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Nghiên cứu Giving Voice to Mothers: sự bất bình đẳng và mistreatment trong quá trình mang thai và sinh nở ở Hoa Kỳ
Tóm tắt
Gần đây, các nhà nghiên cứu của WHO đã mô tả bảy khía cạnh của sự mistreatment trong chăm sóc thai sản có ảnh hưởng tiêu cực đến chất lượng và sự an toàn. Áp dụng khuôn khổ của WHO về chăm sóc chất lượng, người sử dụng dịch vụ đã hợp tác với các tổ chức phi chính phủ, các nhân viên y tế và các nhà nghiên cứu để thiết kế và tiến hành nghiên cứu Giving Voice to Mothers (GVtM)–Mỹ. Đội ngũ đa bên của chúng tôi đã phân phối một khảo sát trực tuyến cắt ngang để ghi lại những trải nghiệm thực tế về chăm sóc thai sản ở các dân cư đa dạng. Các mục do bệnh nhân thiết kế bao gồm các chỉ số về lạm dụng bằng lời nói và thể chất, quyền tự chủ, phân biệt đối xử, sự không đáp ứng các tiêu chuẩn nghề nghiệp trong chăm sóc, mối quan hệ kém với nhà cung cấp, và điều kiện kém trong hệ thống y tế. Chúng tôi đã định lượng tỷ lệ mistreatment theo chủng tộc, đặc điểm xã hội-dân số, phương thức sinh, nơi sinh và bối cảnh chăm sóc, và mô tả mối quan hệ giao thoa giữa các biến này. Trong số các tham gia đủ điều kiện (n = 2700), 2138 đã hoàn thành tất cả các phần của khảo sát. Một trong sáu phụ nữ (17.3%) đã báo cáo trải qua một hoặc nhiều loại mistreatment như: mất quyền tự chủ; bị la mắng, quát tháo, hoặc đe dọa; và bị bỏ qua, từ chối, hoặc không nhận được phản hồi cho các yêu cầu giúp đỡ. Bối cảnh chăm sóc (ví dụ: phương thức sinh; chuyển viện; khác biệt quan điểm) tương quan với việc tăng cường báo cáo mistreatment. Trải nghiệm mistreatment khác biệt đáng kể theo nơi sinh: 5.1% phụ nữ sinh tại nhà so với 28.1% phụ nữ sinh tại bệnh viện. Các yếu tố liên quan đến khả năng bị mistreatment thấp hơn bao gồm sinh âm đạo, sinh tại cộng đồng, có sự hỗ trợ của hộ sinh, và là người da trắng, đã sinh nhiều lần, và trên 30 tuổi. Tỷ lệ mistreatment đối với phụ nữ da màu luôn cao hơn ngay cả khi xem xét các tương tác giữa chủng tộc và các đặc điểm thai sản khác. Ví dụ, 27.2% phụ nữ da màu có thu nhập thấp báo cáo bất kỳ hình thức mistreatment nào so với 18.7% phụ nữ da trắng có thu nhập thấp. Không phân biệt chủng tộc thai sản, việc có một đối tác là người Da đen cũng làm tăng tỷ lệ báo cáo mistreatment. Đây là nghiên cứu đầu tiên sử dụng các chỉ số do người sử dụng dịch vụ phát triển để mô tả mistreatment trong quá trình sinh đẻ ở Hoa Kỳ. Các phát hiện của chúng tôi cho thấy mistreatment xảy ra thường xuyên hơn ở phụ nữ da màu, khi sinh xảy ra tại bệnh viện, và trong số những người có thách thức về xã hội, kinh tế hoặc sức khỏe. Mistreatment trở nên nghiêm trọng hơn do các can thiệp sản khoa không mong đợi và do sự bất đồng giữa bệnh nhân và nhà cung cấp.
Từ khóa
#mistreatment #thai sản #sự bất bình đẳng #nghiên cứu #WHOTài liệu tham khảo
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