scholarly journals Selling Beautiful Births: The Use of Evidence by Brazil’s Humanised Birth Movement

Author(s):  
Lucy C. Irvine

AbstractMaternal health care continues to be excessively medicalised in many national health systems. Global, national, and local level policy initiatives seek to normalise low-risk birth and optimise the use of clinical interventions, informed by strong evidence supporting care that is centred on women’s preferences and needs. Challenges remain in translating evidence into practice in settings where care is primarily clinician-led and hospital-based, such as in Brazil.I conducted an ethnography of the movement for humanised care in childbirth in São Paulo between 2015 and 2018. I draw on interviews and focus groups with movement members (including mothers, doulas, midwives, obstetricians, politicians, programme leads, and researchers), and observations in health facilities implementing humanised protocols, state health council meetings, and key policy fora (including conferences, campaigning events, and social media). Key actors in this movement have been involved in the development and implementation of evidence-based policy programmes to “humanise” childbirth. Scientific evidence is used strategically alongside rights-based language, such as “obstetric violence”, to legitimise moral and ideological aims. When faced with resistance from pro-c-section doctors, movement members make use of other strategies to improve access to quality care, such as stimulating demand for humanised birth in the private health sector. In Brazil, this has led to a greater public awareness of the risks of the excessive medicalisation of birth but can reinforce existing inequalities in access to high-quality maternity care. Lessons might be drawn that have wider relevance in settings where policymakers are trying to reduce iatrogenic harm from unnecessary interventions in childbirth and for supporters of normal birth working to reduce barriers to access to midwifery-led, woman-centred care.

2020 ◽  
Vol 29 ◽  
Author(s):  
Enimar de Paula ◽  
Valdecyr Herdy Alves ◽  
Diego Pereira Rodrigues ◽  
Felipe de Castro Felicio ◽  
Renata Corrêa Bezerra de Araújo ◽  
...  

ABSTRACT Objectives: to understand the perception of managers of public maternity hospitals in the Metropolitan Region II of the state of Rio de Janeiro regarding obstetric violence and the measures to face it aiming at guaranteeing the quality of care. Method: a descriptive, exploratory study with a qualitative approach, conducted with 16 health managers from five maternity hospitals in Metropolitan Region II in the state of Rio de Janeiro. Data were collected through interviews, applied from May 2017 to May 2018, and submitted to content analysis in the thematic modality. Results: the research pointed out thenon-reception, technocratic principles of childbirth, refusal of the companion, disrespect to humanized practices centered on physiology and the choice of women, the need for health training as a guide for the humanization policy and the management of health units, professional unpreparedness for performance and lack of involvement of professionals with longer service time to modify practices in obstetric care. Thus, the need to break away from obstetric violence at the structural/institutional level was evident in order to guarantee quality care for women. Conclusion: it is the responsibility of the managers to provide training to health professionals regarding performance that respects the scientific evidence, the centrality and the axes of policies and recommendations in the area of sexual and reproductive health, especially to women regarding their autonomy.


Medwave ◽  
2020 ◽  
Vol 20 (09) ◽  
pp. e8047-e8047
Author(s):  
Anamaría Silva ◽  
Francisco Pantoja ◽  
Yoselyn Millón ◽  
Verónica Hidalgo ◽  
Jana Stojanova ◽  
...  

Introduction Chile has an incipient policy regarding humanized birth practices. Obstetric violence is becoming an issue in the public discussion, as brought up by women. Despite this advancement, no initiatives were observed to overcome the conflict. Questions arise from the different points of view of the main stakeholders involved. These questions help identify strategies contributing to the development of health policies that consider influencing actors. Objectives To identify stakeholders' perceptions of humanized care in childbirth and obstetric violence. Methods We conducted a scoping review that included articles and analysis of texts reflecting the scientific communities' point of view. We included statements from governmental, social, professional, and political actors as expressed in institutional websites. Moreover, we performed a qualitative inductive, thematic content analysis. Results We included seventy documents. The scientific community is visualized as aligned with ministerial recommendations for personalized childbirth. Several researchers analyze the difficulties for its improvement due to the historical, socio-cultural, and economic construction of the predominantly biomedical model for birthing. Convergence is observed among the scientific community and other stakeholders in recognition of humanized birth benefits and the need to overcome institutional obstacles within the health sector. However, the progress of the proposed change is slow, and health professionals' resistance to address women's complaints towards obstetric violence and claim of quality care is observed. This discussion finds its reflection in a parliamentary discussion. Conclusions The stakeholders' analysis reflects areas of conflict and consensus, as well as the diverse interacting dimensions that hinder the advance of humanized care in childbirth. This broad analysis strategy contributes to identifying critical aspects to be addressed in the development of integral and effective health policies.


Author(s):  
Jeff Barnes ◽  
Barbar O'Hanlon ◽  
Frank Feeley ◽  
McKeon Kimberly ◽  
Gitonga Nelson ◽  
...  

BMJ ◽  
2015 ◽  
Vol 351 (nov17 15) ◽  
pp. h6201-h6201
Author(s):  
G. Iacobucci

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Katiuska Cabrera Suarez ◽  
Elena Rivo-López ◽  
Santiago Lago-Peñas ◽  
Santiago Lago-Peñas

Nowadays, family businesses, the predominant form of business worldwide, face an increasingly changing environment boosted by megatrends such as globalization, digitalization, artificial intelligence, climate change and sustainability. Along with this, are factors that play at a firm level such as stricter rules concerning transparency and compliance or the increasing importance of Corporate Social Responsibil- ity (CSR). Therefore, new strategies and organizational changes are necessary to allow for greater adaptation to the new context. This special issue provides insights on these questions from a variety of perspectives.                                           The work of Hernández-Linares and López-Fernán- dez expands the current thinking on this process of adaptation by exploring the combined effects of three strategic orientations (entrepreneurial, learning, and market orientations) on the family firm ́s performance. The authors provide interesting contributions in terms of highlighting the importance of strategic orientations for value creation in enterprise organizations. They also provide empirical evidence that the family char- acter of the firm determines the relationship between strategic orientations and business performance, and offer some results on the effect of market orientation on firm performance in family firms versus non-family firms.                                                                                                 Those differences in strategies are further ana- lysed within the setting of the business dimension in which financial and economic decisions are made. The contribution by Terrón-Ibáñez, Gómez-Miranda and Rodríguez-Ariza, discusses the influence of that di- mension in their performance, comparing family and non-family firms. This interesting analysis of financial performance provides useful results. The study showsthat, unlike non-family firms, there is an inverted U- shaped relationship between the size of family SMEs and the value of certain economic–financial indicators, such as the return on assets, operating margin and employee productivity. This means that although the increase in the dimension of the family organizations is positively related to its performance, there are lim- its from which the value of certain economic–financial indicators can be negatively affected.                                                                                                                                                           The next paper contributes to the discussion of the family business’s role in the private health sector. Reyes-Santías, Rivo-López and Villanueva-Villar, set out to identify the historical evolution of the family business in this sector, attempting to determine the variation and its contribution to the private health sector during the 1995-2010 period. The findings of this discussion provide family firms with an almost 60% survival level in this sector. Along with this, the au- thors provide some guidelines for future research con- cerning this higher degree of survival, why family firms are leading the concentration process taking place in the sector, as well as their strategies for super-spe- cialization in the services offered especially by family businesses in healthcare.         The effect of family ownership and the character- istics of the board of directors on the implementation level of Enterprise Risk Management is an important topic. The article by Otero-González, Rodríguez-Gil, Durán-Santomil and Tamayo-Herrera certainly adds to the discussion. In particular, their research shows that family businesses are less interested in implementing ERM, except when shareholders have greater control of the company and when professional investors are present in the company. Besides, the importance of a board of directors’ characteristics of in terms of risk taking is confirmed by observing that larger boards en- courage risk managers to be hired.                                                                                                                                                           The paper by Lorenzo-Gómez looks at the barriers to change that are specific to the characteristics of family business, considering both the barriers that af- fect the perception of the need to undertake changes and the availability of resources to face those chang- es, and the barriers to implementing these changes within already consolidated organizations, where new routines are created to replace the existing ones. Thefindings suggest that the factors affecting these barri- ers include the generation at the head of the family business; the influence of interest groups, particularly in terms of the duality between the company and the family; and the participation level of professionals from outside the family.                                                                                         The final contribution by Aragon-Amonarriz and Iturrioz-Landart offers an interesting discussion on how family-responsible ownership practices enhance social responsibility in small and medium family firms. Their results reveal the positive relationships between the elements of family-responsible ownership in terms of succession management, financial resource allocation, professionalism and social responsibility, and ultimate- ly with the socially responsible behaviour of family SMEs.                                                                                                                 The challenges surrounding family business owners and the nuances around strategic and organizational decision making are together an area ripe for future research. The editors look forward to seeing future de- velopments on these topics that pay special attention to the influence of family characteristics and dynamics on the strategic and organizational change of family firms, and that draw on both quantitative and quali- tative research methodologies for the wider develop- ment of the field. Acknowledgements. The papers published in this issue were presented at the “II Workshop of Family Business: Strategic and Organizational Change” at Ourense, Galicia, Spain, June, 13-14, 2019. The conference was organized by GEN group research (http:// infogen.webs.uvigo.es/) and the Chair of Family Business of the University of Vigo, and was sponsored by the AGEF (Galician Family Business Association), Inditex Group, IEF (Spanish Family Firm Institute), and with ECOBAS group as collaborator. Thanks for their invaluable support. We are also very thankful of all other participants at the conference.   Katiuska Cabrera Suárez,  University of Las Palmas Elena Rivo-López, co-director of the Chair of Family Business, University of Vigo Santiago Lago-Peñas, co-director of the Chair of Family Business, University of Vigo    


BMJ ◽  
2005 ◽  
Vol 331 (7528) ◽  
pp. 1338.4-1339 ◽  

Author(s):  
Dr. Madhuri Prakash Kubal ◽  
Dr. Archana Raman Belge

Ayurveda, emerging as an ancient science of life globally, highlighting India as a native drawing attention from every corner of world. Panchakarma, Yoga Science, Marmachikitsa, Ksharsutra, Rasaushadhi etc. are super specialities of Ayurveda, having no other alternative at all, are becoming attractions, raising medical tourism in India. In this era, evaluation of organization as per their performance & quality has become integral part of health sector of India. NABH has established standards by keeping in mind, enhancement of health system & promotion of continuous quality improvement & patient safety. Objective- To have a review of NABH accreditation standards in perceptive of Panchakarma clinics & hospitals. Design- NABH accreditation standards for Ayurveda hospitals second edition is referred to have review in perceptive of Panchakarma clinics & hospitals. Results- Ayurveda hospital accreditation standards consist of 10 chapters, further divided into 98 standards, incorporation of 590 objective elements. These standards are requirements led by NABH which facilitate safe high quality care. These standards provide framework for quality health facilities, mainly defining Panchakarma facility very precisely, right from documentation to staff awareness. Conclusion- Patients well aware about quality health services, especially in terms of medical tourism expects standard & safety assurance. These NABH accreditation standards setting benchmark for AYUSH hospitals, helps in enhancing significance in health sector in India. KEYWORDS- Accreditation, Medical Tourism, NABH, Panchakarma, Quality Assuarance.


2004 ◽  
Vol 28 (1) ◽  
pp. 106
Author(s):  
Michael Roff ◽  
Leonie Segal

TO THE EDITOR: Since its introduction on 1 January 1999, the 30% rebate has been the subject of much misleading comment by the opponents of the private health sector. A recent addition to these ranks was published in the first edition for 2004 of Australian Health Review (Segal 2004). There is no real attempt at balance in the article. While Segal argues that the rebate has failed to take the pressure off public hospitals, we are not told, for example, that almost one-in-five extra patients admitted by public hospitals in the three years to 2002-03 were actually private patients! Similarly, the article is littered with generalisations and, in some cases, misleading or completely incorrect statements, such as ?Private hospitals do not offer a complete hospital service . . .? Even a cursory examination of the available national data indicates that private hospitals provide services in all but 7 of the 654 diagnosis-related groups (DRGs) recorded. Private hospitals perform all the remaining 647 DRGs.


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