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BRAZIL
Janini Cristina Paiz, Stela Maris de Jesus Castro, Elsa Regina Justo Giugliani, Sarah Maria dos Santos Ahne, Camila Bonalume Dall’Aqua, Alice Steglich Souto, Camila Giugliani
This study highlights a gap between women’s perceptions of mistreatment during childbirth and definitions used by health agencies and academic literature, with IRT identifying mistreatment at twice the reported rate. Key issues include the absence of a companion, poor communication, fundal pressure, and feelings of neglect. Developing a standardized measurement tool based on women’s experiences is crucial for improving obstetric care and fostering dialogue among stakeholders. This study represents an initial step toward strategies to address and eliminate obstetric violence.
Tatiana Henriques · Instituto de Medicina Social Hesio Cordeiro
A violência obstétrica (VO) no Brasil tem uma prevalência entre 18,3% e 44,3%, mas ainda há poucos estudos epidemiológicos sobre o tema. O crescente interesse, impulsionado pelo movimento feminista e grupos pró-parto humanizado, enfrenta desafios como a falta de consenso sobre definição, mensuração e impactos na saúde materno-infantil, além da ausência de políticas públicas eficazes. Para abordar essas questões, a pesquisa Nascer no Brasil II (2020) coletará dados sobre VO, utilizando um questionário adaptado da OMS. O estudo visa estimar sua prevalência, identificar fatores de risco e subsidiar políticas públicas, contribuindo para um modelo de atenção ao parto mais respeitoso no Brasil.
Mariana Gouvêa de Matos, Andrea Seixas Magalhães, Terezinha Féres-Carneiro
O presente trabalho integra uma pesquisa mais ampla sobre as experiências de pais e mães em relação ao parto, baseada em um estudo de caso coletivo que analisou 30 relatos publicados em blogs pessoais sobre gestação, parto e parentalidade, sendo 15 escritos por mulheres e 15 por homens. O objetivo deste estudo foi investigar a experiência da chamada violência obstétrica nos relatos maternos. Para isso, foram analisados os relatos de cinco mulheres, as únicas que mencionaram esse fenômeno. Os resultados indicaram que a falta de suporte no ambiente é um fator constitutivo da experiência de violência obstétrica e que a escrita dos relatos serve como um recurso para elaborar essa vivência traumática. Concluímos que procedimentos médicos como episiotomia, anestesia e cesariana, quando realizados de forma rotineira, sem compartilhamento de decisões e sem suporte emocional, funcionam como formas de ritualização que mantêm inconsciente a representação sexual do parto. Essas práticas ritualizadas levam à iatrogenia no parto, causando impactos psicológicos negativos na saúde materno-infantil.
Carmen Simone Grilo Diniz, Denise Yoshie Niy, Cristiane Da Silva Cabral
En s’appuyant sur l’expérience brésilienne, les autrices retracent l’évolution des prises en charge de l’accouchement depuis les années 1930 jusqu’à aujourd’hui, ainsi que les différents mouvements sociaux ayant contesté les modèles de soins en vigueur, aboutissant à l’imposition du concept de violences obstétricales dans un contexte d’abord latino-américain, puis mondial. Elles mettent en lumière le caractère innovant du terme violences obstétricales et les avancées qu’il a permises en matière de liberté épistémique, de droits reproductifs et de respect des femmes. Cependant, elles en soulignent également les limites, notamment l’exclusion des pratiques liées à l’avortement et la difficulté persistante à faire reconnaître les violences sexuelles pouvant accompagner les violences obstétricales.
Sarah Yasmin Pinto Leal, Vera Lúcia de Azevedo Lima, Andrey Ferreira da Silva, Patrícia Danielle Feitosa Lopes Soares, Luzia Ribeiro Santana, Álvaro Pereira
Objective: To understand nurse-midwives' perceptions of obstetric violence. Method: This exploratory qualitative study was conducted with 19 nurses working in the obstetric, labor, delivery, and postpartum center of a maternal-newborn reference hospital in Belém, Pará, Brazil. Data were collected through semi-structured interviews between April and May 2016 and analyzed using the thematic content analysis technique. Results: Nurse-midwives acknowledge that obstetric violence occurs in various forms; however, they do not always recognize certain practices as violations. Additionally, they perceive the lack of knowledge among parturients as a factor that increases their vulnerability to obstetric violence, highlighting its impact on women's lives. Final considerations: The study revealed nurse-midwives' perceptions, emphasizing the need for strategies to prevent obstetric violence.
Marilia Arndt Mesenburg, Cesar Gomes Victora, Suzzane Jacob Serruya, Rodolfo Ponce de León, Andrea Homsi Damaso, Marlos Rodrigues Domingues, Mariangela Freitas da Silveira
This study examines the prevalence and factors associated with disrespect and abuse during childbirth in Pelotas, Brazil. A cross-sectional analysis of 4,087 women from the 2015 Pelotas birth cohort found that 18.3% experienced at least one form of mistreatment, including verbal abuse (10%), denial of care (6%), inappropriate procedures (6%), and physical abuse (5%). Women using the public health system and those undergoing cesarean sections after labor had the highest risk, with up to three times greater likelihood of experiencing abuse. The findings highlight the urgent need for improved maternal care policies. Our study found a high prevalence of disrespect and abuse during childbirth, primarily associated with public sector healthcare and labor before delivery. Efforts by civil society, governments, and international organizations have been insufficient to prevent institutional violence against women in childbirth. To eradicate this issue, it is crucial to: (1) implement targeted policies and actions to address this specific form of violence, and (2) establish laws that promote gender equality, particularly in economic rights, access to education, and employment opportunities for women.
Carmen Simone Grilo Diniz, Daphne Rattner, Ana Flávia Pires Lucas d’Oliveira, Janaína Marques de Aguiar & Denise Yoshie Niy
Brazil, a middle-income country with universal maternity care, has long struggled with rigid birth routines, aggressive interventions, and disrespectful treatment, referred to as dehumanized care and more recently as obstetric violence. Since the 1990s, social movements (SM) have worked to reform maternity care, public policies, and provider training. This study analyzes SM initiatives in Brazil (1993–2018) through a gender-oriented review of institutional and research papers. Key efforts include political actions influencing policy and legislation, public awareness campaigns, collaboration with the Ministry of Health on humanizing childbirth, and legal actions to reform provider training. Achieving real change requires integrating policy advancements, legal protections, and broad information dissemination with comprehensive training for healthcare providers, emphasizing ethics, gender, and human rights.
Dr. Murillo de Oliveira Dias, Valeria Eunice Mori Machado, LLM
Obstetric violence remains an overlooked issue in Brazil despite its severity, with one in four women affected. This study highlights the abusive use of cesarean sections, which exceed 80% of births in Brazil, far above the WHO’s recommended 15%. A case study examines a hearing-impaired woman subjected to a forced cesarean without informed consent, an interpreter, or a companion, illustrating clear violations of her rights. Despite existing laws, enforcement is weak, and the lack of data collection hinders effective policies. The study calls for proactive measures, such as a transparency portal, to prevent and address obstetric violence.
Danúbia Mariane Barbosa Jardim, Celina Maria Modena
This study analyses the scientific literature on obstetric violence (OV) through an integrative review of 24 publications indexed in specialised databases. A growing body of research on the topic has emerged since 2015, employing both quantitative and qualitative methodologies. The study explores the conceptualisation of OV, its various manifestations in obstetric care, its institutionalisation, and the normalisation of the phenomenon through symbolic power relations. Additionally, it identifies strategies for prevention and eradication, including academic training, women's awareness, social mobilisation, and the development of public policies and legal frameworks. OV is recognised as a violation of human rights and a serious public health issue, manifesting through negligent, reckless, discriminatory, and dehumanising acts perpetrated by healthcare professionals. The study highlights the need to strengthen the national debate on strategies to combat OV and implement actions across different obstetric services. The lack of data on OV in private healthcare settings limits a more comprehensive analysis of the issue, underscoring the importance of expanding research to include women receiving care in these services.
Ferdinand José da Costa Cardoso, Ana Carla Marques da Costa, Mayron Morais Almeida, Thiago Sampaio dos Santos, Francisco Braz Milanez Oliveira
Objective: To evaluate health professionals' knowledge and practices regarding obstetric violence. Method: This descriptive, exploratory study with a qualitative approach involved interviews with 20 health professionals. Data were analysed using the Content Analysis technique. Results: Only 40% of health professionals had encountered obstetric violence, and just 15% admitted to having committed it, indicating a general lack of awareness of the issue. Several factors contributing to obstetric violence were identified, including poor healthcare infrastructure, excessive workloads, and inadequate communication between professionals and patients. Conclusion: The analysis of participants’ statements revealed that most professionals were unfamiliar with obstetric violence. The findings suggest that addressing this issue requires a shift towards the humanisation of care.
M. M. Amorim, Isabela Cristina Coutinho, Inês Melo, Leila Katz
This randomized clinical trial compared maternal and perinatal outcomes between a non-episiotomy protocol and a selective episiotomy approach in a tertiary teaching hospital in Recife, Brazil. A total of 241 women with full-term pregnancies were randomized into two groups: one where episiotomies were avoided except in exceptional cases, and another where they were performed selectively based on clinical judgment. The final analysis included 115 women in the non-episiotomy group and 122 in the selective episiotomy group. No significant differences were found in maternal or perinatal outcomes, and the episiotomy rate remained low in both groups (1.7%). Conclusions: A non-episiotomy protocol appears to be safe for both mother and child, emphasizing the need for further investigation into whether there is any valid indication for this procedure.
M. M. Amorim, Isabela Cristina Coutinho, Inês Melo, Leila Katz
This randomized clinical trial compared maternal and perinatal outcomes between a non-episiotomy protocol and a selective episiotomy approach in a tertiary teaching hospital in Recife, Brazil. A total of 241 women with full-term pregnancies were randomized into two groups: one where episiotomies were avoided except in exceptional cases, and another where they were performed selectively based on clinical judgment. The final analysis included 115 women in the non-episiotomy group and 122 in the selective episiotomy group. No significant differences were found in maternal or perinatal outcomes, and the episiotomy rate remained low in both groups (1.7%). Conclusions: A non-episiotomy protocol appears to be safe for both mother and child, emphasizing the need for further investigation into whether there is any valid indication for this procedure.
Luara de Carvalho Barbosa, Márcia Regina Cangiani Fabbro, Geovânia Pereira dos Reis Machado
Objective: To describe how factors affecting childbirth care practices interfere with the childbirth experience and birth outcomes. Content synthesis: This is an integrative review of qualitative research. A total of 17,051 articles were identified through searches in selected databases, from which 54 were chosen based on predefined criteria. The analysis of the selected studies revealed four categories: Contemporary preconceptions about normal birth and caesarean section, Unfavourable factors for a satisfactory birth experience, Trivialisation of obstetric violence, and Assumptions about humanised childbirth care. The findings indicate that childbirth care practices are outdated, inappropriate, perceived as “normal,” and characterised by authoritarianism and a lack of respect towards women, which defines obstetric violence. In contrast, the humanised model, which values women's role in childbirth, contributes to a more positive and fulfilling birth experience. Conclusion: Childbirth care practices in Brazil do not respect sexual and reproductive rights, as reflected in the high rates of unnecessary caesarean sections and the mistreatment women endure in Brazilian maternal and infant hospitals.
Simone Grilo Diniz, Heloisa de Oliveira Salgado, Halana Faria de Aguiar Andrezzo, Paula Galdino Cardin de Carvalho, Priscila Cavalcanti Albuquerque Carvalho, Cláudia de Azevedo Aguiar, Denise Yoshie Niy
Disrespect and abuse (referred to in Brazil as obstetric violence) are described using various terms and are increasingly addressed in social activism, academic research, and public policy formulation. The World Health Organization has recently recognised this issue as a public health concern. As an emerging topic, it requires a thorough mapping of its origins, definitions, typology, impacts on maternal health, and strategies for its prevention and redress. This paper presents a critical-narrative review of the issue, encompassing academic literature, social movement publications, and institutional documents from Brazil and international contexts. After providing a brief historical overview, we outline the definitions and types of obstetric violence. The discussion explores the complex causes of this violence, including the role of professional training, the organisation of health services, and its implications for maternal morbidity and mortality. Finally, we examine public health interventions that have been implemented or proposed to prevent and mitigate obstetric violence and suggest an agenda for innovation and future research in this field.
Simone G Diniz, Alessandra S Chachamb
Over the past 50 years, increasing medical interventions in childbirth have often led to unnecessary and harmful procedures. Despite evidence supporting minimal interference, vaginal birth in Brazil is still treated as high-risk. This paper explores the impact of interventionist models on women's birth experiences and the influence of public and private maternity services on obstetric care. While over two-thirds of births in the private sector involve unnecessary caesarean sections ("the cut above"), less attention is given to the 94.2% episiotomy rate ("the cut below") among poorer women in public hospitals. A shift in how women's bodies are perceived is crucial for change. Since 1993, inspired by campaigns against female genital mutilation, healthcare providers, feminists, and consumer groups have advocated for evidence-based care and the humanisation of childbirth to reduce unnecessary surgical interventions in Brazil.
Ana Flávia Pires Lucas d’Oliveira, Simone Grilo Diniz, Lilia Blima Schraiber
Maternal morbidity and mortality during childbirth is a critical public health issue. In this article, we argue that part of the problem stems from violence perpetrated by healthcare workers in childbirth and abortion services, which negatively impacts access, adherence, quality, and effectiveness of care. We reviewed rigorous research from the past decade and identified four forms of abuse by doctors and nurses: neglect, and verbal, physical, and sexual abuse. These forms of violence are recurrent, often intentional, constitute serious human rights violations, and are linked to poor healthcare quality and effectiveness. This abuse is a learned behaviour reinforced within healthcare facilities as a means of controlling patients. Abuse occurs primarily in contexts where the legitimacy of healthcare services is questionable or as a result of prejudice against specific population groups. Finally, we explore strategies to prevent violent abuse in maternal healthcare settings.