Failure to Deliver: Tolerating Reproductive Health Abuses

Andrea Lynch

Failure to Deliver: Violations of Women's Human Rights in Kenyan Health Facilities paints a distressing portrait of Kenyan women's experiences of reproductive health care.

I've never had a baby, but ever since I was a girl, I've wondered what it would be like to give birth. I can't say the pain factor doesn't give me pause, but for the most part, I've always looked forward to it. My mother has always described my birth as one of the most amazing moments of her life, so I grew up with a sense of curiosity, anticipation, and excitement about what my own experience of childbirth would be like. Childbirth can be such a transformative event in a woman's life — such a significant moment, such a magical experience, such a wonderful blessing. But for some women, childbirth can also be a trauma of unimaginable proportions.

Failure to Deliver: Violations of Women's Human Rights in Kenyan Health Facilities, a report recently released by the Center for Reproductive Rights and the Kenyan Federation of Women Lawyers (FIDA), paints a distressing portrait of Kenyan women's experiences of reproductive health care. The report, which is the result of in-depth interviews, focus groups, and questionnaires with over 120 women, backed up by the observations of healthcare providers and government officials, uncovers decades of physical and verbal abuse, discrimination, and neglect in both public and private health facilities across Kenya. It tells of women abused and neglected during and after giving birth, women receiving biased counseling on contraception, women sterilized without knowing that the procedure is permanent, women denied emergency care because they can't pay deposit fees or detained in the hospital until they manage to clear their debts.

The stories it uncovers are powerful to say the least. From Prudence, a casual worker in a maternity ward at a district hospital in Kisumu, Kenya:

When you go to give birth, [the nurses] always shout, "Did I send you here? Spread your legs the way you did when you got pregnant. That day you did not scream, but today you are screaming at us."

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From Jane, a young mother:

I remember I was a kid and when I was asked to push I didn't know what to push. I pushed till I went for a long call [had a bowel movement]. The nurses left me and told me it's my problem.

And from Jackline, who suspects that she contracted HIV during her 2002 delivery in a district hospital:

[I]n the labour ward we were three women and there was only one nurse who was attending to us. She was not nice. She treated us badly. It was my firstborn. She came and abused me and slapped me as I was screaming. The other women were also being abused. . . The first woman gave birth — she was helped — and within three minutes my baby came and the nurse used the same scissors she had used on the other woman. I can't forge t. . . There was no water there. There is always a complaint about water. She took my baby and wrapped my baby in my lesso. She asked me if I had cotton [and told me where to put it]. . . I was just alone from 3:00 when I gave birth, to 7:00, [when] the woman next to me noticed I was bleeding. I couldn't sit. I was squatting on the bed. There was blood all over. . . I was not checked. The woman got water for me and I bathed. I didn't have anything to wear or sleep on.

These examples may seem extreme, but I have heard women all over the world tell the kinds of stories that Failure to Deliver uncovers, and I've seen other research suggesting that these kinds of experiences are often the norm, rather than the exception, for women seeking all kinds of reproductive health care. A study conducted a few years ago in Rosario, Argentina, revealed that women seeking treatment for either miscarriages or botched illegal abortions (abortion laws are highly restrictive in Argentina, but 1 in 3 pregnancies still ends in abortion) are often subject to similar kinds of verbal and physical abuse — they are harassed, denied anesthesia, made to wait hours by themselves, or examined by medical students without their consent, sometimes with a sheet over their heads. Many of my female colleagues in Nicaragua, where abortion is now totally illegal, told stories of being verbally and physically abused by doctors and hospital staff after being rushed to the hospital with miscarriages, since the medical staff assumed that they had intentionally caused the miscarriages themselves. And I once heard a Nigerian clinic director brag about testing women for HIV without their consent ("These women are stupid — they don't even understand what HIV is. What is the point of telling them?"), as well as reveal that he often denied women treatment for reproductive health problems he did not consider important, such as yeast infections.

Despite our disastrous health care situation, horror stories from the United States are a lot tamer than those listed above. We may have unconscionable health disparities within our population, and the quality of care that Americans receive might vary tremendously, but at least you don't generally have to bring your own anesthesia (or clean syringes).

When it comes to pregnancy and childbirth, however, American women still find themselves with little control over the circumstances under which they give birth (as Jennifer Block's fabulous new book Pushed documents), and often feel abused and neglected by hospital staff. I have friends who describe their first nights in the hospital after giving birth as lonely, scary, and filled with confusion; who were snapped at by hospital staff for doing something they weren't supposed to be doing when no one had ever told them what they were supposed to be doing; who were given their babies to breastfeed without being shown how to breastfeed, then criticized for breastfeeding improperly.

Hospital staff in the United States may be burned out, overworked, and underappreciated, just like hospital staff in Kenya work in crumbling health systems with little institutional support and few basic supplies at their disposal — and none of that is their fault. But this whole global picture has got me thinking hard about how universal it is for cultures to centrally link women's social and individual value to their capacity to bear children, and then deny women the ability to lead healthy reproductive lives — whether it is through cutting funding for reproductive health services, over-legislating reproductive health issues and therefore preventing doctors from being able to offer women the full range of options they deserve, denying pregnant women to right to decide under what circumstances they wish to give birth, or treating pregnant women like idiots at best and sinners at worst whenever they arrive in the hospital. Pregnancy and childbirth may be magical and beautiful in theory, but in practice, they require real support. And I have to ask myself, if our world is willing to tolerate this level of abuse aimed at women who are literally in the process of bringing new life into the world, what do we really think of women? And of life?

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Argentina, Kenya

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Reproductive rights are a public health issue. That's a fact.

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