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We Need To Talk About Obstetric Violence

Expectant mothers deserve proper care when giving birth. Instead, some face forced surgery, bullying, coercion, and insufficient pain relief.

Obstetric violence is a public health problem and directly affects rates of maternal mortality. (Kibae Park/UN Photo)

By Vijayetta Sharma, Manav Rachna International Institute of Research and Studies

FARIDABAD, Feb 27 – Women being threatened with beatings for screaming during labour. Women forced to deliver babies on the floor despite the availability of labour beds. Women handed plastic bags containing the unwashed bodies of their stillborn children.

These are just some of the horrific stories that have emerged from investigations into abuse and mistreatment of expectant mothers in several parts of India.

The deplorable condition of primary health centres and lack of facilities in rural areas are breeding grounds of obstetric violence at the hands of doctors, midwifes and others, which has been compared to rape.

An accredited social health activist from Ropar district in Punjab told this researcher how one woman pretended to go to the toilet and fled a primary health centre out of fear of the treatment she’d receive.

“When she did not return from the toilet after 10 minutes, I rushed to the village,” the social worker said.

“To my surprise, I found her with the lady sarpanch (elected head of the village). The baby’s head was out when she reached home.”

Obstetric violence — defined as mistreatment, disrespect and abuse or dehumanised care of women during childbirth — is a public health problem that directly affects rates of maternal mortality

Forced surgery, lack of consent for procedures such as episiotomies and vaginal examinations during birth, bullying, coercion, and non-cooperative attitudes are common.

Gendered shame, insufficient pain relief, and unethical medical practices are other crude manifestations of this medical malpractice.

Across the world, there is an under-recognised history of obstetric violence.

These obstetric practices mirror the attitudes of abusive men in that they attempt to coercively control women through manipulation and violence, name-calling and character attacks. 

Obstetric violence can also be directed towards women by other women or be marked by aspects of violence that deviate from protocol.

These practices all infringe on the basic principles of autonomy, justice, dignity and the obligation of a physician not to harm the patient.

Women’s subordinate social position in many countries enables this practice to silently continue behind closed doors.

A culture of impunity gives health providers a free hand. 

The irony is that many medical professionals consider labour-room abuse justified as a delivery strategy.

They argue about what degree of violence can be considered gentle, justifying certain acts as “non-violent”.

Passive submission to obstetric violence, dismissal of women’s voices in labour, normalisation of violence, power dynamics between health professionals and patients, and training models that ignore obstetric violence practices all exacerbate the situation in labour rooms. 

Abortion-related obstetric violence has been more frequent in settings that legally restrict abortions.

Threats and violence at the hands of midwifes during birthing has been compared to rape

Indeed, obstetric violence is also sometimes termed “birth rape“. 

Qualitative studies show that such abusive experiences exacerbate victims’ anxiety, helplessness, anger and fear, with many lapsing into postpartum depression or post-traumatic stress disorders.

While there is no specific law against obstetric violence under Indian law, it is considered a human rights violation under international law.

In January 2023, the Inter-American Court of Human Rights recognised obstetric violence as a human rights violation after a pregnant woman in Argentina, who was found to have a dead foetus in her ninth month of pregnancy, died of cardiac arrest after she was hospitalised to induce labour. 

The court found she had not received appropriate medical treatment considering known risk factors of her pregnancy which led to death of the foetus, and wasn’t given necessary information on treatment alternatives.

In 2022, the United Nations Committee on the Elimination of All Forms of Discrimination Against Women found that a forced C-section delivery without informed consent was performed on a Spanish woman — who was also forbidden from eating during labour — had been subjected to obstetric violence and violation of her human rights. 

Some countries do recognise obstetric violence in national laws.

Obstetric violence as a legal term was introduced in Venezuela in 2007 when the “Organic Law on the Right of Women to a Life Free of Violence” came into force. Several other countries in South and Central America have recognised obstetric violence as a legal concept, including Argentina, Mexico, and Uruguay.

Despite concerns about different types of obstetric violence raised by human rights organisations, social movements and academics, there is a dearth of investigations, evidence-based record creation and legislation.

Clear statistical data on the prevalence of obstetric violence worldwide is missing, despite campaigns and living in an age marked by digitisation, artificial intelligence and ethical governance.

Governments have largely ignored the issue, and this medical malpractice has been overlooked and loosely defined by public and private healthcare institutions. This can be pinned to the failure of the medical establishment to confront maternal health issues.

Healthcare institutions and professionals could be first to be held responsible for episodes of obstetric violence on their premises. 

Carefully chartered management and policy strategies to identify obstetric violence — and track how it applies along lines of class, gender, race, and medical power — would help offer respite to expecting mothers.

If these practices are not treated, progress bywomen’s reproductive rights movements, which have fought hard for dignity of care and bodily integrity, could backslide.

Health care institutions and professionals could be made fully accountable for unethical practices inside or outside the labour room which diminish the women’s dignity during delivery.

The judicial system’s role in recognising and punishing obstetric violence in India needs strengthening.

The law could introduce safeguards for women’s rights and choices in obstetric care — ensuring each mother can choose her birthing position, support person and pain control (including non-pharmacological methods) — and that she is given equitable treatment irrespective of caste and socio-economic status.

Obstetric violence legislation in India could clearly lay down the authority, definitions and remedies for physical abuse, verbal abuse, non-confidential and non-consented care, negligent and discriminatory care, and non-dignified care towards women in all stages of pregnancy, childbirth and new motherhood. 

These laws could cover private and public births, as well as home births.

Adoption and use of birth plans by public and private healthcare organisations could help reduce, control or eradicate obstetric violence and misogyny in birth practices.

Women feeling safe and cared for during their pregnancy will result in better maternal and child health.

Ultimately, a flourishing care regime that prioritises women’s concerns, pain management and dignity requires that women are given the right to participate in decisions concerning their labour.

Vijayetta Sharma is an associate professor of public policy at Manav Rachna International Institute of Research and Studies. 

Article courtesy of 360info. 

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