ABSTRACT
Resumen: Desde hace décadas el parto de bajo riesgo ha sido abordado, fundamentalmente en el ámbito clínico-hospitalario, desde una perspectiva intervencionista, caracterizada por la medicalización, tecnificación y mecanización asistencial. En este contexto se sitúa el presente estudio, cuyo objetivo ha sido explorar las limitaciones bioéticas de este paradigma asistencial intervencionista, mediante el análisis de su pragmatismo clínico frente a otros abordajes más humanistas. Para ello se ha llevado a cabo un profundo análisis documental en diferentes bases de datos del ámbito de las ciencias médicas y sociales, seleccionando tanto artículos de difusión científica como libros, declaraciones, estrategias y guías de práctica clínica. Los resultados muestran un patrón asistencial medicalizado, que parece incrementar las intervenciones no justificadas y con ello los efectos iatrogénicos en los partos de bajo riesgo. Se concluye que estamos ante una cultura del nacimiento que, en cierta medida, vulnera los principios bioéticos fundamentales, al subyugar la dignidad de la corporalidad femenina a intereses económicos contingentes e ideologías transhumanistas, biopolíticas y tayloristas cosificadoras.
Abstract: For decades in low-risk deliveries has been addressed, mainly in the clinical-hospital setting, from an interventionist perspective characterized by medicalization, mechanization and machining care. In this context the present study lies, whose aim was to explore the bioethical limitations of this interventionist paradigm of care through an analysis of its clinical pragmatism compared to other approaches more humanistic. For this it has conducted a thorough analysis of documents in different databases in the field of medical and social sciences, selecting both items of scientific diffusion as books, statements, strategies and clinical practice guidelines. The results show a medicalized care pattern appears to increase the iatrogenic effects in low-risk deliveries. We conclude that this is a culture of birth which, to some, it violates basic bioethical principles to subjugate the dignity of female corporeality to contingent economic interests and transhumanists, biopolitics and taylorist ideologies reifying.
Resumo: Por décadas o parto de baixo risco tem sido abordado, fundamentalmente no campo clinico-hospitalar, a partir de uma perspectiva intervencionista caracterizada pela medicalização, tecnificação e mecanização assitencial. Nesse contexto se situa o presente estudo, cujo objetivo tem sido explorar a limitações bioéticas desse paradigma assistencial intervencionista através da análise de seu pragmatismo clínico frente à outras abordagens mais humanistas. Para isto, fora realizada uma profunda análise documental em diferentes bases de dados no campo das ciências médicas e sociais, selecionando tanto artigos de divulgação científica como livros, declarações, estratégias e guias de prática clínica. Os resultados mostram um padrão assistencial medicalizado que parece intensificar as intervenções não justificadas e, por conseguinte, os efeitos iatrogénicos em partos de baixo risco. Conclui-se estamos diante de uma cultura de nascimento que, em certa medida, viola os princípios bioéticos fundamentais ao subjugar a dignidade da corporalidade feminina por interesses econômicos contingentes e ideologias transumanistas, biopolíticas e tayloristas reificantes.
Subject(s)
Humans , Female , Pregnancy , Parturition , Medicalization , Humanism , Obstetrics/ethicsABSTRACT
OBJECTIVES: In Zambia, only 56% of rural women deliver in a health facility, and improving facility delivery rates is a priority of the Zambian government. 'Mama kit' incentives - small packages of childcare items provided to mothers conditional on delivering their baby in a facility - may encourage facility delivery. This study measured the impact and cost-effectiveness of a US$4 mama kit on rural facility delivery rates in Zambia. METHODS: A clustered randomised controlled trial was used to measure the impact of mama kits on facility delivery rates in thirty rural health facilities in Serenje and Chadiza districts. Facility-level antenatal care and delivery registers were used to measure the percentage of women attending antenatal care who delivered at a study facility during the intervention period. Results from the trial were then used to model the cost-effectiveness of mama kits at-scale in terms of cost per death averted. RESULTS: The mama kits intervention resulted in a statistically significant increase in facility delivery rates. The multivariate logistic regression found that the mama kits intervention increased the odds of delivering at a facility by 63% (P-value < 0.01, 95% CI: 29%, 106%), or an increase of 9.9 percentage points, yielding a cost-effectiveness of US$5183 per death averted. CONCLUSIONS: This evaluation confirms that low-cost mama kits can be a cost-effective intervention to increase facility delivery rates in rural Zambia. Mama kits alone are unlikely to completely solve safe delivery challenges but should be embedded in larger maternal and child health programmes.
Subject(s)
Delivery, Obstetric , Health Facilities/statistics & numerical data , Maternal Health Services , Motivation , Patient Acceptance of Health Care , Reward , Rural Population , Cost-Benefit Analysis , Female , Humans , Logistic Models , Maternal Death/prevention & control , Pregnancy , Program Evaluation , ZambiaABSTRACT
OBJECTIVES: In the Tanzanian health system, women are expected to first visit their nearest front-line health facility (FLF) for delivery. However, women frequently bypass these FLF. Our study estimates the extent of bypassing for childbirth and assesses factors associated with this behaviour. METHODS: Data describing the experiences of 597 women who recently delivered at a facility and the EmONC service capability at 107 health facilities were collected in 2011. Women who did not deliver at their nearest FLF were considered 'bypassers'. Factors associated with bypassing were assessed using multivariate logistic regression models. Three sets of analyses were conducted: among 597 women who delivered at the first facility they visited, among 521 women with no previous complications, and among 407 women not primigravida and without previous complications. RESULTS: More than 75.4% of women bypassed. In the fully adjusted model of all 597 women those who had experienced complications were more likely to bypass for delivery [OR = 6.31 (2.36, 16.86)]. In the fully adjusted model excluding women with previous complications, primigravida women were more likely to bypass [OR = 3.70 (1.71, 8.01)]. Fully adjusted models for each set of analysis found that, for each additional emergency obstetric and newborn care signal function (EmONC SF) available at the nearest FLF, women's odds of bypassing almost halved. CONCLUSIONS: Bypassing is highly associated with EmONC SF score at nearest FLF, controlling for individual and community-level factors.
Subject(s)
Delivery, Obstetric , Emergency Medical Services , Health Facilities , Health Services Accessibility , Maternal Health Services , Patient Acceptance of Health Care , Rural Population , Adolescent , Adult , Female , Gravidity , Humans , Infant, Newborn , Logistic Models , Middle Aged , Odds Ratio , Pregnancy , Pregnancy Complications , Quality of Health Care , Tanzania , Young AdultABSTRACT
Objetivo: Determinar el número de partos in-trahospitalarios, en relación al primer control prenatal de las embarazadas de la consulta externa del Hospital "San Sebastián" del Síg-sig. Material y métodos: Se realizó un estudio descriptivo en una muestra de 404 emba-razadas, que acudieron a su primer control prenatal al Hospital "San Sebastián", luego se determinó el porcentaje de gestantes que tuvieron el parto en este hospital.Resultados: La prevalencia del parto intrahospitalario en relación al primer control fue del 54.4%: 220 mujeres tuvieron el parto en el hospital. El resto 45.6% gestantes no acudieron al parto en esta institución. La media de edad fue de 25.7 años. La media de años de instrucción fue 7. La media de embarazos fue de 3. Conclusiones: El parto intrahospitalario en re-lación al primer control en esta zona es bajo: el 54.4% de gestantes, prácticamente solo la mitad, o una de cada dos embarazadas acude para el parto hospitalario; por lo tan-to un gran número de gestantes está en ries-go de sufrir complicaciones, debido a que probablemente se den partos domiciliarios, atendidos por comadronas.
Objective: To determine the number of chil-dren birth, compared to the first prenatal control of pregnant women in the external consultation in " San Sebastián " hospital in Sigsig town.Material and methods: A descriptive study was conducted on a sample of 404 pregnant women who attended to their first prenatal control in "San Sebastián" hospital, and then the percentage of pregnant women who had their babies in the hospital was determi-ned.Results: The prevalence children birth in rela-tion to the first control was 54.4%: A total of 220 women had their babies in the hospital. The other 45.6% of pregnant women did not come back to this institution. The average age was 25.7 years old. The average years of the institution were 7. The average pregnan-cy was 3.Conclusions: The children birth in relation to the first control in this area is low: from the 54.4% of pregnant women, almost the half or one in two pregnant women go to the hos-pital to have their babies; therefore a large number of pregnant women are in risk to have childbirth complications.
