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Author: Patrizia Quattrocchi, Professor of Cultural Anthropology, Università degli Studi di Udine
Original article: https://theconversation.com/obstetric-violence-abuse-during-childbirth-is-widespread-but-the-first-step-to-fighting-it-is-naming-it-235161
When a child is born, the person giving birth is often subject to extremely harsh treatment – verbal humiliation, invasive practices, unnecessary medication, physical violence, and denial of treatment and pain relief are all commonplace before, during and after birth, both in Europe and across the globe. This can include a lack of informed consent when performing caesarean sections, episiotomy, induction and vaginal exploration, as well as verbal or discriminatory insults.
Violation of human rights in this context has a name: obstetric violence.
Many of these practices are deeply rooted in the medical profession, with little conscious, malignant intent from individual midwives, doctors or nurses. Some in the medical profession therefore object to the term “obstetric violence”, specifically to the use of the word “violence”, as it implies “intent to cause harm”. Representatives from three large European professional institutions even signed a paper this year criticising the use of the term.
We, along with a great many others, disagree – an act can be violent regardless of its intention, and it is only by naming and defining obstetric violence that we can empower both patients and professionals to end it.
The extent of the term’s acceptance is proven by our study, commissioned by the European Commission and presented at the November 2023 Scientific Analysis and Advice on Gender Equality Annual Seminar. The main report was informed by four detailed country case study reports undertaken in France, the Netherlands, Slovakia and Spain.
Our aim here is to counter any objections to using the words “obstetric violence”. This term is not only appropriate and helpful in highlighting, preventing and uprooting mistreatment and abuse during labour and childbirth – it also places the needs and wishes of patients on a par with those of health professionals.
Why ‘obstetric violence’ is the right term
At present, obstetric violence is a blind spot for health professionals, largely because it addresses elements of their practice that have not previously been questioned.
However, most women’s and birth-rights associations have readily adopted the term precisely because it was coined and used by women themselves in their testimonies and exchanges – first in Latin America and then across the world.
Today, the term obstetric violence is used not only in international scientific literature on abusive and disrespectful care in labour and childbirth, but also in official documents from the Council of Europe, and international organisations like the United Nations.
It is also used and recognised by various gynaecological and obstetrical associations and government healthcare institutions, including the French Haut Conseil à l’Égalité entre les femmes et les hommes and the Catalonian government in Spain. These organisations present obstetric violence as a specifically gender-based form of violence.
While simply naming this mistreatment and abuse will not make it disappear, the concept of obstetric violence carries huge weight on personal, social, and political levels, for scholars, patients, and health professionals alike. It empowers patients to recognise and legitimately challenge an abnormal or traumatic experience.
Obstetric violence also provides an opportunity to question, and therefore improve, the conditions under which pregnancy and childbirth are approached and managed for future parents, to the benefit of health professionals and society as a whole.
Recognising obstetric violence as gender-based violence
The term obstetric violence allows us to fit patients’ experiences within the existing framework of gender-based and race-based violence, and to relate it to the male-dominated history of gynaecology and obstetrics.
Gender-based violence is defined by the European Parliament as “violence directed against a person because of that person’s gender or violence that affects persons of a particular gender disproportionately”. The approach of defining obstetric violence as a form of gender-based violence has already been adopted in guidelines and scientific work, as well as in laws in Latin America (Venezuela in 2007, Argentina in 2009, Uruguay in 2017) and Europe (Catalonia in 2020).
As a form of gender-based violence, obstetric violence is not exclusively intentional, nor does it always occur between individuals. It is structural and intersectional, meaning that coercion and abuse can be indirect, anonymous and invisible, produced by the State and its institutions or by social norms. It is rooted in complex political, social, cultural, and medical contexts, meaning that working conditions, financial pressure, professional hierarchies and health education may encourage or enable it.
Obstetric violence also perpetuates patterns of dominance that are internalised by the general population, including health professionals. This implicit bias has been explored in scientific literature, principally on matters of race and gender.
Judgements and habits are certainly difficult to question and correct, but that cannot be an excuse for ignoring this violence, for ignoring the words used by those who give birth and suffer its consequences, and for not doing everything possible to reduce this violence by, among many other measures, naming it.
Focusing on the real debate
We must emphasise that there is little debate as to whether disrespect, abuse or mistreatment happen during birth – these are all well documented.
However, terminology is still a point of contention, and obstetric violence is the appropriate term because it emphasises the structural and institutional aspects of this type of violence. It is a systemic problem that needs systemic solutions – these individual acts and behaviours have to be interpreted and resolved as part of the broader, more complex dynamics that enable, encourage and perpetuate them.
This does not mean that individuals should not be held accountable for their actions. Rather, it suggests that those actions are often the product of a system, one that needs to be broken down to its deepest roots.
The time has therefore come to put an end to the the debate on terminology. Today, more than ever, the term obstetric violence is supported at scientific, social, political and, increasingly, medical levels. The real debate – that is, the dialogue between people who give birth and health professionals who attend pregnancies and deliveries every day – is already far ahead of the terminological one.