The announcement by the Ministry of Equality to include obstetric violence in the upcoming reform of the abortion law has caused a stir around this concept. While some sectors welcome the change, arguing that it affects efforts to eradicate male chauvinism, many of the professionals in the field have opposed it, saying they are criminalized.
What is obstetric violence? Where does the concept come from?
Although this may sound like something new, the truth is that the term “obstetric violence” is actually very old: at the latest it appears in an 1827 lecture in London collected in the medical journal The Lancet. In it, James Blundell criticizes certain practices that were common in British childbirth at this time (“huge lacerations, reversals of the uterus”, Blundell quotes), such as trying experimental techniques with serious consequences in women without even them. inform correctly.
Indeed, Blundell takes a heavy toll on the eagerness to intervene in many of his colleagues, advocating allowing work to unfold naturally as much as possible and acting only when the situation calls for it.
This criticism continued for years, albeit in a relatively minor way, on the lips of many obstetrical professionals. However, it was the advent of the feminist movement that gradually succeeded in removing these ideas from the purely academic world and transferring them to collective debate.
So much so that in 2014 the WHO issued a statement in which, without using the words “obstetric violence”, it warned that “many women around the world experience disrespectful, abusive or negligent treatment during childbirth. “which would include” physical violence, profound verbal abuse and humiliation, non-consensual or coercive medical procedures (including sterilization), lack of confidentiality, failure to obtain your informed consent, denial of pain treatment, significant violations of privacy, denial of admission to medical facilities, avoidable neglect leading to life threatening complications, and keeping themselves and children in institutions so they cannot pay. “
This prompted the United Nations General Assembly to prepare a report in 2019 citing many practices considered obstetric violence (this time using those exact words), and which together form the most widely accepted definition today; Following what is stated in said report, we could say that the concept refers to any case of physical abuse, excessive medicalization, unnecessary or inappropriate intervention, refusal of care or necessary interventions, lack of information or respect for informed consent, illegal detention, refusal of anesthesia, lack of respect for privacy or sexist or humiliating remarks made to the woman in labor or her baby.
The feminist perspective and the controversy
The truth is that all the practices cited by the UN are already sanctioned by Spanish law as professional misconduct or negligence. However, what has raised the controversy is the announcement by the Ministry of Equality to include it in the reform of the law on abortion “as a form of gender-based violence”, as announced. Antonia Morillas, director of the Institute for Women.
This approach responds to the feminist perspective, which understands that obstetric violence begins, or at least is determined, from the structural discrimination and violence to which women are subjected in patriarchal societies, and is therefore qualitatively different from other forms. of violence. negligence or medical malpractice.
That is to say that according to this perspective, the practices grouped under the term would be the result of a medicine inevitably conditioned by personal values and prejudices, by economic stakes and by politics (thus taking up the thought expressed by Foucault) and which, in the context of a patriarchal society, therefore reproduces structural discrimination against women.
Taking into account that gender-based violence is understood as this violence to which women are subjected because they are, according to this approach, obstetric violence would fall into this category.
The reluctance of professionals
The greatest opposition to the legal reform announced by Equality is that expressed by many professional associations and professional associations in the gynecological and obstetrical specialties, and which is well summarized in the press release issued by the General Council of official medical orders.
These actors believe that the categorization of obstetric violence as gender-based violence “criminalizes the actions of professionals who work under the principles of scientific rigor and medical ethics”.
However, they go further; In the same press release, the agency is totally opposed to the use of the concept, even specifying that “the use of the term ‘violence’ is particularly offensive: obstetric procedures that could be considered excessive or inappropriate would, in all. eventuality, actions based on the principle of beneficence, that they would seek the best for women. “
Finally, they ask “not to create unnecessary social alarms which can contribute to deteriorate the necessary trust between the doctor and his patient”.
Obstetric violence in Spain
The truth is that in recent years the reality of obstetric violence, as understood by international organizations, has become more and more visible in Spain.
For example, in 2020, the United Nations Committee on the Elimination of Discrimination Against Women (CEDAW) urged Spain to compensate a woman who, in 2011, said she had undergone medical procedures which she claimed. had not been informed and that she had not authorized. , which also caused lasting physical and psychological damage. The facts were then dismissed by the Spanish courts.
Another sample emerges from a study published in 2020 in the International Journal of Environmental Research and Public Health and based on questionnaires completed by a cohort of more than 17,500 women, which explains why 38.3% of mothers perceived as having been victims of this type of violence and 44.4% believe that they have been subjected to unnecessary procedures.