Disrespect and abuse in childbirth in Brazil: social activism, public policies and providers' training

• Published in: Reproductive health matters Vol. 26; no. 53; pp. 19 - 35
• Main Authors: Grilo Diniz, Carmen Simone, Rattner, Daphne, Lucas d'Oliveira, Ana Flávia Pires, de Aguiar, Janaína Marques, Niy, Denise Yoshie
• Format: Journal Article
• Language: English
• Published: Netherlands Taylor & Francis 01.01.2018; Informa UK Limited, trading as Taylor & Francis Group; Taylor & Francis Ltd
• Subjects: Activism; Attitude of Health Personnel; Brazil; Cesarean Section - statistics & numerical data; Child abuse & neglect; Childbirth & labor; Delivery, Obstetric - psychology; disrespect and abuse; evidence-based health care; Evidence-based medicine; Female; gender; Gender-Based Violence - prevention & control; Health Education - organization & administration; Health Personnel - education; Human rights; Humans; Information dissemination; Legislation; Maternal child nursing; Maternal Health Services - organization & administration; maternity hospitals; medical education; Obstetrics; Organizational Culture; Participation; Patient Acceptance of Health Care - psychology; Political Activism; Pregnancy; Pregnant Women - psychology; Private Sector - statistics & numerical data; Professional-Patient Relations; Public Policy; Respect; REVIEW ARTICLE; Sexism; Social activism; Social movements; Training; Women's Health; Womens health; Brazil; Human rights; evidence-based health care; maternity hospitals; gender; medical education; sexism; disrespect and abuse
• ISSN: 0968-8080; 1460-9576; 2641-0397
• DOI: 10.1080/09688080.2018.1502019

Brazil is a middle-income country with universal maternity care, mostly by doctors. The experience of normal birth often includes rigid routines, aggressive interventions, and abusive, disrespectful treatment. In Brazil, this has been referred to as dehumanised care and, more recently, as obstetric violence. Since the early 1990s, social movements (SM) have struggled to change practices, public policies and provider training. The aim of this paper is to describe and analyse the role of SM in promoting change in maternity care, and in provider training. In this integrative review using a gender-oriented approach, we searched the Scielo database and the Ministry of Health's (MofH) publications and edicts for institutional and research papers on SM initiatives addressing disrespect and abuse in the last 25 years (1993-2018) in Brazil, and their impact on public policies and training programmes. We analyse these groups of interrelated initiatives: (1) political actions of SM resulting in changes in public policies and legislation; (2) events organised by SM for diffusion of information to the public; (3) MofH policies to humanise childbirth with participation of SM; and (4) initiatives to change providers' training, including legal actions based on obstetric violence reports. To promote real change in maternity care, the progression of policies and enabling environment of laws, regulations, and broad dissemination of information, need to go hand in hand with changes in all health providers' training - including a solid base in ethics, gender and human rights.