‘No visitors. Induced labor. Converted delivery wards. Tens of thousands of women across the country are giving birth in unprecedented circumstances.’ Maternal healthcare is changing around the world in response to COVID-19. Many of these measures intended to curb the pandemic are at tension with a range of women’s rights in childbirth and deserve close scrutiny.

Problems in maternal healthcare during COVID-19

Different methods are being used to tackle the pandemic around the world. The responses show that, despite current evidence and WHO guidelines, in a crisis, structural violations of women’s rights may quickly become the norm, justified as necessary to contain the epidemic. Some of these include:

• Women being denied the right to a companion during labour and birth, as well as visitors;
• Women increasingly being subjected to (forced) inductions and caesarean sections with no obstetric indication;
• Women being separated from their infants;
• Maternity services de-prioritised with regards to adequate staffing, personal protective equipment for staff and other resources;
• Closing of community and out of hospital maternity services (birth centres and home birth);
• Decades-long practices of centralising maternity care in hospitals resulting in a situation where healthy women must give birth in institutions also caring for COVID-19 patients and raise their own risk of infection.

Women’s rights in childbirth

Many of these practices may amount to violence against women and are at tension with a range of rights, including the right to be free from torture, inhuman and degrading treatment, the right to private life and the right to non-discrimination.

Although temporary restrictions to certain rights and freedoms are allowed under international human rights law it is essential that these measures have a legal basis, are proportionate, necessary and non-discriminatory and are designed to minimise interference with human rights. Many of the measures that are being adopted in maternal healthcare settings do not live up to these requirements. Besides the fact that little or no evidence has been provided for the effectiveness of these measures (and the WHO has advised against them), a number of other countries have shown that less invasive responses are possible. The Netherlands, for example, has converted hotels near obstetric units into popup birth centres, and in New Zealand women who are asymptomatic are still able to choose their place of birth. In France, women can have a birth companion who is asymptomatic and whose movement within facilities is restricted to lower the chances for disease transmission.

Systemic discrimination

The UN Special Rapporteur on Violence against Women (UN SR-VAW) recognises that mistreatment and violence against women during childbirth occurs in the wider context of structural inequality, discrimination and patriarchy. Harmful gender stereotypes in the reproductive health context, ideas about ‘women’s natural role in society and motherhood’ and the belief that childbirth is an event that requires suffering on the part of the woman are being used to limit autonomy and agency. These gendered beliefs, coupled with the power imbalance that exists between healthcare providers and pregnant women (particularly apparent in instances in which providers abuse the doctrine of medical necessity in order to justify mistreatment and abuse during childbirth) require us to be highly critical of harmful short-term remedies in the context of maternal healthcare and make it necessary to search for more proportional alternatives.

Final remarks

The COVID-19 pandemic requires a swift global response to contain the virus’ spread and protect the life and health of others. But this does not mean that states can use any means to achieve this. UN human rights experts have called upon states to maintain a human rights-based approach to regulating the COVID-19 outbreak and have held that the pandemic should not be used as an excuse to target the rights of particular groups, minorities or individuals, nor should it be used as cover for repressive action under the guise of protecting health.

We should be wary of any use of the pandemic to institutionalise harmful practices in maternal healthcare and ensure that hardwon rights in childbirth are not needlessly overrun.