Background Despite growing recognition of neglectful, abusive, and disrespectful treatment of women during childbirth in health facilities, there is no consensus at a global level on how these occurrences are defined and measured. This mixed-methods systematic review aims to synthesize qualitative and quantitative evidence on the mistreatment of women during childbirth in health facilities to inform the development of an evidence-based typology of the phenomenon.

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The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review

This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities, and demonstrates that mistreatment can occur at the level of interaction between the woman and provider, as well as through systemic failures at the health facility and health system levels.

The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review - PLoS Med - Vol. 12, 6 - p.e1001847

A proposta deste estudo qualitativo e analisar a producao cientifica sobre "humanizacao em saude/enfermagem", compreendendo quais concepcoes sobre humanizacao vem se configurando. Realizou-se levantamento bibliografico, sendo analisados 42 artigos, do final da decada de 50 ate os dias atuais, nos periodicos Revista Brasileira de Enfermagem, Revista Paulista de Hospitais e Texto e Contexto. Efetuaram-se analise e sintese integrativa dos mesmos. A tematica vem se constituindo, desde uma perspectiva caritativa ate a preocupacao atual com a valorizacao da saude como direito do cidadao, sendo inserida em projeto politico de saude. Artigos de todas as decadas mostram a necessidade de investir no trabalhador, valorizando a dimensao subjetiva. Todavia, a tematica e pouco abordada na formacao. A humanizacao do atendimento supoe encontro entre sujeitos que compartilham saber, poder e experiencia vivida, implicando em transformacoes politicas, administrativas e subjetivas.

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Humanização do atendimento em saúde: conhecimento veiculado na literatura brasileira de enfermagem

For a half-century, black women have incurred nearly 4 times as many pregnancy complications as white women, even allowing for age, parity, and educational level. Excessive mortality from a given condition may reflect a higher prevalence, a higher case-fatality rate, or both. The investigators calculated these rates for 5 pregnancy complications-preeclampsia, eclampsia, abruptio placentae, placenta previa, and postpartum hemorrhage. These potentially life-threatening conditions together account for about one-fourth of pregnancy-related deaths. National data sets were used to estimate prevalence and case-fatality rates of these disorders in the years 1988-1999. The prevalence rate was defined as the number of affected pregnant women per 100,000 live births, and the case-fatality rate as the number of deaths attributable to the particular condition for every 100,000 affected women. Although there were no significant racial differences in prevalence rates, black women with these diagnoses were 2 to 3 times more likely to die than were white women. Black-white prevalence rate ratios ranged from 0.8 to 1.6; none of them differed significantly from unity. In contrast, case-fatality rates for all 5 conditions were significantly higher for black women. Case-fatality rate ratios for black versus white women ranged from 2.4 for placenta previa to 3.3 for postpartum hemorrhage. For each condition, the pregnancy-related mortality ratio for black women was 2.5 to 3.9 times greater than that for whites. And for each condition, at least two-thirds of the difference was ascribed to higher case-fatality rates in black women. A maximum of one-third of the difference for any of the conditions was ascribed to higher prevalence in blacks. The method used to redistribute women whose race was unknown did not substantially influence the results. The investigators conclude that increased rates of pregnancy-related mortality in black women reflect, to a large extent, higher case-fatality rates. Clarifying the mechanisms that determine the severity of complications and the risk of death-including interactions between biology and health services-might help to identify interventions that improve pregnancy outcomes.

The Black-White Disparity in Pregnancy-Related Mortality From 5 Conditions: Differences in Prevalence and Case-Fatality Rates

Background Many women experience mistreatment during childbirth in health facilities across the world. However, limited evidence exists on how social norms and attitudes of both women and providers influence mistreatment during childbirth. Contextually-specific evidence is needed to understand how normative factors affect how women are treated. This paper explores the acceptability of four scenarios of mistreatment during childbirth. Methods Two facilities were identified in Abuja, Nigeria. Qualitative methods (in-depth interviews (IDIs) and focus group discussions (FGDs)) were used with a purposive sample of women, midwives, doctors and administrators. Participants were presented with four scenarios of mistreatment during childbirth: slapping, verbal abuse, refusing to help the woman and physical restraint. Thematic analysis was used to synthesize findings, which were interpreted within the study context and an existing typology of mistreatment during childbirth. Results Eighty-four IDIs and 4 FGDs are included in this analysis. Participants reported witnessing and experiencing mistreatment during childbirth, including slapping, physical restraint to a delivery bed, shouting, intimidation, and threats of physical abuse or poor health outcomes. Some women and providers considered each of the four scenarios as mistreatment. Others viewed these scenarios as appropriate and acceptable measures to gain compliance from the woman and ensure a good outcome for the baby. Women and providers blamed a woman's “disobedience” and “uncooperativeness” during labor for her experience of mistreatment. Conclusions Blaming women for mistreatment parallels the intimate partner violence literature, demonstrating how traditional practices and low status of women potentiate gender inequality. These findings can be used to facilitate dialogue in Nigeria by engaging stakeholders to discuss how to challenge these norms and hold providers accountable for their actions. Until women and their families are able to freely condemn poor quality care in facilities and providers are held accountable for their actions, there will be little incentive to foster change.

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"By slapping their laps, the patient will know that you truly care for her": A qualitative study on social norms and acceptability of the mistreatment of women during childbirth in Abuja, Nigeria.

The objective of this article was to analyze some cultural aspects of women who have experienced normal deliveries at hospitals of the National Health System. It is a qualitative research, and its theoretic-methodological reference was the Theory of Social Representation. For data collection ten women who had normal childbirth were interviewed. As a result, we could notice that many of the aspects that they had experienced were mostly associated to an institutional culture that revealed a treatment based on violence, and disrespect to the principles of the Birth Humanization Program created by the Brazilian Health Ministry. We concluded that there are still a lot of investments to be done to improve the quality of the assistance given to labor deliveries at the studied hospitals.

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Parto hospitalar - experiências de mulheres da periferia de Cuibá-MT

Partimos do pressuposto de que ha uma estreita convergencia entre educacao-cuidado-politicidade quando se deseja a garantia aos direitos das pessoas em situacoes cronicas de saude. Assim, foi objetivo desta reflexao evidenciar a imbricacao que ha entre o cuidado em saude e em enfermagem, a educacao para a saude e a politicidade que os permeia. Partindo da apresentacao parcial dos dados de uma pesquisa exploratoria realizada junto a pessoas portadoras de estomia em um hospital publico do Estado de Mato Grosso pudemos discutir a estreita relacao que ha entre a educacao, o cuidado e a formacao do sujeito politico, seja ele aluno, profissional ou usuario de servico de saude.

A convergência cuidado-educação-politicidade: um desafio a ser enfrentado pelos profissionais na garantia aos direitos à saúde das pessoas portadoras de estomias

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La convergencia cuidado-educación-politicidad: un reto a ser enfrentado por los profesionales en la garantía a los derechos de la salud de las personas portadoras de ostomías

OBJECTIVES: to examine the correlation between maternal mortality rates and race/color in the Brazilian State of Mato Grosso between 2000 and 2006. METHODS: an epidemiological study was carried out using the death certificates, DATASUS and SIM/SES-MT to provide a time series for these years. The race/color of the women who died during childbirth was related to the variables age, level of education, marital status, primary cause of death and type of obstetric cause. In combination with the Χ2 test and the odds rati were used. RESULTS: the Χ2 test showed a significant association between race/color and maternal mortality, with a level of significance of 95%. The odds ratio revealed that such deaths were 5.13 times more likely among black women and 5.71 times more likely among indigenous women, compared to white women. "Hypertensive disorders during pregnancy, childbirth or puerperium" were the main cause of maternal mortality among African Brazilian women and women of mixed race; 45.4% and 29.93% respectively. Indigenous women died more of "complications during labor" with 27.2%. White women died more (30.7%) of "other obstetric complications". CONCLUSIONS: in the state of Mato Grosso a high maternal mortality rate from direct obstetric causes are found among black and indigenous women.

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Mortalidade materna e sua interface com a raça em Mato Grosso

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Wilza Rocha Pereira

Papers

Parto hospitalar - experiências de mulheres da periferia de Cuibá-MT

A convergência cuidado-educação-politicidade: um desafio a ser enfrentado pelos profissionais na garantia aos direitos à saúde das pessoas portadoras de estomias

La convergencia cuidado-educación-politicidad: un reto a ser enfrentado por los profesionales en la garantía a los derechos de la salud de las personas portadoras de ostomías

Mortalidade materna e sua interface com a raça em Mato Grosso

Poder, violencia y dominación simbólica en los servicios públicos de la salud