Obstetric Violence in Spain (Part I): Women’s Perception and Interterritorial Differences

Abstract

The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth

“…The present study presents the interventionism and medicalization levels during childbirth in Spain; these levels were assessed in both public and private healthcare sectors. This analysis allowed us to see the interventionism distribution in different SAC by means of previously established cluster groups [ 20 ], a certain equity criterion was noted for interventionism and medicalization in the different SAC. Finally, the relation of interventions during childbirth with women’s perceived OV was assessed.…”

“…The differences in the present work among interventions in public/private healthcare, cluster groups, and women perceived having received OV can only be understood from this perspective. As the percentage of OV in Spain is high [ 20 ], this perspective can also explain findings, such as this percentage considerably increasing, while bearing in mind the opinions of those women who indicate having suffered unnecessary and/or painful interventions while giving birth, which means that women’s empowerment can play a very important role [ 41 ]. Nonetheless, all of these literacy assumptions for health, empowerment, and OV should be confirmed by future studies.…”

“…Thus, as in Spain, in order to improve materno-infant health and well-being, it is important to bear in mind better data collection and minimally controllable public indicators of the materno-infant health services rendered in this sector [ 19 , 43 ]. Furthermore, this study indicates higher interventionism levels in the private sector than in the public one and, in turn, perceived OV is also higher in the private sector [ 20 ]. Thus, we should reflect on the technical and human quality of such healthcare in the private health sector, which falls in line with what other authors have reported [ 44 ].…”

“…A descriptive, retrospective, and cross-sectional study was conducted from January 2018 to June 2019. The methodology is explained in-depth in the previous publication, Part I [ 20 ]. This work analyzed the subsample who gave birth during the study period in Spain.…”

“…A descriptive analysis was done on all of the variables with frequency and percentage. A bivariate analysis with the Chi squared test was carried out using contingency tables to compare the interventions and medicalization of the birth process in public, private, and mixed healthcare centers, and in the national territory, according to the cluster groups that the analysis gave in Part I, where SAC were classified according to how women perceived OV [ 20 ]. In this way, the distribution by cluster groups was as follows: group 1 was made up of SAC Madrid, Basque Country, Principality of Asturias and Castilla y León; group 2 with SAC Catalonia, Valencian Community, Aragón and Castilla-La Mancha; group 3 with Andalusia, Balearics, Canaries and Navarre; group 4 with Murcia Region, Galicia, Extremadura and Cantabria; the last group was formed by only one SAC: La Rioja.…”