Croatian MP Ivana Ninčević Lesandrić broke more than one taboo this October, when she stood in the Croatian parliament telling the minister of health her personal story of obstetric violence: "I had a miscarriage. They tied my hands and feet and began the curettage procedure without any anaesthesia. They scraped my uterus without anaesthesia. I can describe every second to you because they were the worst 30 minutes of my life.”
But Lesandrić’s testimony was met with anger and disbelief, rather than support – reactions depressingly familiar to me, as a childbirth-rights campaigner. Obstetric violence (described to me by American writer Elisa Albert as the “last culturally acceptable form of violence against women”) was given its first legal definition in Venezuela in 2007. Used to describe abuse, discrimination and physical or emotional violence against women in reproductive-healthcare settings, it includes withholding necessary treatment and the arbitrary removal of their basic rights to autonomy.
The term can be misleading and divisive – many obstetricians provide deeply respectful care, and violence can be perpetrated by other healthcare workers such as midwives – but it also has an important power and role to play internationally. Despite the controversy that surrounds it – and the defensiveness it can spark in healthcare professionals – it provides a powerful antidote to common platitudes such as “a healthy baby is all that matters”. And it evokes a visceral and frank sense of the unlawful harm being done to women in pregnancy and birth around the world.
Lesandrić’s words are the powerful opener of a complaint to the UN authored by RODA, a group of Croatian parent-activists. The 13-page document describes brutality, a disregard for women’s autonomy and a complete violation of their rights. Its publication comes after several years of lobbying, collecting thousands of women’s stories and, on the back of their contribution to an international #breakthesilence campaign, gathering over 400 Croatian women’s accounts of obstetric violence in a matter of days.
One 2017 testimony, from Merkur Hospital in Zagreb, reads: “I asked them not to cut me. The doctor said I was going to tear if they don't do it and how will I ever give birth if I can't stand the pain. The midwife cut me, without consent, explanation or warning. It hurt badly. Nobody told me why they cut me anyway.” Another woman, in Slavonski Brod, recalled: “For nights [after childbirth] I would wake up my husband in panic, remembering the doctors words, ‘wow, she is so good, you cannot hear that she is alive.’ But I was left voiceless after 15 minutes of screaming. I do not think I will ever give birth again.”
Croatia may be in the obstetric-violence spotlight now, but it is far from the only place in the world where women endure human-rights violations during pregnancy and birth. As a doula, I have witnessed it firsthand in UK hospitals. I have collected evidence from Holland, America, Australia, Tanzania, Italy, Brazil and more – evidence that speaks to the need for the World Health Organization’s 2014 statement on the prevention of disrespect and abuse during childbirth.
For too long, reproductive rights have started and stopped with contraception, sexual consent, sexuality and abortion
There is a growing body of evidence of the scale of this problem, and the negative consequences it can have for women’s physical and emotional health. This is being met by a groundswell of work for change. Organisations like Improving Birth (who spearhead the #breakthesilence campaign), networks of activists, charities like Birthrights in the UK, landmark cases on childbirth rights coming before the European Court and local policy and frontline maternity workers driving forwards respectful maternity care work from east London to east Africa.
And, yet, I find myself increasingly frustrated at the lack of visible anger and attention to this issue among the broader feminist movement. Last year, when letters from survivors of sexual abuse highlighted the importance of rights around pregnancy and birth care in light of the #MeToo movement, there was barely a reaction. Campaigns, like Make Birth Better, have driven the link between mental wellbeing and respectful care further into the consciousness of those of us already working on these issues, but I am yet to see the rights of humans who happen to be pregnant or giving birth filter with sufficient weight into the larger women’s movement.
Today, less than week after a confidential report into maternal deaths again demonstrated the link between discrimination and physical safety in maternity care – with black women in England dying in childbirth five times more frequently than their white counterparts – it is time to change that. Pregnancy and birth have been and will continue to be difficult topics to slot neatly into the work needed to improve women’s lives and afford them the safety, power and equality they are entitled to. But ghettoising the topic is not the answer.
For too long, reproductive rights have started and stopped with contraception, sexual consent, sexuality and abortion. These are vital topics, but now the lack of attention to assaults on women giving birth is holding us back.
Until all women’s rights in childbirth are given the attention they deserve, we cannot expect to make the deep and complex progress needed to achieve true equality. After all, our ability to become pregnant is the root excuse for treating women as second-class citizens. If we don’t value women’s humanity in this act, which is particular to them and something that is so intertwined with the barriers women face to full and equal participation in society, then we make it an easy access point for the disruption of feminist progress.
Moreover, with every time pregnant and birthing individuals are ignored by the movement that should protect them, we are a little complicit. Our silence mirrors and amplifies the silencing of these women.