Image description: Text that reads, ‘reproductive rights are non-negotiable’.
Obstetric Violence (OV) is a global health problem. Whilst this terminology alludes to notions of physical harm, OV also encompasses, “disrespect”, “coercion” and “verbal abuse” alongside “physical violence”. OV is a form of gendered violence, yet the long-term impacts are felt by both mother and child, regardless of gender. OV is not a new phenomenon and over the last decade academia has highlighted its incompatibility with maternal dignity and autonomy, whilst in more recent years bereaved families have begun campaigning for greater recognition of the connection between OV and heightened female and infant mortality. This has resulted in some improvements in the quality of maternal rights. Yet in the midst of a global pandemic, it appears that we have taken a step backwards. New hospital policies worldwide continue to violate the inherent dignity of pregnant women, despite no scientific evidence to suggest that such methods limit the spread of COVID-19. In light of data from the US, published February 2022, showing an increase in female mortality due to obstetric complications linked to COVID-19, is it time for a different approach?
OV during COVID-19
In November 2021 the UN Women’s report was released, which pointed to the existence of a ‘shadow pandemic’, with 50% of women interviewed reporting having experienced some form of violence during the pandemic. Yet the report failed to appreciate an equally important setting where women are vulnerable – the natal ward.
The WHO guidelines for COVID-19 clinical management recognises that OV often encompasses both physical and psychological harm simultaneously and have therefore recommended that structures be put in place to ensure that, regardless of a suspected or confirmed COVID-19 infection, all women are given access to respectful and individualised care. Yet despite Spain altering their childbirth procedures to align with these guidelines, local hospital protocols routinely isolate new-borns from COVID positive mothers, despite no scientific evidence to suggest the existence of vertical transmission and only one suspected case of perinatal transmission. Additionally, women in both Spain and Chile have reported having scheduled inductions of labour, only being given the option of a scheduled c-section and being denied a companion during labour and childbirth. This is despite the potential harms it can bring to both mother and child. For instance, the systematic induction of labour implies a higher change of emergency c-sections and instrumental delivery which have been proven to be a causal factor in postnatal depression and post-traumatic stress disorder. Equally, the isolation of new-borns interferes with the creation of necessary immune and infection protection mechanisms and disrupts breastfeeding bonding time.
A Place for Human Rights?
A recent report by the Special Rapporteur on violence against women drew links between OV and Human Rights. For instance, she highlighted that c-section operations should only be conducted when medically necessary; when practiced without a woman’s consent, they could amount to violence against women. Yet during the pandemic, can truly informed consent happen when women are coerced into believing that scheduled c-sections are their only option?
Within the realm of violence against women, the framing of human rights as substantive, with the requirement to ‘respect, protect and fulfil’, mandates positive action. Whilst connections between OV and rights such as ‘freedom from inhumane and degrading treatment’ and ‘freedom of family life’ have been made at an international level, this has not impacted local medical protocol.
OV rarely stems from the malicious intent of practitioners. Overworked and underfunded, doctors argue that they simply do not have the time to consider the wellbeing of their patients beyond their short-term medical problems. Thus, structural change must occur in order for women to regain their agency and consequently enjoy substantive human rights during childbirth. A right-based analysis, creating a minimum legal standard of positive state obligations is our next logical step.
One important field where this could be utilised is the current medical undergraduate curriculum. Whilst medical law is given some attention, it fails to encompass notions of dignity and autonomy. Indeed, one study found the majority of students could not recognise why procedures such as ‘shaving a woman without her consent’ would constitute violence. Yet it has been proven that attitudinal change does not take very much. The same study also showed that a mere 8-hour educational intervention permanently broke down a number these misconceptions.
Alongside other structural changes, by making earlier connections to the universally understood harms of human rights we are able to demonstrate the severity of what is at stake when doctors violate the fundamental rights of pregnant women.