An educational intervention produces changes in the health student's perception of obstetric violence



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## An educational intervention produces changes in the health student's perception of obstetric violence The study, the first of its kind, was carried out by the Nursing Research Group of the UJI among students of Health Sciences

01/04/2020 |
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* [![ violencia-obstetrica Desiree_Mena](/com/investigacio/arxiu/noticies/2020/4/violencia-obstetrica/Desiree_Mena.jpg)](#)

A study carried out by the Nursing Research Group at the Universitat Jaume I reveals how an educational intervention produces changes in the perception of obstetric violence of health sciences students. According to the results of this analysis, health sciences students integrate the normalisation of obstetric violence throughout their studies, but a training activity aimed at making this type of violence visible and reflecting on it helps to create awareness among the students, thus allowing them to be more receptive and to identify the situations in which it occurs.

Obstetric violence is a type of gender-based violence. Therefore, it is a structural problem that has physical and psychological consequences for both the women who suffer it and the health professionals. The World Health Organization, in the 1985 Fortaleza Declaration, endorsed by obstetricians, paediatricians, midwives, psychologists, epidemiologists, mothers and other professionals and applicable to all perinatal services worldwide, recommended the training of health professionals to "ensure that pregnant women are treated with compassion and dignity".

The study, published in the international journal *Nurse Education Today* with the title "Changes in health sciences students' perception of obstetric violence after an educational intervention", was carried out between January and June 2019 based on 107 questionnaires from students of the Bachelor’s Degree in Nursing and the Bachelor’s Degree in Medicine at the Universitat Jaume I. The objective was to evaluate the students’ perceptions of obstetric violence and to detect possible changes in these perceptions after an educational intervention, since no studies of similar characteristics had been found.

For the evaluation, a questionnaire was designed and developed by three specialists. It was based on the 2014 Spanish Ministry of Health Clinical Practice Guidelines for Normal Delivery and consisted of 33 items to measure the students’ perceptions before and after the educational intervention. The test was divided into four key moments (before birth, during birth, in case of caesarean section and after birth). In addition, sociodemographic and control variables were collected, such as age, sex, field, academic year, experience in health services in gynaecology and obstetrics, duration of experience, having been present at a birth, or personal experience in pregnancy and birth.

The average age of the students was 22.5 years, and women represented 89.7% of the sample. 86.9% of the students belonged to the Bachelor’s Degree in Nursing, and 28% of the students had completed clinical practice in the departments of gynaecology and obstetrics. 20.6% of the students had been present at a birth; 4.7% had been pregnant and 2.8% had given birth.

Of the 33 items included in the questionnaire, 84.84% (28) showed statistically significant changes in the measurement before and after the educational intervention. In addition, 25 of the 33 items (75.75%) showed a relationship with the socio-demographic variables of gender, field, academic year and having ever been pregnant. For example, when comparing responses by gender, a large number of variables showed statistically significant differences in perception among women, which was greater than among men.

The intervention consisted of an 8-hour seminar, which included a theatre performance on obstetric violence by La Otra Parte Teatro; a master class on legal aspects presented by a lawyer specialised in health law; a round table composed of professionals from different fields who contributed their experiences; and another round table in which four volunteer mothers explained their birth experiences.

The analysis of the results shows that there is a change in the perceptions of health science students about obstetric violence following an educational intervention. Furthermore, the research group has confirmed through this study that there is a normalisation of this type of violence related to the progression of training (a lower perception of obstetric violence among the more advanced students and the fact of having participated in obstetric practice during the study) and the normalisation of obstetric violence depending on the personal obstetric experience (the perception decreased after being pregnant or having given birth).

In the opinion of Desirée Mena, main researcher, according to this preliminary data, "it is essential to change the training of health professionals, which must have a solid foundation in ethics and human and gender rights", and public policies should "direct attention towards humane and respectful treatment that is based on and supported by the latest available evidence”. For this to happen, "health professionals working with pregnant women must abandon the hierarchy and traditional structure in which medical supervision implies a subordination of women's bodies and sexuality”.

The World Health Organisation already warned in 2014 that a growing number of studies on women's experiences during pregnancy and particularly during childbirth present an alarming scenario, thus showing that many women worldwide experience disrespectful, offensive or negligent treatment during labour. Therefore, the WHO warned about the need to generate data related to respectful and disrespectful care practices, systems of accountability and valuable professional support, and support and training for health professionals.

This work has been funded by the Universitat Jaume I Educational Innovation Group Recognition Programme 2018.

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