Disrespect and abuse during childbirth in maternity hospitals in Piauí, Brazil: A cross-sectional study.

OBJECTIVES: To assess the prevalence and associated factors of disrespect and abuse during childbirth in Piauí, Brazil. METHODS: A cross-sectional study was performed with 698 postpartum women in 21 maternity hospitals in 14 municipalities between August 2018 and September 2019. Face-to-face interviews were performed at least 6 h after birth, with an assessment of disrespect and abuse during childbirth. Robust Poisson regression was used, with calculation of the adjusted prevalence ratio (aPR) and 95% confidence intervals (95% CIs). RESULTS: There was evidence that 19.8% of women experienced at least one type of disrespect and abuse during childbirth, with verbal abuse (12.6%), noncompliance with professional standards (11.6%), and health service restrictions being more common (8.3%). There was an association of disrespect and abuse during childbirth with women aged 10 to 19 years (aPR, 1.97; 95% CI, 1.58-2.44), absence of companions (aPR, 2.43; 95% CI, 1.85-2.89), cesarean sections after labor (aPR, 2.19; 95% CI, 1.64-3.59), public hospitals (aPR, 1.87; 95% CI, 1.42-2.85), and in the countryside (aPR, 2.29; 95% CI, 1.81-3.98). CONCLUSION: There was a high prevalence of disrespect and abuse during childbirth in Piauí, Brazil, associated with structural conditions of the services, care practices, and characteristics of women.

Analysis of the structural adequacy of maternity hospitals in Piauí, Brazil, 2018-2019 / Análise da adequação estrutural das maternidades do Piauí, Brasil, 2018-2019

Abstract Objectives: to evaluate the structure and adequacy of maternal healthcare facilities in Piauí. Methods: cross-sectional study in 26 hospitals with more than 200 births/year between 2018-2019. The structure was assessed by direct observation and interview with manager, in four domains: physical aspects, human resources, equipment, and drugs. Fisher's chi-square/exact tests were used to assess differences in adequacy of structure. Results: only 46.2% of the maternal healthcare facilities had pre-delivery, parturition and immediate post-partum room. Pediatricians (73.1%) and anesthesiologists (61.5%) were the least present professionals on-duty regime. Regarding drugs, magnesium sulfate and oxytocin were observed in 76.9% of hospitals. Overall adequacy was 23.1%, being higher in maternal healthcare facilities in the capital (p=0.034) and in private ones (p=0.031). Conclusions: Data show inequalities in the structure of maternity hospitals of the state. The absence of health professionals, essential drugs, and appropriate physical structure can expose women and newborns to unnecessary and avoidable risks.

Resumo Objetivos: avaliar a estrutura e adequação das maternidades do Piauí. Métodos: estudo transversal em 26 hospitais com mais de 200 partos/ano entre 2018 e 2019. A estrutura foi avaliada por observação direta e entrevista com gestor, em quatro domínios: aspectos físicos, recursos humanos, equipamentos e medicamentos. Foram empregados os testes do quiquadrado/exato de Fisher para avaliar diferenças na adequação da estrutura. Resultados: apenas 46,2% das maternidades tinham quarto pré-parto, parto e puerpério. Pediatras (73,1%) e anestesistas (61,5%) foram os profissionais menos presentes em regime de plantão. Dos medicamentes, sulfato de magnésio e ocitocina foram observados em 76,9% dos hospitais. A adequação global foi de 23,1%, sendo maior em maternidades da capital (p=0,034) e privadas (p=0,031) Conclusões: os dados exibem desigualdades na estrutura das maternidades do estado. A ausência de profissionais de saúde, medicamentos essenciais e estrutura física apropriada pode expor mulheres e recém-nascidos a riscos desnecessários e evitáveis.