Gracia Maroto-Navarro

El impacto de cuidar en la salud y la calidad de vida de las mujeres

Background: Informal care currently lies at the heart of the debate on welfare policies since demands for such care are increasing and the future availability of informal caregivers is uncertain. Objective: To analyze the distribution of the burden of informal care between men and women and its consequences on health and quality of life. Methods: Data from Spain and other neighboring countries obtained from several bibliographic databases, publications, and official reports were gathered. In addition, the results of a home survey conducted by the authors on 1.000 male and female informal caregivers in Andalusia (Spain) were used. Results: The studies reviewed demonstrate that women are the main providers of informal care in Spain. Most informal carers are women with a low educational level, without employment and from a low social class. The negative impact of caregiving was noted by a large proportion of carers, especially financial consequences and loss of employment and time. Informal caregiving also has a considerable impact on health, especially on psychological health, and is associated with high levels of burden. Conclusions: The present study demonstrates the need to reorganize health and social policies and to provide sufficient resources to meet the increasing need for informal care and to mitigate the impact and costs of caregiving on diverse aspects of women’s lives.

Gender Identity in Informal Care: Impact on Health in Spanish Caregivers

We examined the influence of gender identity on men’s and women’s perceptions of assuming the caregiver role to identify different coping strategies and the effects on caregiver health and quality of life. The study, performed in Andalusia, Spain, was based on a sociological analysis of the narratives produced during semistructured interviews with primary informal caregivers (16 men and 16 women) of different profiles. We observed a cultural assumption that women should assume the caregiver role and found that women shouldered the bulk of caregiving responsibilities and did not usually seek support. This might explain the high prevalence of chronic health disorders, stress, anxiety, depression, neglect of health, and social isolation we observed among women caregivers. Because the caregiver role was not socially imposed on men in our setting, men caregivers adopted a flexible attitude and tended to seek external support before their health and quality of life were seriously affected.

A multilevel model for the study of breastfeeding determinants in Brazil.

The benefits of breastfeeding for the childrens health have been highlighted in many studies. The innovative aspect of the present study lies in its use of a multilevel model, a technique that has rarely been applied to studies on breastfeeding. The data reported were collected from a larger study, the Family Budget Survey-Pesquisa de Orçamentos Familiares, carried out between 2002 and 2003 in Brazil that involved a sample of 48 470 households. A representative national sample of 1477 infants aged 0-6 months was used. The statistical analysis was performed using a multilevel model, with two levels grouped by region. In Brazil, breastfeeding prevalence was 58%. The factors that bore a negative influence on breastfeeding were over four residents living in the same household [odds ratio (OR) = 0.68, 90% confidence interval (CI) = 0.51-0.89] and mothers aged 30 years or more (OR = 0.68, 90% CI = 0.53-0.89). The factors that positively influenced breastfeeding were the following: higher socio-economic levels (OR = 1.37, 90% CI = 1.01-1.88), families with over two infants under 5 years (OR = 1.25, 90% CI = 1.00-1.58) and being a resident in rural areas (OR = 1.25, 90% CI = 1.00-1.58). Although majority of the mothers was aware of the value of maternal milk and breastfed their babies, the prevalence of breastfeeding remains lower than the rate advised by the World Health Organization, and the number of residents living in the same household along with mothers aged 30 years or older were both factors associated with early cessation of infant breastfeeding before 6 months.

Evaluation of quality improvement for cesarean sections programmes through mixed methods

BackgroundThe rate of avoidable caesarean sections (CS) could be reduced through multifaceted strategies focusing on the involvement of health professionals and compliance with clinical practice guidelines (CPGs). Quality improvements for CS (QICS) programmes (QICS) based on this approach, have been implemented in Canada and Spain. Objectives Their objectives are as follows: 1) Toto identify clusters in each setting with similar results in terms of cost-consequences, 2) Toto investigate whether demographic, clinical or context characteristics can distinguish these clusters, and 3) Toto explore the implementation of QICS in the 2 regions, in order to identify factors that have been facilitators in changing practices and reducing the use of obstetric intervention, as well as the challenges faced by hospitals in implementing the recommendations.MethodsDescriptive study with a quantitative and qualitative approach. 1) Cluster analysis at patient level with data from 16 hospitals in Quebec (Canada) (n = 105,348) and 15 hospitals in Andalusia (Spain) (n = 64,760). The outcome measures are CS and costs. For the cost, we will consider the intervention, delivery and complications in mother and baby, from the hospital perspective. Cluster analysis will be used to identify participants with similar patterns of CS and costs based, and t tests will be used to evaluate if the clusters differed in terms of characteristics: Hospital level (academic status of hospital, level of care, supply and demand factors), patient level (mother age, parity, gestational age, previous CS, previous pathology, presentation of the baby, baby birth weight). 2) Analysis of in-depth interviews with obstetricians and midwives in hospitals where the QICS were implemented, to explore the differences in delivery-related practices, and the importance of the different constructs for positive or negative adherence to CPGs. Dimensions: political/management level, hospital level, health professionals, mothers and their birth partner.DiscussionThis work sets out a new approach for programme evaluation, using different techniques to make it possible to take into account the specific context where the programmes were implemented.

Male and female involvement in the birth and child‐rearing process

AIMS AND OBJECTIVES To know the male involvement during pregnancy and childbirth, with special attention to their participation in public services of perinatal health and the impact that this participation has on their subsequent involvement in child-rearing, to compare the male and female involvement in child-rearing and to identify the factors associated with a greater male involvement. BACKGROUND Most of the research on male involvement in birth and child-rearing comes from Anglo-Saxon and Scandinavian countries. These studies show a lower involvement of men in relation to women, even in countries with instruments to promote gender shared responsibility. The Spanish Ministry of Health has developed strategies to improve the male involvement in the public services of perinatal health to advance in gender equality. This is a suitable context to contribute to the lack of information about fatherhood and the gender inequalities in the Spanish context. DESIGN Transversal design. METHODS A questionnaire was administered to 150 fathers and 157 mothers residing in Granada, with at least one biological child aged 2 months to 3 years. RESULTS A minority of the men attended the childbirth education whereas most of them attended pregnancy check-ups and were present at birth. Women spent more time with their children and took charge of tasks of child-rearing to a larger extent. The profile of an involved father is a man with a higher level of education, not married, his partner has a full-time employment, born in Spain and attended to the childbirth education classes. CONCLUSION This study shows gender inequalities in the reproductive field beyond the biological conditions. RELEVANCE TO CLINICAL PRACTICE The challenge of the health services is to promote social change and identify areas for improvement to include the father figure in public services of perinatal health.

A tool to analyse gender mainstreaming and care-giving models in support plans for informal care: case studies in Andalusia and the United Kingdom

Objective: To present a tool to analyse the design of support plans for informal care from a gender perspective, using the plans in Andalusia and the United Kingdom as case studies. Methodology: A tool was drawn up to analyse gender mainstreaming and care-giving models involved in the documents. In the gender mainstreaming aspect, a symbolic dimension (gender mainstreaming in the plan’s theoretical framework and analysis of situation) and an operational dimension (gender mainstreaming in the plan’s proposals and actions) were defined. Four care-giving models were analysed using the following categories: the plan’s definition of carer, focal point of interest, objectives and acknowledgement or otherwise of conflict of interests. A qualitative discourse analysis methodology was used. Results: The analysis tool used shows that the plans do not incorporate gender mainstreaming systematically, but there are interesting aspects from a gender perspective that are present at both a symbolic and an operational level. Both plans use a combination of care-giving models, but the model for superseding informal care is not included in either plan. Conclusions: The proposed tool proved useful for the examination of the gender perspective in the formulation of the plans selected for analysis. Both plans introduce measures to improve the quality of life of informal carers. However, gender mainstreaming also implies interventions that will change situations of sexual inequality and injustice that occur in informal care in the long term. Likewise, aspects of feminist theory must be considered in order to draw up plans and policies that are sensitive to informal care and the emancipation of women carers.

Indifference, Demandingness and Resignation Regarding Support for Childrearing

This article explores the maternal experiences of a heterogeneous group of 26 mothers from Granada (Andalusia, Spain). The aim is to analyse the needs and demands that these women express with regard to childrearing, using a qualitative methodology. The authors conducted in-depth interviews and analysed the discourses of the mothers following the hermeneutical method. The variables used for sample selection and the themes that emerged during the interviews revealed that the discourses of the mothers revolve around three dimensions: indifference, demands and resignation regarding support for childrearing. The lack of paternal involvement in childrearing appears as a transversal dimension. This article shows that the material conditions of existence marked the differences in the responses of the women regarding support for childrearing, while the sexual division of labour and gender inequalities unified their discourses.

Intimate partner violence in women with disabilities: perception of healthcare and attitudes of health professionals

Abstract Purpose: Intimate partner violence (IPV) is a major social problem and public health issue, but we still have a relatively small amount of data about partner violence in women with disabilities. The main objective of this study was to understand the experiences of women with disabilities who are or have been abused by their partners and to explore the knowledge, views and training requirements of primary care professionals. Method: Qualitative study using semi-structured interviews with women with disabilities who had experienced IPV (n = 14), and focus groups with healthcare professionals (n = 16). Results: Women with disabilities suffer specific forms of abuse. Because they depend on the people around them to take action, they are subordinate and this can prolong the abuse. The healthcare staff frequently mentioned that it is often difficult to notice that women with disabilities are being abused. Their lack of training about disabilities and gender-based violence makes them less sure of their ability to identify and deal with any possible cases of abuse. Conclusions: The difficulties described by the women interviewed are broadly speaking the same as those described by the healthcare professionals consulted. A number of suggestions for improvements are provided based on the results found. Implications for Rehabilitation The rehabilitation of abused disabled women implies that women perceive the health system as a resource to resolve their situation. Healthcare professionals should be trained on how to detect, treat and communicate with disabled women who experience partner violence. Is needed to establish a comprehensive system of coordination between services involved in caring for abused women and with disabilities.

Barriers and enablers in the implementation of a program to reduce cesarean deliveries

BackgroundConducting audits, implementing best practices and giving feedback to the professionals have shown considerable promise in reducing rates of cesarean delivery and mother-child morbidity. The purpose of the study is two-fold: a) to identify the factors that facilitate change in current practices and thus reduce the use of obstetric interventions, and b) to better understand the barriers to such changes. To reach these objectives, the study analyzed the experiences of professionals participating in a program to reduce cesarean rates in 20 hospitals in Andalusia (Spain).MethodsA qualitative exploratory study was conducted. Participants were 14 ob-gyns and 14 nurse-midwives who work for Spain’s National Healthcare System and have been involved in the program. To gather information, in-depth individual interviews were used. The interview was designed to examine factors affecting the quality of care, such as issues related to policy/management, hospitals, practitioners and patients.ResultsThe barriers identified include: 1) At the policy/management level: limited influence of institutional policy and the scant political commitment perceived. 2) At the organizational level: separation of the hierarchical structure of doctors from that of nurse-midwives, few positive incentives and the strong threat of sanctions for malpractice, inappropriate reorganization of midwife/obgyns competences. 3) At the healthcare staff and facility level: reluctance to change accentuated by years of professional practice. 4) Physical resources: obsolete delivery rooms with a medical look. 5) At the professional level: medical and legal pressure, cesarean delivery considered safe in the event of a legal claim, low motivation due to decline in working conditions, convenience-based practices. 6) Woman giving birth and her family: fear of pain, impatience while waiting for process to occur, misinformation. The enablers include: 1) At the organizational level: good coordination with pediatrics and emergency departments, 2) Training: skills updates for a less-interventionist approach, increased awareness, 3) Health professionals: satisfaction for a job well done, recognition by patients. 4) Woman giving birth: information circuits for patients and their families, trust in health professionals.ConclusionsThe results can contribute to the design of more effective knowledge translation interventions to reduce cesarean sections, based on overcoming obstacles, reinforcing enabling factors and attempting to (re)define the boundaries between research and practice.

Erratum to: ‘Evaluation of quality improvement for cesarean sections programmes through mixed methods’

Unfortunately, the original version of this article [1] contained an error. The acknowledgements was included incorrectly. The correct acknowledgements can be found below. The authors gratefully acknowledge the funding of this research provided by the Ministry of Health and Consumers’ Affairs - –Spain (FIS Exp. PI13/01340 and FEDER funds) and the CHIR- Quebec Training Network in Perinatal Research (QTNPR). The study funders had no role in the study design, data analysis, data collection, data interpretation or the writing of the report. The views expressed are those of the authors and not necessarily of the funding bodies.