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The condition of women in childbirth and the phenomenon of obstetrical violence

Since motherhood is intrinsic to the female condition, when examining this delicate moment in women's lives, it is necessary to consider issues of gender equity and gender-based violence. It is significant, in fact, that the recognition of women's rights during pregnancy and, above all, the guarantee of specific rights related to the moment of childbirth are not universally guaranteed.

In fact, the Universal Declaration of Human Rights only indirectly refers to women as "mothers", through a paternalistic recognition of motherhood as a concept to be taken into special consideration. Article 25 attributes to pregnant women a vague right to specific care and assistance, leaving a margin of arbitrary action to individual states in deciding how to provide health care for maternity, often bound to specific terms and conditions that do not prioritize the needs of future mothers. In 1981, the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) was issued, aimed at the protection of civil, political, social, cultural and economic rights of women, without, however, mentioning in any way the rights related to motherhood or any form of protection from violence perpetrated during pregnancy. CEDAW, in fact, does not even explicitly acknowledge the enormous physical, psychological and socio-economic impact that pregnancy can have on women. Finally, in 1993, the Declaration on the Elimination of Violence against Women was introduced, in which, however, there is still no mention of gender-based violence against women in medical facilities.

The consequences of such a legislative gap have a strong impact on the lives of pregnant women, leading to the manifestation of phenomena such as obstetrical violence. Obstetrical violence is an abuse that occurs in the context of obstetrical-gynecological care and is committed by health workers who provide assistance to women and newborns (gynecologists, midwives or other professionals). Obstetrical violence occurs whenever a woman loses autonomy in relation to her sexuality and pregnancy status, through practices such as physical abuse, verbal abuse, use of coercive medical procedures not consented to by the patient, lack of informed consent in the choice of treatment, violation of privacy, refusal of reception in hospital facilities, and negligence in childbirth care.

The term first appeared in South America, when some non-governmental organizations and feminist groups began to fight systematically for better access of women to health care. The first official and legal recognition of midwifery violence occurred in a Latin American country: in 2007 Venezuela saw the birth of the "Ley Orgánica sobre el Derecho de las Mujeres a una Vida Libre de Violencia", in which midwifery violence is defined as "Appropriation of the body and the reproductive processes of women by health personnel, which is expressed in inhuman treatment, in the abuse of medicalization and pathologization of natural processes having as a consequence the loss of autonomy and the ability to decide freely about their bodies and their sexuality, negatively impacting the quality of life of women".

The expression has since spread to the Anglo-Saxon world and more recently to the rest of Europe, indicating the beginning of a process of greater legitimacy of women's testimonies regarding the phenomenon itself, their experience with sexuality and reproduction, as well as indicative of greater activism by women themselves. The World Health Organization has described the phenomenon of obstetrical violence as deeply representative of gender inequalities that result in specific forms of violence committed within the health care system. In the document "The Prevention and Elimination of Abuse and Disrespect during Childbirth Care at Hospitals" [1] published by WHO in 2014, it makes explicit how these treatments not only violate "women's right to respectful health care," but can also "threaten their right to life, health, physical integrity and freedom from all forms of discrimination."

Among the procedures to which women are most likely to be subjected in the circumstances of obstetric violence is unnecessary cesarean delivery: research conducted in 2016 by Optibirth [2] attributes a high number of unnecessary cesareans to the progressive "process of medicalization that affects women's autonomous choice," leading the doctors in charge to prefer performing a cesarean as a faster procedure. This form of obstetric violence is often linked to so-called "maternal grooming," which is the way women's expectations of having a safe and respectful birth are altered through doctor-patient discussions that take place in prenatal visits or birth settings. During such discussions, medical personnel often redefine the terms in which the "safety" of the woman and infant during birth is conceived, focusing on potential contraindications that may occur during pregnancy and, as a result, prescribing tests without explanation-including additional and unnecessary tests such as repeat ultrasounds at late term-and emphasizing possible maternal abnormalities that will lead to increased interventions at the time of birth or the inability to deliver without interference. The phenomenon of obstetric violence is further exacerbated by factors such as the woman's ethnicity, status as a migrant woman, the age of the woman giving birth, and her social or economic status.

At the moment in Italy there is no official collection of data on obstetrical violence. It is the Observatory on Obstetric Violence Italy (OVOItalia) that is responsible for collecting data and testimonies of obstetric violence to make the phenomenon visible. In 2017, the observatory reported the Doxa survey "Women and childbirth" [3] (conducted on a representative sample of about 5 million Italian women, aged between 18 and 54 years, with at least one child aged 0-14 years), in which the main negative experience reported by women during childbirth is the practice of episiotomy, suffered by 54% of respondents and practiced without the informed consent of the parturient. Episiotomy is a surgical incision of the perineum, i.e., the area between the vagina and the anus, practiced during childbirth to widen the vaginal opening when the baby's head begins to emerge, a practice that even the WHO defines to date as "harmful, except in rare cases."

Against the phenomenon of obstetrical violence in Italy, a bill was put forward in May 2016, namely "Norms for the protection of the rights of the parturient and the newborn and for the promotion of physiological childbirth", with the first signature of Adriano Zaccagnini (Mdp). The intent of the bill is the promotion of maternal and child health through the respect of women's rights, asking to reduce the use of practices such as unnecessary caesarean section, operative vaginal delivery and, in general, all practices harmful to the psycho-physical integrity of the woman, including episiotomy, use of suction cups or forceps, artificial rupture of membranes, pharmacological induction of labor and all forms of verbal humiliation. It is also requested to ensure the right of women to free and informed consent to medical treatment during labor and delivery, as well as, in general, greater transparency of health care providers.


Fonti consultate per il presente articolo:

[1] WHO_RHR_14.23_ita.pdf;jsessionid=15EC7E4522C7BE078DC50FB3B918084D

[2] Presentati a Roma i risultati di Optibirth, uno studio europeo per la riduzione dei cesarei | Aogoi

[3]Indagine Doxa-OVOItalia | Osservatorio sulla Violenza Ostetrica Italia (OVOItalia) (wordpress.com)

Che cos'è la violenza ostetrica - Il Post

Human Rights in Childbirth.pdf (ohchr.org)

Microsoft Word - Final_Respectful_Care_Charter_12-15-11.docx (who.int)

Violenza ostetrica: cos'è? (laleggepertutti.it)


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  • L'Autore

    Sara Scarano

    Sara Scarano, classe 1996, è laureata con lode in International Cooperation on Human Rights and Intercultural Heritage all’Alma Mater Studiorum di Bologna, dove ha conseguito anche la Laurea Triennale in Sociologia. Femminista, ambientalista, con un forte interesse per la cooperazione e la politica internazionale, la questione migratoria, e in generale i Diritti Umani. Sogna una carriera negli organi internazionali o nelle ONG.

    Sara Scarano, class 1996, graduated with honors in International Cooperation on Human Rights and Intercultural Heritage at the Alma Mater Studiorum of Bologna, where she also graduated in Sociology. Feminist, environmentalist, with a strong interest for international policy and cooperation, migration, and Human Rights in general. She dreams of a career in international bodies or NGOs.

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