The continuum of violence against women: Gynecological violence within the Medical Model in Chile.

OBJECTIVE: This study aims to investigate the presence of gynecological violence within the health system in Chile, quantify the magnitude of this problem, define its general contours, and shed light on a phenomenon that has long been silenced. Additionally, we are interested in detecting differences between public and private health services, as well as exploring the role played by variables such as sexual orientation, ethnicity, age, and educational level in contributing to the prevalence of gynecological violence. METHODS: This study employed a cross-sectional and not probabilistic sampling approach. It included a sample of 1503 women from all regions of Chile, who were of legal age and who had attended gynecological services. A questionnaire was applied between January 2021 and April 2022 using the online platform SurveyMonkey®. Data were collected through the second national survey on obstetric and gynecological violence (GinObs 2021). The study adheres to activist research methodologies and was conducted in collaboration with activists and academic researchers. RESULTS: 57.9% of the women participants reported having experienced violence. Such violence appears to occur most frequently in the public health system, although not exclusively, and the victims are often people who belong to native ethnic groups, who identify as of African descent, whose sexual orientation is lesbian, who are elderly, and who have a lower level of education. CONCLUSION: Gynecological violence is an integral part of the continuum of violence against women and is consistently reported in both public and private health services. This form of violence has serious consequences for women's health and constitutes a significant public health problem.

[Obstetric violence in Chile: women's perceptions and differences among health centersViolência obstétrica no Chile: percepção das mulheres e diferenças entre os serviços de saúde]. / Violencia obstétrica en Chile: percepción de las mujeres y diferencias entre centros de salud.

Objective: The objective of this article is to report the results of the first survey on obstetric violence in Chile, to bring to light a reality more common than we think, and to compare its occurrence by the type of service (public or private) where the birth was attended. Methods: This is a descriptive and cross-sectional study conducted from December 2019 to May 2020. The sample was composed of 2 105 women from all regions of Chile. Results: Data analyses indicate that 79.3% of women believe they have experienced some form of obstetric violence. Despite the many reports of violence in public and private health centers, significant statistical differences were detected between the two, with higher numbers of reports for public centers. Similarly, more reports of obstetric violence were detected in young women (aged 18-29 years), in those who identify as indigenous, and among those with a non-heterosexual sexual orientation. Conclusions: Obstetric violence is part of the continuum of violence against women and is systematically reported by those who give birth in both public and private health services. This form of violence has serious consequences for women, due to both their difference in position with respect to the medical team and the importance of the birthing event in the life of any woman.

Objetivo: Informar os resultados obtidos na primeira pesquisa sobre violência obstétrica realizada no Chile, com o propósito de dar visibilidade a uma realidade mais comum do que se acredita e comparar sua ocorrência por categoria de serviço de assistência ao parto (rede pública ou privada). Métodos: Estudo descritivo transversal realizado entre dezembro de 2019 e maio de 2020. A amostra incluiu 2 105 mulheres provenientes de todas as regiões do país. Resultados: Os dados analisados indicam que 79,3% das mulheres entrevistadas acreditam ter sofrido alguma forma de violência obstétrica. Apesar do alto índice de relatos de violência tanto em serviços públicos quanto privados, observam-se diferenças estatísticas significativas entre eles, com maior ocorrência na rede pública. A violência obstétrica foi relatada com mais frequência entre as jovens (18 a 29 anos), as que se identificam com os povos nativos e as que são de orientação sexual não heterossexual. Conclusões: A violência obstétrica faz parte do ciclo de violência contra a mulher e é sistematicamente relatada pelo pessoal que presta assistência ao parto em serviços públicos e particulares. Trata-se de uma forma de violência com consequências sérias devido à posição ocupada pela equipe médica e à importância do parto na vida da mulher.

Validating a measurement of psychological, physical and sexual abuse against women in gynecological care within the Chilean health system.

Our objective was to create and validate a scale that would allow us to investigate women's experiences of violent practices in healthcare System. The scale was applied to large sample of women (N = 4563) from Chile. We analyzed data and conclude that the final instrument shows good reliability (α = .876 y ω = .921) and a factorial structure of three correlated factors referring to psychological, physical and sexual violence. Similarly, our analysis of the data -using a confirmatory factor analysis and multi-group factor analysis- reveals good fit indexes (CFI = .94 y RSMEA = .06) and supports the scale's metric invariance between groups in age (18 - 31 and 32 - 82) and healthcare centers (public and private). The prevalence rates of the different forms of violence predicted by the scale are reported.

Violencia obstétrica en Chile: percepción de las mujeres y diferencias entre centros de salud / Obstetric violence in Chile: women's perceptions and differences among health centers / Violência obstétrica no Chile: percepção das mulheres e diferenças entre os serviços de saúde

RESUMEN Objetivo. El objetivo del presente artículo es reportar los resultados de la primera encuesta sobre violencia obstétrica en Chile, de modo de hacer visible una realidad más frecuente de lo que creemos y comparar su ocurrencia según tipo de servicio (público o privado) en que se ha atendido el parto. Métodos. Se trata de un estudio descriptivo y de tipo transversal conducido entre los meses de diciembre de 2019 y mayo de 2020. La muestra quedó compuesta por 2105 mujeres de todas las regiones de Chile. Resultados. Los análisis de los datos indican que un 79,3% de las mujeres cree haber experimentado alguna forma de violencia obstétrica. A pesar de la gran cantidad de informes de violencia en centros de salud públicos y privados, se detectan diferencias estadísticas significativas entre ambos, y son más frecuentes en los centros públicos. Del mismo modo, se detectan más informes de violencia obstétrica en mujeres jóvenes (18-29 años), en quienes se identifican con pueblos originarios y entre quienes tienen una orientación sexual no heterosexual. Conclusiones. La violencia obstétrica es parte del continuo de violencia hacia las mujeres e informada de modo sistemático por quienes atienden sus partos tanto en servicios públicos como privados de salud. Es una forma de violencia tiene graves consecuencias en las mujeres debido tanto a la posición del equipo médico y a la relevancia del evento de parto en la vida de cualquier mujer.

ABSTRACT Objective. The objective of this article is to report the results of the first survey on obstetric violence in Chile, to bring to light a reality more common than we think, and to compare its occurrence by the type of service (public or private) where the birth was attended. Methods. This is a descriptive and cross-sectional study conducted from December 2019 to May 2020. The sample was composed of 2 105 women from all regions of Chile. Results. Data analyses indicate that 79.3% of women believe they have experienced some form of obstetric violence. Despite the many reports of violence in public and private health centers, significant statistical differences were detected between the two, with higher numbers of reports for public centers. Similarly, more reports of obstetric violence were detected in young women (aged 18-29 years), in those who identify as indigenous, and among those with a non-heterosexual sexual orientation. Conclusions. Obstetric violence is part of the continuum of violence against women and is systematically reported by those who give birth in both public and private health services. This form of violence has serious consequences for women, due to both their difference in position with respect to the medical team and the importance of the birthing event in the life of any woman.

RESUMO Objetivo. Informar os resultados obtidos na primeira pesquisa sobre violência obstétrica realizada no Chile, com o propósito de dar visibilidade a uma realidade mais comum do que se acredita e comparar sua ocorrência por categoria de serviço de assistência ao parto (rede pública ou privada). Métodos. Estudo descritivo transversal realizado entre dezembro de 2019 e maio de 2020. A amostra incluiu 2 105 mulheres provenientes de todas as regiões do país. Resultados. Os dados analisados indicam que 79,3% das mulheres entrevistadas acreditam ter sofrido alguma forma de violência obstétrica. Apesar do alto índice de relatos de violência tanto em serviços públicos quanto privados, observam-se diferenças estatísticas significativas entre eles, com maior ocorrência na rede pública. A violência obstétrica foi relatada com mais frequência entre as jovens (18 a 29 anos), as que se identificam com os povos nativos e as que são de orientação sexual não heterossexual. Conclusões. A violência obstétrica faz parte do ciclo de violência contra a mulher e é sistematicamente relatada pelo pessoal que presta assistência ao parto em serviços públicos e particulares. Trata-se de uma forma de violência com consequências sérias devido à posição ocupada pela equipe médica e à importância do parto na vida da mulher.

Validación de la escala de violencia obstétrica y pruebas de la invarianza factorial en una muestra de mujeres chilenas / Validation and factorial invariance test of obstetric violence scale in women from Chile

Resumen La violencia obstétrica (VO) es un problema de enorme relevancia social en nuestro contexto, ya que puede afectar psíquica y físicamente a las mujeres, al mismo tiempo que puede socavar la confianza en el sistema de salud y limitar el acceso oportuno a este por parte de las mujeres. La violencia obstétrica se ha definido como la apropiación del cuerpo de la mujer por parte del personal de salud a través de prácticas que redundan en la medicalización y patologización de sus procesos reproductivos. Esta violencia puede ser psicológica (p. e., regaños, negativa a responder a preguntas o realizar un plan de parto ajustado a sus expectativas), física (p. e., uso innecesario de la fuerza o querer causar dolor intencionalmente) y/o sexual (p. e. comentarios de naturaleza sexual referidos a su cuerpo o genitales, etc.). También se puede verificar mediante la realización de prácticas que están desaconsejadas o estrictamente prohibidas (p. e., monitorización fetal continua, uso de oxitocina sintética para agilizar el procedimiento, negación de la libertad de movimiento, maniobra de Kristeller, episiotomía de rutina, entre otros). No existen a la fecha escalas validadas que permitan detectar violencia obstétrica en la atención de salud. Método: Se analiza la fiabilidad (alfa y omega) y se aportan pruebas de la validez (análisis factorial confirmatorio) de la escala de VO. Las participantes de la muestra fueron 367 mujeres, mayores de edad, de la región de Valparaíso (Chile), que habían tenido alguna vez un parto. Los resultados apoyan la validez de la escala de VO y la estructura unifactorial propuesta muestra un buen ajuste (CFI = .94, NFI = .91, IFI = .94 y RSMEA = .067); también apoyan la idea de invarianza a través de diferentes muestras (ΔCFI < .01 y ΔRSMEA < .01), toda vez que la escala de VO demuestra ser un instrumento confiable (α = .83 y ω = .88). Por lo tanto se concluye que la escala de VO es un instrumento fiable y válido para la detección de este tipo específico de violencia contra las mujeres.

Abstract Obstetric violence is a long-standing problem of great social relevance in our context, since it can affect women psychically and physically. Similarly, obstetric violence can strongly undermine confidence in the health system and limit timely access to it by women (who could avoid conducting routine examinations associated with their pregnancy and which would explain the growing proportion women who wish to deliver at home and outside the medical system). Obstetric violence (also commonly referred to as "disrespect and abuse" during childbirth and "mistreatment" during childbirth care) has been defined as the appropriation of women's bodies by health personnel through practices that become the medicalization and pathologization of their reproductive processes. This violence can be psychological (e.g. abuse, scolding, refusal to answer your questions or carry out a birth plan adjusted to your expectations), physical (e.g. use of force or intentionally wanting to cause pain) and / or sexual (e.g. tacts of a sexual nature, comments of a sexual nature referring to your body or genitals, etc.), which can also be verified in the performance of a series of practices that are discouraged or strictly prohibited (for example, continuous fetal monitoring, use of synthetic oxytocin to speed up the procedure, impaired free movement, Kristeller's maneuver, routine episiotomy, among others). To date, there are no validated scales in our context that allow detecting obstetric violence (OV) in health care. These forms of violence can be a traumatic experience for many women. The scale has been created having as its main reference the so-called "obstetric violence test" prepared by the association El parto es nuestro, which includes the most recurrent situations of lack of respect and abuse in obstetric care. Reliability (alpha and omega) is analyzed and validity tests (confirmatory factor analysis) of the VO scale are provided. The invariance tests aim to ensure that the construct being evaluated (in this case obstetric violence) has the same meaning for women who provide care in the private and public health systems. The participants in the sample were 367 women, all of legal age, from the Valparaíso region (Chile) and who had had a child birth at some point in their lives. These women had their deliveries in both the public and private health systems. Of the total number of women who participated in the study, 58.9% declared having experienced some situation of violence during their delivery. The results support the validity of the VO scale, the proposed unifactorial structure shows a good fit (CFI = .94, NFI = .91, IFI = .94 and RSMEA = .067). The results support the idea of ​​invariance through the samples of women who attended their delivery in the private and public health system (ΔCFI < .01 and ΔRSMEA < .01), since the VO scale proves to be a reliable instrument (α = .83 and ω = .88) and with high levels of internal consistency (either based on total item correlations or factor loadings, which would be the most appropriate method for scales that use ordinal level of measurement). In conclusions, the VO scale is a reliable and valid instrument for the detection of this specific type of violence against women that can contribute to studies that detect abusive practices within the health system. Many of the women who do not report having experienced obstetric violence, do report the presence of some practices that are discouraged or prohibited: genital shaving (66.2 %), enema (45.5 %), prohibition of consuming food or water (51.7 %), indication of lying down during labor (24.5 %), induction of labor using medication (36.1 %), repeated vaginal examinations (24.3 %), compression of the abdomen (34.5 %), episiotomy (33.6 %), cesarean section (54.1 %) ) and uterine scraping without anesthesia (2 %). The previous results indicate the normalization of violent practices and their routine performance in the framework of delivery care in public and private health services, which could make us underestimate their prevalence.