TOWARDS EQUALITY: In Spain, a network of activists, lawyers and midwives breaks the silence on obstetric violence: The Asahi Shimbun
The Spanish government recently announced that it will include the term ‘obstetric violence’ in legislation as a form of gender-based violence – a step that comes after dozens of women pushed to raise awareness, support those who l ‘have lived and changed hospital protocols.
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They all thought it only happened to them and they didn’t know why. This was the sentiment of a small group of Spanish women who 20 years ago set up an email channel to talk about the negative experiences they had during pregnancy and childbirth.
Soon after, they began to receive more testimonies from women across Spain, citing an unspoken but systematic and global problem of women: obstetric violence.
Their messaging group quickly reached 1,000 subscribers. Today it has grown into a pioneering Spanish association called “El Parto es Nuestro” (Childbirth is ours), with local groups in over 20 Spanish cities providing space for women to support and listen to each other. , as well as for advice.
Together with lawyers, midwives, activists and other groups, the association is forging a network of nationwide initiatives, the work of which has begun to bear legislative fruit in recent years.
Recently, Spain’s Equality Ministry announced that it will include obstetric violence in law as a type of violence against women – a move hailed by organizations who hope the move will serve to end this type of violence, which has physical and emotional consequences for women and their babies.
The most common negative experiences women report, says Virginia Murialdo, anthropologist and activist for El Parto es Nuestro, include unwarranted and unintentional episiotomies (cutting of the skin, muscles, nerves and fascia surrounding the vagina) during childbirth, excessive administration of drugs, an increasing tendency to cesarean sections and the so-called Kristeller maneuver – strongly questioned by the World Health Organization (WHO) – which consists of applying pressure to the abdomen to push a baby through the birth canal.
Beyond these practices, “women also suffer from humiliating and abusive attitudes and comments”, specifies Ms. Murialdo, as well as “gestures that do not respect their privacy”, ranging from the presence of students without consent during vaginal examinations to the inability to choose the birth position, to sexist remarks intended to intimidate those who refuse the epidural.
These cases are not unusual. The United Nations described obstetric violence in 2019 as a “widespread phenomenon” – a phenomenon the WHO considers “a violation of women’s rights”.
Yet women rarely talk about these experiences out loud, out of fear of stigma and shame, or because they downplay their importance. “Many have normalized what happened to them, so the first step is to break the silence and raise awareness,” says Murialdo.
Now specializing in obstetric violence for 18 years, Spanish lawyer Francisca Fernandez Guillen even approached the United Nations to defend the cases of four Spanish women whose complaints had been rejected by the Spanish courts.
Since she started working in this field, Guillen says she has seen “a good evolution”, with important decisions that have served to pave the way for an end to impunity for this type of violence.
“I get good decisions in the courts. Before, it was much more difficult to get recognition, for example, of the need to obtain the informed consent of the patient to perform an episiotomy or to induce labor,” she said. .
However, some still resist recognizing, medically and judicially, the harm that these practices cause to many women.
One of the four complaints filed by the lawyer to the United Nations Commission on Human Rights in 2018 concerned the case of a woman (who wished to remain anonymous and we will name “S”) who gave birth to the Cruces hospital in the north of the Spanish Basque country. in 2012.
“She behaved badly”, “She doesn’t deserve the child”, “I should take the child away from you, you behaved very badly”, were some of the comments S heard during the meeting. delivery of his midwife, who also performed an unspecified episiotomy despite her refusal.
She had not been allowed to drink anything since being admitted to the hospital and was forced to lie on her back motionless and alone at all times. Even the baby’s father was not allowed into the room. The consequences of the episiotomy later included urinary incontinence and “severe” repercussions on her sexual and relationship relationships.
In 2020, the UN Commission finally reprimanded Spain for obstetric violence committed against one of Guillen’s clients.
In its resolution, the committee said the woman had been subjected to several practices, such as inducing labor, “without apparent justification”, and characterized the events as gender-based violence.
However, introducing obstetric violence into Spanish law will not help, says the lawyer, unless there is a real commitment to comply with childbirth-friendly protocols and regulations, which advise against already many of these practices and oblige women to be informed.
Many hospitals are already evolving.
Soledad Carregui, a midwife for over 20 years at La Plana University Hospital in the province of Castellon in eastern Spain, says a lot has changed since she started working there thanks to a group of professionals who began to question the “over-medicalization” of childbirth and began to research new practices that would humanize the experience, aligning it with new medical evidence.
“A lot of clinical practices have been scientifically challenged, but due to the hospital routine they are difficult to change,” she explains.
The hospital now has a delivery protocol in which staff apply what they have learned.
“We encourage women’s mobility as they dilate, make sure they deliver in the most comfortable position, allow them to eat, drink and be with whomever they want, avoid medication, l ‘oxytocin, episiotomies and induction of labor when not necessary, and we indicate cesarean sections on a case-by-case basis. “
In short, says Carregui, it is “not to work on a whim or according to old and rigid protocols, but to put women and their needs first. A humanized childbirth is perfectly compatible with a childbirth. without risk”.
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This article is published as part of “Towards Equality”, an international and collaborative initiative bringing together 15 international media outlets to highlight the challenges and solutions to achieve gender equality. The Asahi Shimbun is participating in this campaign led by Sparknews.