Disrespect and Abuse in Obstetric Care in Mexico: An Observational Study of Deliveries in Four Hospitals.

INTRODUCTION: To identify and describe the frequency and characteristics of disrespect and abuse practices towards women during facility-based delivery in four hospitals in two Mexican states in 2017, using a mixed method of direct observation and women's reports of health care experiences. METHODS: A cross-sectional study was performed to describe disrespect and abuse practices in obstetric care (interactions or conditions that are experienced as or intended to be humiliating or undignified) committed by healthcare providers. We included all pregnant women admitted for childbirth (vaginal and cesarean). Semi-structured interviews were also conducted with women, prior to discharge, regarding their experience at delivery. RESULTS: 867 deliveries were observed. 18.8% of women (n = 163) experienced at least one disrespect and abuse event, especially at secondary care facilities. There were a total of 493 disrespect and abuse events, which, on average, represents three events per woman (39.4% were verbal abuse, 32% were physical abuse, and 28.6% were discrimination). In the majority of cases (> 50%), women did not give consent to not recommended invasive procedures and were not provided with adequate information to those procedures. CONCLUSIONS FOR PRACTICE: Direct observation and interviews was a useful tool to identify disrespectful and abusive practices during delivery care. Our findings provide new evidence of the frequency and characteristics of disrespect and abuse during delivery care in Mexico, which can be used to inform maternal health programs. Additionally, these results encourage the creation of surveillance policies and committees in order to guarantee violence-free and dignified treatment of women during delivery care.

[Approach to the quality of care during pregnancy,delivery and postpartum in women withobstetric risk factors in Mexico]. / Aproximación a la calidad de la atención durante el embarazo, parto y posparto en mujeres con factores de riesgoobstétrico en México.

OBJECTIVE: To assess the quality of care of women with obstetric risk factors during pregnancy, childbirth, and post-partum. MATERIALS AND METHODS: We use data from The National Survey of Health and Nutrition 2018-19. Women were classified by the presence of obstetric risk factors (ORF) in their last pregnancy. The quality of care provided to women was evaluated with indicators of structure and process dur-ing antenatal care (ANC) and, delivery and postpartum care (DPC). RESULTS: Compliance with process indicators in ANC and DPC for women with ORF was 56.9%. In the face of complications during pregnancy or delivery, it decreased in ANC, and in the face of social vulnerability compliance of ANC and DPC indicators decreases. CONCLUSIONS: It is necessary to systematically improve the quality of care during pregnancy, childbirth, and postpartum, regardless the presence of ORF, with special attention to vulnerable groups.

OBJETIVO: Evaluar la calidad de la atención a mujeres con factores de riesgo obstétrico durante el embarazo, parto y posparto. MATERIAL Y MÉTODOS: Con datos de la Encuesta Nacional de Salud y Nutrición 2018-19, se clasificó a las mu-jeres de acuerdo con los factores de riesgo obstétrico (FRO) presentes en su último embarazo y se evaluó la calidad de la atención con indicadores de estructura y proceso en la atención prenatal (APN), y en la atención del parto y posparto (APP). RESULTADOS: El cumplimiento de indicadores de pro-ceso en APN y APP para mujeres con FRO fue de 56.9%. Ante complicaciones durante el embarazo o el parto, disminuyó en la APN, y ante variables socioeconómicas desfavorables, disminuyó en la APN y en la APP. CONCLUSIONES: Es nece-sario mejorar sistemáticamente la calidad de la atención en el embarazo, parto y posparto en mujeres con y sin riesgo obstétrico, principalmente en grupos vulnerables.

Aproximación a la calidad de la atención durante el embarazo, parto y posparto en mujeres con factores de riesgo obstétrico en México / Approach to the quality of care during pregnancy, delivery and postpartum in women with obstetric risk factors in Mexico

Resumen: Objetivo: Evaluar la calidad de la atención a mujeres con factores de riesgo obstétrico durante el embarazo, parto y posparto. Material y métodos. Con datos de la Encuesta Nacional de Salud y Nutrición 2018-19, se clasificó a las mujeres de acuerdo con los factores de riesgo obstétrico (FRO) presentes en su último embarazo y se evaluó la calidad de la atención con indicadores de estructura y proceso en la atención prenatal (APN), y en la atención del parto y posparto (APP). Resultados: El cumplimiento de indicadores de proceso en APN y APP para mujeres con FRO fue de 56.9%. Ante complicaciones durante el embarazo o el parto, disminuyó en la APN, y ante variables socioeconómicas desfavorables, disminuyó en la APN y en la APP. Conclusiones: Es necesario mejorar sistemáticamente la calidad de la atención en el embarazo, parto y posparto en mujeres con y sin riesgo obstétrico, principalmente en grupos vulnerables.

Abstract: Objective: To assess the quality of care of women with obstetric risk factors during pregnancy, childbirth, and postpartum. Materials and methods: We use data from The National Survey of Health and Nutrition 2018-19. Women were classified by the presence of obstetric risk factors (ORF) in their last pregnancy. The quality of care provided to women was evaluated with indicators of structure and process during antenatal care (ANC) and, delivery and postpartum care (DPC). Results: Compliance with process indicators in ANC and DPC for women with ORF was 56.9%. In the face of complications during pregnancy or delivery, it decreased in ANC, and in the face of social vulnerability compliance of ANC and DPC indicators decreases. Conclusions: It is necessary to systematically improve the quality of care during pregnancy, childbirth, and postpartum, regardless the presence of ORF, with special attention to vulnerable groups.

Are overweight and obesity associated with increased risk of cesarean delivery in Mexico? A cross-sectional study from the National Survey of Health and Nutrition.

BACKGROUND: In Mexico, obesity is a major public health problem; 71% of adults are overweight or obese. The proportion of deliveries by cesarean is also very high (45%). Women of reproductive age with overweight or obesity may be at higher risk of cesarean. METHODS: We conducted a cross-sectional study to test the association between overweight and obesity (using body mass index, BMI) and cesarean delivery in Mexico using data from the 2012 National Survey of Health and Nutrition (ENSANUT). Our sample included women of reproductive age at the time of survey who reported a live birth between 2006 and 2012. We used bivariate statistics and a multivariate logistic regression model to test the association between measured BMI and self-reported cesarean delivery. We included individual, clinical, and household level confounders and used survey weights to produce population estimates. RESULTS: Our sample consisted of 4,570 women (population N = 7,447,541). Overall, 44% of the women reported a cesarean at last delivery. We found differences in the proportion of cesarean delivery by BMI group (normal = 39%; 95% CI [35-43]; overweight = 42%; 95% CI [38-45]; obesity = 52%; 95% CI [48-57]; p < 0.001). In multivariable models controlling for socio-demographic and clinical characteristics, we found a strong and independent association between obesity and cesarean delivery among multiparous women, compared with multiparous women with normal BMI (obesity aOR: 1.60; 95% CI [1.21-2.12]). CONCLUSIONS: We provide new evidence about the proportion of women with overweight and obesity who deliver in Mexico. Multiparous women with obesity are at higher risk of cesarean delivery in Mexico than multiparous women with normal body mass index. Given the high prevalence of both obesity and cesarean delivery in Mexico, this relationship is salient for women, health care providers, and the health system. Efforts to reduce the cesarean deliveries rate need to take the obesity epidemic into account.

Actualización de la prueba general para la evaluación del desarrollo integral del niño entre los 0 meses y 6 años de edad (EDIN) / Update of the general test for evaluation of the integral development of the child between 0 months and 6 years of age (EDIN) / Atualização da prova geral para a avaliação do desenvolvimento integral de crianças entre 0 meses e 6 anos de idade (EDIN)

ResumenIntroducción: En este artículo se presentan los resultados obtenidos en la actualización de la prueba general para la evaluación del desarrollo integral del niño y la niña entre los 0 y 6 años de edad (EDIN).Metodología: la metodología fue de carácter cualitativo, transversal y descriptivo. Se contó con la participación de 14 expertos en el área del desarrollo humano. Los datos fueron recolectados mediante la técnica de juicio de expertos de tipo agregados individuales; la información obtenida fue triangulada con evidencia científica actualizada para determinar la permanencia de los ítems en la propuesta actualizada.Resultados: La prueba juicio de expertos permitió confirmar la inconsistencia de algunos ítems, por lo que fue necesario cambiar, eliminar y adecuar ítems del EDIN. Del total de 456 ítems de esta prueba, 72 (16%) del área de "hábitos", fueron excluidos, por no corresponder a un área del desarrollo, 127 (27.9%) fueron inconsistentes , 257 (56%) fueron consistentes y se crearon 15 nuevos ítems, lo cual da como resultado una prueba actualizada con 287 ítems, distribuidos en seis áreas del desarrollo y 19 grupos de edad, más una lista de cotejo compuesta por 112 recomendaciones sobre los patrones de alimentación, sueño y descanso, eliminación, higiene y vestido y seguridad.Conclusiones: La investigación aporta una prueba actualizada para la población infantil costarricense menor de seis años. El estudio de las pruebas de evaluación del desarrollo es necesario para la atención integral durante la infancia, por lo que es importante que el país cuente con instrumentos de evaluación del desarrollo propios y actualizados.

AbstractIntroduction: In this paper the results in updating the general test for evaluating the development of the child and the child between 0 and 6 years of age (EDIN) are presented.Methodology: The methodology was qualitative, transversal and descriptive. It was attended by 14 experts in the field of human development. Data were collected through technical expert judgment of individual aggregates type. The information obtained was triangulated with updated to determine the permanence of the items in the updated proposal scientific evidence.Results: expert opinion evidence confirmed the inconsistency of some items, so it was necessary to change, delete and adjust items in the EDIN. Of the total of 456 items of this test, 72 (16%) items in the area of "habits" were excluded, not correspond to an area of development, 127 (27.9%) were inconsistent, 257 (56%) were consistent and 15 new items were created, leaving an updated 287 tested, distributed in six areas of development and 19 age groups, plus a checklist consisting of 112 recommendations on eating patterns, sleep and rest, elimination, hygiene and clothing and security.Conclusions: The study provides an updated for minor child population six years Costa Rican test. The study of developmental assessment tests necessary for comprehensive care during childhood, so it is important that the country has own assessment tools development and updated.

ResumoIntrodução: Neste artigo se apresentam os resultados obtidos na atualização da prova geral para a avaliação do desenvolvimento integral de meninos e meninas entre 0 e 6 anos de idade (EDIN).Metodologia: a metodologia foi de tipo qualitativo, transversal e descritiva. Participaram 14 especialistas na área de desenvolvimento humano. ; Os dados foram recoletados mediante a técnica de julgamento de especialistas, de especialistas de tipo agregados individuais; a informação obtida foi triangulada com evidência científica atualizada para determinar a permanência dos ítens na proposta atualizada.Resultados: A prova de julgamento dos especialistas permitiu confirmar a inconsistência de alguns ítens, pelo que foi necessário mudar, eliminar e adequar ítens do EDIN. Do total de 456 ítens desta prova, 72 (16%) ítens da área de "hábitos", foram excluídos, por não corresponder a uma área do desenvolvimento, 127 (27.9%) ítens foram inconsistentes , 257 (56%) ítens foram consistentes e se criaram 15 novos ítens, o qual dá como resultado uma prova atualizada com 287 ítens, distribuídos em 6 seis áreas de desenvolvimento e 19 grupos de idade , mais uma lista de cotejo composta por 112 recomendações sobre os padrões de alimentação, sono e descanso, eliminação, higiene, vestuário e segurança.Conclusões: A pesquisa aporta uma prova atualizada para a população infantil costarriquense menor de 6 (seis) anos. O estudo das provas de avaliação de desenvolvimento é necessário para a atenção integral durante a infância, porque é importante que o país conte com instrumentos de avaliação de desenvolvimento próprios e atualizados.