Keeping in mind the theme #PressforProgress for this years #IWD2018, our team has prepared a set of infographics available in our Birth Guide , that can encourage women to make informed choices. We are also proud to present this brilliant essay by Hermine Hayes-Klein that talks about human rights beyond survival. This International Women’s Day, Know Your Rights as a Childbearing Woman.
Human beings, like all mammals, need to feel safe in order to give birth.
Childbirth as a physiological process is powered by hormones, and those hormones are strongly affected by the birthing women’s emotions, which are in turn affected by her perception of whether she is giving birth in a safe environment (1). In order to feel safe during labor, a birthing woman needs to know that she is supported—by her family, by her community, and by her healthcare system. Decades of global research have demonstrated that families and nations do better when women are empowered and supported, including in their role as mothers. However, economic empowerment and equity remain elusive for women, and especially mothers, worldwide. As women advocate for our right to survive, to live free of sexual violence and harassment, for economic access and political equity, it is also worth discussing the way that women are treated during the fundamental, foundational process of childbirth. The last decade has seen an emerging awareness in the global health community that the goal of advancing safe motherhood raises the question: are women giving birth in environments where they feel safe?
What does a safe environment for childbirth look like?
A woman has the greatest chance for a safe birth if she has enjoyed a healthy, well nourished pregnancy, and has been able to access supportive antenatal care that could help her recognise or anticipate any complications that may arise. The barriers that women face to healthy, supported pregnancies remain significant in nations around the world, especially for women in marginalised communities. Nations have a duty to recognise the worth and uphold the rights of all women and girls by ensuring their access to healthcare. No family should lose its mother, when access to good nutrition and prenatal care, skilled providers, and emergency services could have saved her life. In order to feel safe during childbirth, a woman needs to know that she can access the services that she and her baby need to optimise health, including emergency obstetric services.
Is Facility-Based Birth Safe for Women?
The assumption that facility-based, medically-managed delivery is the best way to ensure safe childbirth has been complicated by evidence showing both that planned hospital birth doesn’t significantly improve maternal and perinatal outcomes, and that many women avoid hospital birth because they do not feel safe going to the hospital to give birth. Current maternity care systems impose an unfortunate tension for many women, between their desire to access medical care if they or their baby need it, and their desire to give birth in an environment where their fundamental human rights will be respected. In order to feel safe while she is giving birth, a woman needs to have her personal and cultural needs for equal treatment, autonomy, privacy and companionship met. She may need to have her body covered in order to feel safe; she may need to feel free to move around and undress. She may need to have her sister, mother, partner or husband by her side. A birthing woman needs to feel safe in the knowledge that the people around her will treat her with respect and dignity, and that nobody will subject her to violence or abuse. Every maternal healthcare system should be able to meet the fundamental need of each birthing human mammal to feel safe. And yet, in healthcare systems around the world, women are asked to sacrifice feeling safe, and even being safe, in order to access the safety that medical backup provides. Widespread reports of disrespect and abuse, dehumanised, traumatising treatment, and violations of women’s rights to privacy and dignity show that women are giving birth in environments in which they cannot feel safe, because in fact, they are not safe (2).
Maternity Care Development and the Cesarean Section Pandemic
The global commitment to safe motherhood reflects a crucial recognition that societies must guarantee women healthcare support to end preventable maternal and neonatal mortalities. But when the only human right we recognise in childbirth is the right to survive, the violation of women’s other human rights is rendered invisible. As the Millenium and Sustainable Development Goals focused billions of dollars in development funding on maternal health in India and many other nations, an exclusive focus on survival resulted in policies that moved women into facility-based birth, without meaningful accountability on whether those women even walk out of the facilities alive, let alone healthy and well (3). In India and elsewhere, obstetric medicine has increasingly shifted to cesarean section surgery for childbirth as a standard mode of delivery in many places, despite the risks that uterine surgery creates for women, their babies, and their future pregnancies (4). Media reports on the cesarean pandemic often claim that women “choose” all these surgeries. In truth, women often consent to cesarean surgery on the basis of misinformation and pressure, and without an alternative option of meaningful support for physiological birth. Most women want to know that the medical system will meet their individual needs, and will have surgery available if they need it, but support them in a vaginal birth if they don’t need a surgical one. Nevertheless, the rate of surgical deliveries has risen astronomically in recent decades in both developed and developing nations. Economic studies all over the world connect providers’ financial and time convenience incentives to the massive increase in surgical deliveries (5). The money that healthcare systems are wasting on the surgical delivery of healthy babies from healthy women could be directed toward underserved women and closing gaps in women’s reproductive health.
Human Rights in Policy and Practice
In response to these trends, and to reports on the mistreatment of women in maternal healthcare worldwide, the last few years have seen a growing call for recognition of the full range of women’s human rights in pregnancy and childbirth (6). Women in both the developing and developed world are organising to speak out about systems of care that dehumanise and traumatise them at their moment of greatest vulnerability. They are demanding recognition of their rights—not only to access healthcare and to survive childbirth, but their rights to autonomy as informed consent and refusal, to privacy, to dignity, and to non-violent and non-discriminatory treatment in labor and birth. The human rights framework takes women beyond asking providers to please give them individualised, humanised care, but requires the state to enforce women’s human rights as legal rights that must be respected in policy and practice. Birthing women are not objects to be processed. They are human beings and citizens, with full claims upon healthcare and human rights.
How would maternity care change if it respected and upheld not only the right of survival, but the humanity and dignity of every woman, baby and family going through this life passage? How would the delivery room change if everybody in it understood that nothing could be done to a woman or her baby without the woman’s genuine, informed, un-coerced consent? What would maternity care look like if every woman could really feel safe, and be safe, while she brought her baby into the world? If we envision a world where women are empowered and supported, including during the vulnerable process of childbirth and into their lives as mothers, then we can work together and make that vision a reality.
Feature Image Photograph by Allison Shelley for Original post
(1) http://www.nationalpartnership.org/research-library/maternal-health/hormonalphysiology-of-childbearing.pdf (2) http://qz.com/422338/in-horrific-indian-hospitals-women-in-labour-are-slappedwhen-they-scream/ (3) https://www.hrw.org/report/2009/10/07/no-tally-anguish/accountabilitymaternal-health-care-india (4) http://qz.com/326402/cesarean-births-in-india-are-skyrocketing-and-there-isreason-to-be-very-worried/ (5) Nathanael Johnson, For Profit Hospitals Performing More C-Sections, California Watch (Sept. 11, 2010), http://californiawatch.org/health-and-welfare/profithospitals-performing-more-c-sections-4069 (“women are at least 17 percent more likely to have a cesarean section at a for-profit hospital than at one that operates as a non-profit”) (5) Elias Mossialos et al., An Investigation of Cesarean Sections in Three Greek Hospitals: The Impact of Financial Incentives and Convenience, 15 Eur. J. Pub. Health 288 (2005) (“[P]hysicians are motivated to perform CS for financial and convenience incentives.”) (5) Hannah G. Dahlen et al., Rates of obstetric intervention and associated perinatal mortality and morbidity among low-risk women giving birth in private and public hospitals in NSW (2000–2008): a linked data population-based cohort study, 4 BMJ Open e004551 (2014) (5) Piya Hanvoravongchai et al., Implications of Private Practice in Public Hospitals on the Cesarean Section Rate in Thailand, 4 Hum. Res. Health Dev. J. (Jan.-Apr., 200-), available at http://www.who.int/hrh/en/HRDJ_4_1_02.pdf (concluding that care in a private hospital, which includes higher rates of intervention, associates with higher rates of neonatal morbidity and no evidence of reduction in perinatal mortality) (5) Kristine Hopkins et al., The impact of payment source and hospital type on rising cesarean section rates in Brazil, 1998 to 2008, 41 Birth 169 (June 2014) (noting that publicly funded births in public and/or private hospitals reported lower c-section rates than privately financed deliveries in public or private hospitals). (6) http://www.who.int/reproductivehealth/topics/maternal_perinatal/statementchildbirth/en/ (6) http://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001847