Advancing The Discourse On Obstetric Violence

Addressing violence against women is one of the most complex challenges of our modern society. Although there are multiple types of violence against women, this article will analyze obstetric violence in specific since it is a form of gender-based violence and a violation of human rights that is often ignored. Obstetric violence represents an almost inevitable consequence of the application of the current medical paradigm in almost all the countries of the Latin American region. It can be defined as the type of violence exerted by health professionals on women’s bodies and their reproductive processes. This type of violence usually occurs through the dehumanized treatment of pregnant women, which has varying manifestations that can be threatening in the context of sexual health care, pregnancy, childbirth, and postpartum circumstances.

Obstetric violence implies a violation of human rights as a manifestation of gender-based violence against women, as well as being a violation against the right to protection of health. Obstetric violence represents one of the most frequent forms of violation to human, sexual and reproductive rights against women. Furthermore, this type of violence constitutes a serious public health problem that has both economic and social consequences. It is important to note that obstetric violence lacks an exact definition, but although it is usually related exclusively to the experience of childbirth, it actually includes several additional domains in the field of sexual and reproductive health. Among others, such domains can include contraception, family planning, abortion and menopause.

Little by little, the term “obstetric violence” has been promoted by social movements in different parts of the world to denounce what many women understand as disrespectful and violent practices carried out by medical personnel during the care of their deliveries.

Examples of obstetric violence
Obstetric violence portrays a violation of human rights and a serious public health problem. It manifests itself in the form of negligent, reckless, exclusionary, discriminatory, and disrespectful acts practiced by health professionals. Obstetric violence has been legitimized by the symbolic power relations that health professionals naturalize, leading to the trivialization of its occurrence.

There are different actions that can be considered obstetric violence. For example, physical obstetric violence can occur when a woman undergoes invasive practices such as an unjustified administration of medication. Such practices may not be suited to the condition of the woman in labor or of the unborn person and is especially problematic when there is physical abuse involved. Among other abuses, undue harm occurs when biological delivery times are not respected or when episiotomies are performed improperly. Beyond the harms of physical abuse, psychological obstetric violence is also a prevalent and damaging occurrence. It can manifest in varying forms of humiliation, verbal abuse, dehumanization, rude treatment and discrimination. It is of particular concern when a woman seeks professional advice and attention, as they often do in the course of obstetric practice. Similarly, other examples of violence include authoritarian procedures imposed upon women. Such examples include coercive pressures into the use of particular contraceptive methods, or pressures to perform an unwarranted cesarean section procedure. Among others, obstetric abuse can also extend to include violations of confidentiality, the omission of information, violations of privacy, involuntary or poorly-informed consent, denials of treatment, lack of anesthesia in curettage and even the detention of women and newborns due to an inability to pay.

Obstetric violence in figures

The data pertaining to obstetric violence is alarming. In Ecuador, a study carried out by the National Institute of Statistics and Censuses revealed that 48 out of 100 women felt offended, uncomfortable, or humiliated by a comment or question from the gynecologist who tended to them. Abuse is more frequent in rural areas where the number of women who have suffered this type of abuse rises to 55. In addition, the figures indicate that 70 out of 100 indigenous women were mistreated at their gynecological appointments and 60 out of 100 older adult women suffered similar abuse.

In Mexico, the National Institute of Statistics and Geography determined that between 2011 and 2016, 33.4% of women between the ages of 15 and 49 who had childbirth suffered some type of mistreatment by the personnel who attended them. In addition, of the 3.7 million women who underwent a cesarean section, 10.3% were not informed of the reason, and 9.7% were not asked for their authorization to perform the surgical procedure. In Argentina, according to the National Index of Sexual Violence (a survey that collected more than 59,000 testimonies), 77% of women claimed to have suffered some form of obstetric violence.

In recent years, especially in the United States, there has been increasing public attention to this health problem. Many U.S. institutions and health providers have expressed their rejection of the harassment and harmful practices used by health care personnel against pregnant women during their labor. It should be taken into account that the practice of cesarean sections, inductions, episiotomies and other procedures that are not medically necessary, or that do not have informed consent, is prohibited in the legislation of countries such as Argentina, Ecuador, Mexico, Uruguay, and Venezuela; however, in practice, cases continue to occur and as a result of the pandemic, the situation has actually worsened.

Violence against women is a frequent and persistent global problem that induces high economic and social costs. The health crisis in Latin American countries is especially prevalent being that they lack the adequate personnel, technological support and resources to remedy the situation. Nevertheless, this reality does not justify any ignorance of the mistreatment against women. All women, without distinction, deserve to exercise their right to access a life free of violence through all stages of their lives. There is still much to do, therefore, it is necessary to continue to advance the discourse and to support avenues toward a society free of gender-based violence.

Desirée Viteri Almeida
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