Obstetric Violence : The Reality Of Maternity Care In Hospitals

 

During pregnancy, women experience various challenging phases, including mental health adjustments and physical changes. Unfortunately, alongside these natural processes, they also encounter obstetric violence during labor.

Obstetric violence encompasses verbal, emotional, and physical abuse that women face before and during pregnancy and childbirth. This mistreatment can take various forms, including humiliation, sexual abuse, and psychological violations. For instance, some women endure slapping and pinching of their thighs while bearing down. Additionally, medical staff may subject them to constant verbal abuse, including yelling and scolding, especially when their premature babies are in the NICU and they struggle to breastfeed. These experiences compound their distress.

In such situations, pregnancy becomes a time of suffering, discomfort, and even fear of death due to obstetric violence. Shockingly, this grim reality exists in many countries, often hidden from view. It permeates every aspect of reproductive healthcare, occurring within hospitals. Unfortunately, obstetric violence is often overlooked as a normal part of violence against women.

In 2014, the World Health Organization (WHO) developed a manifesto for the prevention and elimination of disrespect and abuse during childbirth in health facilities. The WHO emphasized that if there is one time when women are particularly vulnerable, it is during childbirth. Obstetric violence can have negative effects on both the mother and the baby. Despite these efforts, the practice continues among doctors, especially gynecologists.

As for why obstetric violence persists, it's a complex issue influenced by various factors, including cultural norms, power dynamics, and systemic challenges within healthcare systems.

What is Obstetric Violence?,

Obstetric violence refers to the abuse and trauma inflicted on women during pregnancy, childbirth, and the postpartum period, specifically by medical staff.

"Childbirth trauma" and obstetric violence are facets of the traumatic experiences women face during labor. These abusive treatment experiences often lead to Postpartum Depression or Post-Traumatic Stress Disorder, affecting a woman's relationships, her ability to care for her infant, and her future interactions with healthcare.

Obstetric violence, along with gynecological violence, is a form of abuse that especially affects women and is ignored because it is still a taboo subject. It remains largely unreported due to the impunity and silence surrounding it. Studies indicate that obstetric violence doubles the risk of maternal and neonatal complications.

Forms of Obstetric Violence:

Discrimination - Based on race, ethnicity, economic background, age, HIV status, or gender nonconformity. Verbal abuse and humiliation exacerbate the trauma.

Invasive Procedures and Caesarean Births - This involves unnecessary interventions, disrespect, and incivility. Specific procedures include Episiotomies (surgical cuts made at the opening of the vagina during childbirth, usually to assist difficult deliveries) performed without consent, bag rupture, enemas, Kristeller’s maneuver, Hamilton’s surgery, and other medical interventions. According to a survey, 59.0% of observed women and 49.7% of surveyed women do not consent to vaginal examinations. Additionally, 75.1% of observed women and 56.1% of surveyed women do not consent to episiotomy. This analysis provides researchers worldwide with new tools to measure this important construct.

Additionally, pain often goes unattended, and there may be forceful actions such as abdominal compression. Lack of information provided to women and excessive or inappropriate vaginal touching during birth or when under anesthesia further contribute to this issue. Notably, twenty percent of the caesarean sections and 75% of the episiotomies are performed without consent — and often without a painkiller.

Lack of Confidentiality and Pain Management - This includes breaches of confidentiality and denial of pain relief or misuse of drugs.

Neglect and Induction - Neglect and Induction refer to neglect by the doctor during delivery and induction of labor without medical justification. Additionally, other aspects include non-consensual care, undignified treatment, discrimination, and abandonment, all of which contribute to the negative impact on mental health in detention facilities.

Global Prevalence of Obstetric Violence,

A study conducted by the World Health Organization (WHO) revealed that physical and verbal abuse of women during childbirth is a worldwide phenomenon. Unmarried, young or uneducated women face the greatest risk. Globally, approximately 62% of the women experienced physical or verbal abuse or discrimination during childbirth in health centers, with some of the women being punched, slapped, shouted at, mocked, or forcibly held down. There have also been some incidents where the doctor jumped and sat on the woman to help her deliver the baby.

Unfortunately, even in developed countries, this mistreatment is sometimes normalized. Many victims and survivors are unaware that it violates their human rights, accepting it as an inevitable part of childbirth care.

Low- and middle-income countries have a higher incidence of obstetric violence due to factors like women's lower socioeconomic status, poverty, inadequate health services, and cultural norms. Recent studies report varying prevalence rates across countries: Mexico: 33%, Argentina: 44%, Türkiye: 76%, India: 23%, United States: 17%.

Status of Obstetric violence in India,

In Indian hospitals especially government ones. The acceptance of physical and verbal abuse by doctors is a grave concern. However, it is an assault on human rights and dignity that increases morbidity and mortality. Nearly every woman experiences some form of disrespect and abuse during childbirth. States like Bihar, where over 70% of women give birth in hospitals, face particularly high levels of labor room violence. A separate study found that 32.4% of Indian women have encountered obstetric violence, with higher rates among lower-caste and lower socioeconomic groups.

Private hospitals are not exceptions when it comes to misbehavior against women. In many private hospitals, the actual incidence of obstetric violence is reported to be closer to 40.9%.This rate has increased from 27.7% in 2005–06 to 20% in 2015–16, according to the National Family Health Survey. Obstetric violence against urban women occurs here, manifesting as painful vaginal checks, pressure to proceed with caesarean sections, and sometimes even operations performed against their will.

Here, it also becomes important to revisit the case of a Delhi hospital. Where, a newly bereaved mother was handed the bloody and dirty body of her stillborn baby in a garbage bag, leading to a legal case filed against the hospital in the High Court.

Regrettably, Indian delivery rooms witness instances of abusive and discriminatory care practices. These include slanderous remarks, uninvited medical procedures, power imbalances between patients and medical professionals, forced surgeries, and unwarranted physical examinations. Shockingly, some doctors justify mistreatment, administering medications like Buscopan and Drotaverine to speed up labor, which can adversely affect women's mental health.

Not only doctors, even nurses, who are anecdotally linked to more gentle, caring care, have been known to physically mistreat or cruelly mock laboring mothers, as well as make crude remarks. In certain instances, particularly in Uttar Pradesh, laboring women have been instructed to give birth on the floor in order to prevent soiled bed linens. Following the delivery, they are also requested to clean up any blood or other debris off the floor. In fact some women have reported that ward boys were touching them inappropriately when they were tired or unconscious after delivery and the nurses were busy with other patients.

The issue of obstetric violence is extremely concerning, with several studies highlighting its prevalence in India. For instance

Body Mapping Study in Bihar (2022):

This study employed an art-based participatory method called ‘body mapping’ to understand women’s experiences during childbirth. The findings revealed interventions without consent, verbal and physical abuse, extortion, and a lack of privacy. These body maps offer valuable insights into this issue within a patriarchal culture.

Aligarh Study (2022):

Another study conducted in Aligarh found that at least 84.3% of women faced obstetric violence.

Government Hospitals (2013):

A 2013 blog entry exposed the underbelly of most government hospitals, revealing the magnitude of aggression against women during childbirth. These studies show instances of disrespect, abuse, and mistreatment during childbirth.

Despite having landmark laws like the Protection of Women from Domestic Violence Act, 2005, which recognizes various forms of abuse (physical, emotional, sexual, and economic) and provides mechanisms for redressal, and initiatives like Janani Suraksha Yojana (JSY), which focuses on safe motherhood, India still fails to adequately address the issue of obstetric violence.

To effectively combat obstetric violence, India needs a specific law that clearly defines the authority, roles, definitions, and remedies for various acts constituting abusive behavior towards women during prenatal, childbirth, and postpartum periods.

How Obstetric Violence Affects Women’s Human Rights?,

Each of the above mentioned practices is a serious violation of women's human rights, such as the right to equality, freedom from discrimination and the right to reproductive autonomy. Regrettably, many women do not report it. According to the World Health Organization (WHO), approximately 62% of women experience physical or verbal abuse or discrimination during childbirth in health centers. Despite this prevalence, obstetric violence remains inadequately recognized.

Human rights experts have acknowledged the harmful consequences of obstetric violence. The UN special rapporteur on violence against women asserts that mistreatment and violence during pregnancy and birthing care in hospitals jeopardize women’s rights to life, health, bodily integrity, privacy, autonomy, and freedom from discrimination.

Moreover, experts from the UN, Inter-American Commission, and African Commission have urged governments to address institutional and obstetric violence against women in healthcare facilities. They emphasize the need for legal and practical measures to prevent, prohibit, prosecute, and compensate for these acts.

Human Rights Watch has also investigated mistreatment of women during childbirth. The World Health Organization has highlighted instances of physical and verbal abuse, sterilization, denial of pain relief, and preventable complications due to negligence in hospitals.

Obstetric violence has significant negative impacts on the mental health of childbearing women. While evidence suggests that the problem is both structural and modifiable, it unfortunately persists worldwide. Addressing this problem requires comprehensive policy changes, awareness campaigns, and training for healthcare professionals. Advocacy and legal remedies are essential to protect women's rights during childbirth and promote respectful maternity care.