Grilo Diniz Carmen Simone, Rattner Daphne, Lucas d'Oliveira Ana Flávia Pires, de Aguiar Janaína Marques, Niy Denise Yoshie
a Professor, School of Public Health , University of São Paulo , São Paulo , Brazil.
b Adjunct Professor, Department of Collective Health, School of Health Sciences , University of Brasilia , Brasília , Brazil.
Reprod Health Matters. 2018;26(53):19-35. doi: 10.1080/09688080.2018.1502019. Epub 2018 Aug 14.
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.
巴西是一个中等收入国家，提供全民孕产妇护理服务，主要由医生负责。正常分娩的经历往往包括严格的常规流程、激进的干预措施以及粗暴、无礼的对待。在巴西，这被称为非人性化护理，最近又被称为产科暴力。自20世纪90年代初以来，社会运动一直在努力改变这种做法、公共政策以及医疗服务提供者的培训。本文旨在描述和分析社会运动在促进孕产妇护理变革以及医疗服务提供者培训方面所起的作用。在这项采用性别导向方法的综合综述中，我们在Scielo数据库以及卫生部的出版物和法令中搜索了关于巴西过去25年（1993 - 2018年）针对不尊重和虐待行为的社会运动倡议的机构和研究论文，以及它们对公共政策和培训项目的影响。我们分析了这些相互关联的倡议组：（1）社会运动的政治行动导致公共政策和立法的变化；（2）社会运动组织的向公众传播信息的活动；（3）卫生部在社会运动参与下使分娩人性化的政策；（4）改变医疗服务提供者培训的倡议，包括基于产科暴力报告的法律行动。为了促进孕产妇护理的真正变革，政策的推进以及法律、法规的有利环境和信息广泛传播需要与所有医疗服务提供者培训的变革齐头并进——包括在伦理、性别和人权方面有坚实的基础。
