Con en s lis s a ailable a ScienceDi ec
Nu se Educa ion Today
jou nal homepage: www.else ie .com/loca e/ned
Changes in heal h sciences s uden s' pe cep ion o obs e ic iolence a e an
educa ional in e en ion
Desi ée Mena-Tudela
a
, Víc o Manuel González-Cho dá
a,⁎
, F ancisco Ja ie So iano-Vidal
b,c
,
Te esa Bonanad-Ca asco
a
, Lau a Cen eno-Rico
a
, Ra a Vila-Candel
b,d
, En ique Cas o-Sánchez
e
,
Águeda Ce e a Gasch
a
a
Nu sing Depa men , Uni e si a Jaume I, Spain
b
Nu sing Depa men , Uni e sidad de Valencia, Spain
c
Depa men o Obs e ics and Gynecology, Hospi al Lluis Alcanyis, Founda ion o he P omo ion o Heal h and Biomedical Resea ch in he Valencian Region (FISABIO),
Valencia, Spain
d
Depa men o Obs e ics and Gynecology, Hospi al Uni e si a io de la Ribe a, Founda ion o he P omo ion o Heal h and Biomedical Resea ch in he ValencianRegion
(FISABIO), Valencia, Spain
e
Na ional Ins i u e o Heal h Resea ch, Heal h P o ec ion Resea ch Uni (NIHRHPRU) in Heal hca e-Associa ed In ec ion and An imic obial Resis ance, Impe ial College,
London, Uni ed Kingdom
ARTICLE INFO
Keywo ds:
Obs e ic iolence
Nu sing s uden s
Medical s uden s
Pe cep ion
ABSTRACT
Backg ound: Obs e ic iolence is a ype o gende -based iolence ha is p esen ed s uc u ally. This ype o
iolence has physical and psychological consequences o bo h he women who expe ience i and heal h p o-
essionals. The Wo ld Heal h O ganiza ion adds ha heal h p o essionals need aining o ensu e ha p egnan
women a e ea ed wi h compassion and digni y.
Objec i es: The objec i e o he s udy was o e alua e heal h sciences s uden s' pe cep ion o obs e ic iolence
and o iden i y possible changes a e an educa ional in e en ion.
Design: A p e-pos quasi-expe imen al s udy was ca ied ou be ween Janua y and June 2019.
Se ings and pa icipan s: S uden s o medicine and nu sing om Jaume I Uni e si y (Uni e si a Jaume I)
(Spain).
Me hods: An ad hoc scale comp ising 33 i ems was designed o measu e he s uden s' pe cep ions. In addi ion,
sociodemog aphic and con ol a iables we e collec ed. Desc ip i e analyses o he sample and he scale we e
ca ied ou , and a bi a ia e analysis was pe o med.
Resul s: O he s uden s su eyed, 89.7% we e women, and he majo i y was nu sing s uden s. O he 33 i ems,
28 (84.84%) showed s a is ically significan changes in he p e-pos -in e en ion measu emen . Twen y-fi e o
he 33 i ems (75.75%) showed a ela ionship wi h he sociodemog aphic a iables o gende , field, cou se and
e e ha ing been p egnan .
Conclusion: This s udy shows he change in heal h sciences s uden s' pe cep ions o obs e ic iolence a e an
educa ional in e en ion. In addi ion, he no maliza ion o his ype o iolence was obse ed wi h he p o-
g ession o aining and wi h pe sonal obs e ic expe ience.
1. In oduc ion
The Wo ld Heal h O ganiza ion (WHO) s a es ha “all women ha e
he igh o ecei e he highes le el o heal h ca e, which includes he igh o
dignified and espec ul ca e in p egnancy and childbi h, and he igh no o
suffe iolence o disc imina ion”(WHO, 2014). In 1985, he Eu opean
egional office o he WHO, he Pan Ame ican Heal h O ganiza ion and
he egional office o he WHO o he Ame icas, a a con e ence on
app op ia e echnology o childbi h, c ea ed a se ies o consensus
ecommenda ions among obs e icians, paedia icians, midwi es, psy-
chologis s, epidemiologis s, mo he s and o he p o essionals. The esul
was he “Decla a ion o Fo aleza”(Wo ld Heal h O ganiza ion, 1985),
which he WHO conside s applicable o all pe ina al se ices
h oughou he wo ld.
h ps://doi.o g/10.1016/j.ned .2020.104364
Recei ed 24 July 2019; Recei ed in e ised o m 18 Decembe 2019; Accep ed 7 Feb ua y 2020
⁎
Co esponding au ho .
E-mail add ess: [email p o ec ed] (V.M. González-Cho dá).
Nu se Educa ion Today 88 (2020) 104364
0260-6917/ © 2020 Else ie L d. All igh s ese ed.
T
2. Backg ound
Some defini ions o obs e ic iolence (OV) exis . Specifically, he
“O ganic Law on he Righ o Women o a Li e F ee o Violence”,
published in Ma ch 2007 in Venezuela, defines his e m as “… he ap-
p op ia ion o he body and ep oduc i e p ocesses o women by heal h
pe sonnel, which is exp essed as dehumanized ea men , an abuse o
medica ion, and he con e sion o na u al p ocesses in o pa hological ones,
b inging wi h i loss o au onomy and he abili y o decide eely abou hei
bodies and sexuali y, nega i ely impac ing he quali y o li e o women”
(Diaz-Tello, 2016;Pé ez D'g ego io, 2010).
The WHO wa ns ha an inc easing numbe o s udies on he ex-
pe iences o women du ing p egnancy and, in pa icula , du ing
childbi h p esen an ala ming scena io, indica ing ha many women
a ound he wo ld expe ience dis espec ul, offensi e o negligen
ea men du ing labou (WHO, 2014). In addi ion, i desc ibes he
p ac ices ha make OV isible: dis espec ul and offensi e ea men
du ing childbi h, physical abuse, p o ound humilia ion and e bal abuse,
medical p ocedu es pe o med wi hou consen o unde coe cion (including
s e iliza ion), lack o confiden iali y, ailu e o ob ain he comple e in o med
consen , e usal o adminis e analgesics, flag an iola ions o p i acy, e-
usal o admission o a heal h cen e, negligence owa ds women du ing
childbi h and he e en ion o women and new-bo ns in heal h cen es due o
hei inabili y o pay (WHO, 2014), among o he s.
Conce ning his ype o iolence, se e al conjec u es ha e been
aised ega ding possible a iables ha a ou i s social s a ifica ion
(Cas o and F ías, 2019): lowe socioeconomic le el (B andão e al.,
2018;San iago e al., 2018); you h, ace, poo economic s a us and
women's igno ance o hei igh s (Pe e a e al., 2018); o ha ing da k
skin (G ilo Diniz e al., 2018). Howe e , an analysis o he main easons
and places o occu ence o his ype o iolence can e eal ha OV is a
ype o s uc u al iolence. S uc u al iolence is one way o desc ibing
social a angemen s ha pu indi iduals and popula ions in ha m's way
[…]; he a angemen s a e s uc u al because hey a e embedded in he
poli ical and economic o ganiza ion o ou social wo ld (Fa me e al.,
2006).
The main eason o OV is gende bias, in which women's igh o
choose is nullified and eplaced (Ja dim and Modena, 2018). Rega ding
si es o occu ence, OV occu s h oughou he wo ld. E idence shows
ha i exis s in coun ies such as Mexico (Cas o and Sa age, 2019;
Cas o and F ías, 2019;San iago e al., 2018), Venezuela, A gen ina,
B azil (Ishola e al., 2017;Ja dim and Modena, 2018), India
(Bha acha ya and Sunda i Ra ind an, 2018), Tanzania (Mselle e al.,
2018), he Czech Republic (Begley e al., 2018), Ecuado (B andão
e al., 2018), I aly (Cas o and F ías, 2019;Ra aldi e al., 2018;Scambia
e al., 2018), he Uni ed S a es (Pe e a e al., 2018), and Nige ia (Ishola
e al., 2017), among o he places. The s uc u al na u e o OV makes he
heal h p o essional who exe cises i unawa e o i and e en no malizes
his p ac ice (Bo ges, 2018).
P ac ices cha ac e ized by OV ha e physical and psychological
consequences o bo h he women who expe ience hem and he heal h
p o essionals who p ac ise o wi ness hem. Women ha e shown how
hei physical, sexual and psychological heal h has been nega i ely
affec ed (Cha opadhyay e al., 2018), and a e y meaning ul expe i-
ence in hei li es has been ans o med in o a iolen and nega i e one
(Bo ges, 2018;McGa y e al., 2017). On he o he hand, he li e a u e
sugges s ha pe sonnel who wi ness his ype o iolence du ing
childbi h may suffe om compassion a igue o seconda y auma ic
s ess in esponse o obse ing he aumas he woman expe iences
fi s -hand (Sadle e al., 2016). The WHO s a es ha i is necessa y o
gene a e da a ela ed o espec ul and dis espec ul ca e p ac ices,
esponsibili y sys ems and aluable p o essional suppo , adding ha
heal h p o essionals need suppo and aining o ensu e ha p egnan
women a e ea ed wi h compassion and digni y (WHO, 2014).
Is impo an o no e ha no simila s udies ha e been ound in he
li e a u e; mo e specifically, he e a e no s udies analysing heal h
sciences s uden s' pe spec i es ega ding OV. The e o e, he main ob-
jec i e o his s udy was o e alua e he pe cep ions o heal h sciences
s uden s a Jaume I Uni e si y (Uni e si a Jaume I) (Spain) ha e e-
ga ding OV and o de ec possible changes in hese pe cep ions a e an
educa ional in e en ion.
3. Me hods
3.1. Design and sample
A p e-pos quasi-expe imen al s udy was conduc ed among heal h
sciences s uden s a Jaume I Uni e si y (Uni e si a Jaume I) (Spain)
be ween Janua y and June 2019.
Re u ned ques ionnai es wi h up o 10% o i ems incomple e we e
excluded om he s udy analysis. A sample size calcula ion was pe -
o med using he GRANMO p og amme, which de e mined ha a
sample o 99 subjec s was sufficien . The alues conside ed o he
calcula ion o he sample size included a confidence in e al o 95%,
highligh ing an ini ial p opo ion o e en s o 0.1 pe cen age poin s and
a loss o ollow-up o 20%.
3.2. Va iables and ins umen s
The sociodemog aphic a iables ha we e conside ed we e age,
gende , field (medicine, nu sing), cou se, heal h expe ience in gynae-
cology and obs e ics se ices (yes, no), du a ion o expe ience
(< 1 yea , be ween 1 and 4 yea s, > 4 yea s), ha ing been p esen a a
bi h (yes, no), du a ion o expe ience being p esen a bi hs (< 1 yea ,
be ween 1 and 4 yea s, > 4 yea s), pe sonal expe ience wi h p egnan-
cies and bi hs (yes, no), ime since p egnancy and bi h (< 1 yea ,
be ween 1 and 4 yea s, > 4 yea s).
The pe cep ion o OV was measu ed wi h an ad hoc ques ionnai e
composed o 33 i ems ha e e ed o OV p ac ices and we e di ided
in o 4 key momen s (be o e deli e y, du ing deli e y, in case o cae-
sa ean sec ion and a e deli e y). These i ems we e measu ed using a
5-poin Like scale (1 s ongly disag ee - 5 s ongly ag ee). The ques-
ionnai e was de eloped by a g oup o 3 expe s and was based on he
Guía de P ác ica Clínica de A ención al Pa o No mal (Clinical P ac ice
o No mal Bi h Ca e Guide) (Minis e io de Sanidad, 2014). The in-
e nal consis ency o he scale, measu ed wi h C onbach's alpha, was
0.922 o he p e-in e en ion measu emen and 0.975 o he pos -
in e en ion measu emen .
The in e en ion consis ed o an 8-hou semina . This ac i i y was
composed o a hea ical pe o mance on OV in he deli e y oom
pe o med by “The O he Pa o he Thea e”(1 h); a mas e class on
legal aspec s p esen ed by a lawye specializing in heal h law (2 h); a
ound able composed o p o essionals om he diffe en fields, who
con ibu ed hei expe iences (4 h); and ano he ound able in which
ou olun ee mo he s na a ed hei expe iences o childbi h (1 h).
The session wi h he hea ical pe o mance and he mas e class on
legal issues was conduc ed on 03/07/2019. The ound ables o he
p o essionals and he mo he s we e held a a second session on 03/12/
2019.
3.3. Da a collec ion
Fieldwo k was conduc ed in Ma ch 2019 a e he launch o a
semina ela ed o OV, in which s uden s olun a ily en olled. Da a
we e collec ed h ough a sel -comple ed su ey adminis e ed be o e he
s uden s en e ed he semina on 03/07/2019 and a e he ac i i y on
03/12/2019. This su ey was accompanied by an explana ion o he
s udy objec i e and an explana ion o i s olun a y and anonymous
na u e.
D. Mena-Tudela, e al. Nu se Educa ion Today 88 (2020) 104364
2
3.4. Analysis
A desc ip i e analysis o he da a was pe o med conside ing means,
s anda d de ia ions and 95% confidence in e als o he quan i a i e
a iables and he dis ibu ion o equencies and pe cen ages we e
aken in o accoun o he quali a i e a iables. Fo he bi a ia e ana-
lysis, applicabili y was de e mined using pa ame ic es s, he
Kolmogo o -Smi no no mali y es and Le ene es o he homo-
genei y o a iances. A e hese condi ions we e confi med as accep-
able, S uden 's - es was applied o pai ed da a, wi h he in en ion o
de ec ing he effec o he change in he diffe en measu emen s, and
he Mann Whi ney U and K uskal Wallis es s we e used o de e mine
he ela ionships o he sociodemog aphic a iables and pe cep ions o
OV wi h he esponses on he p e-in e en ion measu emen . The
analysis was ca ied ou wi h he s a is ical package S a is ical Package
o Social Sciences (SPSS), e sion 21. A s a is ical significance le el o
p< 0.05 was es ablished.
3.5. E hical conside a ions
The s udy was app o ed by he managemen o he Jaume I
Uni e si y (Uni e si a Jaume I) Nu sing Resea ch G oup. The in e -
en ion was app o ed by he di ec o a e o he Nu sing Depa men and
he dean o he School o Heal h Sciences o Jaume I Uni e si y
(Uni e si a Jaume I). Be o e da a collec ion, he s uden s ecei ed in-
o ma ion abou he objec i es o he s udy as well as i s me hodology
and he olun a y and anonymous na u e o pa icipa ion. The da a
collec ion ool did no include any pe sonal da a ha could comp omise
he iden i y o he pa icipan s. The p ojec was designed in acco dance
wi h he Decembe 5 P o ec ion o Pe sonal Da a and Gua an ee o
Digi al Righ s O ganic Law 03/2018. In addi ion, he p inciples o he
Decla a ion o Helsinki (cha i y, nonmaleficence, au onomy and jus-
ice) we e espec ed. To espec he anonymi y o he da a and o ma ch
he fi s and second measu emen s, an ID was c ea ed consis ing o he
las wo digi s o he s uden 's cell phone numbe , he las wo digi s o
his o he Na ional ID and his o he ini ials.
4. Resul s
A o al o 107 ques ionnai es we e collec ed. The mean age o he
s uden s was 22.5 yea s ( ± 5.87). Women ep esen ed 89.7% o he
sample (n= 96). A o al o 86.9% (n= 93) o he s uden s belonged o
he deg ee p og amme in nu sing, and 28% (n= 30) o he s uden s
had comple ed clinical p ac ice in he gynaecology and obs e ics de-
pa men s. O he sample, 20.6% (n= 22) had been p esen a a bi h;
only 4.7% (n= 5) had been p egnan , and 2.8% (n = 3) had gi en
bi h (Table 1).
The Kolmogo o -Smi no es (p< 0.01) and he Le ene es
(p< 0.05) e ified he app op ia eness o he S uden 's - es o pai ed
da a. Table 2 shows he desc ip i e analysis o he a iables o he p e-
and pos -in e en ion measu emen s and he bi a ia e analysis. All
analyses o he OV pe cep ion scale by pai ed da a showed s a is ically
significan diffe ences be ween he p e- and pos -in e en ion mea-
su es, excep on he i ems ela ed o pe o ming a pel ic examina ion
wi hou consen (p= 0.368); no p ese ing he p i acy o he woman
(p= 0.389); no conside ing he woman's decision (p= 0.086); aking
pic u es wi hou pe mission (p= 0.379); saying “S op complaining, i is
no ha bad”(p= 0.181); Sepa a ing he mo he and new-bo n
(p= 1.00); and gi ing o mula o he baby wi hou he mo he 's con-
sen (p= 0.320).
O he 33 i ems on he OV pe cep ion scale, only 24.24% (n=8)
had no ela ionship wi h he sample's sociodemog aphic and con ol
a iables. The a iables wi h he mos s a is ically significan diffe -
ences in ela ion o he OV pe cep ion scale we e gende , cou se, and
ha ing been p egnan . Field (nu sing s. medicine) showed s a is ically
significan diffe ences on he i ems ela ed o no offe ing measu es o
pain (nu sing: m = 4.43, SD = 0.85, medicine: m = 4.86, SD = 0.36,
p= 0.047); pe o ming he K is elle manoeu e (nu sing: m = 4.60,
SD = 0.75; medicine: m = 3.92, SD = 1.17, p≤0.01); pe o ming an
episio omy wi hou anaes hesia (nu sing: m = 4.46, SD = 1.01; med-
icine: m = 3.89, SD = 1.05; p= 0.033); allowing skin- o-skin con ac
a e he paedia ic examina ion (nu sing: m = 3.93, SD = 1.35;
medicine: m = 3.15, SD = 1.52, p= 0.049) and aking he new-bo n o
he nu se y (nu sing: m = 3.85, SD = 1.12; medicine: m = 3.15,
SD = 1.14, p= 0.025) (Table 3).
The comple ion o o a ions in obs e ics-gynaecology was s a is i-
cally significan ela ed o he a iables on he OV pe cep ion scale:
di ec ing he posi ion o he woman in labou (yes: m = 2.57,
SD = 1.33; no: m = 1.95, SD = 1.33; p= 0.025); pe o ming geni al
sha ing (yes: m = 3.80, SD = 1.29; no: m = 3.16, SD = 1.46;
p= 0.041) and con incing he woman o unde go a caesa ean sec ion
o end he labou quickly and wi hou pain (yes: m = 4.70, SD = 0.79;
no: m = 4.38, SD = 0.93; p= 0.021). Ha ing been p esen a a
childbi h was s a is ically significan ly ela ed o he ollowing a i-
able on he OV pe cep ion scale: Saying “you do no know how o push”
(yes: m = 4.45, SD = 1.01; no: m = 4.84, SD = 0.65; p≤0.01).
Table 4 shows he desc ip i e and compa a i e esul s o he con-
ol a iables wi h espec o he i ems on he OV pe cep ion scale.
Ha ing gi en bi h was s a is ically significan ly ela ed o he ol-
lowing i ems on he scale: pe o ming ou ine geni al sha ing (yes:
m = 1.00, SD = 0.00; no: m = 3.41, SD = 1.40, p≤0.01), pe o ming
ou ine episio omy (yes: m = 2.67, SD = 0.57; no: m = 4.44,
SD = 0.95; p ≤0.01); saying “you do no know how o push”(yes:
m = 2.33, SD = 1.15; no: m = 4.82, SD = 0.62; p ≤0.01); pe o ming
a caesa ean sec ion due o slow dila ion (yes: m = 2.00, SD = 1.00; no:
m= 4.09, SD = 1.07; p ≤0.01) and no allowing company in cases o
ins umen a ion o caesa ean sec ion (yes: m = 3.33, SD = 0.57; no:
m = 4.09, SD = 1.07; p = 0.02). Ha ing been p egnan was s a is i-
cally significan ly ela ed o he ollowing i ems: pe o ming ou ine
Table 1
Sociodemog aphic and con ol a iables o he sample.
To al Nu sing Medicine
n%n%n%
Gende
Male 11 10.3 10 9.3 1 0.9
Female 96 89.7 83 77.6 13 12.1
Cou se
Fi s 10 9.3 8 7.5 2 1.9
Second 46 43.0 40 37.4 6 5.6
Thi d 10 9.3 7 6.5 3 2.8
Fou h 40 37.4 37 34.6 3 2.8
Heal h expe ience in gynaecology and
obs e ics se ices
Yes 30 28.0 25 23.5 5 4.7
No 77 72.0 68 63.6 9 8.4
Du a ion o expe ience
< 1 yea 16 15.0 12 11.2 4 3.7
Be ween 1 and 4 yea s 13 12.1 12 11.2 1 0.9
> 4 yea s 1 0.9 1 0.9 ––
Ha ing been p esen a a bi h
Yes 22 20.6 20 18.7 2 1.9
No 85 79.4 73 68.2 12 11.2
Pe sonal expe ience wi h p egnancies
Yes 5 4.7 5 4.7 ––
No 102 95.3 88 82.2 14 13.1
Time since p egnancy
Be ween 1 and 4 yea s 2 1.9 2 1.9 ––
> 4 yea s 3 2.8 3 2.8 ––
Pe sonal expe ience wi h bi h
Yes 3 2.8 3 2.8 ––
No 104 97.2 90 84.1 14 13.1
Time since bi h
> 4 yea s 3 2.8 3 2.8 ––
D. Mena-Tudela, e al. Nu se Educa ion Today 88 (2020) 104364
3
Table 2
Resul s o s uden pe cep ions o obs e ic iolence.
I em no Va iable P e-in e en ion measu e Pos -in e en ion measu e p-Value
a
n M SD IC 95% n M SD IC 95%
1 Inse ing an in a enous channel 105 2.15 1.18 1.92–2.38 98 4.00 1.00 3.80–4.20 < 0.01
2 Di ec ing he woman's posi ion 105 2.12 1.35 1.86–2.39 98 3.97 1.21 3.73–4.21 < 0.01
3 Accele a e he bi hing p ocess a ificially 105 3.34 1.31 3.09–3.60 98 4.61 0.83 4.45–4.78 < 0.01
4 Adminis e ing ou ine enemas 106 3.12 1.37 2.86–3.39 98 4.65 0.79 4.50–4.81 < 0.01
5 Pe o ming ou ine amnio hexis 106 4.08 0.93 3.90–4.27 98 4.82 0.66 4.68–4.95 < 0.01
6 Pe o ming ou ine geni al sha ing 105 3.34 1.44 3.06–3.62 98 4.57 0.76 4.42–4.72 < 0.01
7 Immobilizing he woman 106 4.49 0.85 4.33–4.65 98 4.87 0.62 4.74–4.99 < 0.01
8 Pe o ming a pel ic exam wi hou consen 106 4.8 0.69 4.67–4.94 98 4.87 0.62 4.74–4.99 0.368
9 No offe ing measu es o pain 106 4.49 0.81 4.33–4.65 98 4.72 0.80 4.56–4.88 < 0.01
10 Encou aging he use o an epidu al 106 3.94 0.99 3.75–4.13 98 4.58 0.73 4.44–4.73 < 0.01
11 No p ese ing p i acy 106 4.79 0.68 4.66–4.92 98 4.84 0.63 4.71–4.96 0.389
12 Con incing he woman o unde go a c-sec ion o end labou quickly and wi hou pain 106 4.47 0.91 4.30–4.65 98 4.83 0.65 4.69–4.96 < 0.01
13 No conside ing he woman's decision 106 4.77 0.62 4.65–4.89 98 4.88 0.59 4.76–5.00 0.086
14 Taking pic u es wi hou pe mission 106 4.81 0.71 4.67–4.95 98 4.86 0.71 4.71–5.00 < 0.01
15 En o cing he li ho omy posi ion 103 3.27 1.30 3.02–3.53 98 4.53 0.84 4.36–4.70 0.379
16 Allowing accompanimen du ing he second s age 105 2.95 1.55 2.65–3.25 95 4.12 1.27 3.86–4.38 < 0.01
17 Pe o ming ou ine episio omy 102 4.39 0.98 4.20–4.59 98 4.81 0.68 4.67–4.94 < 0.01
18 Saying “You do no know how o push”105 4.75 0.75 4.61–4.90 98 4.88 0.64 4.75–5.01 0.05
19 Pe o ming he K is elle manoeu e 104 4.52 0.83 4.36–4.68 98 4.85 0.63 4.72–4.97 < 0.01
20 Pe o ming an episio omy wi hou anaes hesia 101 4.41 1.02 4.20–4.61 98 4.76 0.71 4.61–4.90 < 0.01
21 P ohibi ing ea ing and d inking 105 3.51 1.17 3.29–3.74 98 4.62 0.76 4.47–4.78 < 0.01
22 No p o iding co e ing/hea ing du ing deli e y 105 4.43 0.85 4.26–4.59 97 4.70 0.85 4.53–4.87 0.01
23 Saying “S op complaining, i is no ha bad”105 4.78 0.73 4.64–4.92 98 4.88 0.64 4.75–5.01 0.181
24 No le ing he woman shou 104 4.51 0.89 4.34–4.68 98 4.78 0.76 4.62–4.93 0.012
25 Pe o ming a caesa ean sec ion due o slow dila ion 105 4.03 1.12 3.81–4.25 98 4.76 0.62 4.63–4.88 < 0.01
26 Pe o ming an eme gency caesa ean sec ion wi hou consen 104 4.38 1.07 4.17–4.58 98 4.77 0.63 4.64–4.89 < 0.01
27 No allowing accompanimen in cases o ins umen a ion o caesa ean sec ion 105 4.49 0.84 4.32–4.65 98 4.82 0.69 4.68–4.96 < 0.01
28 Immedia ely cu ing he co d 104 3.51 1.30 3.26–3.76 98 4.35 0.89 4.17–4.53 0.018
29 Su u ing a ea wi hou anaes hesia 104 4.39 0.91 4.22–4.57 98 4.74 0.80 4.58–4.91 < 0.01
30 Sepa a ing he mo he and new-bo n 105 4.90 0.57 4.78–5.01 98 4.86 0.65 4.73–4.99 1.00
31 Allowing skin- o-skin con ac a e he paedia ic examina ion 105 3.84 1.38 3.57–4.11 98 4.66 0.77 4.51–4.82 < 0.01
32 Taking he baby o he nu se y 105 3.76 1.14 3.54–3.98 97 4.58 0.85 4.41–4.75 < 0.01
33 Gi ing o mula wi hou he mo he 's consen 105 4.74 0.77 4.59–4.89 98 4.82 0.67 4.68–4.95 0.320
a
T o S uden o ela ed samples.
Table 3
Desc ip i e and compa a i e esul s o he sociodemog aphic a iables and he obs e ic iolence scale.
I em no Gende Field Cou se
Male Female p-Value
a
Nu sing Medicine p-Value
a
Fi s Second Thi d Fou h p-Value
b
MSDMSD MSDMSD MSDMSDMSDMSD
2 1.90 1.37 2.15 1.18 –2.09 1.33 2.36 1.55 –1.30 0.48 2.34 1.44 2.40 1.64 1.98 1.25 –
6 2.70 1.33 3.41 1.44 –3.42 1.43 2.77 1.36 –3.40 1.71 3.30 1.44 3.00 1.82 3.52 1.26 –
8 4.40 1.35 4.84 0,58 –4.78 0.73 4.93 0.26 –5.00 0.00 4.80 0.72 4.80 0.42 4.83 0.67 0.020
9 4.00 1.24 4.54 0.75 –4.43 0.85 4.86 0.36 0.047 4.70 0.48 4.36 0.80 4.80 0.42 4.58 0.87 0.042
10 3.30 0.95 4.01 0.97 0.025 3.93 0.99 4.00 1.03 –3.40 0.96 3.98 0.96 4.40 0.69 3.98 1.02 –
11 4.30 1.94 4.84 0.53 –4.76 0.73 5.00 0.00 –4.80 0.42 4.80 0.75 4.90 0.31 4.78 0.73 –
12 3.80 1.39 4.54 0.82 0.040 4.45 0.95 4.64 0.49 –4.40 0.51 4.56 0.81 4.70 0.48 4.40 1.08 –
13 4.40 0.97 4.81 0.56 0.030 4.75 0.65 4.93 0.26 –4.70 0.48 4.80 0.62 4.80 0.42 4.78 0.69 –
14 4.40 1.35 4.85 0.61 –4.78 0.76 5.00 0.00 –5.00 0.00 4.80 0.69 4.90 0.31 4.85 0.66 0.015
16 2.40 1.57 3.01 1.55 –2.99 1.55 2.71 1.63 –2.60 1.64 2.60 1.54 2.50 1.58 3.54 1.43 0.046
17 3.22 1.30 4.51 0.88 0.01 4.39 1.55 4.40 1.07 –4.11 0.92 4.55 0.95 4.25 0.88 4.37 1.00 –
18 4.30 1.25 4.80 0.67 0.016 4.72 0.80 5.00 0.00 –4.89 0.33 4.80 0.69 4.50 1.26 4.78 0.69 –
19 4.44 0.88 4.53 0.83 –4.60 0.75 3.92 1.17 < 0.01 4.11 0.78 4.36 0.98 4.56 0.72 4.83 0.54 < 0.01
20 3.67 1.58 4.48 0.93 0.035 4.46 1.01 3.89 1.05 0.033 4.56 0.72 4.40 0.97 4.38 0.91 4.48 1.03
21 2.30 0.67 3.64 1.14 < 0.01 3.54 1.12 3.31 1.54 –2.78 0.97 3.22 1.18 4.10 1.10 3.85 1.09 0.011
22 4.00 0.94 4.47 0.83 0.048 4.40 0.77 5.00 0.00 –4.22 0.83 4.38 0.91 4.90 0.31 4.43 0.87 –
23 4.40 1.26 4.82 0.65 –4.75 0.77 5.00 0.00 –4.89 0.33 4.82 0.68 5.00 0.00 4.75 0.70 0.024
24 4.00 1.24 4.56 0.89 0.040 4.46 0.93 4.92 0.29 –4.44 0.72 4.57 0.92 4.60 0.69 4.48 0.93 –
25 3.40 1.57 4.09 1.05 –4.00 1.14 4.23 0.92 –3.89 0.92 3.98 1.13 3.70 1.41 4.23 1.07 –
27 3.80 1.40 4.56 0.74 0.040 3.54 0.79 4.08 1.11 –4.33 0.86 4.36 0.98 4.50 0.70 4.70 0.64 –
29 3.60 1.17 4.48 0.85 < 0.01 4.37 0.94 4.58 0.66 –4.44 1.01 4.45 0.79 4.60 0.69 4.35 0.94 –
30 4.50 1.26 4.94 0.43 0.017 4.88 0.60 5.00 0.00 –5.00 0.00 4.87 0.62 5.00 0.00 4.88 0.64 –
31 3.10 1.59 3.92 1.35 –3.93 1.35 3.15 1.52 0.049 3.00 0.86 4.09 1.41 3.30 1.49 3.85 1.36 0.018
32 3.00 0.94 3.84 1.14 0.012 3.85 1.12 3.15 1.14 0.025 3.56 0.52 3.96 0.97 3.70 1.25 3.60 1.39 –
33 4.30 1.34 4.79 0.68 –4.72 0.82 4.92 0.27 –4.78 0.66 4.84 0.63 5.00 0.00 4.65 0.80 0.015
a
Mann-Whi ney U es .
b
K uskal-Wallis es .
D. Mena-Tudela, e al. Nu se Educa ion Today 88 (2020) 104364
4
geni al sha ing (yes: m = 1.80; SD = 1.78; no: m = 3.42, SD = 1.38;
p= 0.028); pe o ming a pel ic exam wi hou consen (yes: m = 4.20,
SD = 1.30; no: m = 4.83, SD = 0.64, p= 0.026); encou aging he use
o an epidu al (yes: m = 4.40, SD = 0.54; no: m = 4.81, SD = 0.68,
p≤0.01); no conside ing he woman's decision (yes: m = 4.40,
SD = 0.54; no: m = 4.79, SD = 0.62; p= 0.01); aking pic u es
wi hou pe mission (yes: m = 4.00, SD = 1.73; no: m = 4.85,
SD = 0.62; p= 0.015); pe o ming ou ine episio omy (yes: m = 3.00,
SD = 0.70; no: m = 4.46, SD = 0.94; p ≤0.01); saying “you do no
know how o push”(yes: m = 3.40, SD = 1.67; no: m = 4.82,
SD = 0.62; p ≤0.01); saying “s op complaining, i is no ha bad”
(yes: m = 3.80, SD = 1.78; no: m = 4.83, SD = 0.62; p= 0.034); and
pe o ming a caesa ean due o slow dila ion (yes: m = 2.60; SD = 1.51;
no: m = 4.10, SD = 1.05; p= 0.022) (Table 4).
5. Discussion
Fi s , is impo an o emphasize ha s uden s' pa icipa ion in he
p oposed eaching ac i i y was much g ea e han ini ially expec ed.
The s uden s seemed e y mo i a ed by he cen al heme, and hei
in ol emen was no able; he e o e, he cap u e o indi iduals om he
sample exceeded he calcula ed sample size. The high pe cen age o
women in he sample (89.7%) should be no ed; i may ha e occu ed
because women we e especially mo i a ed by he issue o because e-
male ep esen a ion is inc easing in he heal h sciences (Be nal e-Ma í,
2015). I is no ewo hy ha s uden s in diffe en yea s o hei p o-
g amme we e equi ably ep esen ed in he semina , al hough mo e
second- and ou h-yea s uden s han s uden s o o he yea s we e in
a endance. The ep esen a ion o medical s uden s was low; some
possible easons o his low a endance may be low dissemina ion o
he ac i i y among hese s uden s o he possibili y ha nu sing s u-
den s eel mo e linked o his ype o p ac ice (Olza-Fe nández and
Ruiz-Be dún, 2015). Because ou sample was young in ela ion o he
mean age (32.58 yea s) o ma e ni y in Spain acco ding o da a om
he Na ional Ins i u e o S a is ics (Ins i u o Nacional de Es adís ica
INE.), e y ew pa icipan s had a pe sonal medical his o y o p eg-
nancy o bi h, al hough 30% o he sample had expe ience in gynae-
cology and obs e ics.
Rega ding he compa ison o he p e- and pos -in e en ion mea-
su es by pai ed da a, i is no ewo hy ha wi h he excep ion o a ew
i ems, all measu es p esen ed s a is ically significan diffe ences. E en
so, i is wo h highligh ing he low esul s ound in he p e-in e en ion
measu emen . The Fo aleza documen (Wo ld Heal h O ganiza ion,
1985) s a es ha a amily membe chosen by he mo he may accom-
pany he du ing childbi h and h oughou he pos na al pe iod o
p omo e he well-being; he new-bo n should s ay wi h his/he mo he
whene e possible; immedia e b eas eeding should be p omo ed; he
do sal posi ion o he woman in li ho omy du ing dila ion is no e-
commended; and he sha ing o pubic hai , he adminis a ion o en-
emas, he sys ema ic use o episio omy and he ea ly a ificial up u e o
memb anes should no be pe o med as ou ine p ocedu es. All hese
p ocedu es we e included in he ques ionnai e, and o hem, he only
one ha was iden ified as iolence p e-in e en ion was “gi ing o mula
wi hou he mo he 's consen ”.
I should be no ed ha heal h science s uden s should be ained in
he la es a ailable e idence (Aglen, 2016). Appa en ly, his does no
occu in he field o obs e ics in Spain, highligh ing he need o all
women o child-bea ing age o ecei e e idence-based ca e ha is ap-
plied espec ully wi hou neglec ing he woman's opinions and p e-
e ences (Begley e al., 2018). Along he same lines, he Fédé a ion
In e na ionale de Gynécologie e d'Obs é ique (FIGO) adds ha “E e y
woman and e e y baby should be p o ec ed om unnecessa y in e en ions,
p ac ices and p ocedu es ha a e no e idence-based, and any p ac ices ha
a e no espec ul o hei cul u e, bodily in eg i y, and digni y”
(In e na ional Fede a ion o Gynaecology and Obs e ics e al., 2014).
Special ocus alls on he K is elle manoeu e, which, despi e being
con aindica ed, con inues o be pu in o p ac ice (Bo ges, 2018;F i z
e al., 2017;Rubashkin e al., 2019) and was no ecognized by he
s uden s as OV.
I is e iden ha he e is a close ela ionship be ween ideological
Table 4
Desc ip i e and compa a i e esul s o he con ol a iables and he obs e ic iolence scale.
I em no Pe sonal expe ience wi h p egnancies Pe sonal expe ience wi h bi h
Yes No p-Value
a
Yes No p-Value
a
M SD M SD M SD M SD
2 2.80 1.78 2.12 1.14 –3.00 2.00 2.13 1.15 –
6 1.80 1.78 3.42 1.38 0.028 1.00 0.00 3.41 1.40 < 0.01
8 4.20 1.30 4.83 0.64 0.026 3.67 1.52 4.83 0.64 –
9 4.00 1.22 4.51 0.79 –3.67 1.52 4.51 0.79 –
10 3.20 1.64 3.98 0.94 –3.00 1.73 3.97 0.96 –
11 4.40 0.54 4.81 0.68 < 0.01 4.33 0.57 4.81 0.68 –
12 4.20 1.30 4.49 0.89 –4.00 1.73 4.49 0.88 –
13 4.40 0.54 4.79 0.62 0.010 4.33 0.57 4.79 0.62 –
14 4.00 1.73 4.85 0.62 0.015 3.33 2.08 4.85 0.61 –
16 2.40 1.94 2.98 1.54 –2.00 1.73 2.98 1.55 –
17 3.00 0.70 4.46 0.94 < 0.01 2.67 0.57 4.44 0.95 < 0.01
18 3.40 1.67 4.82 0.62 < 0.01 2.33 1.15 4.82 0.62 < 0.01
19 4.00 1.00 4.55 0.82 –4.00 1.00 4.53 0.83 –
20 3.80 1.78 4.44 0.97 –3.00 2.00 4.45 0.96 –
21 2.80 1.64 3.55 1.14 –2.67 1.15 3.54 1.17 –
22 4.20 1.30 4.44 0.83 –3.67 1.52 4.45 0.82 –
23 3.80 1.78 4.83 0.62 0.034 3.00 2.00 4.83 0.61 –
24 4.00 1.41 4.54 0.86 –3.33 1.52 4.54 0.85 –
25 2.60 1.51 4.10 1.05 0.022 2.00 1.00 4.09 1.07 < 0.01
27 4.00 1.00 4.51 0.83 –3.33 0.57 4.52 0.82 0.020
29 3.80 1.64 4.42 0.87 –3.33 2.08 4.43 0.86 –
30 4.80 0.44 4.90 0.57 –4.67 0.57 4.90 0.57 –
31 4.00 1.73 3.83 1.37 –3.67 2.30 3.84 1.37 –
32 4.20 0.83 3.74 1.16 –4.00 1.00 3.75 1.15 –
33 4.00 1.73 4.78 0.69 –3.33 2.08 4.78 0.68 –
a
Mann-Whi ney U es .
D. Mena-Tudela, e al. Nu se Educa ion Today 88 (2020) 104364
5
ep esen a ions o he emale gende and he exis ence o OV. The
cul u al image o women as ep oduc i e and submissi e se es as a
p eceden o he domina ion, con ol and abuse hey expe ience in
ela ion o hei bodies and sexuali y. As a consequence, women a e
nullified, and hei igh s o choose a e eplaced (Ja dim and Modena,
2018). These asse ions a e co obo a ed by he esul s ob ained in his
s udy; when he esponses o he OV scale we e compa ed by gende , a
la ge numbe o a iables p esen ed s a is ically significan diffe ences,
and in all o hem, he pe cep ion o OV was highe among emales.
Ano he ea u e o his OV is ha i is oo ed in a sys em ha s ands
in he way o op imal heal h ou comes (Cas o and Sa age, 2019); hus,
i also has a s uc u al na u e (Bha acha ya and Sunda i Ra ind an,
2018). In his way, he esea che s assumed wo ac s ha we e con-
fi med h ough his s udy: a) he no maliza ion o his ype o iolence
acco ding o he s uden 's yea o s udy, i.e., a lowe pe cep ion o OV
among mo e ad anced s uden s and a ela ionship be ween pe cep ions
o OV and ha ing pa icipa ed in obs e ic p ac ices du ing s udy; and
b) he no maliza ion o his ype o obs e ic p ac ices in ela ion o he
pa icipan 's pe sonal expe ience wi h p egnancies and bi hs (a de-
c eased pe cep ion o OV a e ha ing been p egnan o gi en bi h). A
la ge s udy is necessa y o de e mine he deg ee o no maliza ion and
he no maliza ion p ocess; howe e , gi en hese p elimina y da a, i is
essen ial o change he aining o heal h pe sonnel, who should ha e a
solid ounda ion in e hics and gende and human igh s because emo-
ional ac o s o bu nou may be among he easons o p ac ising OV
(Olza Fe nández, 2013). The s ain on heal h pe sonnel is so high ha
many p o essionals ha e o abandon hei job and e en hei p o ession
(Beck and Gable, 2012). The e o e, public policies mus di ec a en ion
owa ds humane and espec ul ea men ha is based on and sup-
po ed by he la es a ailable e idence. Howe e , in o de o his o
happen, heal h pe sonnel who wo k wi h p egnan women mus
abandon he adi ional hie a chy and s uc u e in which medical su-
pe ision implies a subo dina ion o women's bodies and sexuali y. This
ac is u he agg a a ed when all a en ion is paid o echniques, and
he alue o how people a e ea ed is los (G ilo Diniz e al., 2018;
Mselle e al., 2018). Educa ion ha p omo es espec and in o ms and
aises awa eness among u u e p o essionals, along wi h policies,
guides, p o ocols and educa ion, will e adica e OV (B andão e al.,
2018;Diaz-Tello, 2016;G ilo Diniz e al., 2018;Mselle e al., 2018;Sen
e al., 2018). Educa ion is a undamen al aspec o ending he no -
maliza ion o OV in socie y; i app oaches he p oblem om he oo
and will e ol e un il he igh s o women a e espec ed. The esul s
should be aken wi h cau ion because he e a e some limi a ions. This is
a quasi-expe imen al s udy wi hou a con ol g oup, ca ied ou in a
single ins i u ion and, also, he pos - es da a we e collec ed im-
media ely a e he in e en ion. In spi e o hese limi a ions, he esul s
ob ained a e in e es ing because hey highligh he conside a ion o OV
by heal h s uden s and add alue because hey show ha i is possible o
change his pe cep ion wi h an educa ional in e en ion di ec ed spe-
cifically a OV. Among he u u e lines o esea ch, he au ho s p opose
designs ha o e come hese limi a ions, o example, conside ing a
con ol g oup and long- e m moni o ing o s uden s.
6. Conclusions
Acco ding o he esul s o his s udy, heal h sciences s uden s in-
eg a e he no maliza ions o OV du ing hei s udies. A o ma i e ac-
i i y aimed a making his ype o iolence isible and eflec ing on OV
helps o c ea e awa eness among s uden s, making i possible o hem
o no ice his ype o iolence and be able o iden i y i . I is no ewo hy
ha om he beginning, he women in he s udy ha e pe cei ed all he
poin s aised on he OV scale as ha ing highe OV; addi ionally, OV
becomes no malized as a esul o being p esen a a deli e y, he
p og ession o aining (depending on he cou se) and obs e ic ex-
pe ience i sel , including p egnancies and bi hs.
Acknowledgemen s
This wo k has been unded by he Recogni ion o Educa ional
Inno a ion G oups P og amme o Jaume I Uni e si y in 2018 (3674/
18).
Re e ences
Aglen, B., 2016. Pedagogical s a egies o each bachelo s uden s e idence-based p ac-
ice: a sys ema ic e iew. Nu se Educ. Today 36, 255–263. h ps://doi.o g/10.1016/
j.ned .2015.08.025.
Beck, C.T., Gable, R.K., 2012. A mixed me hods s udy o seconda y auma ic s ess in
labo and deli e y nu ses. JOGNN - J. Obs e . Gynecol. Neona al Nu s. 41, 747–760.
h ps://doi.o g/10.1111/j.1552-6909.2012.01386.x.
Begley, C., Sedlicka, N., Daly, D., 2018. Respec ul and dis espec ul ca e in he Czech
Republic: an online su ey. Rep od. Heal h 15, 198. h ps://doi.o g/10.1186/
s12978-018-0648-7.
Be nal e-Ma í, V., 2015. The mino i y o male in he nu sing p o ession. Reflexions o
hei his o y, image and hei e olu ion in Spain. En e me ía Glob. 14, 328–334.
Bha acha ya, S., Sunda i Ra ind an, T.K., 2018. Silen oices: ins i u ional dis espec
and abuse du ing deli e y among women o Va anasi dis ic , no he n India. BMC
P egnancy Childbi h 18, 338. h ps://doi.o g/10.1186/s12884-018-1970-3.
Bo ges, M.T., 2018. A iolen bi h: e aming coe ced p ocedu es du ing childbi h as
obs e ic iolence. Duke Law J. 67, 827–862.
B andão, T., Cañadas, S., Gal is, A., de los Ríos, M.M., Meije , M., Falcon, K., 2018.
Childbi h expe iences ela ed o obs e ic iolence in public heal h uni s in Qui o,
Ecuado . In . J. Gynecol. Obs e . 143, 84–88. h ps://doi.o g/10.1002/ijgo.12625.
Cas o, A., Sa age, V., 2019. Obs e ic iolence as ep oduc i e go e nance in he
Dominican Republic. Med. An h opol. C oss Cul . S ud. Heal. Illn. 38, 123–136.
h ps://doi.o g/10.1080/01459740.2018.1512984.
Cas o, R., F ías, S.M., 2019. Obs e ic iolence in Mexico: esul s om a 2016 Na ional
Household Su ey. Violence Agains Women. h ps://doi.o g/10.1177/
1077801219836732.
Cha opadhyay, S., Mish a, A., Jacob, S., 2018. ‘Sa e’, ye iolen ? Women’s expe iences
wi h obs e ic iolence du ing hospi al bi hs in u al No heas India. Cul . Heal h
Sex. 20, 815–829. h ps://doi.o g/10.1080/13691058.2017.1384572.
Diaz-Tello, F., 2016. In isible wounds: obs e ic iolence in he Uni ed S a es. Rep od.
Heal h Ma e s 24, 56–64. h ps://doi.o g/10.1016/j. hm.2016.04.004.
Fa me , P.E., Nizeye, B., S ulac, S., Kesha jee, S., 2006. S uc u al iolence and clinical
medicine. PLoS Med. 3, e449. h ps://doi.o g/10.1371/jou nal.pmed.0030449.
F i z, J., Walke , D.M., Cohen, S., Angeles, G., Lamad id-Figue oa, H., 2017. Can a si-
mula ion-based aining p og am impac he use o e idence based ou ine p ac ices
a bi h? Resul s o a hospi al-based clus e andomized ial in Mexico. PLoS One 12,
e0172623. h ps://doi.o g/10.1371/jou nal.pone.0172623.
G ilo Diniz, C.S., Ra ne , D., Lucas d’Oli ei a, A.F.P., de Aguia , J.M., Niy, D.Y., 2018.
Dis espec and abuse in childbi h in B azil: social ac i ism, public policies and
p o ide s’ aining. Rep od. Heal h Ma e s 26, 19–35. h ps://doi.o g/10.1080/
09688080.2018.1502019.
Edad Media a la Ma e nidad po o den del nacimien o según nacionalidad (española/
ex anje a) de la mad e. España, Accessed da e: 21 Feb ua y 2020.
In e na ional Fede a ion o Gynecology and Obs e ics, In e na ional Confide a ion o
Midwi es, Whi e Ribbon Alliance, In e na ional Pedia ic Associa ion, Wo ld Heal h
O ganiza ion, 2014. Mo he −baby iendly bi hing acili ies. In . J. Gynecol. Obs e .
h ps://doi.o g/10.1016/j.ijgo.2014.10.013.
Ishola, F., Owolabi, O., Filippi, V., 2017. Dis espec and abuse o women du ing childbi h
in Nige ia: a sys ema ic e iew. PLoS One 12, e0174084. h ps://doi.o g/10.1371/
jou nal.pone.0174084.
Ja dim, D.M.B., Modena, C.M., 2018. Obs e ic iolence in he daily ou ine o ca e and
i s cha ac e is ics. Re . La . Am. En e magem 26, e3069. h ps://doi.o g/10.1590/
1518-8345.2450.3069.
McGa y, J., Hinsliff-Smi h, K., Wa s, K., McCloskey, P., E ans, C., 2017. Expe iences and
impac o mis ea men and obs e ic iolence on women du ing childbea ing: a
sys ema ic e iew p o ocol. JBI Da abase Sys . Re . Implemen . Repo s 15, 620–627.
h ps://doi.o g/10.11124/JBISRIR-2016-002950.
Minis e io de Sanidad, 2014. Guía de P ác ica Clínica sob e la A ención al Pa o No mal,
In e ne . doi. h p://www.guiasalud.es/GPC/GPC_472_Pa o_No mal_Os eba_compl.
pd .
Mselle, L.T., Kohi, T.W., Dol, J., 2018. Ba ie s and acili a o s o humanizing bi h ca e in
Tanzania: findings om semi-s uc u ed in e iews wi h midwi es and obs e icians.
Rep od. Heal h 15, 137. h ps://doi.o g/10.1186/s12978-018-0583-7.
Olza Fe nández, I., 2013. PTSD and obs e ic iolence. Midwi e y Today In . Midwi e
Sp ing 48–49.
Olza-Fe nández, I., Ruiz-Be dún, D., 2015. Midwi es Expe iences Rega ding Obs e ic
Violence, en: A chi es o Women’s Men al Heal h. h ps://doi.o g/10.1007/s00737-
014-0488-6.
Pe e a, D., Lund, R., Swahnbe g, K., Schei, B., In an i, J.J., Da j, E., Lukasse, M.,
Bjø ngaa d, J.H., Joshi, S.K., Rishal, P., Koju, R., Pun, K.D., Wijewa dena, K., Muz i ,
M.M., Campbell, J.C., 2018. «When helpe s hu »: women’s and midwi es’s o ies o
obs e ic iolence in s a e heal h ins i u ions, Colombo dis ic , S i Lanka. BMC
P egnancy Childbi h 18, 211. h ps://doi.o g/10.1186/s12884-018-1869-z.
Pé ez D’g ego io, R., 2010. Obs e ic iolence: a new legal e m in oduced in Venezuela.
In . J. Gynecol. Obs e . 111, 201–202. h ps://doi.o g/10.1016/j.ijgo.2010.09.002.
Ra aldi, C., Skoko, E., Ba is i, A., Ce icco, M., Vannacci, A., 2018. Sociodemog aphic
D. Mena-Tudela, e al. Nu se Educa ion Today 88 (2020) 104364
6
cha ac e is ics o women pa icipa ing o he LOVE-THEM (Lis ening o Obs e ic
Violence Expe iences TH ough Enuncia ions and Measu emen ) in es iga ion in I aly.
Da a B . 19, 226–229. h ps://doi.o g/10.1016/j.dib.2018.04.146.
Rubashkin, N., To es, C., Escu ie , R., Dolo es Ruiz-Be dún, M., 2019. “Jus a li le help”:
a quali a i e inqui y in o he pe sis en use o u e ine undal p essu e in he second
s age o labo in Spain. Bi h. h ps://doi.o g/10.1111/bi .12424.
Sadle , M., San os, M.J., Ruiz-Be dún, D., Rojas, G.L., Skoko, E., Gillen, P., Clausen, J.A.,
2016. Mo ing beyond dis espec and abuse: add essing he s uc u al dimensions o
obs e ic iolence. Rep od. Heal h Ma e s 24, 47–55. h ps://doi.o g/10.1016/j.
hm.2016.04.002.
San iago, R.V., Mon eal, L.A., Rojas Ca mona, A., Domínguez, M.S., 2018. «I we’ e he e,
i ’s only because we ha e no money.» disc imina ion and iolence in Mexican
ma e ni y wa ds. BMC P egnancy Childbi h 18, 244. h ps://doi.o g/10.1186/
s12884-018-1897-8.
Scambia, G., Vio a, E., Chian e a, A., Colacu ci, N., Vica io, M., 2018. “Obs e ic io-
lence”: be ween misunde s anding and mys ifica ion. Eu . J. Obs e . Gynecol.
Rep od. Biol. 331. h ps://doi.o g/10.1016/j.ejog b.2018.06.012. Sep.
Sen, G., Reddy, B., Iye , A., 2018. Beyond measu emen : he d i e s o dis espec and
abuse in obs e ic ca e. Rep od. Heal h Ma e s 26, 6–18. h ps://doi.o g/10.1080/
09688080.2018.1508173.
Wo ld Heal h O ganiza ion, 1985. App op ia e echnology o bi h. Lance 24, 436–437.
Wo ld Heal h O ganiza ion, 2014. The p e en ion and elimina ion o dis espec and
abuse du ing acili y-based childbi h. Wo ld Heal h O ganiza ion (doi:WHO/RHR/
14.23).
D. Mena-Tudela, e al. Nu se Educa ion Today 88 (2020) 104364
7
