Amroussia Nada, Hernandez Alison, Vives-Cases Carmen, Goicolea Isabel
Epidemiology and Global Health, Department of Public Health and Clinical Medicine, Umeå University, 901 87, Umeå, Sweden.
Department of Community Nursing, Preventive Medicine and Public Health and History of Science Alicante University, Alicante, Spain.
Reprod Health. 2017 Mar 4;14(1):32. doi: 10.1186/s12978-017-0290-9.
Disrespectful and abusive treatment during childbirth is a violation of women's right to dignified, respectful healthcare throughout pregnancy and childbirth. Although reports point out that marginalized groups in society such as single mothers are particularly vulnerable to abusive and disrespectful care, there is a lack of in-depth research exploring single mothers' encounters at the maternal healthcare facilities, especially in Tunisia. In Tunisia, single mothers are particularly vulnerable due to their social stigmatization and socio-economic marginalization. This study examines the self-perceptions and childbirth experiences of single mothers at the public healthcare facilities in Tunisia.
This study follows a qualitative design. Eleven single mothers were interviewed in regard to their experiences with maternal healthcare services and their perceptions of the attitudes of the health workers towards them. The interviews also addressed the barriers faced by the participants in accessing adequate maternal healthcare services, and their self-perceptions as single mothers. The data were analyzed using an inductive thematic approach guided by the feminist intersectional approach. Emergent codes were grouped into three final themes.
Three themes emerged during the data analysis: 1) Experiencing disrespect and abuse, 2) Perceptions of regret and shame attributed to being a single mother, and 3) The triad of vulnerability: stigma, social challenges, and health system challenges. The study highlights that the childbirth experiences of single mothers are shaped by intersectional factors that go beyond the health system. Gender plays a major role in constructing these experiences while intersecting with other social structures. The participants had experienced disrespectful and discriminatory practices and even violence when they sought maternal healthcare services at the public healthcare facilities in Tunisia. Those experiences reflect not only the poor quality of maternal health services but also how health system practices translate the stigma culturally associated with single motherhood in this setting. Social stigma did not only affect how single mothers were treated during the childbirth, but also how they perceived themselves and how they perceived their care.
Ensuring women's right to dignified, respectful healthcare during childbirth requires tackling the underlying causes of social inequalities leading to women's marginalization and discrimination.
分娩期间的不尊重和虐待行为侵犯了妇女在整个孕期和分娩期间获得有尊严、受尊重的医疗保健的权利。尽管报告指出，单身母亲等社会边缘群体特别容易受到虐待和不尊重的护理，但缺乏深入研究探讨单身母亲在孕产妇保健机构的遭遇，尤其是在突尼斯。在突尼斯，单身母亲因其社会污名化和社会经济边缘化而特别脆弱。本研究考察了突尼斯公共医疗保健机构中单身母亲的自我认知和分娩经历。
本研究采用定性设计。对11位单身母亲进行了访谈，了解她们在孕产妇保健服务方面的经历以及她们对医护人员态度的看法。访谈还涉及了参与者在获得充分的孕产妇保健服务方面面临的障碍，以及她们作为单身母亲的自我认知。数据采用归纳主题分析法进行分析，该方法以女性主义交叉性方法为指导。浮现的代码被归纳为三个最终主题。
数据分析过程中出现了三个主题：1）经历不尊重和虐待；2）因身为单身母亲而产生的遗憾和羞耻感；3）脆弱性三元组：污名、社会挑战和卫生系统挑战。该研究强调，单身母亲的分娩经历受到超越卫生系统的交叉因素的影响。性别在构建这些经历的同时与其他社会结构相互交织，发挥着重要作用。参与者在突尼斯的公共医疗保健机构寻求孕产妇保健服务时，曾经历过不尊重和歧视性的行为，甚至暴力。这些经历不仅反映了孕产妇保健服务质量差，还反映了卫生系统的做法如何在这种背景下转化与单身母亲身份相关的文化污名。社会污名不仅影响了单身母亲在分娩期间的待遇，还影响了她们对自己的认知以及对护理的认知。
确保妇女在分娩期间获得有尊严、受尊重的医疗保健的权利，需要解决导致妇女边缘化和歧视的社会不平等的根本原因。
