CORTH Member Raquel Drovetta and their associate Mitzy Flores Sequera discuss obstetric and epistemic violence

The debate on obstetric violence has gained momentum over the past decade, underscoring the urgent need to address abusive and dehumanizing practices in childbirth from a human rights perspective. Obstetric violence refers to the mistreatment, neglect, and abuse of women during pregnancy, childbirth, and the postpartum period within healthcare facilities. The CLACSO (Latin American Council of Social Sciences) Working Group on Feminisms, Resistances, and Emancipation supports this debate, promoting research and gathering data that reveal the extent and impact of obstetric violence in Latin America. Our recent publication highlights the efforts of the Obstetric Violence Observatories (OVOs) to raise awareness and combat this issue in Chile, Bolivia, Argentina, Venezuela, Uruguay, and Colombia (Drovetta, Flores Sequera, and Villegas Rodríguez, 2024).

OVOs are organizations dedicated to investigating, documenting, and raising awareness of obstetric violence cases to promote changes in maternal health policies and practices. They collect data through surveys, testimonies, and studies that reveal abusive practices during pregnancy, childbirth, and the postpartum period. These observatories also collaborate with activists, health professionals, and legislators to push for legal and educational reforms that ensure respectful and dignified treatment for women. Their goal is to sensitize society and institutions to the severity of obstetric violence and promote care based on human rights.

A recent article published in the European Journal of Obstetrics & Gynecology and Reproductive Biology has sparked controversy in the field. Titled "Joint Position Statement: Substandard and Disrespectful Care in Labor – Because Words Matter," the article is authored by the European Association of Perinatal Medicine (EAPM), the European Board and College of Obstetricians and Gynaecologists (EBCOG), and the European Midwives Association (EMA). It describes obstetric violence as a controversial term that suggests intentional aggression mainly by obstetricians. The authors argue that this term is not useful for identifying and correcting underlying issues in intrapartum care.

Instead, they prefer terms like "substandard and disrespectful care" to describe practices that affect patients' dignity, individuality, privacy, and intimacy. They also note that the term "obstetric violence" can be seen as unjust and offensive by health professionals, leading to a defensive and less collaborative mindset.

In response to this publication, obstetric violence observatories and organizations in Europe and Latin America have issued a joint statement. They reaffirm the need to maintain the concept of "obstetric violence" as a precise term that reflects the reality of the affected women and newborns. The response argues that using other terms minimizes the severity of these practices instead of explicitly recognizing them as a form of gender-based violence. Moreover, avoiding the term and preferring euphemisms like "substandard care" represents a form of institutional and epistemic violence that perpetuates its invisibility.

Obstetric violence has been recognized as a human rights violation by international bodies such as the Belém do Pará Convention and the World Health Organization (WHO), and it is codified in the laws of several countries, including Argentina, Mexico, and Venezuela (Inter-American Commission on Human Rights, 2012; World Health Organization, 2014; Council of Europe, 2019). This form of violence not only generates negative feelings but also causes significant physical and psychological harm to women and their families, further eroding trust in health institutions.

Ignoring international standards and recommendations, as well as the vast scientific literature documenting this phenomenon, not only discredits women's suffering but also hinders the implementation of effective measures to eradicate it. In 2012, the Committee of Experts of the Follow-up Mechanism to the Belém do Pará Convention was the first to recognize obstetric violence as a human rights violation and recommended that states adopt legal provisions to criminalize it (Inter-American Commission on Human Rights, 2012). Additionally, the WHO in 2014 and the Parliamentary Assembly of the Council of Europe in 2019 have made explicit calls to prevent disrespectful and abusive treatment during childbirth (World Health Organization, 2014; Council of Europe, 2019).

It is imperative that the healthcare community takes a firm stance against obstetric violence by promoting comprehensive human rights education for all health professionals to ensure respectful and dignified care for all women. The term "obstetric violence" is not just a semantic issue but an essential tool to highlight and address a reality that affects millions of women worldwide. The use of euphemisms constitutes a lack of commitment to women's human rights.

In conclusion, we call on healthcare professionals, policymakers, and society at large to acknowledge the term "obstetric violence" and work collectively towards its eradication. This includes implementing evidence-based practices, improving communication between healthcare providers and patients, and fostering a culture of respect and dignity in maternal care. Only by confronting this issue head-on can we hope to create a healthcare system that truly serves and protects the rights of all women during one of the most vulnerable and important moments of their lives.

References

Ayres-de-Campos, D., Louwen, F., Vivilaki, V., Benedetto, C., Modi, N., Wielgos, M., Pop Tudose, M.-E., Timonen, S., Reyns, M., Yli, B., Stenback, P., Nunes, I., Yurtsal, B., Vayssière, C., Roth, G.-E., Jonsson, M., Bakker, P., Lopriore, E., Verlohren, S., & Jacobsson, B. 2024. European Association of Perinatal Medicine, European Board and College of Obstetricians and Gynaecologists, & European Midwives Association. (2024). Joint position statement: Substandard and disrespectful care in labor – Because words matter. European Journal of Obstetrics & Gynecology and Reproductive Biology, 296, 205-207. https://doi.org/10.1016/j.ejogrb.2024.02.048

Brigidi, S., Battisti, A., Skoko, E., Santos, C., Morais, L., Sadler, M., Candia, M., Brocker, Á., Contreras, L., Trouvé, A., Bish, S., González, C., Rossel, J., Yáñez, F., Werner, L., Mena-Tudela, D., Villegas, A., Galliardo, R., & Fernandez, S. (2024). Joint response from Latin American, European Obstetric Violence Observatories and others organizations all over Europe to the Joint Position Statement on Substandard and Disrespectful Care in Labour – Because Words Matter. European Journal of Obstetrics & Gynecology and Reproductive Biology. https://doi.org/10.1016/j.ejogrb.2024.05.008

Drovetta, R., Flores Sequera, M., Villegas Rodríguez, A. (2024). Miradas y horizontes feministas: La violencia obstétrica como violencia de género. Boletín de trabajo N°6. Buenos Aires: CLACSO. Retrieved from https://biblioteca-repositorio.clacso.edu.ar/bitstream/CLACSO/250557/1/N6-Miradas-y-horizontes.pdf

Inter-American Commission on Human Rights. (2012). Report of the Committee of Experts of the Follow-up Mechanism to the Belém do Pará Convention (MESECVI). Retrieved from https://belemdopara.org/publicaciones/

Parliamentary Assembly Council of Europe. (2019). Resolution 2306/2019. https://pace.coe.int/en/files/28236

Šimonović, D. (2019). Report of the Special Rapporteur on violence against women, its causes and consequences: Mistreatment and violence against women during reproductive health care with a focus on childbirth and obstetric violence (A/74/137). United Nations. Retrieved from https://undocs.org/A/74/137

World Health Organization. (2014). The prevention and elimination of disrespect and abuse during facility-based childbirth. https://www.who.int/publications/i/item/WHO-RHR-14.23