Latin America Claims to Love Its Mothers. Why Does It Abuse Them?

from The New York Times

How
the region became home to an epidemic of obstetric violence.
Ms.
Barbara is an author and a contributing opinion writer.
March 11, 2019
SÃO PAULO, Brazil — Five
years ago, a Brazilian woman in labor was detained by police officers
and forced to deliver by C-section.

The woman, Adelir
de Goes, had already had two cesarean sections — an all-too-common procedure in my country — and was
hoping to deliver her third child vaginally. But her baby was in breech
presentation. Doctors felt that a vaginal birth would put the baby in danger.
And so they got a court
order for a mandatory operation. Ms. de Goes was almost fully
dilated and preparing to return to the hospital when nine police officers
knocked on her door to take her away. In the hospital, she was anesthetized,
and operated on without her consent. Women’s rights groups denounced the
procedure as an assault on her autonomy and a violation of her right to make
informed decisions about her baby’s health as well as her own.

But if Ms. de Goes’s case was especially notorious, it was also
far from exceptional. According to a 2010 survey, one
in every four Brazilian women has suffered mistreatment during labor. Many of
them were denied pain relief or weren’t informed about a procedure that was
being done to them. Twenty-three percent were verbally abused by a health
professional; one of the most common insults was “Na hora de fazer não chorou”
(“You didn’t cry like that when making the baby”).

Another survey found
that, in 2011, 75 percent of women in labor in hospitals were not
provided water and food (last year, I became one of them), although this
practice is not supported by scientific evidence. The World Health Organization
recommends that low-risk women in labor eat or drink 
as they wish.

But some doctors are
unaware of the concept of “wish” as it relates to women. Faced with a patient
who refuses a procedure, they do it to her anyway. “I am the boss here,” they
insist.
Outraged by this enduring
abuse, Latin American women in the last few decades have helped to identify and
to legally define a different type of gender-based violence: “obstetric
violence.” It refers to disrespectful, abusive or neglectful treatment during
pregnancy, childbirth, abortion and the postpartum period.

One example is
episiotomy, a surgical cut in the vagina made during labor that has been
proven ineffective and even harmful when performed routinely. Doctors
still perform it in Brazil, with or without the women’s consent. And when it’s
suturing time, they sometimes include an extra stitch to supposedly tighten the
vagina to increase male pleasure — a “husband stitch.” (Five years ago, in Rio
de Janeiro, an obstetrician was caught on video asking a patient’s husband, “Do
you want it small, medium or large?”)

The struggle against obstetric violence in Latin America began
in the 1990s with activists’ efforts to disseminate evidence-based practices in
maternal and newborn care. Those efforts were encouraged by a document issued
by the World Health Organization in 1996 (“Care in Normal Birth: A Practical
Guide”), which warns against turning a normal physiological event into a
medical procedure, via “the uncritical adoption of a range of unhelpful,
untimely, inappropriate and/or unnecessary interventions, all too frequently poorly
evaluated.”
Within a few years of the report, Uruguay (2001), Argentina
(2004), Brazil (2005) and Puerto Rico (2006) approved laws granting women the
right to be accompanied during labor and delivery. Brazil and Argentina also
developed broader legislation encouraging the “humanization” of childbirth.

In 2007, Venezuela became
the first nation to create a law specifically addressing obstetric violence.
Two years later, Argentina enacted a similar law; it was followed by Panama,
multiple states in Mexico, Bolivia (with a law referring to “violence against
reproductive rights” and “violence in health services”) and El Salvador (this
one calling for dignified treatment in maternal and reproductive health
services).
These laws came not a
moment too soon. In Latin America, reports of obstetric violence have been
extensively documented. They’ve even come to be expected, as if this is the
price women have to pay for having any sexuality. The most common kinds of
mistreatment are non-consensual procedures (including sterilization),
non-evidence-based interventions like routine episiotomies, and physical,
verbal and sexual abuse.

We can only wonder why
obstetric abuse is so ubiquitous in Latin America, a place where motherhood is
often sanctified. Maybe it’s precisely because of this. In our conservative,
patriarchal societies, a woman’s true vocation is to be a mother. We must
sacrifice ourselves to fulfill our biological destinies. This means submitting
to the wills of husbands and doctors; selflessness and devotion are our most prized
attributes. And if we remain long-suffering saints, we cannot gain sexual
consciousness, or bodily autonomy.

Putting a name to the
practice of obstetric violence is the first step toward standing up against it,
and so, of course, doctors have begun fighting back. Last year, Brazil’s
Federal Council of Medicine condemned the term obstetric violence as an
aggression toward doctors bordering on “hysteria.” Note that the council did
not condemn the violence itself, merely the word choices of the victims. I
wonder if it used the word “hysteria” on purpose.
In a similar vein, in
February, Rio de Janeiro’s Regional Medical Council issued a resolution
forbidding obstetricians from signing personal birth plans, calling them a
deleterious “fad.” The council also argued that childbirth is risky and demands
quick decisions that doctors should be able to make without the fear of legal
repercussions. “There is no time to explain what will be done or to revoke
birth plans,” it stated. According to the council, obstetric violence is
“another invented term to defame doctors.”

It is disappointing to see that some doctors are more concerned
with the way this semantic “aggression” injures their prestige than with the
concrete, horrendous reality of abuse that abounds against women in childbirth,
not only in Latin America but elsewhere. It’s plain that they resent the
limitations on their authority.
But pregnancy is not an
exception to the idea that a capable patient has the right to make informed
decisions about her medical care. Health care providers should not “explain
what will be done” to pregnant women; they should honestly discuss our choices
and respect our bodily autonomy.

And choosing another term such as “disrespect during childbirth”
instead of “obstetric violence” will not soften the atrocities often committed
by caregivers in the name of “doctor knows best.”

More from Vanessa Barbara see NYT Opinion:
Vanessa Barbara, a
contributing opinion writer, is the editor of the literary website A Hortaliça
and the author of two novels and two nonfiction books in Portuguese.

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