Gender regime change in decentralized states: the case of Spain
Abstract
This article applies Walby’s systemic theory of gender regime to Spain’s decentralized state, to capture changes in the gender regime. Locating the “hegemon” at different levels of government for each domain (economy, polity, violence, and civil society) and considering interactions between governmental levels provided a clear understanding of changes in the gender regime. The relationship between governmental level acting as hegemon in specific domains and variations in political majorities across governmental levels explained changes toward a neoliberal– conservative type in the economy domain. Shifts toward a neoliberal gender regime in violence and polity, and toward a conservative type in civil society, were contested.
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Gender Regime Change in Decentralized States: The Case of Spain Emanuela Lombardo * 1 and Alba Alonso * 2 This article applies Walby’s systemic theory of gender regime to Spain’s decentralized state, to capture changes in the gender regime. Locating the “hegemon” at different levels of government for each domain (economy, polity, violence, and civil society) and considering interactions between governmental levels provided a clear understanding of changes in the gender regime. The relationship between governmental level acting as hegemon in specific domains and variations in political majorities across governmental levels explained changes toward a neoliberal– conservative type in the economy domain. Shifts toward a neoliberal gender regime in violence and polity, and toward a conservative type in civil society, were contested. Introduction The economic and political responses to the 2008 crisis have triggered changes in gender equality, institutions, and policies in Europe (Durbin, Page, and Walby 2017;Kantola and Lombardo 2017). Following scholarly debates about gender and politics, further questions have arisen in an attempt to explore the extent of these transformations and their impact on different European gender regimes (Walby 2015). The need to understand the complex coevolution of gender relations in different domains in the postcrisis context has become paramount. This article aims at contributing to such understanding by applying Walby’s systemic theory of gender regime to a decentralized state such as Spain. This required building an analytical framework appropriate for grasping the role of different levels of government (European Union [EU], statelevel, regional, and local) in influencing variations in the gender regime. Spain is an EU Member State that features a complex institutional setting, where regions hold extensive competencies over key fields, including welfare 1 Universidad Complutense de Madrid 2 Universidad de Santiago de Compostela *[email protected]; [email protected] socpol: Social Politics, Fall 2020 pp. 449–466 doi:10.1093/sp/jxaa016 #The Author(s) 2020. Published by Oxford University Press. This is an Open Access article distributed under the terms of the Creative Commons AttributionNonCommercial-NoDerivs licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact [email protected] Social Politics 2020 Volume 27 Number 3 Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
and equality (Alonso and Verge 2014). It is, therefore, a case that provides suitable empirical material for exploring struggles over gender regime change that involve a variety of governmental levels. This study investigates policy shifts reshaping gender equality in domains such as the economy (employment and care/welfare), polity (political representation and gender-equality machinery), violence (gender-based violence policies), and civil society (sexual and reproductive rights), during the last two legislative terms (2011–2018). 1 The analysis of the Spanish case contributes to gender regime theory by supporting systemic theories such as Walby’s (2009) when complemented with theories that can explain intricate processes of change in multilevel contexts. Existing literature on Europeanization and federalism shows that the territorial distribution of power might vary across domains. Consequently, the governmental level that plays the role of “hegemon” in each domain might also differ. Capturing the location of the “hegemon” role for each case allows a more accurate understanding of changes in gender regimes. Scholarly works taking into account territorial complexity tend to focus either on upwards or downwards developments, by analyzing, for example, bilateral processes of influence between the EU and Member States. We argue for the importance of addressing interactions between all the different levels of government in each domain, while considering the role of party ideology in explaining resistance to backlashes in the gender regime. We maintain that a multitiered polity where political majorities varied across levels of government interacted to shape the Spanish gender regime. The postcrisis context of EU and state-level political priorities helps to understand how Spain’s gender regime shifted toward a more neoliberal–conservative type through processes of Europeanization (Lombardo 2017) and state recentralization justified in the name of austerity (Colino 2013). However, left-wing regional cabinets and local governments emerging from civil society platforms showing a continued commitment to gender equality and responsiveness to the demands of the feminist movement played a key role in resisting neoliberal–conservative changes. Gender-Regime Change: A Framework for Analysis Understanding gender-regime change requires considering a variety of scholarly debates (Walby 2009,2015;Walby et al. 2007). In this study, we combine systemic theories of gender regimes (Walby 2009,2015) and debates that integrate varieties of capitalism and gender regimes (Walby et al. 2007) with analytical insights from Europeanization and federalism studies that we deem necessary for understanding changes in multilevel settings. We adopt Walby’s systemic theory of gender regimes, which has been central for grasping developments in the last decade, and suggest a number of revisions necessary to adapt it to decentralized states. Walby’s systemic 450 E. Lombardo and A. Alonso Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
conceptualization understands gender regime as “a set of inter-related gendered social relations and gendered institutions that constitutes a system” (Walby 2009, 301). This conceptualization, while maintaining the relation between production (paid work) and reproduction (care and domestic work) that is central in feminist analyses of gender regimes, comprises other components that allow capturing the complex coevolution of gender relations in different domains and in interaction with other social relations. These other components, which we rely on in our study, include the four institutional domains theorized by Walby (2009,2015) as complex systems that mutually coevolve as a result of their interaction: economy, polity, violence, and civil society. Gender relations, intersecting with other inequalities, are shaped and transformed in each of these domains and in the whole system. Economy includes both waged labor and domestic labor; polity includes states, the EU, organized religion, and regions with self-governing capacities; violence refers to gender-based violence and its regulation; and civil society refers to contestations that create meanings through collective “projects” that provisionally bring together different actors of civil society around particular social goals. Although, due to their interdependency, changes in one domain transform opportunities for the other domains, the time and direction of their evolution might differ. Therefore, the result of change can be a transformation in the whole form of gender regime or only in some domains. Walby (2009) integrates the two main forms of class regimes in modernity, that is the neoliberal and social democratic, in the conceptualization of “public” forms of gender regime, as opposed to “domestic forms.” Both are points on a continuum where the domestic regime tends to exclude women from access to employment, political representation, and autonomy. The public regime, while allowing women to be present in the public sphere, tends to segregate them in less powerful positions. While maintaining the public/domestic forms theorized by Walby, we further specify the form of gender regimes by including a “conservative” form theorized by Shire and Nemoto (2020), typical of countries with authoritarian legacy, such as Spain, that captures state policies that promote traditional gender roles, such as family and reproduction policies that treat women only as mothers. This allows us to specify the ideological nature of regimes that the public/domestic divide had left unaddressed. We, therefore, consider policies that restrict access to sexual and reproductive rights as a sign of conservative gender regimes, in order to capture regimes that might promote women’s employment but not their sexual and reproductive autonomy. Another important concept in our framework that Walby develops in her theory of gender regimes is that of “hegemon,” which she conceives as a “dominating state” or polity “that is able to deploy a range of forms of power over many other countries in the contemporary era” (2009, 166). Hegemons, as in the Gramscian concept, use a mix of coercion and consent to dominate other polities, employing a combination of political, economic, social, and Gender Regime Change in Decentralized States 451 Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
military means. The examples Walby gives are those of the United States and the EU. Both play as hegemons because they set the rules and change the landscape for other polities (2009, 166–69). Walby’s macro theory comprises systems, forms, domains, and hegemons, but does not specify the role played by different levels of government. However, we contend that applying this framework to specific contexts requires considering the territorial complexity of each political and institutional setting. This implies amending Walby’s theory as follows. First, the concept of hegemon needs to be applied to different governmental levels, because the role each of them plays in different domains depends on the territorial distribution of power. Debates on the contribution of different levels of governments to the promotion of gender equality became central in the last decade. Scholarly works shifted from an exclusive focus on the state level to consider the influence of EU policies and the role of regional institutions, along with general analyses of welfare provision. Gender studies of Europeanization and federalism are particularly relevant to capture this complexity, especially when analyzing decentralized states that are EU members such as Spain. They have shown that concurrent processes of uploading and downloading formerly state-level powers have shaped the location of key gender-equality policies and institutions (Alonso 2016;Haussman, Sawer, and Vickers 2010;Liebert 2003;Meier 2016). Accounting for this territorial complexity is necessary, according to us, in systemic analyses of gender regimes, due to the explanatory function of levels of government for the coevolution of, and mismatch between, different domains and the system as a whole. We consider the role of governmental levels that behave as “hegemons” through structuring consent as well as employing coercion, around particular “hegemonic projects.” Therefore, in this article, we extend our view beyond the state level to ask specifically: at which level of government were significant decisions taken about the four domains? Who influenced (“hegemon”) variations in the gender regime? What were the main changes during the period analyzed? Second, the interaction of different levels of government needs to be considered because it is key for understanding change and capturing the complexity of gender regimes. Studies on Europeanization and federalism show that interactions between levels of government can capture the changes leading to hybrid, patchy, or transitioning regimes (Mahon 2006,2007). Territorial dynamics trigger both differentiation in the way(s) the EU “hits home” (McRae 2006) and diversity among regional welfare regimes in decentralized countries (Moreno and McEwen 2005). Accordingly, we assume that multitiered polities provide ground for struggles over gender regimes that are crucial for understanding change. Opportunity structures afforded by the women’s movement might be available at different levels (Mahon 2007), thanks to the presence of multilevel party systems (Keith and Verge 2016). 452 E. Lombardo and A. Alonso Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
The concept of “competitive federalism” is particularly helpful to grasp interactions between levels that explain similarities and differences in regional political developments (Mahon and Collier 2010). It shows how regions, by competing with the central level and among each other, enact emulation dynamics that might mitigate differentiation as gender-equality policies tend to spread across regions. Nevertheless, a myriad of factors can operate to yield complex patterns of gender regime change at a specific time. The color of the party in government is a crucial explanatory variable to understand heterogeneous developments at various levels. Accordingly, our analysis incorporates relevant questions such as: What struggles were articulated in Spain? And what alternative (with respect to central government) gender-equality policies were promoted at the substate levels by left-wing cabinets? For a comprehensive understanding of changes in the gender regime, we suggest addressing interactions between all tiers of government, rather than bilateral interactions such as the EU–Member States or federal–regional. The combination of theoretical insights from the aforementioned debates offers analytical keys to capture variations in the gender regimes and helps us explain the uneven evolution of the four domains in the Spanish postcrisis gender regime, and the coevolution of different gender regime types at various governmental levels. The postcrisis context is at the background of our study, because austerity politics enacted by the EU and the central Spanish conservative government in response to the 2008 economic crisis promoted a backlash against gender-equality policies, budgets, and institutions (Paleo and Alonso 2014), and shifts toward a more neoliberal gender regime (Lombardo 2017). In the next section, we introduce historic legacies that are crucial to understand changes in Spain’s gender regime. The Spanish Gender Regime and Decentralization Legacies In this section, we analyze, in light of relevant historic legacies, which level of government had especially influenced variations in the Spanish gender regime before the economic crisis. In Spain, the promotion of gender equality and the development of the “State of Autonomies”—that is the degree of regional autonomy with respect to the central government—were extremely intertwined. A federalized institutional setting, deeply entrenched in the EU polity, shaped the evolution of the gender regime. The central government pioneered the creation of the first equality machinery and the adoption of antidiscriminatory legislation after the transition to democracy, pressured by European Community 1986 preaccession conditions (Lombardo 2004). A key legacy of the authoritarian repression of regional variety and autonomy was the post-1975 development of self-governing competencies. This led to differentiated patterns in welfare and gender institutionalization, matching Gender Regime Change in Decentralized States 453 Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
regional context specificities. The so-called fast-track regions—the first ones to have access to self-government—included executive and legislative powers over gender-equality policies in their regional constitutions, along with references to key areas of the welfare state. Andalusia, the Basque Country, and Catalonia set up their regional equality bodies in the late 1980s, a model that was replicated statewide (Bustelo and Ortbals 2007). The other regions progressively developed too, following the strong emulation patterns that inform Spanish competitive federalism (Alonso 2016). Municipalities used the powers over welfare policies granted by the Law of Local Regime to expand the equality institutional framework to the local level. Changes in the polity domain exemplify the regions’ prominent role in relation to the introduction of legislative gender quotas. The regional parliaments of the Balearic Islands and Castile-La Mancha pioneered the introduction of quotas in the electoral laws, while the Basque Country put forward targets for ensuring gender-balanced cabinets (Alonso and Verge 2014). Despite the initial opposition from the Popular Party (PP), compulsory electoral quotas were finally introduced in the 2007 Equality Act under Zapatero’s socialist central cabinet. This gave impulse to a significant increase in the numbers of female representatives in the institutions at different levels of government: by 2019, 44 percent of Deputies 2 , 38.8 percent of Senators 3 , 46.3 percent of regional MPs; and 35.6 percent of local councilors were women. 4 The role of competitive federalism in the introduction of gender quotas was supported by opportunities opened by left-wing party ideology, Europeanization, and the multilevel party system. Feminists within left-wing parties—the Socialist Party (PSOE, Partido Socialista Obrero Espa~ nol), the Communist Party (PCE, Partido Comunista Espa~ nol), and United Left (IU, Izquierda Unida)—were critical actors in the introduction of voluntary party quotas. Europeanization provided “cross-loading” resources or policy transfer through learning from other European countries’ and parties’ experiences. The PSC (Partido Socialista de Catalu~ na), the Catalan section of the Socialist Party, introduced in 1982 a 12 percent quota for party and elected offices for women thanks to the action of party feminists inspired by a similar measure adopted by the French Parti Socialiste (Verge and Lombardo, 2018). In the economy, the central government holds exclusive powers over the regulation of the labor market, social security, and public pension schemes, always within the framework of economic parameters set at the EU level for Eurozone members. The Spanish welfare regime is considered part of the Mediterranean type, a via media between conservative, social democratic, and liberal types. This is because it mixes conservative elements of familism, another key legacy of the authoritarian period, whereby themainweightofcareforchildren,elderly, and dependants is attributed towomenwithinthefamily,withsocial democratic universal access to health and education, and liberal means-tested benefits (Del Pino 2013). The Spanish regions showed willingness to play a crucial role in the 454 E. Lombardo and A. Alonso Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
development of the welfare state (Moreno and McEwen 2005). The fasttrack regions pioneered the introduction of policies on childcare, social inclusion, or minimum income that were replicated in other territories (Subirats 2005). They also initiated the adoption of legislative and executive competencies over healthcare, education, and social services granted by the Constitution. The catching-up attitude of the slow-track regions generalizedthismodelandshapedadeeply decentralized welfare state (Moreno and Trelles 2005). The domain of violence reproduced similar decentralized patterns. The central government issued important legislation to eradicate violence against women which affected the penal code, such as Act 1/2004. However, the implementation of a comprehensive approach required coordination with regional institutions. Their competencies on welfare, and in some cases, the police and the judiciary, made regions critical institutions for ensuring an effective intervention (Alonso and Verge 2014). Moreover, regional governments passed their own laws, plans, and protocols, which surpassed in some respects the statewide legal framework that focused on intrapartnership violence. Competitive federalism encouraged here the development of policies to address other types of violence such as female genital mutilation. The EU promoted women’s mobilization in this domain through funding programs on violence such as Daphne (Lombardo 2004). Territorial dynamics had analogous effects in the civil society domain. Civil society’s contestations over the meaning of gender equality in Spain touched upon many different issues. Women’s access to sexual and reproductive rights is one of the key issues influencing women’s autonomy, raising heated debates, and helping to classify a gender regime as conservative in case of limited autonomy (Shire and Nemoto 2020). We, therefore, analyze this domain by focusing on the struggles around this topic. Basic reproductive rights had long been regulated in the penal code, a matter of exclusive competence of the central state. Yet, the role of regional governments in healthcare, education, or family policies allowed decentralized policies in this area to be developed. The result was the adoption of diverging approaches, ranging from those focused on protecting the embryo to those aiming at guaranteeing women’s autonomy (Alonso and Paleo 2017). Precrisis developments in the four domains show that the predominance of a model based on concurrent competencies and emulation processes generated a “race to the top” effect. This, along with the influence of the EU acquis, benefited the promotion of gender equality and the evolution toward a public gender regime in Spain (Lombardo 2017). Nevertheless, the leading role of left-wing parties, together with other factors, explains relevant variations in regional equality frameworks. In the following section, we analyze how the postcrisis context affected patterns of interaction between governmental levels, promoting changes in the gender regime. Gender Regime Change in Decentralized States 455 Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
Struggles over the Gender Regime in Multi-Governed Spain Economy In 2011–2018, there were deep changes in territorial dynamics as compared to the precrisis period, which signaled a recentralization process. The EU, through Spain’s central government, played the hegemon’s role in the domain of the economy because the main economic competencies belong to those levels. In response to the economic crisis, the EU demanded from Spain a strict control of public expenditure growth and a neoliberal program of policy and labor market deregulation (Council of the European Union 2012). The central government enforced this EU neoliberal project through a process of recentralization that surpassed political ideology. Neoliberal and recentralization targets were in line with the ideology of the PP central government, ruling from 2011 to 2018, though the former PSOE government had fostered centralization too through a reform of the Constitution in 2011 to meet the EU fiscal targets. Reforms to limit regional self-governing capacities were not new in Spain (Ma´iz, Caama~ no, and Azpitarte 2010), but the crisis gave recentralization a neoliberal direction detrimental to gender policies. The 2011–2018 PP cabinet “disciplined” regional institutions (Colino 2013) through Act 2/2012 on Budgetary Stability and Financial Sustainability, which curtailed their already limited financial autonomy—with the exception of the Basque Country and Navarre that enjoy their own fiscal regime—to enforce EU austerity policies throughout the country. Parallel to this, it legislated in key welfare areas of regional competence, while bringing policies adopted by several substate institutions before the Constitutional Court. This body reflected the conservative predominance and often ruled in favor of limiting decentralized powers. As a result, measures concerning social housing or universal healthcare were suspended and the Spanish welfare state experienced a severe retrenchment (Del Pino 2013). The joint action of the EU and central government pushed the country toward a neoliberal gender regime (Lombardo 2017). The main indicators of this shift were in the areas of employment and care, welfare, and genderequality policies. These included an increase of women’s unemployment (27.2 percent in 2013, while the EU-28 figure was 11 percent, Statistical Office of the European Communities 2013), a worsening of working conditions for women and rising poverty, 5 and a substantial decrease in the government’s budget dedicated to gender-equality policies at all governmental levels (Paleo and Alonso 2014). The replacement of retired civil servants was severely restricted and norms were issued to prevent the renationalization of formerly privatized services. Moreover, the conservative government promoted the neoliberalization of the gender regime through budget cuts in the welfare state, privatizations, and 456 E. Lombardo and A. Alonso Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
attacks to the universality of the public health system by excluding foreigners without a regular residence permit from the National Health Services, except for urgent cases, and introducing citizens’ copayment of medicines and health services. Public care services were dismantled, privatized, or not implemented. Budget cuts in the Dependency Law since 2010 reduced financial state support to people caring for elderly or dependent relatives, thus increasing the strain on (predominantly women) carers. In childcare, budget cuts resulted in “increases in child-to-adult ratios and fees, and the worsening of staff working conditions” (Iba´~ nez and Leo´n 2014, 9). The Spanish regions had competency in the development of welfare policies. However, severe budget restrictions by the central government heavily limited self-government in this realm. Concerning the local level, Law 27/2013 of “rationalization and sustainability of local administration” restricted the autonomy of local governments and limited their ability to invest in welfare and care provision. To implement a neoliberal approach in municipalities, the conservative central government issued legislation that hindered the capacity to renationalize public services that had been privatized. While data show that the gender regime at the central level was more neoliberal than before the crisis, the change toward a more domestic gender regime did not occur, as the high women’s activity rate shows (53.3 percent, INE March 2018). However, if EU and Spain’s government policies continue this path of neoliberalization, this could change the gender regime to neoliberal–domestic. The struggles of anti-austerity feminist and social movements and alternative policies promoted by local and regional left-wing and coalition governments offered an alternative to both neoliberalism and recentralization. Spanish civil society mobilized more intensively since 2011 against the PP’s austerity measures to defend labor rights, public health, housing, public education, and gender-equality policies. Gaining momentum in the Indignados social movement, civil society struggles proposed alternative social democratic projects by preventing the privatization of public hospitals and the eviction of families from their homes (Calvo 2013). The feminist movement was active both in the anti-austerity social movement and in its own struggles for gender equality. Groups such as Las Kellys domestic workers or Cuidadoras de Bizkaia carers exposed the gendered effects of the neoliberal Labour Reform which made feminized work even more precarious. The feminist movement organized massive protests on March 8, 2018 with a women’s general strike, inspiring millions of women to go on strike from work, care, study, and consumption, to demand effective gender equality in all spheres. At the institutional level, 2015 elections gave power to left-wing regional governments and local councils with coalition governments, and also led to the election of female leftist mayors from civil society both in Madrid and Barcelona. These substate governments implemented an anti-austerity social democratic agenda that renationalized local public services and increased Gender Regime Change in Decentralized States 457 Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
information see https://www.researchgate.net/profile/Emanuela_Lombardo; Researcher ID: W-4938-2017. Alba Alonso is Lecturer at the Department of Political Science and Sociology of the University of Santiago de Compostela (Spain). Her main research areas refer to gender and politics, territorial politics, and public policies. Her work has been published in Gender & Politics, Politics and Governance, Social Politics, European Journal of Women’s Studies, European Political Science, and in collective books like the Handbook on Gender, Diversity and Federalism edited by Jill Vickers, Joan Grace and Cheryl Collier (Edward Elgar Publishing, forthcoming). 1. The Spanish political context is undergoing changes that will affect the gender regime. The 2019 general elections show the victory of the socialist party (28.7 percent) and the entry of Vox populist radical right party (10.3 percent) in Parliament. These developments, together with results of political pacts following local and general elections, will be considered in future research. 2. http://www.congreso.es/portal/page/portal/Congreso/Congreso/ Diputados/Diputadas%20en%20activo 3. http://www.senado.es/web/conocersenado/temasclave/presenciamujeres/ listasenadoras/index.html 4. https://eige.europa.eu/gender-statistics/dgs/browse/wmidm/wmidm_pol/ wmidm_pol_parl 5. The Labour Reform increased employers’ opportunities to fire employees, especially in women-dominated contracts, and limited workers’ care rights. 6. https://cedawsombraesp.wordpress.com/ (accessed 5/3/2020). 7. https://plataforma7n.wordpress.com (accessed 5/3/2020). 8. https://www.eldiario.es/sociedad/mujeres-Puerta-Sol-finalizan-hambre_ 0_619789259.html (accessed 5/3/2020). 9. https://elpais.com/tag/caso_juana_rivas/a/ (accessed 5/3/2020). Acknowledgments We wish to thank the editors of the special section Varieties of Gender Regimes, Sylvia Walby and Karen Shire, for their constructive comments and invitation to the workshop at City, University of London June 7, 2019, as well as all participants for inspiring debates, and anonymous reviewers for their helpful evaluations. Research for this article has been funded by the Spanish Ministry of Research through the UNIGUAL Project (Ref: Fem2017-86004-R). References Alfama, Eva. 2017. >Transformando el estado? Avances y obsta´culos en la implementacio´n del mainstreaming de ge´nero. Doctoral Dissertation. Universidad Auto´noma de Barcelona. 464 E. Lombardo and A. Alonso Downloaded from https://academic.oup.com/sp/article/27/3/449/5899528 by EVES-Escola Valenciana dÉstudis de la Salut user on 29 March 2022
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