Thousands of women around the world experience obstetric violence during labor such as verbal abuse, induced births or unjustified caesarean sections. This occurs within hospitals by doctors and health personnel towards pregnant women. A type of violence naturalized and made invisible, despite the fact that the United Nations recognized it in 2019. “When our health is attacked, our right to live full lives is being attacked,” says Marta Busquets, an expert lawyer in Law, Gender and Health .
Invisible, naturalized and even unknown. Obstetric violence is part of the practices carried out by health professionals to women during pregnancy, childbirth and postpartum and that by action or omission are violent or can be perceived as violent. From unjustified caesarean sections, induced births or archaic maneuvers that can harm the health of women and newborns.
In 2019, the United Nations recognized this type of violence as a “widespread and systematic phenomenon of this form of violence” that affects thousands of women around the world every day. And it published a report that provides recommendations on how to address the structural problems and root causes of violence against women in reproductive health services.
The World Health Organization also recommends that countries do not exceed 10% of deliveries by cesarean section, something that is not met in practically any nation. Latin America has one of the highest rates of cesarean sections, with the Dominican Republic leading the list, followed by Brazil. In the region, Venezuela became in 2007 the pioneering nation in regulating obstetric violence. Other countries such as Argentina, Panama, Mexico, Bolivia and Brazil are implementing regulations to reduce this violence against mothers.
And it is that many times the woman becomes a passive actor once she crosses the doors of a hospital room, losing autonomy over her body. Last Wednesday, August 31, World Obstetrics Day was celebrated and this Friday France 24 spoke with Marta Busquets, a Spanish lawyer specializing in Law, Gender and Health:
France 24: When does obstetric violence occur?
Marta Busquets: I believe that there is a first phase in activism in relation to obstetric violence that has to do with the excess of intervention or the excess of neutralization. Here we could think of an excess of caesarean sections, of inductions, which exceed international recommendations, in forcing women to give birth in certain positions, in performing interventions without medical necessity and only routinely and that may be aggressive.
Another aspect has to do with a legal perspective. Beyond the scientific evidence of certain interventions and statistics, we have to take into account that women are full-fledged people with fundamental rights. Therefore, we have the right to inform ourselves, to give consent, to be able to decide what type of birth we want to have in relation to our children.
France 24: What can be the consequences of, for example, an episiotomy (an incision made in the perineum – the tissue between the vaginal opening and the anus – during childbirth) on the physical and mental health of the mother?
MB: Episiotomy is often a practice that is trivialized. In many places it was a practice that was completely routine despite the fact that it had to be done at very specific times, with very specific indications.
Many women report, and I see it as a lawyer, serious injuries to their pelvic floor, tensions that can enhance incontinence, whether urinary, can cause significant pain, that this woman cannot carry out activities such as working and standing, sitting, having satisfying sexual intercourse, and so on.
All of this can have a real impact on your life. Even if it doesn’t have a long-term affectation, the fact that you have just had an episiotomy can make you spend a very sore postpartum, with difficulty sitting, lying down, with difficulty breastfeeding. Because you’re in pain, it’s harder for you to recover or bond with the baby.
The “husband point” thing (consists of adding a point to the episiotomy process so that the vaginal orifice is narrower and can give the man greater sexual pleasure at the time of intercourse) in theory it happens less and less, but we know that it continues happening and there are women who report that this comment has been made to them, which is unfortunate.
It is violent because it has nothing to do with what a woman’s physical or mental well-being needs, but directly converting her sexual organs or her body into a place where the priority is the pleasure associated with a male partner.
France 24: What women’s rights are violated when a health professional exercises this type of violence? What can women do to seek redress for this damage?
MB: The Convention for the Elimination of Violence against Women has a protocol in relation to health and says that women have the right to live our health, our lives, fully and with dignity. When our health is threatened, our rights to live full, dignified lives are being violated.
Here obviously there are violations of rights that we normally think of in a more humane or general way. For example, if they do not inform me or they inform me and do not ask for my consent to carry out an intervention, what they are doing is attacking my physical or moral integrity because an intervention is being carried out on my body that I have not consented to. Also, if they make inhuman, degrading comments to me… it could also be an attack and there have been some sentences of the European Court of Human Rights in this sense.
With which there may be a real affectation of our rights. For example, in relation to privacy, if our data is shared with students that we have not allowed, that these students access or intervene with us, our privacy and the secrecy of our medical data may also be violated.
As you pointed out, the special report made by the United Nations rapporteur also spoke in this sense and was close or positively expressed in relation to this.
France 24: What is needed within the health systems so that this does not happen? What kind of pedagogy or special training for health personnel is needed?
MB: One of the things the UN said is that States have to be, and health systems, directly responsible for what is happening. It is true that a lot of emphasis is placed on pedagogy, on training, on the replacement of professionals; it seems that the younger professionals are trying to change things.
But it also goes through public policies, not only because of a training issue. In many countries there have been cuts at the level of health budgets and this means fewer teams or less paid teams, a poorer environment both at the level of material and personal means. This also has direct repercussions on the service that will be able to be provided because, as much as I want to work well, if I am alone and have to deal with a very large ratio of women and, furthermore, I have no means, I am surely going to end up immersed in situations that are violence towards users.
I think that we also have not resolved what to do when a woman complains of obstetric violence, alternative ways to judicialization in case of malpractice to be able to intervene on this.
Unfortunately, for example, in Spain, where there was this sexual and reproductive law reform, there has not even been a consensus at the state level on the term obstetric violence, so there is still a lot left at the political level in this area.
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