An Impact Evaluation of the Strategy for Normal Birth Care on Caesarean Section Rates and Perinatal Mortality in Spain

The objectives of this research are to evaluate the impact of a health policy (the Strategy for Normal Birth Care, EAPN) on caesarean rates and perinatal mortality in Spanish public hospitals belonging to the National Health System (NHS) and to assess the related cost savings. Data from the Spanish Ministry of Health for the period 2002 −2011 and quantitative impact evaluation techniques (double difference method) are used to compare the effects of this policy in a treatment group composed of the NHS hos- pitals and a control group made up of private for-profit hospitals outside the scope of the EAPN. Both groups are compared some years before and after the health policy initiated in 2006 and approved in October 2007. The estimation results show that the EAPN had a significant effect in reducing caesarean rates of approximately 2 percentage points between 2007 and 2011, with increasing cost savings over the years ranging from 24 to 44 million euros depending on the year. Furthermore, EAPN reduced perinatal mortality levels by 0.08% in years 20 08 −20 09

La atención al parto en España: Cifras para reflexionar sobre un problema

Childbirth is the first reason for hospitalization in Spain. After giving birth, it is not easy to get out unscathed from the hospital, in the sense of not having gone through a surgery (cesarean), a cut in the vagina (episiotomy), or other invasive procedures. The aim of this article is to question how scientific evidence is integrated in medical decisions about the delivery. For this, the article describes and analyzes the existing variability of perinatal care in Spain, which shows that the result of the delivery depends much more on factors such as the geography zone or whether the hospital is public or private, rather than the delivery process of women itself. It also analyzes the adequacy of interventions to the standards set by organizations such as the World Health Organization and the Ministry of Health.El parto es el motivo número uno de ingreso hospitalario en España. Después de parir, no es fácil salir ilesa del hospital, en el sentido de no haber sido sometida a una operación quirúrgica (cesárea), a un corte en la vagina (episiotomía), o a otras intervenciones invasivas. El objetivo de este artículo es cuestionar el modo en que la evidencia científica se integra en las decisiones médicas en torno al parto. Para ello, el artículo describe y analiza la variabilidad de la atención perinatal existente en España, que demuestra que el resultado de un parto depende mucho más de factores como la zona geográfica o de si el centro hospitalario es público o privado, que del propio proceso de parto de la mujer. Además analiza la adecuación de las intervenciones a los estándares fijados por organismos como la Organización Mundial de la Salud o el Ministerio de Sanidad

El parto es nuestro: El impacto de una asociación de usuarias en la reforma del sistema obstétrico de España

This paper analyzes the contribution of the civil society association Birth is Ours (El Parto es Nuestro) to the reform of the obstetric health system in Spain from its origins in 2003 until the present years. The aim is to show to which extent the user’s association Birth is Ours has contributed to deliberative democracy within the medical arena in Spain. To understand the kind of debate produced by childbirth activism in Spain, Marcelo Dascal’s theory of controversies will be used. In relation to this theory, this article presents three epistemological hypotheses. First hypothesis: the civil society association Birth is Ours has contributed to deliberative democracy in Spain and Europe by deeply engaging in the obstetric debate as to achieve the move from phase 1 – an initial phase of technical discussion between 2001 and 2004 – to phase 2 – an intermediate phase of technical dispute between 2004 and 2007 –, and to phase 3 – the actual state of technical controversy from 2007 until now. Second hypothesis: around childbirth there is nowadays a debate that we classify as controversy, following Dascalian terms. Many examples of obstetric controversies relate to when and why particular medical interventions are or are not necessary. Third hypothesis: linguistic innovation is one of the factors that turn a discussion or a dispute into a controversy. The article concludes that the civil society association Birth is Ours has: 1) given visibility to the situation of childbirth in Spain; 2) opened a controversy around obstetric issues; 3) helped to implement very important legal, social and political changes in its context. Consequently, Birth is Ours has played, and continues playing, a critical role in assessing obstetric issues. It has then assumed the shared social responsibility that is peculiar of what Bunge calls an “integral democracy” (Bunge, 2013).Este trabajo analiza la contribución de la asociación civil El Parto es Nuestro a la reforma del sistema de salud obstétrica vigente durante los últimos diez años en España. El objetivo del estudio es mostrar hasta qué punto esta asociación de usuarias ha contribuido de manera directa al desarrollo de la democracia deliberativa en el campo sanitario en España. Como instrumento de análisis para explicar el tipo de debate que el activismo en torno al parto y nacimiento ha puesto en marcha durante estos años en nuestro país, este trabajo utiliza una herramienta novedosa: la teoría de las controversias de Marcelo Dascal y su tipología de los debates como discusiones, disputas y controversias. En relación con esta teoría, el presente capítulo presenta tres hipótesis epistemológicas. La primera hipótesis sostiene que la asociación El Parto es Nuestro ha contribuido al desarrollo de la democracia deliberativa en España al implicarse de manera activa en el debate obstétrico para lograr el paso desde lo que podemos considerar un primer periodo – una fase inicial de discusión, en sentido técnico dascaliano, entre 2001 y 2004 – a través de un segundo periodo – una fase intermedia de disputa, entre 2004 y 2007 – hasta llegar al tercer periodo actual – la fase de controversia, desde 2007 hasta el presente. La segunda hipótesis considera que el debate en torno al nacimiento es, en estos momentos en nuestro contexto, una controversia, en términos estrictos dascalianos. La tercera hipótesis de trabajo identifica la innovación conceptual como uno de los factores que transforman un debate tipo discusión o disputa en un debate tipo controversia. Este texto localiza, presenta y analiza algunos datos y situaciones concretos que permiten formular y validar cada una de dichas hipótesis. Como conclusión, el estudio sostiene que esta asociación: 1) ha contribuido a hacer visible la situación del parto y nacimiento en España; 2) ha abierto el espacio argumental para que en el campo de la obstetricia puedan surgir debates que son técnicamente controversias; 3) ha contribuido a implementar cambios legales, sociales y políticos de gran alcance dentro de su propio contexto. Por estas razones, el estudio considera que la asociación ha jugado, y continúa jugando, un papel crítico y central al asumir la responsabilidad social compartida que debe caracterizar la evaluación de la atención sanitaria en lo que Mario Bunge ha definido como “democracia integral” (Bunge, 2013)

Developing and testing a protocol using a common data model for federated collection and analysis of national perinatal health indicators in Europe

Context: International comparisons of the health of mothers and babies provide essential benchmarks for guiding health practice and policy, but statistics are not routinely compiled in a comparable way. These data are especially critical during health emergencies, such as the coronavirus disease (COVID-19) pandemic. The Population Health Information Research Infrastructure (PHIRI) project aimed to promote the exchange of population data in Europe and included a Use Case on perinatal health. Objective: To develop and test a protocol for federated analysis of population birth data in Europe. Methods: The Euro-Peristat network with participants from 31 countries developed a Common Data Model (CDM) and R scripts to exchange and analyse aggregated data on perinatal indicators. Building on recommended Euro-Peristat indicators, complemented by a three-round consensus process, the network specified variables for a CDM and common outputs. The protocol was tested using routine birth data for 2015 to 2020; a survey was conducted assessing data provider experiences and opinions. Results: The CDM included 17 core data items for the testing phase and 18 for a future expanded phase. 28 countries and the four UK nations created individual person-level databases and ran R scripts to produce anonymous aggregate tables. Seven had all core items, 17 had 13-16, while eight had ≤12. Limitations were not having all items in the same database, required for this protocol. Infant death and mode of birth were most frequently missing. Countries took from under a day to several weeks to set up the CDM, after which the protocol was easy and quick to use. Conclusion: This open-source protocol enables rapid production and analysis of perinatal indicators and constitutes a roadmap for a sustainable European information system. It also provides minimum standards for improving national data systems and can be used in other countries to facilitate comparison of perinatal indicators

Developing and testing a protocol using a common data model for federated collection and analysis of national perinatal health indicators in Europe

Context: International comparisons of the health of mothers and babies provide essential benchmarks for guiding health practice and policy, but statistics are not routinely compiled in a comparable way. These data are especially critical during health emergencies, such as the coronavirus disease (COVID-19) pandemic. The Population Health Information Research Infrastructure (PHIRI) project aimed to promote the exchange of population data in Europe and included a Use Case on perinatal health. Objective: To develop and test a protocol for federated analysis of population birth data in Europe. Methods: The Euro-Peristat network with participants from 31 countries developed a Common Data Model (CDM) and R scripts to exchange and analyse aggregated data on perinatal indicators. Building on recommended Euro-Peristat indicators, complemented by a three-round consensus process, the network specified variables for a CDM and common outputs. The protocol was tested using routine birth data for 2015 to 2020; a survey was conducted assessing data provider experiences and opinions. Results: The CDM included 17 core data items for the testing phase and 18 for a future expanded phase. 28 countries and the four UK nations created individual person-level databases and ran R scripts to produce anonymous aggregate tables. Seven had all core items, 17 had 13-16, while eight had ≤12. Limitations were not having all items in the same database, required for this protocol. Infant death and mode of birth were most frequently missing. Countries took from under a day to several weeks to set up the CDM, after which the protocol was easy and quick to use. Conclusion: This open-source protocol enables rapid production and analysis of perinatal indicators and constitutes a roadmap for a sustainable European information system. It also provides minimum standards for improving national data systems and can be used in other countries to facilitate comparison of perinatal indicators

Population birth data and pandemic readiness in Europe

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadThe SARS-CoV-2 pandemic exposed multiple shortcomings in national and international capacity to respond to an infectious disease outbreak. It is essential to learn from these deficiencies to prepare for future epidemics. One major gap is the limited availability of timely and comprehensive population-based routine data about COVID-19's impact on pregnant women and babies. As part of the Horizon 2020 PHIRI (Population Health Information Research Infrastructure) project on the use of population data for COVID-19 surveillance, the Euro-Peristat research network investigated the extent to which routine information systems could be used to assess the effects of the pandemic by constructing indicators of maternal and child health and of COVID-19 infection. The Euro-Peristat network brings together researchers and statisticians from 31 countries to monitor population indicators of perinatal health in Europe and periodically compiles data on a set of 10 core and 20 recommended indicators.Horizon 2020 Framework Programm

Population birth data and pandemic readiness in Europe

The SARS-CoV-2 pandemic exposed multiple shortcomings in national and international capacity to respond to an infectious disease outbreak. It is essential to learn from these deficiencies to prepare for future epidemics. One major gap is the limited availability of timely and comprehensive population-based routine data about COVID-19's impact on pregnant women and babies. As part of the Horizon 2020 PHIRI (Population Health Information Research Infrastructure) project on the use of population data for COVID-19 surveillance, the Euro-Peristat research network investigated the extent to which routine information systems could be used to assess the effects of the pandemic by constructing indicators of maternal and child health and of COVID-19 infection. The Euro-Peristat network brings together researchers and statisticians from 31 countries to monitor population indicators of perinatal health in Europe and periodically compiles data on a set of 10 core and 20 recommended indicators1