Obstetric violence denied in Spain

Rodríguez Mir, Javier; Martínez Gandolfi, Alejandra

doi:10.1016/j.enfcle.2021.09.004

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The debate was triggered by the intention to reform Law 2/2010 on Sexual and Reproductive Health and Voluntary Termination of Pregnancy towards recognising OV as a form of gender-based violence in childbirth care. Statements from the Spanish Society of Gynaecology and Obstetrics (SEGO)<a class="elsevierStyleCrossRef" href="#bib0010">2</a> and the General Council of Official Medical Colleges (CGCOM)<a class="elsevierStyleCrossRef" href="#bib0015">3</a> caused unease among several scientific associations. Thus, associations such as the Andalusian Association of Midwives, Spanish Association of Perinatal Psychology, Spanish Society of Perinatal Mental Health, Galician Association of Midwives, Federation of Associations of Midwives of Spain, Spanish Association of Midwives, and Association of Midwives of the Valencian Community were forced to take a position.The statements issued by SEGO and CGCOM identify 3 problems:<ul class="elsevierStyleList" id="lis0005"><li class="elsevierStyleListItem" id="lsti0005">1)The inappropriate and offensive use of the term OV, which criminalises the health professional (HP).</li><li class="elsevierStyleListItem" id="lsti0010">2)The confusion between VO and malpractice.</li><li class="elsevierStyleListItem" id="lsti0015">3)The social alarm created that undermines the doctor-patient relationship.</li></ul>On the first point, there is no doubt that OV is a global public health problem, identified as a type of gender-based violence that affects medical care. The World Health Organisation (WHO) recognised in 2014 that many women worldwide suffer disrespectful and offensive treatment during childbirth.<a class="elsevierStyleCrossRef" href="#bib0020">4</a> In fact, there are already specific laws addressing OV in Venezuela (2007), Argentina (2009), and Mexico (2014).<a class="elsevierStyleCrossRef" href="#bib0025">5</a>Denying or changing terminology will not stop violence continuing in a patriarchal and androcentric system. SEGO and CGCOM consider the term OV to be offensive to HPs; however, the opposite is true.Denying the existence of OV is offensive to the victims of this type of violence, whose numbers in Spain are not negligible,<a class="elsevierStyleCrossRef" href="#bib0030">6</a> and it is also offensive to HPs, since recognising OV makes it possible to distinguish those who are exercising their profession inappropriately. The impact of hierarchy in the healthcare structure and how it affects the mental health of HPs should be investigated when it is a superior who is engaging in OV. In this regard, the other HPs can be considered victims of OV. The offence is not to recognise OV and its damage, thus delaying the advancement of human rights and better quality medical care. Finally, CGCOM guarantees that there will be no violent acts in patient care,<a class="elsevierStyleCrossRef" href="#bib0015">3</a> when it should be guaranteeing the detection and prevention of these cases that violate women’s rights.On the second point, SEGO states that OV should not be confused with malpractice.<a class="elsevierStyleCrossRef" href="#bib0010">2</a> We do not question the intention of HPs to want the best for their patients, but neither should we forget that, on occasion, practices guided by good intentions can cause irreparable damage to the patient. Regarding malpractice, we should note that OV includes it, but goes beyond it. We could mention the existence in the Spanish healthcare system of systemic malpractice in certain medical practices; for example, certain studies that report that episiotomy rates in Spain far exceed the recommendations of the WHO and the Ministry of Health.<a class="elsevierStyleCrossRefs" href="#bib0030">6,7</a> In this respect, the WHO warns that a rate above 20% is not justified, whereas the Ministry of Health proposes a rate of less than 15% as a quality standard.<a class="elsevierStyleCrossRef" href="#bib0035">7</a> To make the debate more complex, we must consider certain aspects of obstetric care that are difficult to address statistically, but which do exist, such as psychological and emotional mistreatment, poorly humanised care, the use of pejorative phrases, and the infantilisation of patients, among other practices.Finally, as for creating a generalised state of alarm, if one exists, it is present worldwide. OV is recognised by the WHO,<a class="elsevierStyleCrossRef" href="#bib0020">4</a> and the Spanish health system cannot ignore it. The real alarm would be not to recognise the problem. Solutions must be sought consensually by all sectors involved and affected, to move towards healthier societies.This is an attitudinal problem that requires, first and foremost, recognition of the difficulties in order to overcome them. It is advisable to ensure the training and retraining of HPs in humanised childbirth, a gender focus in medical care, and effective compliance with the Birth and Childbirth Plan of the Ministry of Health, Social Policy and Equality.To ignore and not confront OV is to deepen this problem in the Spanish healthcare system. If we want an excellent and exemplary system, we must tackle this problem and adopt transparency measures and mechanisms to reduce certain practices in the field of obstetric care, which cause patients so much harm." 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Vol. 32. Issue S1.

Maternal and Child Nursing

Pages S82-S83 (June 2022)

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