Author: Sarisha Harikrishna
December 12, 2024
Background
Obstetric violence is defined as any act performed by a healthcare worker that inflicts harm on someone who is currently pregnant or who is in the postpartum stage of pregnancy. Obstetric violence is not only confined to women who have gone through pregnancy, but it also includes other elements of subpar quality care, such as the failure to comply with evidence-based test practices (EBM). EBM practices bring together the best clinical research available to match the patient’s values and circumstances. Obstetric violence in Latin America is at the forefront of efforts by human rights groups, who have contributed greatly to the creation of a legal framework in order to address this issue.
The pressing issue of obstetric violence in Argentina, a country of over 45 million people, has received renewed attention since the monumental Brítez Arce v. Argentina case was decided in January 2023. This ruling holds considerable significance, as it marks the first Inter-American Court of Human Rights case that explicitly uses the term “obstetric violence.” In this case, Ms. Britez Arce, who was nine months pregnant, had to be induced into labor after ultrasounds showed that her pregnancy was no longer viable. Unfortunately, as a result of inadequate information given to her surrounding the risks of undergoing the procedure, along with the substandard level of medical treatment, she passed away from a cardiac arrest. The court recognised the presence of “obstetric violence” and ordered the Argentinian government to create a campaign to increase awareness regarding human rights in relation to pregnancy, postpartum, and other situations that may yield increased incidence of obstetric violence. Judicial recognition of this kind is important, as it solidifies legal support of the movement to bring awareness to obstetric violence, which has been active for over a decade, in order to provide humanizing maternity care to the region.
The legal framework in Argentina’s Maternal Care
At present, Argentina uses two laws in order to address the issue of obstetric violence, known respectively as the National Law 25,929 of Humanised Birth and as the National Law 26,485 [1]. National Law 25,929 was approved in Argentina in 2004 but was only officially regulated in 2015 due to intense pressure by certain birth rights groups. This law outlines the rights of women, families, and babies in healthcare facilities and also cements a woman’s right to full bodily autonomy, along with complete access to information regarding her procedures.
On the other hand, National Law 26,485 (the Law of Comprehensive Protection to Prevent, Sanction and Eradicate Violence Against Women), was created in the year 2009, and clearly set out a definition of the term “obstetric violence.” The creation of this law followed in the footsteps of Venezuela, which, in 2007, became the first country in the world to mention obstetric violence in its laws. Article 6 of National Law 26,485 states that obstetric violence is “the violence that health care personnel exercise on women’s bodies and reproductive processes, expressed by dehumanizing treatment, excessive medicalization and pathologization of natural processes, in accordance with Law 25,929.” Both laws have yielded positive impacts in the accountability of medical practitioners who perform procedures on pregnant or postpartum women that have little to no proof of improving their overall state of health; some of these procedures could relate to episiotomies, enemas, or non-consensual cesarean sections (C-sections). There is clear evidence that performing enemas during labour is not only harmful, but extremely unnecessary. In addition, the denial of proper healthcare to women in times of vulnerability, such as when they are seeking an abortion after being raped, may constitute institutional violence against women, as was outlined by the Argentinian Supreme Court.
The psychological impact of obstetric violence on mothers
Obstetric violence is not only a physically scarring event, but it is also one that can damage a woman’s mental and emotional state. By stripping away a woman’s right of choice to make decisions regarding her own body, a woman inevitably unempowered via the subjugation of her bodily autonomy. The fundamental right to receive respectful sexual and reproductive healthcare, including during childbirth is enshrined in the Charter on the Universal Rights of Childbearing Women. As a result of being subjected to obstetric violence during childbirth, women are more at risk of developing depression and post-traumatic stress disorder (PTSD).
Besides, the prevalence of obstetric violence in healthcare facilities during pregnancy or postpartum has resulted in waves of terror among other women, who, in turn, may avoid going to hospitals out of fear of mistreatment. This leads to high statistics of maternal mortality, which could have easily been prevented had proper procedures been followed in healthcare facilities. Mistreatment while receiving maternal care has also resulted in the contraction of postpartum acute stress disorder (ASD) and postpartum depression (PPD). For example, Ruth Micaela Vilchez, who arrived at the hospital with a healthy, full-term pregnancy, was told by her midwives that she would need a cesarean section (C-section). They informed the obstetrician who was treating her at the time of this fact, but the doctors refused and forced her to give birth to her son without the procedure, which sadly resulted in his passing. Her story is not an isolated one; it paints a poignant picture of why women’s anxiety surrounding receiving maternal care in hospitals is due to genuine threat.
How does Argentina respond to cases of obstetric violence? How effective are these efforts?
In order to properly supplement both laws while properly monitoring its efficacy, the Buenos Aires Provincial Ombudsman’s Office started developing protocols to address cases of obstetric violence and to receive complaints. Although the passage of these laws is a start, their long-term efficacy remains to be seen. For instance, Maria (pseudonym), an Argentinian psychologist, stated that, despite the protocols set in place, these regulations still are not a blanket that offers a full solution to incidences of obstetric violence that continue to taint the maternal health landscape.
She outlined how her experiences presenting formal complaints to various official bodies fell on deaf ears; Maria was directed to different places and people instead of having her concerns listened to; eventually, she exhausted all legal channels available to her in Argentina. legal assistance further exacerbated her dilemma, leading her to seek help from human rights organizations including Las Casildas and Justicia y Reparación, who published a press release stating that her claim should be brought to the committee on the Convention on the Elimination of Discrimination Against Women (CEDAW) within the United Nations (UN). This highlights the need for stronger enforcement mechanisms, increased accessibility to legal support, and comprehensive reforms to ensure that these laws are not merely symbolic, but also are effective in addressing obstetric violence.
Suggested recommendations
In addressing the various gaps regarding the loose implementation of these laws, as well as the lack of efficiency of the bodies set up to monitor complaints, it is recommended that criminal sanctions be imposed on healthcare professionals or institutions found guilty of committing obstetric violence, including abusive, negligent or coercive practices that violate the rights and dignity of patients during childbirth. Its enforcement should be overseen by legal and regulatory bodies such as healthcare oversight agencies, medical licensing boards and the judicial system in order to promote accountability and justice for affected individuals. Obstetric violence has a high risk of resulting in mortality of both mother and baby in cases of pregnancy and it is suggested that stricter policies be put into place to complement the existing laws.
Glossary
Bodily autonomy: The right to control one’s own body without interference from others.
Cardiac arrest: The abrupt loss of heart function in a person who may or may not have been diagnosed with heart disease. Cardiac arrest is also referred to as a heart attack.
Cesarean section: An operation in which the uterus is cut open to allow a baby to be born.
Enema: A treatment for cleaning the bowels by filling them with liquid through the anus.
Episiotomy: A cut made at the opening of the vagina while a woman is giving birth, to make it easier for the baby to come out without causing injury.
Enshrined: A political or social right that is enshrined in something, meaning that the right is protected.
Evidence-based test practices (EBM): Practices that are based on scientific evidence.
Full-term pregnancy: A pregnancy is considered full-term at 39 weeks.
Induced into labor: Also referred to as labor induction, this process means to get the uterus to contract before labor begins on its own.
Inter-American Court of Human Rights: One of three regional human rights tribunals, together with the European Court of Human Rights and the African Court of Human and Peoples’ Rights. It is an autonomous legal institution whose objective is to interpret and apply the American Convention.
Legal framework: The set of laws, regulations and rules that apply in a particular country.
Medicalization: The act of considering something to be a medical problem, or representing it as a medical problem.
Midwives: Healthcare providers who are trained to provide obstetric and gynecological services, including primary care, prenatal and obstetric care, and routine gynecological care like annual exams or contraceptives.
Obstetrician: A physician that specializes in delivering babies and caring for people during pregnancy and after they give birth. They treat medical conditions unique to pregnancy and perform surgeries related to labor and delivery.
Pathologization: The act of unfairly or wrongly considering something or someone as a problem, especially a medical problem.
Poignant: Causing or having a very sharp feeling of sadness.
Postpartum: The period after childbirth, which typically lasts anywhere between six to eight weeks.
Postpartum acute stress disorder (ASD): A psychiatric disorder that can have physiological manifestations, such as tachycardia, which is a condition causing an increased heart rate.
Postpartum depression: A form of depression that occurs after having a baby
Subpar: Worse than the usual or expected standard.
Footnote
[1] The laws are in Spanish as no official translation of the laws in English are available online. To get an overview of the laws in English, please see: Obstetric violence: a Latin American legal response to mistreatment during childbirth (bhekisisa.org).