Validación de la escala de violencia obstétrica y pruebas de la invarianza factorial en una muestra de mujeres chilenas / Validation and factorial invariance test of obstetric violence scale in women from Chile

RESUMEN

Resumen La violencia obstétrica (VO) es un problema de enorme relevancia social en nuestro contexto, ya que puede afectar psíquica y físicamente a las mujeres, al mismo tiempo que puede socavar la confianza en el sistema de salud y limitar el acceso oportuno a este por parte de las mujeres. La violencia obstétrica se ha definido como la apropiación del cuerpo de la mujer por parte del personal de salud a través de prácticas que redundan en la medicalización y patologización de sus procesos reproductivos. Esta violencia puede ser psicológica (p. e., regaños, negativa a responder a preguntas o realizar un plan de parto ajustado a sus expectativas), física (p. e., uso innecesario de la fuerza o querer causar dolor intencionalmente) y/o sexual (p. e. comentarios de naturaleza sexual referidos a su cuerpo o genitales, etc.). También se puede verificar mediante la realización de prácticas que están desaconsejadas o estrictamente prohibidas (p. e., monitorización fetal continua, uso de oxitocina sintética para agilizar el procedimiento, negación de la libertad de movimiento, maniobra de Kristeller, episiotomía de rutina, entre otros). No existen a la fecha escalas validadas que permitan detectar violencia obstétrica en la atención de salud. Método: Se analiza la fiabilidad (alfa y omega) y se aportan pruebas de la validez (análisis factorial confirmatorio) de la escala de VO. Las participantes de la muestra fueron 367 mujeres, mayores de edad, de la región de Valparaíso (Chile), que habían tenido alguna vez un parto. Los resultados apoyan la validez de la escala de VO y la estructura unifactorial propuesta muestra un buen ajuste (CFI = .94, NFI = .91, IFI = .94 y RSMEA = .067); también apoyan la idea de invarianza a través de diferentes muestras (ΔCFI < .01 y ΔRSMEA < .01), toda vez que la escala de VO demuestra ser un instrumento confiable (α = .83 y ω = .88). Por lo tanto se concluye que la escala de VO es un instrumento fiable y válido para la detección de este tipo específico de violencia contra las mujeres.

ABSTRACT

Abstract Obstetric violence is a long-standing problem of great social relevance in our context, since it can affect women psychically and physically. Similarly, obstetric violence can strongly undermine confidence in the health system and limit timely access to it by women (who could avoid conducting routine examinations associated with their pregnancy and which would explain the growing proportion women who wish to deliver at home and outside the medical system). Obstetric violence (also commonly referred to as "disrespect and abuse" during childbirth and "mistreatment" during childbirth care) has been defined as the appropriation of women's bodies by health personnel through practices that become the medicalization and pathologization of their reproductive processes. This violence can be psychological (e.g. abuse, scolding, refusal to answer your questions or carry out a birth plan adjusted to your expectations), physical (e.g. use of force or intentionally wanting to cause pain) and / or sexual (e.g. tacts of a sexual nature, comments of a sexual nature referring to your body or genitals, etc.), which can also be verified in the performance of a series of practices that are discouraged or strictly prohibited (for example, continuous fetal monitoring, use of synthetic oxytocin to speed up the procedure, impaired free movement, Kristeller's maneuver, routine episiotomy, among others). To date, there are no validated scales in our context that allow detecting obstetric violence (OV) in health care. These forms of violence can be a traumatic experience for many women. The scale has been created having as its main reference the so-called "obstetric violence test" prepared by the association El parto es nuestro, which includes the most recurrent situations of lack of respect and abuse in obstetric care. Reliability (alpha and omega) is analyzed and validity tests (confirmatory factor analysis) of the VO scale are provided. The invariance tests aim to ensure that the construct being evaluated (in this case obstetric violence) has the same meaning for women who provide care in the private and public health systems. The participants in the sample were 367 women, all of legal age, from the Valparaíso region (Chile) and who had had a child birth at some point in their lives. These women had their deliveries in both the public and private health systems. Of the total number of women who participated in the study, 58.9% declared having experienced some situation of violence during their delivery. The results support the validity of the VO scale, the proposed unifactorial structure shows a good fit (CFI = .94, NFI = .91, IFI = .94 and RSMEA = .067). The results support the idea of ​​invariance through the samples of women who attended their delivery in the private and public health system (ΔCFI < .01 and ΔRSMEA < .01), since the VO scale proves to be a reliable instrument (α = .83 and ω = .88) and with high levels of internal consistency (either based on total item correlations or factor loadings, which would be the most appropriate method for scales that use ordinal level of measurement). In conclusions, the VO scale is a reliable and valid instrument for the detection of this specific type of violence against women that can contribute to studies that detect abusive practices within the health system. Many of the women who do not report having experienced obstetric violence, do report the presence of some practices that are discouraged or prohibited genital shaving (66.2 %), enema (45.5 %), prohibition of consuming food or water (51.7 %), indication of lying down during labor (24.5 %), induction of labor using medication (36.1 %), repeated vaginal examinations (24.3 %), compression of the abdomen (34.5 %), episiotomy (33.6 %), cesarean section (54.1 %) ) and uterine scraping without anesthesia (2 %). The previous results indicate the normalization of violent practices and their routine performance in the framework of delivery care in public and private health services, which could make us underestimate their prevalence.