Today is International Women's Day. The United Nations theme this year is "Women and men united to end violence against women and girls." As I've referenced before, domestic violence was the first cause in which I became deeply invested. Though I do not work in shelters any more and my focus has shifted to birth work, I continue to pay special attention to matters concerning violence against women. So, this theme naturally made me think about violence against women in the birth place. In 2002, Susan Hodges wrote an article for CfM News called "Medical Model Maternity Care and 'Violence Against Women'" and I wanted to share some thoughts from that article today.
I recently read an article from The Lancet that put “what’s wrong” into language that made me sit up and take notice. In Violence against women in health-care institutions: an emerging problem by A. F.P.L. d’Oliveira, S.G. Diniz and L. B. Schraiber (The Lancet, Vol. 359. May 11, 2002) the women authors looked at documentation of violence against women in health institutions worldwide, focusing “on four types of violence: neglect; verbal violence, including rough treatment, threats, scolding, shouting, and intentional humiliation; physical violence, including denial of pain relief when technically indicated; and sexual violence.” In other words: emotional, physical and sexual abuse. The authors go on to specifically mention violence against women in reproductive health services: “These forms include excessive or inappropriate medical treatments in childbirth, such as doctors doing cesarean sections for reasons related to their social or work schedules or financial incentives; or adhering to obstetric practices that are known to be unpleasant, sometimes harmful, and not evidence based, including shaving pubic hair, giving enemas, routine episiotomy, routine induction of labour, and preventing women having companions in labour.”Speaking of hospital care and women, there is another good article from CfM News available online called Effects of Hospital Economics on Maternity Care.
In other words, our work is about stopping violence against women in the birthplace – we just haven’t been calling it that. I am not saying that everything that happens in hospitals is bad, or that even the abusive aspects of hospital maternity care is necessarily equivalent to being raped or beaten. However, abuse is abuse, from relatively mild to severe, and just because it is not extreme does not negate the fact of abuse or violence against women. In particular, we are talking about government-regulated health care being provided to women having babies – we should expect and demand that every aspect of that care is the opposite of abusive, that the care is respectful of us in every way.
Think about the stories you have heard, or seen on TV, or just read in the newspaper. Here we are, healthy women giving birth, but the doctor or hospital does or does not “allow” us to walk, eat, drink, have a doula, or whatever! Think of all the times women have been threatened “if you don’t progress to x-centimeters by such-and-such a time, you’ll have to have a c-section,” or told to shut up during labor, or coerced into interventions, or berated for complaining, or yelled at to PUSH. Think of all the times vaginal exams and other interventions have been conducted without asking the woman’s permission, and sometimes by strangers. Not to mention all the invasive interventions (drugs, IVs, episiotomies, etc.) that are commonly imposed without informed consent, or women who are persuaded to acquiesce by means of lies about their necessity and lack of information about risks. Etc. etc. etc. We have known these things are wrong and very disturbing, but most of us have not called them acts of “violence against women.” Under any other circumstances, many of the actions and behaviors visited upon women laboring in hospitals would be completely unacceptable as verbal abuse or, in many cases, could warrant legal action for assault and battery. They certainly include acts that are in violation of professional conduct and standards of care as delineated in state laws. Violence against women is about abuse of power, whether on the street or in the hospital. So let’s start calling the disrespect, violations of privacy, loss of freedom, unnecessary interventions, intimidation, etc. what they are: Violence Against Women.
And, this post by Gloria Lemay has been making the rounds lately and I think it is also fitting for today: Are You a Good Candidate for Hospital Birth?