Violencia de género durante la gestación: asociación con la interrupción voluntaria del embarazo y complicaciones de salud neonatales / Intimate partner violence during pregnancy as associated with voluntary abortions and neonatal health complications

Objetivo: Evaluar si la exposición a la violencia de género durante la gestación se relaciona con la interrupción voluntaria del embarazo y las complicaciones de salud neonatales que conlleven el ingreso en una Unidad de Cuidados Neonatales. Metodología: Estudio observacional, descriptivo y prospectivo, llevado a cabo en los dos centros de Atención a la Salud Sexual y Reproductiva de L’Hospitalet de Llobregat (Barcelona). Cumplimentaron el cuestionario validado de detección de violencia de género Index of Spouse Abuse las mujeres gestantes asistidas por matronas de los centros participantes. Conjuntamente, se recogieron variables sociodemográficas y obstétricas. Se realizó un análisis descriptivo, bivariante y multivariante de los datos. Resultados: Se obtuvo una muestra de 120 mujeres que solicitaron una interrupción voluntaria del embarazo y 381 que continuaron con la gestación. La prevalencia de violencia de género en el último año fue significativamente mayor (p <0,001) entre las mujeres gestantes que decidieron interrumpir el embarazo (25%) que entre las que decidieron continuar con el mismo (8,92%). La exposición a la violencia de género se asocia, después de ajustar otros factores explicativos, con un mayor riesgo de solicitar una interrupción voluntaria del embarazo (odds ratio [OR]= 4,06; intervalo de confianza [IC] del 95%: 2,23-7,48; p <0,001), y con un mayor riesgo de complicaciones neonatales (OR= 2,68; IC del 95%: 1,02-6,48). Conclusiones: La exposición a la violencia de género durante la gestación se relaciona con la interrupción voluntaria del embarazo y los ingresos del recién nacido por complicaciones de salud. Por ello, es necesario preguntar sobre violencia de género durante la asistencia sanitaria, tanto a las mujeres que continúan con el embarazo como a las que deciden interrumpirlo. (AU)

Objective: To assess whether exposure to intimate partner violence during pregnancy is associated with voluntary abortion and neonatal health complications that entail admittance to the Neonatal Care Unit. Methodology: Prospective, descriptive, observational study carried out in the two sexual and reproductive health care centers in L’Hospitalet de Llobregat (Barcelona, Spain). Pregnant women being assisted by midwives at the participating centres completed the Index of Spouse Abuse, the validated survey for detecting intimate partner violence. Sociodemographic and obstetrical data were collected concurrently. Bivariate, multivariate and descriptive analyses of the data were performed. Results: The sample size of women who voluntarily requested that their pregnancies be terminated was 120 and the sample size of women who brought their pregnancy to term was 381. The prevalence of intimate partner violence during the last year was significantly greater (p <0.001) among pregnant women who decided to terminate their pregnancies (25%) than among those who decided to carry their pregnancies to term (8.92%). After adjusting for other explanatory factors, exposure to intimate partner violence is associated with a greater risk of requesting an abortion (OR= 4.06; 95% CI= 2.23-7.48; p <0.001) and an increased risk of neonatal health complications (OR= 2.68; 95% CI= 1.02-6.48). Conclusions: Exposure to intimate partner violence during pregnancy is associated with voluntary abortion and neonatal health complications that entail admittance to the Neonatal Care Unit. Because of that, it is necessary to detect intimate partner violence during the provision of health care for both women who carry their pregnancies to term and those who decide to terminate them. (AU)

El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo / The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study

Objetivo: Conocer a través de las narraciones de las matronas de Atención Primaria los factores que obstaculizan o contribuyen a la detección y el abordaje de la violencia de género durante el embarazo, así como sus propuestas de mejora para tal fin. Método: Estudio cualitativo con un enfoque fenomenológico interpretativo. Se hicieron entrevistas semiestructuradas a las 12 matronas que trabajan en los centros de Atención Primaria de L’Hospitalet de Llobregat (Barcelona). Resultados: Las dificultades en la detección se relacionan con el sistema de visitas, el contexto de las mujeres y barreras del propio profesional como el miedo. Destacan como factores facilitadores el seguimiento en el control del embarazo y la relación de confianza con la matrona. Las propuestas de mejora se relacionan con la formación y el uso de procedimientos seguros y fiables. Conclusiones: Sería deseable poner en marcha acciones de mejora, tales como ampliar la formación y consensuar un circuito interno de trabajo que incluya instrumentos objetivos de ayuda de la detección, la coordinación con otros servicios y la forma ética, y legalmente adecuada de registro en la historia clínica

Aim: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. Method: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12 midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). Results: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. Conclusions: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record

The experiential expertise of primary care midwives in the detection of gender violence during pregnancy. Qualitative study. / El saber experiencial de las matronas de Atención Primaria en la detección de violencia de género durante el embarazo. Estudio cualitativo.

AIM: To use the reflections of primary care midwives to find out the barriers and facilitators for detecting IPV during pregnancy. The second aim is to determine proposals for measures to improve detection of IPV. METHOD: Qualitative methodology with a interpretative phenomenological approach. In-depth interviews were conducted with 12midwives, working in the sexual and reproductive health care centres of Hospitalet de Llobregat (Barcelona). RESULTS: The difficulties in detection relate to the system of visits, the situation of women and barriers of practitioners themselves, such as fear. Follow-up of pregnancy and the relationship of trust with the midwife stand out as facilitators. The proposals for improvement were to increase training and use safe and reliable health care procedures. CONCLUSIONS: The complexity of IPV makes it likely that IPV during pregnancy is undetected. It would be desirable to implement actions such as expanding training and agreeing on an internal work circuit that includes objective instruments to detect IPV, coordination with other services and ethical and legally appropriate way of recording in the clinical record.

Intimate partner violence as a subject of study during the training of nurses and midwives in Catalonia (Spain): A qualitative study.

While nurses and midwives are in a unique position to identify and help victims of IPV, since they are often their first point of contact in the healthcare system, they need appropriate training. This study sought to examine the presence of IPV-related contents and the depth to which they are addressed in the bachelor's degree in Nursing and in the Midwifery specialisation programme. The study also explored lecturers' motivations for including IPV in their subjects. The methodology employed was qualitative. In-depth interviews were conducted with 16 university lecturers who teach IPV contents in the Nursing degree and Midwifery specialisation programme. The study took place in Catalonia (Spain). The research shows that lecturers feel personally committed in the training for prevention and detection of IPV. The main teaching methodology is active, experiential and requires student activity. In all cases, the lecturers call for more time and spaces to be made available to carry out this training. It would be desirable for more time to be dedicated to nurses and midwives' university training in IPV. The topic should be approached with a more cross-disciplinary, systematised focus from all perspectives: health, psychological, social, ethical and legal. It is important that the training of teaching staff in IPV should be fostered and methodised.

Las matronas y la detección de la violencia en el embarazo / Midwives and intimate partner violence during pregnancy

La violencia de género es un grave problema social en todo el mundo, por su gravedad y su elevada prevalencia. Puede provocar patologías, incapacidad e incluso la muerte, y tiene repercusiones sobre la salud física, psíquica, social y sexual-reproductiva de la mujer. Si la violencia se ejerce durante el embarazo, puede tener consecuencias no sólo para la mujer, sino también para el feto en desarrollo y el futuro hijo. Existen una serie de funciones mínimas que los profesionales deben desarrollar, como preguntar sobre violencia de género con regularidad, informar y remitir a las mujeres que la sufran a los recursos disponibles de la comunidad, registrar los casos y conocer la legislación vigente del país

Gender violence is a major social problem at global level due to its serious nature and prevalence. It can lead to pathologies, disabilities and even death, and has repercussions for women’s physical, mental, social and sexual/reproductive health. If it occurs during pregnancy it can have consequences not only for the woman but for the developing foetus and the future child. There are a series of minimum functions professionals can perform, such as asking regularly about gender violence, informing women who suffer it about and referring them to the resources available in the community, recording cases and being familiar with current legislation in the country