Childbirth is a powerful event that should be protected. Tragically, mistreatment, abuse, and obstetric violence are far too common in the delivery room. Although pregnancy itself can pose risks, seeking care during labor should not.
Neglect and maltreatment during all stages of maternal care is a chronic and global problem. These abuses are dangerous and can have long-lasting and fatal consequences. Yet internationally, and in many countries, laws fail to fully address this issue.
Women and people who give birth have the fundamental right to safe and dignified birthing care and violations have been widely recognized as both a healthcare and a human rights issue.
A Failure to Care and Protect
A recent WHO study found that “more than one-third of women experience mistreatment during childbirth in health facilities” – the highest risk is within thirty minutes prior and 15 minutes after giving birth. While this study focused on only four countries, it does indicate a global problem.
The WHO research was a continuation of a mixed-methods systematic review of mistreatment of women during childbirth in health facilities. Subsequent studies from other sources report similar issues globally, including in the US.
There are different types of mistreatment surrounding childbirth. They include physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to provide appropriate care, and denials of privacy and confidentiality.
While no one is immune, a link between marginalization and likelihood of mistreatment is apparent. Whether due to cultural or religious bias, racism, misogyny, poverty, or other structural inequalities – this is yet another example where research shows marginalized communities suffer worse healthcare outcomes.
Delivering Torture
In 2019, the UN Special Rapporteur on violence against women, its causes and consequences, Dubravka Šimonović, submitted a report focused on a human-rights approach to obstetric violence and mistreatment in childbirth. It outlines how mistreatment varies regionally.
Some countries have spousal and third-party consent laws so people whose biological sex is female are never actually in control of their medical decisions and can be legally subjected to procedures against their will. In others, practices such as forced sterilization, restraint during labor, and detention for inability to pay medical bills remove bodily autonomy and criminalize birth.
Facilities employ the unnecessary use of medication to induce labor and overuse procedures such as cesarean and episiotomy – either for scheduling or financial benefit. Delays in care and lack of anesthesia and pain medication are also problems.
All of the above have been condemned and could be considered torture. Some practices, such as the use of symphysiotomy in Ireland, have been determined to constitute torture.
Improving Quality of Care
This problem is of enormous importance and scale. Social media has allowed people from diverse backgrounds and regions to share their experiences and shed light on how widespread this violence is. It also allows for public demands for urgent redress and improvement in maternal care worldwide. Hopefully the combination of voices from researchers, human rights experts, and those with lived experience will be too loud to ignore.
Some advocates support implementing Respectful Maternity Care through steps like total redesigns of most labor wards and training of medical professionals to provide and demand proper treatment of their patients. Others champion wider access to maternal care outside of the traditional facility setting, and studies have found this decreases instances of abuse.
International law and human rights standards must also advance. Currently the regulatory focus on mistreatment during facility-based childbirth remains largely concerned with issues such as forced or coerced sterilization and denial of care. Those are urgent needs, but they are also a mere subset of a much larger global scourge of violence and mistreatment.