The decentralization of health systems can have direct repercussions on maternity care. Some inequalities can be noted in outcomes, like neonatal and child mortality in Spain. This study aimed to make the presence of obstetric violence in Spain visible as an interterritorial equity criterion. A descriptive, restrospective and cross-sectional study was conducted between January 2018 and June 2019. The sample comprised 17,541 questionnaires, which represented all Spanish Autonomous Communities. Of our sample, 38.3% perceived having suffered obstetric violence; 44.4% perceived that they had undergone unnecessary and/or painful procedures, of whom 83.4% were not requested to provide informed consent. The mean satisfaction with the attention women received obtained 6.94 points in the general sample and 4.85 points for those women who viewed themselves as victims of obstetric violence. Spain seems to have a serious problem with public health and respecting human rights in obstetric violence. Offering information to women and requesting their informed consent are barely practiced in the healthcare system, so it is necessary to profoundly reflect on obstetric practices with, and request informed consent from, women in Spain.

Background: obstetric violence can partially be represented by the high number of interventions and medicalization rates during the birthing process. The objective of the present study was to determine the interventionism and medicalization levels during childbirth in Spain. Methods: a descriptive, retrospective, and cross-sectional study was conducted between January 2018 and June 2019. Results: the intervention percentages were 34.2% for Kristeller maneuver and 39.3% for episiotomy. Differences appeared in public, private, and mixed healthcare settings (p < 0.001). The mean satisfaction, with healthcare in the different settings, was estimated at 6.88 points (SD ± 2.146) in public healthcare, 4.76 points (SD ± 3.968) in private healthcare, and 8.03 points (SD ± 1.930) in mixed healthcare (p < 0.001). No statistically significant differences were found in Spanish autonomous communities. Conclusions: births in Spain seem to be highly intervened. In this study, a certain equity criterion was found concerning interventionism during childbirth in Spain. Healthcare influenced female intervention, satisfaction, and perception levels for obstetric violence; this evidences that female empowerment plays an important role.

Background: Obstetric violence is a worldwide public health problem, which seems greater in Spain. As no studies were found that identify the most representative healthcare professionals, times, and areas involved in obstetric violence, the objective of this work was to study at what time of maternity, with which professionals, and in what areas women identified obstetric violence. Methods: This descriptive, retrospective, and cross-sectional study was performed from January 2018 to June 2019. The main variables were the area (hospital, primary care, both), the time (pregnancy, birth, puerperium), and the professionals attending to women. Results: Our sample comprised 17,541 participants. The area identified with the most obstetric violence for the different studied variables was hospitals. Women identified more obstetric violence at time of birth. Findings such as lack of information and informed consent (74.2%), and criticism of infantile behavior and treatment (87.6%), stood out. The main identified healthcare professionals were midwives and gynecologists, and “other” professionals repeatedly appeared. Conclusions: Having identified the professionals, times, and areas of most obstetric violence in Spain, it seems necessary to reflect on not only the Spanish National Health System’s structure and management but also on healthcare professionals’ training.

Catalan legislation, a pioneer in Europe, has defined obstetric violence (OV) as “preventing or hindering access to truthful information, necessary for autonomous and informed decision-making”. The definition also states that OV can affect physical and mental health, as well as sexual and reproductive health. Some authors have expressed concern about an increase in OV during the SARS-CoV-2 pandemic. During the pandemic, recommendations were also openly offered on the non-establishment and/or early abandonment of breastfeeding without scientific evidence to support them. Experiencing a traumatic childbirth can influence breastfeeding outcomes. Here, we conducted a cross-sectional study using a self-administered online questionnaire. The sample consisted of women who gave birth in Spain between March 2020 and April 2021. The mean age was 34.41 (±4.23) years. Of the women, 73% were employed, 78.2% had a university education, and almost all were Caucasian. Among the subjects, 3.3% were diagnosed with SARS-CoV-2 during pregnancy and 1% were diagnosed during delivery. Some of the women (1.6%) were advised to stop breastfeeding in order to be vaccinated. Women diagnosed with SARS-CoV-2 during delivery (p = 0.048), belonging to a low social class (p = 0.031), with secondary education (p = 0.029), or who suffered obstetric violence (p < 0.001) perceived less support and that the health care providers were less inclined to resolve doubts and difficulties about breastfeeding. Breastfeeding has been significantly challenged during the pandemic. In addition to all the variables to be considered that make breastfeeding support difficult, we now probably need to add SARS-CoV-2 diagnosis and OV.

Background: Developed countries report specific issues regarding the declining midwifery workforce, and their shortage could have serious consequences for women’s sexual and reproductive health. The aim was to understand the perception of autonomy among midwives working in Spain, as well as factors related to their intention to leave the profession and their work environment. Method: A descriptive and cross-sectional study using an online questionnaire. Population: midwives working in Spain in any field (clinical, research, teaching, or management). Results: A sample of 1060 midwives was obtained. Of these, 53.7% (n = 569) feel autonomous in their work, 92.4% (n = 978) perceive that their profession frequently suffers from external interference, 46.6% (n = 494) have experienced sexist behaviors at work, and 53% (n = 561) have considered leaving the profession in the last year. Midwives with less than 10 years of experience (57.7%), those aged 31–45 years (59.8%), those with temporary contracts (38.3%), and those working in hospital care (71.9%) show a higher rate of considering leaving the profession (p < 0.001). Conclusions: Considering the current midwifery workforce crisis in Spain, it seems urgent to improve the working conditions of midwives to ensure the continuity and quality of women’s sexual and reproductive healthcare.

Background/Objectives: The aim of this study is to analyse the association between sociodemographic and obstetric characteristics and perceived or suspected obstetric violence in Spain, informed by an intersectional framework. Methods: A cross-sectional study was conducted using a non-probabilistic online survey of women who gave birth in Spain between March 2020 and April 2021. “Yes” and “do not know” responses were combined as perceived or suspected obstetric violence. Descriptive and bivariate analyses (chi-squared and Fisher’s exact tests) were followed by a multivariable binary logistic regression including, a priori, age, occupation, educational level, social class, ethnicity, type of birth, type of healthcare and autonomous community. Results: Of 6060 women, 33.5% (n = 2030) reported or suspected obstetric violence. In the adjusted model (n = 5978; Nagelkerke R² = 0.071), the outcome was associated with all variables except social class. Odds were higher after urgent caesarean section (aOR = 2.16) and instrumental birth (aOR = 2.76) than after vaginal birth, and lower in private than in public healthcare (aOR = 0.67). Estimates for ethnic minorities were very imprecise because of the small size of these groups. Conclusions: Perceived or suspected obstetric violence was associated with several sociodemographic, obstetric and healthcare characteristics, most strongly with type of birth, although the explanatory capacity of the model was low. These findings support reviewing interventionist obstetric practices and using sampling strategies that include minority groups.