Books/libros by Michelle Sadler
Logros, pendientes y desafíos en torno al descenso de la fecundidad adolescente en Chile. En INJU... more Logros, pendientes y desafíos en torno al descenso de la fecundidad adolescente en Chile. En INJUV. Problemáticas y desafíos de las juventudes en Chile, Evidencias desde las Encuestas Nacionales de Juventud. Recuperado de: https://www.injuv.gob.cl/sites/default/files/injuv2021_pro-blematicas_y_desafios_de_las_juventudes_en_chile_-1.pdf Sadler, M. (2018) Cuerpos vividos en el nacimiento: Del cuerpo muerto de miedo al cuerpo gozoso. En Cordero, Moscoso, & Viu (Eds.), Rastros y gestos de las emociones (pp. 199-245). Cuarto propio.
“La Historia Ilustrada de un Embarazo” relata la historia de Ana y Miguel, joven pareja que enfre... more “La Historia Ilustrada de un Embarazo” relata la historia de Ana y Miguel, joven pareja que enfrenta su primer embarazo. El libro recorre el proceso de gestación desde que la pareja se entera de la noticia hasta el nacimiento de su hijo, mostrando los temores a los que se enfrentan, y la información confusa que reciben del entorno social y médico. La historia busca potenciar una reflexión en torno a la excesiva medicalización del nacimiento y al protagonismo de madres y padres en el nacimiento de un hijo.
"The Illustrated Story of a Pregnancy" tells the story of Ana and Miguel, a young couple facing their first pregnancy. The book goes through their pregnancy until the birth of their child, showing the fears they face, and the confusing information they receive from the social and medical environment. The story seeks to promote a reflection on the excessive medicalization of birth.
Reportajes y algunas imágenes del libro en: http://www.paula.cl/galerias/historia-ilustrada-de-un-embarazo/ http://culto.latercera.com/2017/03/23/la-historia-ilustrada-embarazo-humor-mitos-tabues/
Estos tres ensayos se erigen como estructuras de materias cruciales que los estudios de género ha... more Estos tres ensayos se erigen como estructuras de materias cruciales que los estudios de género han tratado y que, precisamente, al ser abordados con un enfoque etnográfico y etnológico, logran producir engarces de sentidos nuevos. podemos leer este libro como un viaje y una estadía en tres salas: la sala de parto, la sala de clases y la sala de la consulta médica. las autoras, sin complacencias, parecen querer decirnos que es preciso y urgente humanizar las políticas que tocan ámbitos tan claves como lo son el modo en que se llega al mundo, cómo se aprende y cómo se recupera la salud. todos ellos espacios, salas, donde se estructura y construye nuestra vida.
Papers by Michelle Sadler
Cuadernos del ISCo: Salud sexual y reproductiva y vulnerabilidad estructural en América Latina: Contribuciones de la antropología médica crítica. Rubén Muñoz Martínez y Paola María Sesia (coordinadores), 2024
European Journal of Obstetrics & Gynecology and Reproductive Biology (ISSN: 0301-2115), 2024
The issue of obstetric violence is internationally acknowledged as a serious violation of human r... more 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 Bel´em do Par´a 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.
BMC Public Health, 2024
Background Chile has become a destination country for immigrants from Latin America, including yo... more Background Chile has become a destination country for immigrants from Latin America, including youth. Guaranteeing access and use of sexual and reproductive health services for young migrants is crucial because of their overlapping experiences of transitioning to a new country and to adulthood. However, the existing evidence shows barriers to accessing sexual and reproductive healthcare among young migrant populations. In this context, the main objective of this article is to identify the barriers and facilitators that young migrants experience to access sexual and reproductive healthcare in the Tarapacá region of Chile. Methods A qualitative study was conducted in the Tarapacá region of Chile. Semi-structured interviews with 25 young migrants from Venezuela, Colombia, and Ecuador, as well as 10 health workers, were carried out. The interviews were transcribed and thematically analysed. The study was approved by the Ethics Committee of the Universidad del Desarrollo (#2019-22). Results Young migrants face barriers linked to structural shortcomings within the healthcare system, which may be similar to those faced by the local population. Barriers are also derived from reductionist sexual and reproductive health approaches, which prioritise the prevention of pregnancy, sexually transmitted infections, and HIV, with a predominantly heteronormative focus. The prevailing narratives from the health system are those of risk and lack of control and self-care among young people, and they are exacerbated in the case of migrants. Young migrants, especially from the Caribbean, are stereotyped as over-sexualised and liberal in comparison to the local population and believed to be engaging in riskier sexual behaviours that should be kept under check. This may translate into experiences of discrimination and mistreatment when receiving care. Facilitators include good-quality information and community-level interventions. Conclusions This study shows a limited approach to the sexual and reproductive health of young migrants in Chile, severely hampering their reproductive and sexual rights. Policies and initiatives must work towards removing structural barriers, changing narratives, and empowering young migrants regarding their sexual and reproductive health.
Antropologias del Sur, 2024
La formación del campo de la antropología de la salud (o antropología médica) en Chile es paralel... more La formación del campo de la antropología de la salud (o antropología médica) en Chile es paralela al desarrollo de la disciplina en el país. Actualmente observamos la consolidación de distintos temas y el surgimiento de nuevos diálogos y desafíos. El artículo reflexiona sobre el pasado, el presente y el futuro del campo, y propone una caracterización de las distintas etapas de esta subdisciplina basada en una revisión de investigaciones nacionales y de tesis de pregrado y postgrado dedicadas al tema. Se destacan los aportes y las limitaciones de cada período y se reflexiona en torno a los desafíos que la subdisciplina enfrenta actualmente considerando el arribo a un momento histórico de mayor reconocimiento y de implicación en el debate nacional sobre los procesos de salud/enfermedad/atención/cuidado.
Revista de Antropología Social , 2023
El artículo-que da cuenta de los resultados de dos investigaciones cualitativas ejecutadas entre ... more El artículo-que da cuenta de los resultados de dos investigaciones cualitativas ejecutadas entre 2020 y 2022-, tiene como propósito, desde un enfoque de salud global, salud colectiva y vulnerabilidad estructural, reflexionar en torno al rol que juegan nuevos actores de la sociedad civil en la promoción de la salud sexual, de derechos sexuales y en la prevención y detección del VIH en Chile. Estos actores son organizaciones de la sociedad civil conformadas por jóvenes profesionales de la salud que han construido espacios de información, promoción y atención en salud sexual y reproductiva fuera del sistema formal de salud; y organizaciones lideradas por jóvenes LGBTIQA+ en torno a información en sexualidades en general, y a acceso a prevención y detección del VIH en particular. El artículo contribuye en mostrar la importancia que tienen estos nuevos actores en las trayectorias terapéuticas en materia de salud sexual de jóvenes en Chile, y la relevancia aún mayor que han adquirido desde el inicio de la pandemia de Covid-19. Palabras clave: Salud global; salud sexual; derechos sexuales; salud sexual y reproductiva; jóvenes [en] The role of new civil society organizations in promoting sexual health in Chile Abstract. The article-which gives an account of the results of two qualitative investigations carried out between 2020 and 2022-, has the purpose, from a global health, collective health and structural vulnerability approach, to reflect on the role played by new civil society actors in the promotion of sexual health, sexual rights and in the prevention and detection of HIV in Chile. These actors are civil society organizations led by young health professionals who have built spaces for information, promotion, and care in sexual and reproductive health outside the formal health system; and organizations led by LGBTIQA+ youth around information on sexualities in general, and access to HIV prevention and detection in particular. The article contributes to show the importance that these new civil society actors have in therapeutic trajectories in the field of sexual health of young people in Chile, and the even greater relevance that they have acquired since the beginning of the Covid-19 pandemic.
Hypatia, 2023
Obstetric violence has been described in terms not only of violence in general but of gender viol... more Obstetric violence has been described in terms not only of violence in general but of gender violence specifically. This feminist-phenomenological analysis demonstrates features that the experiences of torture and of obstetric violence share. Many birthing subjects describe their experiences of obstetric violence as torture. This use of the concept of torture to explain what they have gone through is not trivial and deserves philosophical attention. In this article, we give several examples (mainly from Chilean women's birth narratives), examining them through phenomenological and feminist phenomenological analyses of torture. We argue that, as with torture, it is not mere pain that marks the experience of obstetric violence, but rather a state of ontological loneliness and desolation, a detachment from the previous known world, and a loss of trust in those surrounding us. But if obstetric violence is gender violence, this must be gendered torture: it is perpetrated with the goal of humiliating and controlling women, of reifying them and robbing them of their free embodied subjectivities in labor.
COGNITION, RISK, AND RESPONSIBILITY IN OBSTETRICS. Anthropological Analyses and Critiques of Obstetricians’ Practices, 2023
The chapter shows results of a project which aimed to understand the factors driving the persiste... more The chapter shows results of a project which aimed to understand the factors driving the persistence and/or increase of routine obstetric interventions and cesareans in Chile, especially considering the large differences in interventions between health sub-systems. Drawing on interviews with obstetricians and on secondary data, we argue that economic incentives are among the main factors influencing those high rates. Since caesareans are decided mainly by obstetricians, understanding the factors and incentives that lead them to practice obstetric interventions becomes vitally important for the effective design of humanistic birth models. / El capítulo muestra los resultados de un proyecto que tuvo como objetivo comprender los factores que impulsan la persistencia y/o el aumento de las intervenciones obstétricas y cesáreas de rutina en Chile, especialmente considerando las grandes diferencias en las intervenciones entre los subsistemas de salud. Basándonos en entrevistas con obstetras y en datos secundarios, argumentamos que los incentivos económicos se encuentran entre los principales factores que influyen en esas altas tasas. Dado que las cesáreas son decididas principalmente por obstetras, comprender los factores e incentivos que los llevan a practicar intervenciones obstétricas se vuelve de vital importancia para el diseño efectivo de modelos humanistas de atención del nacimiento.
Religación Revista de Ciencias Sociales y Humanidades, 2022
Durante el siglo XX, la episiotomía se expandió como práctica en la atención obstétrica del parto... more Durante el siglo XX, la episiotomía se expandió como práctica en la atención obstétrica del parto. En la actualidad, tras más de tres décadas de sólida evidencia científica que recomienda no practicarla en forma rutinaria, sigue realizándose en números alarmantemente elevados. El presente artículo analiza el sentido cultural que posee la episiotomía como rito dentro del parto tecnocrático, en base a testimonios de parto vertidos por mujeres en la Primera Encuesta sobre el Nacimiento en Chile, realizada por el Observatorio de Violencia Obstétrica de Chile en el año 2017. Estos testimonios demuestran que la episiotomía se practica en la mayoría de los casos en forma rutinaria, sin consentimiento, y que deja graves secuelas en la salud física, mental y en la vida sexual de las mujeres; lo que nos lleva a afirmar que se trata de una forma occidental de mutilación genital femenina. Se concluye planteando la urgencia de revisar esta práctica y de nombrarla por lo que es: un tipo de mutilación genital con graves secuelas en la vida de las mujeres, que debe ser visibilizado.
International Journal of Environmental Research and Public Health, 2022
The sexual and reproductive health of young migrants has not been sufficiently addressed in mobil... more The sexual and reproductive health of young migrants has not been sufficiently addressed in mobility studies. In this article, we dwell on some aspects of this issue in the migration process of Latin American youth. We conducted a qualitative study in the region of Tarapacá, Chile, carrying out in-depth interviews with key informants, health staff and young migrants between 18 and 25 years old. The results show some motivations to migrate related to sexual and reproductive health: young
pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services.
ODS 1: Poner fin a la pobreza en todas sus formas en todo el mundo. ODS 3: Garantizar una vida sa... more ODS 1: Poner fin a la pobreza en todas sus formas en todo el mundo. ODS 3: Garantizar una vida sana y promover el bienestar para todos en todas las edades. ODS 5: Lograr la igualdad entre los géneros y empoderar a todas las mujeres y las niñas. ODS 10: Reducir la desigualdad en y entre los países.
El quehacer de la salud pública. Divergencias e inequidades en salud. , 2022
Si bien durante las últimas décadas se ha avanzado en la visibilización
de múltiples formas de vi... more Si bien durante las últimas décadas se ha avanzado en la visibilización
de múltiples formas de violencia de género, hay una que ha presentado
particular resistencia a ser nombrada y reconocida. Se trata de la
violencia obstétrica, que se ejerce principalmente al interior de los
establecimientos de salud, y que constituye un grave problema de
salud pública y de violación a los derechos sexuales, reproductivos, y
humanos de las mujeres. A diferencia de otros tipos de violencia en que
es (más) fácil apuntar a victimarios, en este caso la responsabilidad se
PLOS ONE, 2022
Background
Adolescent sexual and reproductive health services in Chile have been primarily provid... more Background
Adolescent sexual and reproductive health services in Chile have been primarily provided through health centers. Although some school-based initiatives have been implemented, to date, these have not been assessed. This study aims to identify strengths and challenges of the affectivity and sexuality component of the school-based 3A Program, a health program which seeks to prevent risk behaviors and promote healthy lifestyle habits within public schools (addressing health topics which in Spanish begin with the letter ‘A’, hence ‘3A’), implemented in the municipality of Lo Prado, city of Santiago.
Methods
We carried out a qualitative study with a descriptive-interpretative approach in three schools. We conducted in-depth interviews with students, teachers, health professionals, and school principals (N = 44); and focus groups with students (N = 3), teachers and health personnel (N = 3). The interviews were analyzed using thematic analysis.
Results
Participants highlight the integrative approach to health and to sexual and reproductive health promoted in the 3A Program, which is enhanced by the collaboration of interdisciplinary health teams. Permanent and expedited student access to sexual and reproductive health care is achieved, and affectional bonds are developed between students and the Program’s health staff. The Program assists female participants to imagine and form identities that are not inherently tied to motherhood. It also assists boys and LGBTQ+ adolescents in feeling included as relevant actors in sexual and reproductive health and decision making. The delivery of contraception in schools is highly valued. The most significant challenge identified is ensuring effective and ongoing collaboration between health staff and teachers.
Conclusion
Participants value the effectivity and sexuality component of the 3A Program as an initiative to improve adolescents’ access to sexual and reproductive health care. Our findings suggest that this Program could be replicated throughout the region and the country to improve the quality and accessibility of health services for adolescents.
Women & Birth, 2021
Background
Significant adjustments to maternity care in response to the COVID-19 pandemic and the... more Background
Significant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care.
Aim
To explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally.
Methods
We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses.
Findings
Health workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission.
Discussion
Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term.
Conclusions
The measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.
Revista Chilena de Antropología, 2021
En el presente artículo proponemos una reflexión en torno al cuidado en la atención del nacimient... more En el presente artículo proponemos una reflexión en torno al cuidado en la atención del nacimiento, que surge del análisis de testimonios de experiencias de parto que fueron expresados por mujeres en la Primera Encuesta sobre Nacimiento en Chile, aplicada por el Observatorio de Violencia Obstétrica (OVO Chile) en el año 2017. Desde el activismo basado en la evidencia, damos voz a las experiencias vividas por las mujeres como fuente fundamental de conocimiento que pueda dialogar con el saber biomédico y así posibilitar la emergencia de nuevas formas de reflexividad colectiva. Dentro de la gran diversidad de experiencias de parto vividas, identificamos una percepción generalizada de que en el sistema de salud chileno no hay garantía de una atención integral y respetuosa, y de que el acceso a dicha atención es responsabilidad principal de las propias mujeres, en procesos autogestionados de acceso a información y de toma de decisiones individuales. Esta lógica centrada en las elecciones personales se contrapone a una ética del cuidado entendida en términos de responsabilidad colectiva, dependiente de entramados de redes de solidaridad y colaboración.
In this article, we propose a reflection about caregiving during childbirth, which arises from the analysis of testimonies of childbirth experiences that were expressed by women in the First Survey on Childbirth in Chile, applied by the Observatory of Obstetric Violence (OVO Chile) in 2017. From evidence-based activism, we give voice to women's lived experiences as a fundamental source of knowledge that can dialogue with biomedical knowledge and thus enable the emergence of new forms of collective reflexivity. Within the great diversity of childbirth experiences, we identify a generalized perception that in the Chilean health system there is no guarantee of receiving comprehensive and respectful care, and that access to such care is the responsibility of women themselves, in self-managed decision-making processes. This logic centered on personal choices is opposed to an ethic of care understood in terms of collective responsibility, dependent on solidarity and collaboration networks.
Sustainable Birth in Disruptive Times, 2021
In Chile, almost 100% of births take place in health institutions, with no legal out-of-hospital ... more In Chile, almost 100% of births take place in health institutions, with no legal out-of-hospital alternatives for childbirth, and obstetric interventions are extremely high, including a 50% cesarean rate. Despite government efforts and policies to promote physiologic and respectful birth since 2007, the technocratic model of childbirth remains hegemonic. However, strong childbirth activists, together with groups of health professionals who seek change, are advocating for a law on respectful childbirth, directing innovative initiatives within maternities, and positioning home birth as a valid option that needs to be legalized and reimbursed by health insurance. The chapter describes and reflects on these recent changes in the landscape of childbirth in Chile, arguing they might bring winds of change and reverse the excessive medicalization of birth. In the context of the COVID-19 pandemic, activist and health professionals were alerted to how recent improvements in maternity care were being threatened and were pushing to accelerate a deep discussion on birth territories and alternatives to hospital. We are confident that after the passing of the pandemic, the humanistic winds of change in Chile will continue to blow with renewed momentum.
Available at: https://link.springer.com/chapter/10.1007/978-3-030-54775-2_9
Frontiers in Sociology, 2021
The Maternity in Dra. Eloísa Díaz' hospital, located in the municipality of La Florida and city o... more The Maternity in Dra. Eloísa Díaz' hospital, located in the municipality of La Florida and city of Santiago, Chile, opened its doors in 2014, and has integrated a humanistic model of care called the "Safe Model of Personalized Childbirth" since 2016. With around 3,000 births per year, it has been recognized as an example of excellence in maternity care in the country. The COVID-19 outbreak presented a big challenge to this Maternity: to maintain its quality of care standards despite the health crisis. This article presents the Maternity's responses to the pandemic from March to July 2020, describing the strategies that were deployed and the obstetric outcomes achieved. Semi-structured interviews with midwives and OB-GYNs, and a retrospective review of the childbirth standards of care and outcomes of the 55 women who tested positive for SARS-CoV-2, were carried out. The results show how the Maternity's staff responded in order to avoid a significant negative impact on the rights of women and newborns. Protocols to reestablish the companion during labor and childbirth and skin-to-skin contact, which were suspended for almost three weeks at the beginning of the outbreak, and the creation of an Instagram account to communicate with the external community were some of the measures taken. After some initial weeks of adjustment, the standards of care for all women, included for those diagnosed with COVID-19, were reestablished almost to pre-pandemic levels. This case shows that quality of care can be maintained and the rights of women and newborns can be respected during health crisis such as the COVID-19 pandemic.
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Books/libros by Michelle Sadler
"The Illustrated Story of a Pregnancy" tells the story of Ana and Miguel, a young couple facing their first pregnancy. The book goes through their pregnancy until the birth of their child, showing the fears they face, and the confusing information they receive from the social and medical environment. The story seeks to promote a reflection on the excessive medicalization of birth.
Reportajes y algunas imágenes del libro en: http://www.paula.cl/galerias/historia-ilustrada-de-un-embarazo/ http://culto.latercera.com/2017/03/23/la-historia-ilustrada-embarazo-humor-mitos-tabues/
Papers by Michelle Sadler
pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services.
de múltiples formas de violencia de género, hay una que ha presentado
particular resistencia a ser nombrada y reconocida. Se trata de la
violencia obstétrica, que se ejerce principalmente al interior de los
establecimientos de salud, y que constituye un grave problema de
salud pública y de violación a los derechos sexuales, reproductivos, y
humanos de las mujeres. A diferencia de otros tipos de violencia en que
es (más) fácil apuntar a victimarios, en este caso la responsabilidad se
Adolescent sexual and reproductive health services in Chile have been primarily provided through health centers. Although some school-based initiatives have been implemented, to date, these have not been assessed. This study aims to identify strengths and challenges of the affectivity and sexuality component of the school-based 3A Program, a health program which seeks to prevent risk behaviors and promote healthy lifestyle habits within public schools (addressing health topics which in Spanish begin with the letter ‘A’, hence ‘3A’), implemented in the municipality of Lo Prado, city of Santiago.
Methods
We carried out a qualitative study with a descriptive-interpretative approach in three schools. We conducted in-depth interviews with students, teachers, health professionals, and school principals (N = 44); and focus groups with students (N = 3), teachers and health personnel (N = 3). The interviews were analyzed using thematic analysis.
Results
Participants highlight the integrative approach to health and to sexual and reproductive health promoted in the 3A Program, which is enhanced by the collaboration of interdisciplinary health teams. Permanent and expedited student access to sexual and reproductive health care is achieved, and affectional bonds are developed between students and the Program’s health staff. The Program assists female participants to imagine and form identities that are not inherently tied to motherhood. It also assists boys and LGBTQ+ adolescents in feeling included as relevant actors in sexual and reproductive health and decision making. The delivery of contraception in schools is highly valued. The most significant challenge identified is ensuring effective and ongoing collaboration between health staff and teachers.
Conclusion
Participants value the effectivity and sexuality component of the 3A Program as an initiative to improve adolescents’ access to sexual and reproductive health care. Our findings suggest that this Program could be replicated throughout the region and the country to improve the quality and accessibility of health services for adolescents.
Significant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care.
Aim
To explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally.
Methods
We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses.
Findings
Health workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission.
Discussion
Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term.
Conclusions
The measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.
In this article, we propose a reflection about caregiving during childbirth, which arises from the analysis of testimonies of childbirth experiences that were expressed by women in the First Survey on Childbirth in Chile, applied by the Observatory of Obstetric Violence (OVO Chile) in 2017. From evidence-based activism, we give voice to women's lived experiences as a fundamental source of knowledge that can dialogue with biomedical knowledge and thus enable the emergence of new forms of collective reflexivity. Within the great diversity of childbirth experiences, we identify a generalized perception that in the Chilean health system there is no guarantee of receiving comprehensive and respectful care, and that access to such care is the responsibility of women themselves, in self-managed decision-making processes. This logic centered on personal choices is opposed to an ethic of care understood in terms of collective responsibility, dependent on solidarity and collaboration networks.
Available at: https://link.springer.com/chapter/10.1007/978-3-030-54775-2_9
"The Illustrated Story of a Pregnancy" tells the story of Ana and Miguel, a young couple facing their first pregnancy. The book goes through their pregnancy until the birth of their child, showing the fears they face, and the confusing information they receive from the social and medical environment. The story seeks to promote a reflection on the excessive medicalization of birth.
Reportajes y algunas imágenes del libro en: http://www.paula.cl/galerias/historia-ilustrada-de-un-embarazo/ http://culto.latercera.com/2017/03/23/la-historia-ilustrada-embarazo-humor-mitos-tabues/
pregnant women, LGBTQI+ and HIV-positive people seeking access to health care and social contexts of reduced gender discrimination. During the migration process, young people are exposed to various kinds of sexual violence, and in their settlement in Chile, to situations of racism, stigma and discrimination in society as a whole and in access to and during sexual and reproductive health care. Health care for young migrants is mainly focused on maternal care and reproductive issues, while sexual health as a whole is disregarded. We argue that sexual health must be addressed as a central dimension of the lived experiences of young migrants, and that the social, cultural and structural factors that undermine their sexual and reproductive health must be addressed in order to provide culturally competent health services.
de múltiples formas de violencia de género, hay una que ha presentado
particular resistencia a ser nombrada y reconocida. Se trata de la
violencia obstétrica, que se ejerce principalmente al interior de los
establecimientos de salud, y que constituye un grave problema de
salud pública y de violación a los derechos sexuales, reproductivos, y
humanos de las mujeres. A diferencia de otros tipos de violencia en que
es (más) fácil apuntar a victimarios, en este caso la responsabilidad se
Adolescent sexual and reproductive health services in Chile have been primarily provided through health centers. Although some school-based initiatives have been implemented, to date, these have not been assessed. This study aims to identify strengths and challenges of the affectivity and sexuality component of the school-based 3A Program, a health program which seeks to prevent risk behaviors and promote healthy lifestyle habits within public schools (addressing health topics which in Spanish begin with the letter ‘A’, hence ‘3A’), implemented in the municipality of Lo Prado, city of Santiago.
Methods
We carried out a qualitative study with a descriptive-interpretative approach in three schools. We conducted in-depth interviews with students, teachers, health professionals, and school principals (N = 44); and focus groups with students (N = 3), teachers and health personnel (N = 3). The interviews were analyzed using thematic analysis.
Results
Participants highlight the integrative approach to health and to sexual and reproductive health promoted in the 3A Program, which is enhanced by the collaboration of interdisciplinary health teams. Permanent and expedited student access to sexual and reproductive health care is achieved, and affectional bonds are developed between students and the Program’s health staff. The Program assists female participants to imagine and form identities that are not inherently tied to motherhood. It also assists boys and LGBTQ+ adolescents in feeling included as relevant actors in sexual and reproductive health and decision making. The delivery of contraception in schools is highly valued. The most significant challenge identified is ensuring effective and ongoing collaboration between health staff and teachers.
Conclusion
Participants value the effectivity and sexuality component of the 3A Program as an initiative to improve adolescents’ access to sexual and reproductive health care. Our findings suggest that this Program could be replicated throughout the region and the country to improve the quality and accessibility of health services for adolescents.
Significant adjustments to maternity care in response to the COVID-19 pandemic and the direct impacts of COVID-19 can compromise the quality of maternal and newborn care.
Aim
To explore how the COVID-19 pandemic negatively affected frontline health workers’ ability to provide respectful maternity care globally.
Methods
We conducted a global online survey of health workers to assess the provision of maternal and newborn healthcare during the COVID-19 pandemic. We collected qualitative data between July and December 2020 among a subset of respondents and conducted a qualitative content analysis to explore open-ended responses.
Findings
Health workers (n = 1127) from 71 countries participated; and 120 participants from 33 countries provided qualitative data. The COVID-19 pandemic negatively affected the provision of respectful maternity care in multiple ways. Six central themes were identified: less family involvement, reduced emotional and physical support for women, compromised standards of care, increased exposure to medically unjustified caesarean section, and staff overwhelmed by rapidly changing guidelines and enhanced infection prevention measures. Further, respectful care provided to women and newborns with suspected or confirmed COVID-19 infection was severely affected due to health workers’ fear of getting infected and measures taken to minimise COVID-19 transmission.
Discussion
Multidimensional and contextually-adapted actions are urgently needed to mitigate the impacts of the COVID-19 pandemic on the provision and continued promotion of respectful maternity care globally in the long-term.
Conclusions
The measures taken during the COVID-19 pandemic had the capacity to disrupt the provision of respectful maternity care and therefore the quality of maternity care.
In this article, we propose a reflection about caregiving during childbirth, which arises from the analysis of testimonies of childbirth experiences that were expressed by women in the First Survey on Childbirth in Chile, applied by the Observatory of Obstetric Violence (OVO Chile) in 2017. From evidence-based activism, we give voice to women's lived experiences as a fundamental source of knowledge that can dialogue with biomedical knowledge and thus enable the emergence of new forms of collective reflexivity. Within the great diversity of childbirth experiences, we identify a generalized perception that in the Chilean health system there is no guarantee of receiving comprehensive and respectful care, and that access to such care is the responsibility of women themselves, in self-managed decision-making processes. This logic centered on personal choices is opposed to an ethic of care understood in terms of collective responsibility, dependent on solidarity and collaboration networks.
Available at: https://link.springer.com/chapter/10.1007/978-3-030-54775-2_9
Libro completo disponible en http://www.injuv.gob.cl/storage/docs/INJUV2021__Problematicas_y_desafios_de_las_juventudes_en_Chile_-1.pdf
El estudio se basa en una encuesta on-line que describe cuantitativamente la experiencia de parto de mujeres en Chile. El diseño corresponde a un estudio descriptivo poblacional, en el cual se incluyó a mujeres que parieron en Chile entre los años 1970 y 2017. Al ser un estudio netamente descriptivo, no se consideraron criterios de exclusión. El cuestionario fue aplicado vía on-line, a través del servidor www.onlineencuesta.com entre el 1 de marzo y 31 de mayo del año 2017, y la participación fue voluntaria y anónima. Las personas que respondieron la encuesta fueron mujeres que dieron a luz en Chile entre los años 1970 y 2017. La unidad de muestreo fueron las experiencias de parto o cesárea de mujeres ocurridas en Chile.
La muestra fue no probabilística por conveniencia. Si bien el tamaño muestral no fue estimado previamente, se trata de una muestra representativa numéricamente del universo o población de estudio. El análisis de la encuesta se realizó por medio del software de análisis cuantitativo SPSS 21, utilizando estadística descriptiva bi-variada y multi-variada.
El número de encuestas respondidas en forma completa fue de 11.357, de las cuales un 39,7% de partos ocurrieron en hospitales públicos, un 57,6% en clínicas privadas y un 2,7% en otras dependencias. Para este informe, se optó por analizar los partos institucionales, es decir, aquellos declarados como ocurridos en hospitales/clínicas. Por ello, la muestra de 11.357 se redujo a 11.054, que constituye la muestra total sobre la que se construye este informe.
Las experiencias de parto se presentan distinguiendo entre partos ocurridos en clínicas y hospitales, y organizados según su ocurrencia en tres periodos de tiempo: 1970 a 2008, 2009 a 2013, y 2014 a 2017. Del total de experiencias de parto reportadas, un 25% ocurrieron entre 1970 y 2008, un 25% entre 2009 y 2013, y un 50% entre 2015 y 2017. El término del primer periodo considerado se ubica en el año 2008 debido a que se trata del año en que se publicó desde el Ministerio de Salud del Gobierno de Chile el “Manual de Atención Personalizada con Enfoque Familiar en el Proceso Reproductivo”, que coincide con la promulgación en 2009 de la Ley N°20.379 que creó el Sistema Intersectorial de Protección Social e institucionalizó el Subsistema de Protección Integral a la Infancia Chile Crece Contigo, ambas normativas que incorporan claras recomendaciones para la atención del nacimiento. El primer tramo pretende ser un punto de comparación previo a la incorporación de estos programas/políticas, el segundo tramo representa los primero años de implementación de dichas políticas y de adaptación a las medidas. En el último periodo se esperaría que dichas recomendaciones/políticas estuvieran más institucionalizadas. Este último periodo además se divide del anterior debido a que el 50% de la muestra se ubica en él (es decir, 50% de los nacimientos reportados en las encuestas sucedieron en este periodo), y además debido a que el 2014 marca el inicio de un debate público y activismo muy visibles en torno a los derechos en el nacimiento. La distinción entre los tres periodos permite analizar las continuidades y/o cambios en lo que refiere a las intervenciones y el trato recibido durante la atención de nacimiento en el sistema de salud.
Con respecto a intervenciones obstétricas que no debieran realizarse de forma rutinaria, los resultados muestran una progresiva reducción del rasurado, enema, rotura artificial de membranas y uso de maniobra de Kristeller, tanto en hospitales como clínicas. No obstante lo anterior, la rotura artificial de membranas se reporta en el periodo 2014-2017 en un 44% de los partos en hospitales y 39,9% en clínicas; y la episiotomía en un 44% de los partos en hospitales y 41,1% en clínicas. Más preocupante aun es lo que ocurre con el monitoreo fetal continuo y oxitocina artificial, que en hospitales ha aumentado durante los tres periodos descritos, cuando según las recomendaciones internacionales y nacionales debieran usarse con discreción. En el caso de clínicas, estas intervenciones descienden levemente entre el segundo y tercer periodo. Así, en el periodo 2014-2017 el monitoreo fetal continuo se reportó en un 84,6% de los partos en hospitales y 81,6% en clínicas, y la administración de oxitocina artificial en un 51,8% y 45,3% respectivamente. Comparando las intervenciones en hospitales y clínicas en el periodo 2014-2017, apreciamos que en las segundas se utiliza más la anestesia, maniobra de Kristeller y se practican más cesáreas.
El acompañamiento continuo de personas significativas para la mujer, la libertad de movimiento, la hidratación, alimentación, acceso a métodos no farmacológicos de alivio del dolor durante el trabajo de parto, y el contacto piel con piel entre mujer y recién nacido mayor a 30 minutos, si bien presentan mejoras a lo largo del tiempo, aun no se reportan como el estándar generalizado de cuidado. La posición litotómica fue reportada en aproximadamente un 80% de los partos, y el contacto piel con piel inferior a 30 minutos en una proporción similar, tanto en hospitales como clínicas en el periodo 2014-2017, lo que muestra que las recomendaciones de que el parto suceda en posición libre y que el contacto piel con piel sea igual o mayor a 30 minutos no se han logrado instalar. El acompañamiento, libertad de movimiento e ingesta de líquidos/alimentos durante el trabajo de parto/parto, son practicados en mayor forma en clínicas que en hospitales. La mayor brecha entre hospitales y clínicas se da en cuanto al acompañamiento: en hospitales en 3 de cada 5 experiencias de parto las mujeres no contaron con un acompañante significativo en algún/ningún momento, mientras que en clínicas esto ocurrió en 1 de cada 5 experiencias.
Los resultados de la encuesta muestran que la asistencia a talleres de educación prenatal, tanto si se trata de los talleres realizados en el marco del programa Chile Crece Contigo (salud pública) o de talleres contratados en forma privada, tiene una relación positiva en cuanto a la disminución de intervenciones obstétricas. Es decir, las experiencias de parto de mujeres que asistieron a talleres prenatales muestran menos intervenciones obstétricas que aquellas que no lo hicieron, y el impacto es más notorio en el caso de talleres particulares.
Con respecto a ciertos estándares de cuidado y buen trato como el respeto por la intimidad y privacidad de la mujer, amabilidad y comprensión, y empatía frente a los dolores, los resultados muestran mejores percepciones en el periodo 2014-2017 que antes del 2008, tanto en hospitales como clínicas. No obstante lo anterior, en estas dimensiones las brechas entre los tipos de instituciones son muy grandes, y las experiencias en las que estos estándares no se cumplieron son entre 3 y 7 veces más altas en hospitales que clínicas. Se observa además que estos estándares de cuidado son peores en las experiencias de parto de mujeres de niveles educacionales más bajos y aquellas más jóvenes. Lo mismo se observa con respecto a las dimensiones que componen el abuso verbal; si bien se reducen a lo largo del tiempo, las brechas entre tipos de instituciones son altas y aún suceden en proporciones preocupantes. Por ejemplo, en el periodo 2014-2017, en un 43,4% de las experiencias de parto en hospitales se reportó haber vivido crítica o represión de expresiones de dolor y emociones, lo cual sucedió en el 16,6% de las experiencias en clínicas.
Los resultados muestran que si bien hay mejoras en cuanto a reducción de algunas intervenciones obstétricas entre los periodos descritos, se siguen reportando intervenciones que no están recomendadas de forma rutinaria en proporciones preocupantes y que no se condicen con las recomendaciones sanitarias ni con la evidencia científica actual. En un sentido similar, si bien la percepción de calidad del trato ha mejorado a través de los años, en una proporción importante de experiencias de parto (en especial en hospitales), se reportan faltas de respeto y de dignidad en la atención.
Esperamos que los resultados de este estudio nos motiven como sociedad a complejizar la discusión en torno a lo que se considera calidad de la atención durante el nacimiento, y a poner urgencia a esta temática. Se necesita un abordaje que considere tanto las dimensiones de cuidado interpersonal, a saber, la calidad del trato entre profesionales de atención de salud y población usuaria, como aquellas estructurales que permiten que se perpetúe un modelo excesivamente intervencionista de atención del nacimiento.