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BACKGROUND: Living-donor transplantation is the best treatment option in patients with chronic kidney failure. Global data show that women are less likely to be kidney recipients than men but are more likely to become living kidney donors. We explored the experience of women who donate a kidney to relatives with biological and socio-cultural ties and to understand the similarities and differences in their experience. METHODS: A qualitative hermeneutic phenomenological study with an intersectional analysis of gender. Ten women donors accepted in the transplant evaluation period participated, all of whom donated a kidney to a pre-dialysis relative. Two categories were included: women with biological kinship ties (mothers, sisters) and women who have a socio-cultural relationship (wives) with kidney recipient. The data were collected through semi-structured in-depth interviews and analysed using thematic analysis. RESULTS: Women donate their kidneys in a convinced manner, without worrying about their health, with an optimistic and positive attitude, and without believing that they are acting heroically. Women with biological kinship ties see it as a 'naturalization thing'. In contrast, wives donate conditioned by gender roles, but also as a form of empowerment and as a personal benefit: they donate in order to avoid taking on carer role for their husband and as a way of protecting their children. CONCLUSION: The study's findings expand the conception of kidney donation as solely altruistic and may help professionals to pay attention to the complexity and intersectionality of features present in women who are living kidney donors.
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Transplante de Rim , Doadores Vivos/psicologia , Doadores Vivos/estatística & dados numéricos , Mulheres/psicologia , Adulto , Idoso , Altruísmo , Feminino , Humanos , Pessoa de Meia-Idade , Pesquisa QualitativaRESUMO
The issue of obstetric violence is internationally acknowledged as a serious violation of human rights. First identified by the Committee of Experts of the Inter-American Belém do Pará Convention in 2012, it is recognized as a form of gender-based violence that infringes upon women's rights during childbirth. Nations such as Argentina, Mexico, Venezuela, and certain regions in Spain have implemented laws against it, highlighting its severity and the need for protective legislation. Major international organizations, including WHO and the Council of Europe, advocate for the elimination of disrespectful and abusive treatment in maternity care. In 2019, the UN Special Rapporteur on violence against women called on states to protect women's human rights in reproductive services by enforcing laws, prosecuting perpetrators, and providing compensation to victims. However, despite advances, there remains institutional and systemic resistance to recognizing obstetric violence, which undermines trust in healthcare and impacts women's quality of life. Addressing this violence is imperative, requiring education and training in women's human rights for all healthcare professionals. As part of the coalition of experts from various organizations (InterOVO), we respond to the publication by EAPM, EBCOG, and EMA: "Joint Position Statement: Substandard and Disrespectful Care in Labor - Because Words Matter." We are committed to preventing and mitigating obstetric violence and improving care for women and newborns.
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Direitos da Mulher , Humanos , Feminino , Gravidez , Direitos da Mulher/legislação & jurisprudência , Europa (Continente) , América Latina , Violência de Gênero/prevenção & controle , Violência de Gênero/legislação & jurisprudência , Trabalho de Parto , Parto Obstétrico/legislação & jurisprudência , Qualidade da Assistência à Saúde/legislação & jurisprudência , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/legislação & jurisprudênciaRESUMO
OBJECTIVE: To measure the perception of obstetric violence among health sciences students. METHOD: Cross-sectional design in which the validated questionnaire PercOV-S (Perception of Student Obstetric Violence) was used. The questionnaire was offered to the students who participated in the I Congress of Feminist Medicine of the CEEM (State Councils of Medical Students) held on March 12, 2021. This questionnaire was sent online through Google Forms. RESULTS: The mean score obtained on the total scale was 3.83 scores (SD=0.61). For the dimension of protocolized-visible obstetric violence, the mean score is 2.79 points (SD=0.84) and for the dimension of non-protocolized-invisible obstetric violence, a mean of 4.16 points is obtained (SD=0.61). The global score of the displayed question differs statistically significantly with the variable scope (p=0.019), course (p=0.008), treatment according to ethnicity (p=0.008), treatment according to socioeconomic level, immigrant status (p<0.001), and prior knowledge about the concept of obstetric violence (p<0.001). CONCLUSIONS: The data show a marked generalised sensitivity of the sample to the issue of obstetric violence, especially with regard to the ethnic characteristics of the women. Likewise, the need to generate ethical-attitudinal training in the response to obstetric violence is observed.
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Estudantes de Medicina , Gravidez , Humanos , Feminino , Estudos Transversais , Violência , Feminismo , PercepçãoRESUMO
Background: Although current guidelines recommend that mothers with suspected or confirmed SARS-CoV-2 infection should be encouraged to initiate and continue breastfeeding, up-to-date literature shows conflicting data regarding breastfeeding experiences in infected women. This survey aimed to report on the psychological impact of SARS-CoV-2 infection on breastfeeding practice and medical counselling in a single tertiary center in Southern Italy. Methods: One-hundred breastfeeding women with SARS-CoV-2 infection at delivery were given an anonymous questionnaire regarding breastfeeding and women's perception of the impact of COVID-19 on breastfeeding. Results: 75% of women reported they had difficulty breastfeeding; among them, 66 (66%) declared that separation from their babies after delivery affected their ability to breastfeed. Incidence of reported difficulties in breastfeeding was higher in women who underwent caesarean section compared to women with vaginal delivery (56/65, 86.2% vs. 19/35, 54.3%, χ2 = 12.322, p < 0.001) and in women with a hospital stay of more than 5 days (48/57, 84.2% vs. 23/37, 62.2%, χ2 = 5.902, p = 0.015). Furthermore, the incidence of difficulties in breastfeeding was higher in women who subsequently decided to use exclusively infant formula compared to women who mixed maternal milk with infant formula and women who breastfed exclusively with maternal milk (48/49, 98% vs. 20/25, 80% vs. 7/26, 26.9%, χ2 = 46.160, p < 0.001). Conclusions: Our survey highlights the importance of healthcare support and information on hygiene practices to decrease the perceived stress related to breastfeeding for infected mothers under restrictions, especially in women undergoing cesarean section and with a long hospital stay.
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COVID-19 , Complicações Infecciosas na Gravidez , Lactente , Feminino , Humanos , Gravidez , Aleitamento Materno , COVID-19/epidemiologia , SARS-CoV-2 , Cesárea , Gestantes , Complicações Infecciosas na Gravidez/epidemiologia , Inquéritos e Questionários , Transmissão Vertical de Doenças InfecciosasRESUMO
BACKGROUND: Multi-country studies assessing the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic, as defined by WHO Standards, are lacking. METHODS: Women who gave birth in 12 countries of the WHO European Region from March 1, 2020 - March 15, 2021 answered an online questionnaire, including 40 WHO Standard-based Quality Measures. FINDINGS: 21,027 mothers were included in the analysis. Among those who experienced labour (N=18,063), 41·8% (26·1%- 63·5%) experienced difficulties in accessing antenatal care, 62% (12·6%-99·0%) were not allowed a companion of choice, 31·1% (16·5%-56·9%) received inadequate breastfeeding support, 34·4% (5·2%-64·8%) reported that health workers were not always using protective personal equipment, and 31·8% (17·8%-53·1%) rated the health workers' number as "insufficient". Episiotomy was performed in 20·1% (6·1%-66·0%) of spontaneous vaginal births and fundal pressure applied in 41·2% (11·5% -100%) of instrumental vaginal births. In addition, 23·9% women felt they were not treated with dignity (12·8%-59·8%), 12·5% (7·0%-23·4%) suffered abuse, and 2·4% (0·1%-26·2%) made informal payments. Most findings were significantly worse among women with prelabour caesarean birth (N=2,964). Multivariate analyses confirmed significant differences among countries, with Croatia, Romania, Serbia showing significant lower QMNC Indexes and Luxemburg showing a significantly higher QMNC Index than the total sample. Younger women and those with operative births also reported significantly lower QMNC Indexes. INTERPRETATION: Mothers reports revealed large inequities in QMNC across countries of the WHO European Region. Quality improvement initiatives to reduce these inequities and promote evidence-based, patient-centred respectful care for all mothers and newborns during the COVID-19 pandemic and beyond are urgently needed. FUNDING: The study was financially supported by the Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy. STUDY REGISTRATION: ClinicalTrials.gov Identifier: NCT04847336.
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OBJECTIVE: To explore the quality of maternal and newborn care (QMNC) during the COVID-19 pandemic by facility type among 16 European countries, comparing rates of instrumental vaginal birth and cesarean. METHODS: Women who gave birth in the WHO European Region from March 1, 2020, to February 7, 2022, answered a validated online questionnaire. Rates of instrumental birth, instrumental vaginal birth, and cesarean, and a QMNC index were calculated for births in public versus private facilities. RESULTS: Responses from 25 206 participants were analyzed. Women giving birth in private compared with public facilities reported significantly more frequent total cesarean (32.5% vs 19.0%; aOR 1.70; 95% CI 1.52-1.90), elective cesarean (17.3% vs 7.8%; aOR 1.90; 95% CI 1.65-2.19), and emergency cesarean before labor (7.4% vs 3.9%; aOR 1.39; 95% CI 1.14-1.70) (P < 0.001 for all comparisons), with analyses by country confirming these results. QMNC index results were heterogeneous across countries and regions in the same country and were largely affected by geographical distribution of regions rather than by type of facility alone. CONCLUSION: The study confirms that births in private facilities have higher odds of cesarean. It also suggests that QMNC should be closely monitored in all facilities to achieve high-quality care, independent of facility type or geographical distribution. GOV IDENTIFIER: NCT04847336.
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COVID-19 , Cesárea , Feminino , Humanos , Recém-Nascido , Gravidez , COVID-19/epidemiologia , Saúde do Lactente , Pandemias , Logradouros PúblicosRESUMO
BACKGROUND: The experiences described by people who have undergone kidney transplant are complex. Understanding how donors and recipients experience kidney transplantation can help us to design strategies that provide a more person-centred health care. OBJECTIVES: To review articles that report the experiences of donors and recipients in the living-donor kidney transplantation process. METHOD: A systematic review of qualitative studies was carried out. PubMed, Scopus, Web of Science, CINAHL and PsycINFO databases were used to search for articles published in English, French and Spanish between 2005 and 2018. RESULTS: Twenty-nine articles were included in this review. For recipients, receiving a kidney is a positive experience (positive feelings and significant experience) that also involves certain difficulties and stressors (making a difficult decision, fears and worries). The experience of the donors is positive as they are motivated to improve the life of the recipient. They are committed to donating and use coping strategies as well as experiencing personal growth. On the contrary, being a donor involves certain difficulties and stressors (personal investment, mental, physical and economic impact and overcoming opposition) and a perception of deficiency in the health system (lack of information and attentiveness). CONCLUSION: Donating and receiving a kidney is a positive experience that involves certain difficulties and a variety of stressors for both the donors and recipients. Moreover, the donors note deficiencies in the health system.
ANTECEDENTES: Las experiencias que explican las personas sometidas a un trasplante renal son complejas. Entender como experimentan el trasplante renal los donantes y los receptores nos puede ayudar a diseñar estrategias para proporcionar una atención sanitaria más centrada en la persona. OBJETIVOS: Revisar artículos que hablen sobre las experiencias de los donantes y los receptores en el proceso de trasplante renal de donante vivo. MÉTODO: Se realizó una revisión sistemática de estudios cualitativos. Se utilizaron las bases de datos Pubmed, Scopus, Web of Science, Cinahl y Psycinfo para buscar artículos desde el año 2005 hasta 2018 publicados en inglés, francés o español. RESULTADOS: Se incluyeron 29 artículos en esta revisión. Para los donantes la experiencia de donar es positiva ya que están motivados para mejorar la vida del receptor, donan de forma convencida, utilizan estrategias de afrontamiento y experimentan crecimiento personal. Por otro lado, donar supone dificultades y estresores (inversión personal, impacto económico, físico, mental y superar la oposición) y percepción de carencia en el sistema sanitario (falta de información y desatención). Para los receptores el recibir un riñón es una experiencia positiva (sentimientos positivos y experiencia significativa) ligada también a dificultades y estresores (toma de decisión difícil, temores y preocupaciones). CONCLUSIONES: Dar y recibir un riñón es una experiencia positiva que comporta dificultades y factores estresantes diferentes para los donantes y para los receptores. Además, los donantes constatan una carencia en el sistema sanitario. This article is protected by copyright. All rights reserved.