability of data varies, with the majority gathered in the United States and Canada, focusing on medicine, psychotherapy and nursing. However, even for those professions, this field of research is in its early stages. Within the past few years, research has been undertaken in Australia and New Zealand, Germany, the Netherlands, Norway and the United Kingdom. Central to any discussion of this aspect of women's access to safe and appropriate health care are 3 questions about data. Do we know whether women are the principal victims of this abuse? Do such numbers count? Do we in fact need more data collection as we learn to respond more effectively to this particular form of violence against women? The author, who chaired Canada's first inquiry into the sexual abuse of patients by doctors, answers all 3 questions in the affirmative, with an emphasis on combining data collection with action. The sampling of research in this article demonstrates the need to combine qualitative and quantitative data to gain a more accurate understanding of the dynamics of abuse, within the social context of women's experience.
Physicians who abuse their patients sexually cause immense harm, and, therefore, the discipline of physicians who commit any sex-related offenses is an important public health issue that should be examined.
To determine the frequency and severity of discipline against physicians who commit sex-related offenses and to describe the characteristics of these physicians.
Analysis of sex-related orders from a national database of disciplinary orders taken by state medical boards and federal agencies.
A total of 761 physicians disciplined for sex-related offenses from 1981 through 1996.
Rate and severity of discipline over time for sex-related offenses and specialty, age, and board certification status of disciplined physicians.
The number of physicians disciplined per year for sex-related offenses increased from 42 in 1989 to 147 in 1996, and the proportion of all disciplinary orders that were sex related increased from 2.1% in 1989 to 4.4% in 1996 (P<.001 for trend). Discipline for sex-related offenses was significantly more severe (P<.001) than for non-sex-related offenses, with 71.9% of sex-related orders involving revocation, surrender, or suspension of medical license. Of 761 physicians disciplined, the offenses committed by 567 (75%) involved patients, including sexual intercourse, rape, sexual molestation, and sexual favors for drugs. As of March 1997, 216 physicians (39.9%) disciplined for sex-related offenses between 1981 and 1994 were licensed to practice. Compared with all physicians, physicians disciplined for sex-related offenses were more likely to practice in the specialties of psychiatry, child psychiatry, obstetrics and gynecology, and family and general practice (all P<.001) than in other specialties and were older than the national physician population, but were no different in terms of board certification status.
Discipline against physicians for sex-related offenses is increasing over time and is relatively severe, although few physicians are disciplined for sexual offenses each year. In addition, a substantial proportion of physicians disciplined for these offenses are allowed to either continue to practice or return to practice.
Nurse-patient relationships are a substantially neglected area of empirical research, the more so in developing than developed countries. Although nursing discourse usually emphasises "caring", nursing practice is often quite different and may be more strongly characterised by humiliation of patients and physical abuse. This paper explores the question: why do nurses abuse patients, through presentation and discussion of findings of research on health seeking practices in one part of the South African maternity services. The research was qualitative and based on 103 minimally structured in-depth individual interviews and four group discussions held with patients and staff in the services. Many of the patients reported clinical neglect, verbal and physical abuse from nursing staff which was at times reactive, and at others, ritualised, in nature. Although they explained nurses' treatment of them in terms of a few 'rotten apples in the barrel', analysis of the data revealed a complex interplay of concerns including organisational issues. professional insecurities, perceived need to assert "control" over the environment and sanctioning of the use of coercive and punitive measures to do so, and an underpinning ideology of patient inferiority. The findings suggest that the nurses were engaged in a continuous struggle to assert their professional and middle class identity and in the process deployed violence against patients as a means of creating social distance and maintaining fantasies of identity and power. The deployment of violence became commonplace because of the lack of local accountability of services and lack of action taken by managers and higher levels of the profession against nurses who abuse patients. It also became established as "normal" in nursing practice because of a lack of powerful competing ideologies of patient care and nursing ethics. The paper concludes by discussing avenues for intervention to improve staff-patient relationships.
The available literature reflects the growing interest in gender violence and reproductive health. Violence is generally studied by identifying pathologies, measuring their demands on services and evaluating their repercussions on fetal outcome. Institutional violence, however, has received little attention and is mainly concerned with the consequences of inappropriate use of technologies. Data from the Sexuality and Health Feminist Collective shows that among patients, 20.5% stated that they have never talked about their sexual life with their partners; 38.3% stated that they have had sexual intercourse against their will, including situations ranging from sexual harassment to rape which was referred by 12.3% of them. One of the most relevant issues arising from the anamnesis and interviews of these women was the violence to which they were submitted by health services. The high prevalence of violent situations indicates the urgency of incorporating an approach which deals with gender violence and promotes the empowerment of women into the routine of reproductive health services.
To estimate the incidences of caesarean sections in Latin American countries and correlate these with socioeconomic, demographic, and healthcare variables.
Descriptive and ecological study. Setting: 19 Latin American countries.
National estimates of caesarean section rates in each country.
Seven countries had caesarean section rates below 15%. The remaining 12 countries had rates above 15% (range 16.8% to 40.0%). These 12 countries account for 81% of the deliveries in the region. A positive and significant correlation was observed between the gross national product per capita and rate of caesarean section (r(s)=0.746), and higher rates were observed in private hospitals than in public ones. Taking 15% as a medically justified accepted rate, over 850 000 unnecessary caesarean sections are performed each year in the region.
The reported figures represent an unnecessary increased risk for young women and their babies. From the economic perspective, this is a burden to health systems that work with limited budgets.
To assess the extent of Sexual harassment of female nurses by male physicians, patients or patient's relatives.
A general hospital in Islamabad.
A cross sectional written study through a self administered brief questionnaire.
Male physicians were identified as the major perpetrators of sexual harassment, followed by the patients and their relatives.
The nurses and hospital administration need to work together for fostering work environment conducive to healthy environment for effective health care delivery.
The purpose of this paper is to identify and describe Rio de Janeiro maternity hospital profiles and the route between the mother's place of residence and the hospital. Data sources were: the State Live Birth Information System (1995) and the National Survey on Medical Care (1992). Two groups of maternity hospitals were identified using multivariate cluster analysis. Group A had an extremely high cesarean rate (81%), with mothers and neonates presenting good health conditions. Cesarean rates were lower in Group B, although still high (32%), and other variables reflected worse neonatal conditions. Cesarean rate was the indicator which best discriminated between the groups, followed by proportion of adolescent mothers and mothers with a high school education. The uneven spatial distribution of maternity hospitals, which were concentrated in the richest area of the city, was a factor in the long routes used by women to reach medical care for childbirth.
Although there have been significant improvements in post-abortion care programmes around the world, improving pain management has remained a significant challenge. The introduction of manual vacuum aspiration (MVA) has led to many positive changes in programmes, but the guidelines for pain control have generally been vague. Women are often treated with no pain control or in some cases receive too much pain medication. There are many factors contributing to this situation, including: the belief that women who have induced an abortion should be punished, the idea that pain control is unnecessary, the lack of availability of drugs and inadequate training and/or skills of providers. This paper argues for a greater focus on this important element of quality of care and for clearer guidelines on pain management during treatment of incomplete abortion with MVA. This includes the provision of analgesics immediately before the procedure, counselling and reassurance during the procedure and local anaesthesia when necessary.
PIP:
The objective of the 'safe motherhood' initiative is to reduce maternal mortality by 50% by the year 2000. A strong policy is needed to permit development of national and international programs. The lifetime risk of death from causes related to complications of pregnancy is estimated at 1/16 in Africa, 1/65 in Asia, 1/130 in Latin America and the Caribbean, 1/1400 in Europe, and 1/3700 in North America. A minimum of 585,000 women die of maternal causes each year, with nearly 90% of the deaths occurring in Asia and Africa. Approximately 50 million women suffer from illnesses related to childbearing. A principal cause of maternal mortality is lack of medical care during labor, delivery, and the postpartum period. Motherhood will become safe if governments, multilateral and bilateral funding agencies, and nongovernmental organizations give it the high priority it requires. Women also die because they lack rights. Their reduced decision-making power and inequitable access to family and social resources prevents them from overcoming barriers to health care. Women die when they begin childbearing at a very young age, yet an estimated 11% of births throughout the world each year are to adolescents. Adolescents have very limited access to family planning, either through legal restrictions or obstacles created by family planning workers. Maternal deaths would be avoided if all births were attended by trained health workers; an estimated 60 million births annually are not. Prevention of unwanted pregnancy and, thus, of the 50 million abortions estimated to take place each year would avoid over 200 maternal deaths each day. Unsafe abortions account for 13% of maternal deaths. The evidence demonstrates that rates of unsafe abortion and abortion mortality are higher where laws are more restrictive.
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17 Wood K, Maepa J, Jewkes R. Adolescent sex and contraceptive
experiences: perspectives of teenagers and clinic nurses in the
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March 19, 2002).
@BULLET www.thelancet.com Figure 2: Mothers receive their babies for early skin contact and breastfeeding immediately after delivery in a humanised public maternity ward in Sâo Paulo
THE LANCET @BULLET Vol 359 @BULLET May 11, 2002 @BULLET www.thelancet.com
Figure 2: Mothers receive their babies for early skin contact
and breastfeeding immediately after delivery in a humanised
public maternity ward in Sâo Paulo, Brazil. 1
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