Amplifying voices on obstetric violence: recommendations for advocacy by an obstetric nurse

Zanchetta, Margareth Santos; Santos, Walterlânia Silva; Souza, Kleyde Ventura de; Pina, Vanessa Rodrigues; Hwu, Hilary; Stahl, Hannah; Argumedo-Stenner, Hannah; Osei-Boateng, Juliet; Zimmerman, Rebecca; Pena, Érica Dumont; Cabral, Ivone Evangelista; Carvalho, Ana Luiza de Oliveira; Pereira, Audrey Vidal; Vieira, Bianca Dargam Gomes; Alves, Valdecyr Herdy; Felipe, Ingryd Cunha Ventura; Guruge, Sepali; Amant, Oona St.; Costa, Edwaldo; Escobar, Haydée Padilla Vda de

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Sumário

RESEARCH • Esc. Anna. Nery 25 (5) • 2021 • https://doi.org/10.1590/2177-9465-EAN-2020-0449 copy

Amplifying voices on obstetric violence: recommendations for advocacy by an obstetric nurse

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objectives

Explore women’s and the general public’s demands to improve the quality of obstetric care. Discuss respondents’ suggestions to improve obstetric care, and propose recommendations for nursing advocacy in matters of obstetric violence.

Method

A multi-site online survey (in three cities in Brazil’s southeastern region) hosted by Opinio platform exploring the respondents’ opinions. Data was analyzed by descriptive statistics and thematic analysis.

Results

Respondents (n=414) aged 33-37 years (26%), including women (75%) with more than 15 years of schooling, who are married (45%) and with one child (35%), demonstrated a knowledge gap on obstetric violence and women’s rights. Newspapers, radio, and television were cited as the main sources of information. Family support was a suggested strategy to deal with obstetric violence. For the renewed praxis, collective education on obstetric care rights (53.1%) and humanized care (38.2%) were suggested to mobilize professional power to consolidate humanization in care. Central analytical themes included situations faced by women and an idealized context of practice.

Conclusion and implications for practice

Discussion in organizations increases humanization and shared governance. Recommendations proposed for advocacy are consistent with the global perspective of women’s health promotion and social leadership.

Keywords:
Education, nursing; Health advocacy; Professional competence; Professional practice; Violence against women

Priority action	Integrated strategies of implementation
- Collaborate for the development and availability of educational resources with the Brazilian Association of Obstetric Nurses and Obstetricians (ABENFO), the Brazilian Nursing Association, the Federal Council of Nursing and the Regional Councils of Nursing, through programs (online and face-to-face), regardless of nurses’ areas of professional practice.	- Develop new instruments, methods, and approaches for socially inclusive educational work related to women’s rights, responding to the particularities and diversity of women cared for in the primary, secondary, and tertiary health care system in the continuous pregnancy-labour-postpartum-childbirth-puerperium.
- Promote university education, in-service education and professional development activities to increase the political literacy of nurses.	- Create a mentoring/coaching system in the area of political literacy for nurses and students to expand networks of relationships, support specific demands, and stimulate updating/continuing education processes.
- Create practical opportunities for students to develop advocacy skills in macro-systems.	- Increase the exposure of teachers and students to practical examples of advocacy performed by nurses to redirect political actions.
- Collaborate with legal professionals to provide nurses with specific training on potential unethical conduct, professional errors, and unintentional damages, in addition to implications of processes of legal suing of the professional practice, with an emphasis on obstetric nurses.	- Review, in undergraduate and graduate programs, the possible redirection of the process of the academic-scientific production to address the social impact and results in the quality of obstetric care, due to the political work of nurses engaged in the defence of women’s rights and the PHPN.
- Lead quantitative-qualitative evaluation projects of the social impacts of women’s rights advocacy and training by nurses focusing on respect for diversity, person-centred care, decreased gender inequality, and balance in power relations.	- Facilitate simulations for students and nurses to provide them with tools for advocacy.
- Strengthen undergraduate nursing programs, the role of critical education that promotes students’ understanding of competencies for nursing advocacy.	- Systematize with the administration of health organizations new standardized administrative practices of accountability/professional engagement for the advocacy of women’s rights.
	- Stimulate the implementation of permanent in-service education for the administrative staff on the PHPN recommendations.

Priority action	Integrated strategies of implementation
- Establish intersectional collaboration between the Municipal and State Departments of Health, Education, and Social Assistance and Human Rights; Ministry of Women, Family, and Human Rights; Secretary of Labour, with religious and community leaders, and residents’ associations to create strategies for building community capacity for citizen leadership and popular participation in PHPN.	- Establish a partnership between the professional media, the business sector, and ABENFO for integrative actions for the production and dissemination of information material on women’s rights.
- Design health promotion actions for women who are workers in collaboration with the National Association of Occupational Health Nurses.	- Popularize knowledge about the characterization of OV and the recognition of its indicators through the production and dissemination of educational material, with accessible language including synonyms used by common sense.
- Decode for popular language the legal language present in PHPN, disseminating it among women, as well as among professionals in the areas of health, social services, and education.	- Establish partnerships with primary health care professionals, especially community health agents, producing educational videos and video clips aiming to fill in gaps in knowledge of PHPN among women and families registered in the Family Health Strategy.
- Collaborate with the authorities of the Civil Police and Military Police to implement programs to raise awareness of their troops regarding PHPN.	- Create a complaint service about OV in health services, which can go beyond the listening offered by the ombudsman office.
- Establish a partnership with the entertainment sector for the dissemination of educational campaigns for civil society.	- Develop a checklist on situations characterizing disrespect for women’s rights, extended to OV, to be shared at the first prenatal consultation, and discussed in subsequent consultations.
- Promote safe spaces to denounce OV and violence against women, in general.	violê

Priority action	Integrated strategies of implementation
- Promote education for women from the standpoint of peer education, about their roles and contributions as informed users about women’s/obstetric rights, from a perspective of popular participation, citizenship, meanings of grouping/ collective engagement, and advocacy of groups, among others.	- Ensure the functioning of groups of pregnant women in health care units with regular follow-up and participation of professionals from other areas related to the multiple dimensions of women’s rights.
- Advise existing groups for the creation of mechanisms to defend women’s rights based on local/state monitoring of PHPN implementation and on reported cases of OV.	- Collaborate with information technology and communication professionals, as well as with the telecommunications business, for the development of applications for smartphones and videos for individuals without internet access, but who have electronic devices.
- Promote the broad debate on obstetric rights, neglect in obstetric care, or violations of PHPN.	- Disseminate mechanisms and protocols for reporting cases of OV.
	- Provoke internal discussions in health care organizations about the effect on its reputation, due to cases of violence against pregnant women when accusations reach the public knowledge.

Priority action	Integrated strategies of implementation
- Propose multi-/inter-disciplinary university outreach projects focused on the young and adult women population, concerning the undoing of their social realities and experiences of the gestational and childbirth process.	- Advise teachers and students in the secondary and university education system for the creation of a student health commission focused on peer education on women’s rights.
- Establish continuous, independent community forums on women’s rights advocacy in synchrony with the Municipal Health Councils’ meetings.	- Create a work agenda with representative groups of the university, civil society, and vulnerable groups to define proposals to be submitted to municipal, state, and national health conferences.
- Collaborate with researchers in the areas of political, social, and health sciences to conduct evaluation research and produce criticisms based on knowledge and monitoring the implementation of PHPN.	- Translate scientific knowledge produced by local research into educational material, re-signifying the popular culture of the trivialization of OV, to provide tools for collective political literacy in the different spheres of society.

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[1] Corresponding author: Margareth Santos Zanchetta mzanchet@ryerson.ca