It has become all too clear lately that to be pregnant, to be in labor, or to birth a child is to put oneself at the mercy of larger powers—powers that sometimes seem unconvinced of women’s humanity. Anti-choice politicians are often the most egregious in leaving out any trace of women’s agency from their rhetoric around pregnancy and abortion. But now we are increasingly seeing evidence that some health-care providers, both in the United States and globally, tend to also reproduce the persistent narrative that girls and women relinquish their human rights when they conceive. Beginning last year, advocates launched the International Day for Maternal Health and Rights on April 11 to ensure that women’s rights in pregnancy, labor, and childbirth become an international priority, including among health providers and politicians.
The cases of Purvi Patel in Indiana and Las 17 in El Salvador have exposed violations of women’s human rights within health systems in the United States and internationally. As has been well-documented by others at Rewire, Purvi Patel’s health providers, who were supposed to be focused on her wellbeing, instead reported her to the police. In El Salvador, 17 women have been imprisoned for miscarriages and other pregnancy complications, with some health providers pressured by strict anti-abortion laws to become witnesses against them.
Alongside these individual cases, widespread disrespect and abuse toward women during pregnancy and childbirth have become impossible to ignore, with mounting evidence that these rights violations are serious and common throughout the world. Although turning patients over to police for their pregnancy outcomes may be an extreme example, women and girls often face violations such as non-consented care, verbal abuse, lack of privacy, discrimination, detention, abandonment, and even physical violence, as documented by leading experts Diane Bowser and Kathleen Hill. Prevalence measures are tricky to establish across cultural contexts, and they must include both observation and reports from women themselves. A recent study of 2,000 women in Tanzania, however, found a 12-to-15 percent prevalence rate of disrespect and abuse during labor and childbirth, while a study of facility-based births in Nigeria found that almost all women—98 percent—experienced at least one form of disrespect and abuse, most commonly stemming from providers touching the woman without obtaining her consent.
Yet health workers guilty of such treatment do not bear the full blame. They are operating in a larger context that often devalues women (including female health providers themselves) and disrespects women’s decisions. While it varies from country to country, national laws and policies, human rights laws and policies, individual and community norms, and health facility policies all play a part in this behavior.
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It’s becoming increasingly evident that the consequences of these human rights violations are dire. Disrespect and abuse in labor and childbirth contribute to maternal deaths and complications, although to what extent is still unknown. Not surprisingly, though, women are not clamoring to use providers or facilities that mistreat them, which means that some choose the risks of birth with potentially unskilled attendants over a potentially abusive clinic or hospital setting with technically skilled providers. A recent review by the World Health Organization (WHO) of 34 studies across 17 countries found that fear of discrimination during delivery was a direct barrier to facility-based birth.
These ramifications extend past the experiences of pregnancy and birth too. Imagine what fear of abuse means for the many different women who, like Purvi Patel, are dealing with multiple layers of discrimination, such as those that stem from race, economic status, or age—and who are more likely to suffer mistreatment, research has shown. For the woman living with HIV, what is the likelihood she will stay on treatment postpartum if she experiences stigma from her care providers? For the sex worker, what possibility will she see of getting confidential HIV testing if she could not trust hospital workers with private information during birth? For the adolescent girl, what are the chances she will ask how to prevent a subsequent pregnancy if she’s been yelled at by health workers for getting pregnant the first time? For the woman beaten by her husband, will she report him to health workers if she encounters physical violence at their hands as well? For any woman who needs to access a range of sexual and reproductive health services, the implications of disrespect and abuse during labor and childbirth are potentially life-threatening.
Trying to end this behavior by training staff and educating clients at the clinic or hospital level is necessary, but not at all sufficient to address the rampant mistreatment women and girls suffer. Consistent and sustained effort at this level will also depend heavily on management that understands and values human rights in health-care settings, which itself cannot be assured unless global and national leaders also understand and value these rights.
Affirming women’s full sexual and reproductive rights in documents and strategies is a critical way for leaders to demonstrate how seriously they take the issue. On a very practical level, for example, maternal health and rights advocates are calling for the Global Strategy 2.0, the renewed global strategy for women’s and children’s health, to include indicators measuring how well providers and health systems protect rights in pregnancy and childbirth. National governments should also adopt responsibility mechanisms, informed by women, to address and prevent abuse.
It is vital for advocates and leadership at all levels to take action ensuring that the human rights of women and girls in pregnancy and childbirth is a global priority, enforced and rewarded with accountability systems and targets. If we are serious about ending preventable maternal deaths, if we believe that women’s rights are human rights, we must ensure that clinics and hospitals are safe for every woman and every girl.