This post was written by Isabel Barbosa and Rebecca Reingold in honor of the International Day for Maternal Health and Rights.
Obstetric violence is disrespectful, abusive, and neglectful treatment by health providers during the provision of health care related to pregnancy, childbirth, and the post-partum period in both public and private settings. Experiences of obstetric violence include: physical abuse; humiliation or verbal abuse; coercive or unconsented practices; refusal of treatment or admission to a health facility; unnecessary use of medication; failure to maintain confidentiality or obtain informed consent; detention in facilities for failure to pay; discrimination based on race, ethnic or economic background, age, HIV status, gender non-conformity, etc; among others.
Such practices can be a powerful disincentive for women to seek and use maternal health care services and may have direct adverse consequences for both the mother and infant. They also result in violations of not only ethical principles that guide health providers’ behavior but also women’s human rights, including their rights to health, integrity, autonomy, equality, freedom from discrimination, and information.
The Inter-American Convention on the Prevention, Punishment, and Eradication of Violence against Women (Convention of Belém do Pará) defines violence against women, establishes that women have the right to live a life free of such violence, and states that it constitutes a violation of human rights and fundamental freedoms. The Convention of Belém do Pará also creates an accountability mechanism, MESECVI, that reviews its implementation by States that have signed on to the treaty.
MESECVI has taken a firm stance on how signatories to the Convention of Belém do Pará should tackle the problem of obstetric violence. For the past few years, MESECVI’s Committee of Experts has urged countries to criminalize obstetric violence and repeatedly requested reports on the number of prosecutions and convictions for this type of violence. As of 2014, only three of the States that have signed on to the Convention of Belém do Pará reported having criminalized obstetric violence: Argentina, Suriname, and Venezuela. The Committee of Experts, moreover, has not received any information on the number of prosecutions and convictions for obstetric violence, suggesting a gap between the adoption and effective implementation of criminal laws related to obstetric violence.
Relying primarily on criminal law to tackle obstetric violence, as a result, is not sufficient. According to the World Health Organization, greater action is needed to support changes in provider behavior, clinical environments, and health systems. Health providers, for example, would benefit from additional training on what constitutes obstetric violence and on how to provide safe, high-quality, people-centered care. Women, similarly, would benefit from greater access to information about their rights as patients. These interventions are more likely than criminal prosecutions or convictions to challenge the inherent imbalance of information and power between between women and their health care providers, thereby improving women’s experiences when accessing maternal health services.
Interventions aimed at reducing the incidence of obstetric violence, regardless of the point of entry, should be grounded in human rights principles. They should be carefully tailored to ensure that women receiving health services during pregnancy, childbirth, or the post-partum period are treated with respect, compassion, and dignity.