Violencia ginecológica-obstétrica / Definition of obstetric violence

El artículo define la violencia ginecológica-obstetrica (VGO) como una forma de violencia estructural, simbólica y de género, que puede experimentarse a lo largo de todo el ciclo vital sexual y reproductivo de las mujeres. A su vez, también menciona la relación entre patriarcado, capitalismo y colonialismo en la salud sexual y reproductiva (SSR) de las mujeres. Por ello, se habla también de los fenómenos de racismo obstétrico y estratificación obstétrica interseccional, que terminan de dar forma al constructo de la VGO y a cómo ésta se acrecienta ante determinadas características de las mujeres (gestantes tardías, adolescentes, migrantes, etc.). Por tanto, la VGO se refiere a un fenómeno complejo que precisa un cambio urgente en la formación sanitaria, no sólo en gineco-obstetricia, sino también en pediatría y anestesiología, así como un cambio en el modelo asistencial para profesionales que atienden la SSR de las mujeres, además de una sensibilización a nivel de ciudadanía. En definitiva, la VGO es hoy día un grave problema de salud pública y salud global que pone en riesgo el bienestar biopsicosocial de madres, bebés y profesionales, al que se debería estar atendiendo seriamente para su prevención y erradicación.(AU)

Perception of health sciences and feminist medical students about obstetric violence.

OBJECTIVE: To measure the perception of obstetric violence among health sciences students. METHOD: Cross-sectional design in which the validated questionnaire PercOV-S (Perception of Student Obstetric Violence) was used. The questionnaire was offered to the students who participated in the I Congress of Feminist Medicine of the CEEM (State Councils of Medical Students) held on March 12, 2021. This questionnaire was sent online through Google Forms. RESULTS: The mean score obtained on the total scale was 3.83 scores (SD=0.61). For the dimension of protocolized-visible obstetric violence, the mean score is 2.79 points (SD=0.84) and for the dimension of non-protocolized-invisible obstetric violence, a mean of 4.16 points is obtained (SD=0.61). The global score of the displayed question differs statistically significantly with the variable scope (p=0.019), course (p=0.008), treatment according to ethnicity (p=0.008), treatment according to socioeconomic level, immigrant status (p<0.001), and prior knowledge about the concept of obstetric violence (p<0.001). CONCLUSIONS: The data show a marked generalised sensitivity of the sample to the issue of obstetric violence, especially with regard to the ethnic characteristics of the women. Likewise, the need to generate ethical-attitudinal training in the response to obstetric violence is observed.

Sexo y género en la donación de riñón: visiones desde las profesionales de la consulta de trasplante renal / Sex and gender in kidney donation: views from the clinic

Introducción: En el trasplante renal de donante vivo son las mujeres las que donan con más frecuencia. Las profesionales de nefrología tienen un papel muy importante en la información sobre los tratamientos de sustitución renal y la ayuda en la toma de decisiones.Objetivo:Explorar cómo influye la perspectiva de género en el trasplante renal de donante vivo desde la visión de las profesionales de nefrología.Metodología:Estudio cualitativo fenomenológico. Participaron 13 profesionales de las Unidades de Nefrología y Trasplante Renal de Catalunya. Se realizaron entrevistas semiestructuradas y se analizaron a través de un análisis temático.Resultados:Las opiniones y percepciones de las profesionales de nefrología se clasificaron a través de los siguientes temas: 1) manera de informar sobre los tratamientos; 2) donación habitual; 3) predisposición para donar y 4) actitud de la persona donante. Las mujeres se muestran más predispuestas a donar debido a los mandatos de género, además de las desigualdades en el mercado laboral. Cabe destacar que, la forma en la toma de decisión es igual para hombres y mujeres. Así mismo, las mujeres se muestran más preparadas psicológicamente y se recuperan más rápido del postoperatorio.Conclusiones:La feminización en la donación de riñón es la suma de factores médicos, socioculturales y económicos. Los roles de género influyen en las mujeres en sus actitudes y comportamientos a lo largo de todo el proceso de trasplante renal de vivo. Las profesionales de nefrología entrevistadas describen las diferencias entre hombres y mujeres en la donación de riñón. (AU)

Introduction: In living donor kidney transplantation, women are the most frequent donors. Nephrology professionals play a very important role in informing about renal replacement treatments and assisting in decision-making.Objective:To explore how gender perspective influences living donor renal transplantation from the views of nephrology professionals.Methodology:A qualitative phenomenological study was carried out. Thirteen professionals from the Nephrology and Renal Transplant Units in Catalonia participated in this study. Semi-structured interviews were conducted and analysed using a thematic analysis.Results:The opinions and perceptions of female nephrology professionals were classified according to the following topics: 1) way of informing about treatments; 2) habitual donation; 3) predisposition to donate and 4) attitude of the donor. Women are more likely to donate due to gender mandates, as well as to inequalities in the labour market. It should be noted that the decision-making process is the same for men and women, that women are better psychologically prepared and recover more quickly from the postoperative period.Conclusions:Feminization in kidney donation is the sum of medical, socio-cultural and economic factors. Gender roles influence women’s attitudes and behaviours throughout the living kidney transplantation process. The female nephrology professionals interviewed describe the differences between men and women in kidney donation. (AU)

Impact of COVID-19 on Breastfeeding among SARS-CoV-2 Infected Pregnant Women: A Single Centre Survey Study.

Background: Although current guidelines recommend that mothers with suspected or confirmed SARS-CoV-2 infection should be encouraged to initiate and continue breastfeeding, up-to-date literature shows conflicting data regarding breastfeeding experiences in infected women. This survey aimed to report on the psychological impact of SARS-CoV-2 infection on breastfeeding practice and medical counselling in a single tertiary center in Southern Italy. Methods: One-hundred breastfeeding women with SARS-CoV-2 infection at delivery were given an anonymous questionnaire regarding breastfeeding and women's perception of the impact of COVID-19 on breastfeeding. Results: 75% of women reported they had difficulty breastfeeding; among them, 66 (66%) declared that separation from their babies after delivery affected their ability to breastfeed. Incidence of reported difficulties in breastfeeding was higher in women who underwent caesarean section compared to women with vaginal delivery (56/65, 86.2% vs. 19/35, 54.3%, χ2 = 12.322, p < 0.001) and in women with a hospital stay of more than 5 days (48/57, 84.2% vs. 23/37, 62.2%, χ2 = 5.902, p = 0.015). Furthermore, the incidence of difficulties in breastfeeding was higher in women who subsequently decided to use exclusively infant formula compared to women who mixed maternal milk with infant formula and women who breastfed exclusively with maternal milk (48/49, 98% vs. 20/25, 80% vs. 7/26, 26.9%, χ2 = 46.160, p < 0.001). Conclusions: Our survey highlights the importance of healthcare support and information on hygiene practices to decrease the perceived stress related to breastfeeding for infected mothers under restrictions, especially in women undergoing cesarean section and with a long hospital stay.

Rates of instrumental vaginal birth and cesarean and quality of maternal and newborn health care in private versus public facilities: Results of the IMAgiNE EURO study in 16 countries.

OBJECTIVE: To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. METHODS: Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. RESULTS: Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. CONCLUSION: The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution. GOV IDENTIFIER: NCT04847336.

Quality of facility-based maternal and newborn care around the time of childbirth during the COVID-19 pandemic: online survey investigating maternal perspectives in 12 countries of the WHO European Region.

BACKGROUND: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. METHODS: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. FINDINGS: 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers' number as "insufficient". Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. INTERPRETATION: Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. FUNDING: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT04847336.

An intersectional gender analysis in kidney transplantation: women who donate a kidney.

BACKGROUND: Living-donor transplantation is the best treatment option in patients with chronic kidney failure. Global data show that women are less likely to be kidney recipients than men but are more likely to become living kidney donors. We explored the experience of women who donate a kidney to relatives with biological and socio-cultural ties and to understand the similarities and differences in their experience. METHODS: A qualitative hermeneutic phenomenological study with an intersectional analysis of gender. Ten women donors accepted in the transplant evaluation period participated, all of whom donated a kidney to a pre-dialysis relative. Two categories were included: women with biological kinship ties (mothers, sisters) and women who have a socio-cultural relationship (wives) with kidney recipient. The data were collected through semi-structured in-depth interviews and analysed using thematic analysis. RESULTS: Women donate their kidneys in a convinced manner, without worrying about their health, with an optimistic and positive attitude, and without believing that they are acting heroically. Women with biological kinship ties see it as a 'naturalization thing'. In contrast, wives donate conditioned by gender roles, but also as a form of empowerment and as a personal benefit: they donate in order to avoid taking on carer role for their husband and as a way of protecting their children. CONCLUSION: The study's findings expand the conception of kidney donation as solely altruistic and may help professionals to pay attention to the complexity and intersectionality of features present in women who are living kidney donors.

La sensibilización en temas de violencias de género en estudiantes de Enfermería / Awareness on issues of gender-based in violence in nursing students

JUSTIFICACIÓN: Se presentan los resultados de la encuesta sobre la sensibilización en materia de género, violencias y salud realizada durante el proyecto "Violencias sexuales según el paradigma de las violencias de género: un proyecto de aprendizaje servicio" llevado a cabo con el alumnado de 1er curso de Enfermería (2017-2018), de la Universitat de Vic. OBJETIVO: Identificar si la participación del alumnado de Enfermería en el proyecto supone una disminución de su tolerancia ante situaciones de violencias de género, que les permita identificar de forma más eficaz actitudes y comportamientos sexistas en su entorno. MÉTODO: Se llevó a cabo un diseño pre-test y post-test con grupo único basado en un muestreo de conveniencia por cuotas en estudiantes del primer curso de Enfermería. Se recogieron un total de 96 respuestas y, sucesivamente, 64. RESULTADOS: Se ha observado una falta de educación en materia de género dentro de los espacios formales de aprendizaje, además, dicha ausencia se relaciona con la percepción que se construye entorno al riesgo. Como resultados se generan y refuerzan estereotipos que no corresponden a la evidencia científica existente. No se destacan diferencias significativas entre hombres y mujeres. CONCLUSIONES: El proyecto ha incluido una formación en cuestiones de género, violencias y salud. Dicho aprendizaje-servicio ha aumentado el grado de sensibilización en materia de género evidenciando una importante disminución de la tolerancia ante situaciones de violencias y una mayor identificación de actitudes y comportamientos sexistas en su entorno. Estos elementos se consideran competencias enfermeras fundamentales para detectar y atender situaciones de violencias en Atención Primaria y Urgencias

JUSTIFICATION: The results of the survey on awareness of gender, violence and health carried out with first year students of Nursing (2017-2018) at University of Vic. OBJECTIVE: Identify if the participation of Nursing students in the project involves a decrease in their tolerance of situations of gender violence, which allows them to more effectively identify sexist attitudes and behaviours in their environment. METHOD: A pre-test and post-test design was carried out with a single group based on a sampling of convenience by quotas with the students of Nursing. A total of 96 responses were collected and, successively, 64. RESULTS: A lack of gender education has been observed within formal learning spaces in nursing students and that this absence is related to the perception that is built around risk. These generate and reinforce stereotypes that do not correspond to the scientific evidence we handle.No significant differences between men and women are highlighted. CONCLUSIONS: The project has included training in gender, violence and health issues.This service-learning has increased the degree of gender awareness, showing a significant decrease in tolerance in situations of violence and a greater identification of sexist attitudes and behaviours in their environment. These elements are considered fundamental nursing competencies to detect and attend situations of gender-based violence in primary and emergencies

The experience of donating and receiving a kidney: A systematic review of qualitative studies.

BACKGROUND: The experiences described by people who have undergone kidney transplant are complex. Understanding how donors and recipients experience kidney transplantation can help us to design strategies that provide a more person-centred health care. OBJECTIVES: To review articles that report the experiences of donors and recipients in the living-donor kidney transplantation process. METHOD: A systematic review of qualitative studies was carried out. PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases were used to search for articles published in English, French and Spanish between 2005 and 2018. RESULTS: Twenty-nine articles were included in this review. For recipients, receiving a kidney is a positive experience (positive feelings and significant experience) that also involves certain difficulties and stressors (making a difficult decision, fears and worries). The experience of the donors is positive as they are motivated to improve the life of the recipient. They are committed to donating and use coping strategies as well as experiencing personal growth. On the contrary, being a donor involves certain difficulties and stressors (personal investment, mental, physical and economic impact and overcoming opposition) and a perception of deficiency in the health system (lack of information and attentiveness). CONCLUSION: Donating and receiving a kidney is a positive experience that involves certain difficulties and a variety of stressors for both the donors and recipients. Moreover, the donors note deficiencies in the health system.

ANTECEDENTES: Las experiencias que explican las personas sometidas a un trasplante renal son complejas. Entender como experimentan el trasplante renal los donantes y los receptores nos puede ayudar a diseñar estrategias para proporcionar una atención sanitaria más centrada en la persona. OBJETIVOS: Revisar artículos que hablen sobre las experiencias de los donantes y los receptores en el proceso de trasplante renal de donante vivo. MÉTODO: Se realizó una revisión sistemática de estudios cualitativos. Se utilizaron las bases de datos Pubmed, Scopus, Web of Science, Cinahl y Psycinfo para buscar artículos desde el año 2005 hasta 2018 publicados en inglés, francés o español. RESULTADOS: Se incluyeron 29 artículos en esta revisión. Para los donantes la experiencia de donar es positiva ya que están motivados para mejorar la vida del receptor, donan de forma convencida, utilizan estrategias de afrontamiento y experimentan crecimiento personal. Por otro lado, donar supone dificultades y estresores (inversión personal, impacto económico, físico, mental y superar la oposición) y percepción de carencia en el sistema sanitario (falta de información y desatención). Para los receptores el recibir un riñón es una experiencia positiva (sentimientos positivos y experiencia significativa) ligada también a dificultades y estresores (toma de decisión difícil, temores y preocupaciones). CONCLUSIONES: Dar y recibir un riñón es una experiencia positiva que comporta dificultades y factores estresantes diferentes para los donantes y para los receptores. Además, los donantes constatan una carencia en el sistema sanitario. This article is protected by copyright. All rights reserved.

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