The scale of violence described in this article is a very useful and reliable instrument to assess marital violence against women. It is suggested that this instrument be used in other settings to compare results with different samples.

BackgroundStructural and gender violence in Mexico take on various forms, obstetric violence among them. The objective of our study consisted in analyzing experiences of structural and gender discrimination against women during childbirth care at two public hospitals in Mexico.MethodsWe conducted a cross-sectional mixed methods study including a survey of closed questions administered to all women who received health care for vaginal or cesarean childbirth at two public hospitals from May 7 to June 7, 2012 (N = 512). Those who reported some form of abuse on the part of health-care professionals were then invited to complete a semi-structured interview (20 women agreed to participate). In addition, three focus groups were organized with health-care professionals from both institutions (31 participants): two were composed of nurses and one of obstetrician-gynecologists (OB-GYNs). This work deals with the qualitative component of the study.ResultsThe narratives of the health-care professionals interviewed contained expressions of health discrimination relating to certain characteristics of their clients, namely poverty, ignorance, failure to understand instructions and being women. The women, on the other hand, perceived themselves as belonging to a low social class and, as a result, behaved passively with staff throughout their hospital stay. They reported both physical and psychological abuse during care. The first included having their legs manipulated roughly, being strapped to the bed, and being subjected to multiple and careless pelvic examinations. Psychological abuse included reprimands, insults, disrespectful remarks, neglect and scowling gestures when requesting assistance.ConclusionsThe results of our study bear implications for the doctor-client relationship and for the health system in general. They suggest a need to dismantle medical practice – particularly with regard to obstetrics and gynecology - as it has been historically learned and internalized in Mexico. It is imperative to design public policies and strategies based on targeted interventions for dismantling the multiple forms of structural and gender violence replicated daily by actors in the health system.

Objetivo.Esta revisión sintetiza la evidencia cuantitativa, general y desglosada por categorías tipológicas de la falta de respeto y maltrato en la atención institucional del parto y el aborto en América Latina y el Caribe.Métodos.Mediante búsquedas sistemáticas se identificaron 18 estudios primarios. Se calcularon Q e I2y se realizaron metaanálisis, metarregresiones y análisis de subgrupos con la aplicación de un modelo de Der Simonian-Laird de efectos aleatorios agrupados con varianza inversa y la transformación arco-seno doble de Freeman-Tukey.Resultados.Se identificaron estudios realizados en cinco países de América Latina. No se identificaron estudios del Caribe. La prevalencia agregada de falta de respeto y maltrato durante el parto y el aborto fue de 39%. La medida agregada para este fenómeno durante el parto fue de 43% y la medida agregada en los casos de aborto fue de 29%. La heterogeneidad elevada no permitió generar medidas agregadas según categorías tipológicas. No obstante, se presentan las frecuencias de formas específicas del fenómeno agrupadas tipológicamente.Conclusiones.La evidencia sugiere que la falta de respeto y maltrato durante la atención del parto y el aborto son problemas de derechos humanos y salud pública prevalentes en algunos países de la Región. Es necesario lograr consenso internacional sobre la definición y operacionalización de este problema y desarrollar métodos estandarizados para su medición. Lo anterior es imprescindible para el alcance de las metas de la Agenda 2030 relacionadas con la reducción de la morbimortalidad maternoperinatal y la eliminación de todas las formas de violencia y discriminación contra la mujer.

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Objective. To asses the affective, cognitive, and behavioral attitudes of healthcare providers at the Mexican Institute of Social Security (MISS) in Morelos, Mexico; to identify the institutional and medical practice barriers that hinder screening and reference of battered women. Material and Methods. A cross-sectional study was conducted between September and December 1999. A self-administered questionnaire was applied to 269 general practitioners, specialists, and pre-and postdoctoral students working in 30 primary and secondary level of healthcare units in Morelos State. The data collection instrument was designed to assess healthcare providers' knowledge of and attitudes towards domestic violence during medical office visits. A knowledge index was constructed and analyzed using multivariate regression methods. Results. Ninety percent of healthcare providers had never received training on violence against women. Healthcare providers' affective and cognitive attitudes after receiving training on the subject matter were more favorable compared to those with no training. Favorable attitudes were directly related to the number of ResumenObjetivo. Evaluar la actitud afectiva, cognoscitiva y conductual del personal médico del Instituto Mexicano del Seguro Social del estado de Morelos, México, hacia la identificación y canalización de mujeres maltratadas que acuden a consulta médica, así como identificar las barreras institucionales y de la práctica médica que dificultan el manejo dentro de los servicios de salud de las mujeres maltratadas. Material y métodos. De septiembre a diciembre de 1999 se realizó un estudio transversal mediante un cuestionario de autoaplicación que se proporcionó a 269 médicos y médi-cas generales, especialistas y estudiantes de pre y posgrado que laboran en 30 unidades de salud, de primer y segundo nivel de atención, del Instituto Mexicano del Seguro Social del estado de Morelos. El instrumento se diseñó para evaluar el nivel de conocimiento sobre violencia doméstica y la actitud del personal médico hacia la atención, en la consulta, de mujeres maltratadas. Se construyó un índice de conocimiento, además de un análisis multivariado de los datos. Resultados. El 90% de los entrevistados nunca ha recibido capacitación en violencia contra la mujer. La actitud Violencia contra la mujer: conocimiento y actitud del personal médico del Instituto Mexicano del Seguro Social, Morelos, México