SEATTLE, Washington — In discussing the topic of violence against women, one sub-branch that people too often sweep under the rug is obstetric violence. After The Borgen Project interviewed Dr. Danubia Mariane Jardim, author of the paper Obstetric violence in the daily routine of care and its characteristics in the Latin-American Journal of Nursing (Revista Latino-Americana de Enfermagem), she explained that one can define OV as violence against women in delivery, after delivery or in the process of abortion. In every situation, it constitutes a human rights violation in caring for women.
Victims may experience abuse, neglect, humiliation and discrimination such as forced cesarean sections, forced episiotomies, slapping and mocking, etc. “It is a worldwide phenomenon,” said Dr. Jardim; a World Health Organization (WHO) study of over 2000 women pre- and post-childbirth in Ghana, Nigeria and Guinea concluded that 42% of respondents experienced discrimination or abuse, supporting Dr. Jardim’s statement.
Causes of Obstetric Violence
According to Dr. Jardim, one of the principal reasons for the widespread nature of this practice is the massive power disparities between doctors and patients. Physicians’ status as an authority on science contributes massively to a loss of women’s autonomy to make decisions related to their own bodies. In Jardim’s paper Obstetric violence in the daily routine of care and its characteristics, she holds obstetric violence to be a feminist question; “the culturally consolidated image of women as reproductive, submissive and physically and morally inferior” has opened a path for patriarchal oppression that “leads to the undervaluation, oppression and objectification of the female body limiting the power and ways of expression of the women.” Additionally, the vulnerable setting that constitutes labor and childbirth acts as an environment ripe for abuse often leads to permanent emotional or physical damage.
Importantly, however, Dr. Jardim also emphasized that male physicians are not the only ones guilty of obstetric violence. She explained in her paper that female health professionals are “at times identified as torturers and more violent than their male peers in the obstetric practice.” She told The Borgen Project how “medical power relations and a lack of empathy with the women who are in their care” cause many female obstetricians to become perpetrators of OV as well. Importantly, as a result of OV, women frequently have a distrust for medical professionals. Women are disincentivized from consulting with maternal health services, presenting negative consequences for their sexual health as mothers and for their children. Further, the silence surrounding OV perpetrates the normalization of such abuse during labor, childbirth and post-childbirth.
Who Does it Affect the Most?
Another important aspect of obstetric violence that Dr. Jardim pointed out is the idea that it disproportionately affects minorities and the disenfranchised. Indeed, ethnic minorities, low income, unmarried, adolescent and migrant women are much more likely to experience abuse in the maternity clinic than their majority counterparts. The WHO study mentioned previously explained how young, unmarried women were more likely to receive non-consented vaginal examinations. “The minority and socioeconomic factors contribute to OV at the moment they impede access to information, to qualified health services, or to health professionals prepared to take care of women in their delivery,” said Dr. Jardim.
When asked about the solutions to ending obstetric violence, at a state level, Dr. Jardim said that she believes “in the formation of a collective awareness of rights and duties and in the strength of citizenship.” In this sense, she explained that she believes in the creation of laws and public policies that protect women against OV by acknowledging their right to carefree of violence and by bequeathing them autonomy over their bodies. She also stressed the importance of urging judicial entities to consider OV as an offense worthy of disciplinary proceedings ranging from payment of fines to convictions of imprisonment.
Furthermore, in order to break the doctor-patient power dynamics that discourage women from speaking out against OV and creating “respectful, dignified obstetrical care,” Dr. Jardim highlighted the importance of also going beyond punishing the perpetrators. In the interview, she suggested creating public policies to combat OV that disseminate information about OV, denunciate the organs responsible for allowing it to happen, sharing the responsibilities among those involved in obstetrical processes such as health professionals and service managers and increasing cyber-activism about OV. In this sense, she maintained that “the confrontation of obstetric violence depends on the dissemination of information to civil society, women, social movements, health professionals, and institutions” about the existence of OV and the need for greater regulation.
In conclusion, Dr. Jardim provides insight into the dynamics that cause women to suffer from obstetric violence at the hands of their physicians, and what others must do to combat it. Obstetricians must be accountable for their actions, and power dynamics between doctor and patient should rebalance in the favor of women. For this, it is crucial for civil society, as well as government institutions to become aware of the prevalence of obstetric violence in maternity wards across the globe. Increased information will help women reclaim the power they hold to make decisions over their own bodies.
– Mathilde Venet