Khalil Merette, Carasso Kashi Barbara, Kabakian-Khasholian Tamar
Your Egyptian Doula, Cairo, Egypt.
International Course for Health and Development, Health Unit, KIT Royal Tropical Institute, Amsterdam, Netherlands.
Front Glob Womens Health. 2022 Apr 25;3:850796. doi: 10.3389/fgwh.2022.850796. eCollection 2022.
Obstetric violence (OV) threatens the provision of dignified, rights-based, high-quality, and respectful maternal care (RMC). The dearth of evidence on OV in the Eastern Mediterranean Region poses a knowledge gap requiring research to improve rights-based and respectful health practice and policy. While efforts to improve the quality of maternal health have long-existed, women's experiences of childbirth and perceptions of dignity and respect are not adequately or systematically recorded, especially in the said region.
This study centered on the experiences of women's mistreatment in childbirth to provide an overview of OV and offer recommendations to improve RMC.
A scoping review was conducted, and a total of 38 articles met the inclusion criteria and were analyzed using Bowser and Hill's framework of the seven typologies of Disrespect and Abuse (D&A) in childbirth. D&A in childbirth (or violations to RMC) is a manifestation of OV and served as a proxy to analyze its prevalence in the EMR.
This study indicated that across the EMR, women experienced every type of D&A in childbirth. This happens regardless of health systems' strength or country's income, with 6 out of 7 types of D&A found in almost two-thirds of included countries. In the EMR, the most common types of D&A in childbirth are physical abuse (especially overused routine interventions) and non-dignified care (embedded in patriarchal socio-cultural norms). The intersections of these abuses enable the objectification of women's bodies and overuse of unconsented routine interventions in a hierarchical and patriarchal system that regards the power and autonomy of doctors above birthing women. If unchecked, the implications include acceptance, continuation, and underreporting of D&A in childbirth, as well as passivity toward human-rights violations, which all further cause the continuing the cycle of OV.
In order to eliminate OV, a paradigm shift is required involving infrastructure changes, education, empowerment, advocacy, a women-centered and gender-sensitive approach to health system strengthening, and policy development. Recommendations are given at individual, community, health systems, and policy levels to ensure that every woman achieves her right to health and birth in a dignified, respectful, and empowered manner.
产科暴力（OV）威胁到提供有尊严、基于权利、高质量且尊重产妇的护理（RMC）。东地中海区域缺乏关于产科暴力的证据，这造成了知识空白，需要开展研究以改进基于权利和尊重的卫生实践及政策。尽管长期以来一直在努力提高孕产妇健康质量，但妇女的分娩经历以及对尊严和尊重的认知并未得到充分或系统的记录，尤其是在该地区。
本研究聚焦于妇女在分娩过程中遭受虐待的经历，以概述产科暴力并提出改进尊重产妇护理的建议。
进行了一项范围综述，共有38篇文章符合纳入标准，并使用鲍泽和希尔的分娩中不尊重和虐待（D&A）的七种类型框架进行分析。分娩中的不尊重和虐待（或对尊重产妇护理的侵犯）是产科暴力的一种表现，并用作分析其在东地中海区域的流行情况的替代指标。
本研究表明，在整个东地中海区域，妇女在分娩过程中经历了各种类型的不尊重和虐待。无论卫生系统的实力或国家的收入如何，在所纳入国家中，近三分之二的国家存在七种类型的不尊重和虐待中的六种。在东地中海区域，分娩中最常见的不尊重和虐待类型是身体虐待（尤其是过度使用常规干预措施）和缺乏尊严的护理（植根于父权制社会文化规范）。这些虐待行为的交织使得女性身体被物化，并在一个将医生的权力和自主权置于产妇之上的等级制和父权制系统中过度使用未经同意的常规干预措施。如果不加以制止，其影响包括接受、延续和瞒报分娩中的不尊重和虐待行为，以及对侵犯人权行为的消极态度，所有这些都会进一步导致产科暴力的循环持续。
为了消除产科暴力，需要进行范式转变，包括基础设施变革、教育、赋权、宣传、以妇女为中心且对性别敏感的加强卫生系统的方法以及政策制定。在个人、社区、卫生系统和政策层面提出了建议，以确保每位妇女都能以有尊严、受尊重且赋权的方式实现其健康和生育权利。
