Obstetric violence in Latin America: The pandemic only made things worse
The UN High Commissioner for Human Rights has received disturbing reports on the human rights of pregnant women and girls in the context of the pandemic
A recent report by the Open Democracy portal alerts on the rise in obstetric violence in the midst of the new coronavirus pandemic in Latin America, as well as other irregular situations that put pregnant women at risk as well as their tranquility at the time when they are giving birth to a child.
The report indicates that women who gave birth in the midst of the COVID-19 pandemic faced increasing pressure in favor of caesarean sections, in addition to mistreatment, companion bans and refusals to assist in emergency cases — despite the existence of laws against “obstetric violence” and “abusive medicalization”.
The region already had the highest caesarean section rate in the world, estimated at 40% of all births, although the World Health Organization (WHO) recommends that they should not exceed 15% of the total number of births in a country and insists that they should only be performed when medical reasons justify it. .
In March, the WHO reiterated this recommendation in its guidelines on childbirth during the pandemic: also that women should have the companionship of their choice when giving birth, receive dignified and respectful treatment, clear information, adequate analgesia and support to breastfeed if they wish. .
The practice of caesarean sections, inductions, episiotomies and other procedures that are not medically necessary, or that do not have informed consent, is prohibited by national or state laws against obstetric violence in at least eight Latin American countries, including Argentina, Ecuador, Mexico, Uruguay and Venezuela.
Most of these laws guarantee companionship for the mother in childbirth, cohabitation with the newborn and support for breastfeeding. But maternal health activists say that neither these norms nor the WHO guidelines are sufficient to protect these rights, even before COVID-19. The pandemic only made matters worse.
Some examples in the region
In Ecuador, for example, activist Sofía Benavides commented that her study group collected testimonies from 26 women who gave birth during the COVID-19 outbreak. In total, 13 of them said that they were not allowed to give birth with a companion, as part of hospital restrictions, and 15 commented that they could not have early skin-to-skin contact with the newborns.
Benavides reported that, at the worst moment of the outbreak in the city of Guayaquil (April and May), a private clinic offered the following: “You come alone, you have a cesarean section, we do not give you room, we keep you in the observation area and we charge you $ 1,200. The only good thing is that they allow her to stay with the baby”.
In the case of Mexico, gynecologist and obstetrician Christian Mera of the Proparto Natural Medical Group, estimates that -when the statistics are accessed- we will see that “in April and May there was an increase in caesarean sections”, driven by “the fear that the hospitals are saturated ”. However, “it is contradictory because the cesarean section has higher risks and, in the case of COVID-19, the risk of hospitalization and infection adds up”.
In the region, “in the name of the pandemic, caesarean levels have become extremely high, even for women without COVID-19”, said Bremen de Mucio, regional adviser on maternal health for WHO and the Pan American Health Organization (PAHO) to Democracy Now.
In Uruguay, which registers just 1,000 cases of COVID-19 and thirty deaths, the authorities were accused of turning a blind eye when several health centers temporarily suspended companions during childbirth, caesarean sections and ultrasounds, in violation of the law.
Women alone and misinformed
Starting in March, Open Democracy interviewed 17 women and a large number of non-governmental organizations, midwives and obstetricians from Argentina, Ecuador, Mexico, Uruguay and Venezuela, who detailed experiences of childbirth in the pandemic that seem to violate both international guidelines and local laws.
Most of the women had to give birth alone because companions were prohibited by COVID-19. This “multiplies the risk of abuse” in countries where obstetric violence “is always present”, said Mexican midwife Nuria Landa, from the Nueve Lunas group.
Many of these women reported verbal and physical abuse by overworked hospital staff, who also did not give them enough information to understand what was going on. In addition, several women in labor said they were separated from their babies and were unable to breastfeed them.
Violations of the WHO guidelines and laws are reported in both public and private hospitals. “They did not treat us with dignity”; this is how Lidia Cordero describes what it felt like to be left alone in labor in an emergency room of a public hospital in Huixquilucan, Mexico, where she assures that they did not give her the necessary information.
“Literal, we were treated like pariahs in the hospital”, said Montse Reyes, who had a scheduled C-section in May at a private clinic in Mexico. Reyes assures that after birth she and her baby tested positive for the COVID-19, but the staff did not inform her of the results until she was discharged, after spending two days in isolation.
They did not separate her from the newborn, but both were placed “in an isolated area behind a glass door” and “nobody wanted to have contact with us. It was eleven o’clock at night and I hadn’t had a glass of water since ten o’clock the night before”, she said.
“I felt abandoned”
Daniela Echeverría had been promised a delivery with music, freedom of movement and massages in the public health center of Conocoto, Quito, Ecuador. But while they allowed her to be with her husband, they left them alone in the delivery room. “I felt abandoned. It was a mixture of anguish and pain”, she recalled when she explained her own experience.
Echeverría believes that the staff was reduced due to the pandemic, and said that the only on-call team (one doctor and two nurses) was attending another delivery and only appeared three hours later; by then, she suffered a vaginal tear and her baby had swallowed amniotic fluid and meconium, a sign of fetal distress.
In Uruguay, the coordinator of the Grupo por la Humanización del Parto Y Nacimiento (Group for the Humanization of Childbirth), Laura Vega, said that her organization received “70 complaints throughout the country”.
The absence of clear information is a matter that is reiterated in the testimonies collected by Open Democracy. Two women who had cesarean sections in two Uruguayan cities in April (before the government reversed the ban on companions in May) said they were informed, at the last minute, that they would give birth alone.
“They didn’t even ask me. The gynecologist told my partner that it was not convenient for him to enter the operating room”, said Anahí Oudri; while Andrea Fernández added: “At that time I just did not have the strength to argue. I was terrified of a caesarean section, and you know that if you don’t win the discussion, it’s not good to see bad faces”.
Risky deliveries
The Open Democracy investigation identified more than 100 violations of WHO guidelines in at least 45 countries since the pandemic began. This evidence comes from direct testimonies, from NGOs and other journalistic media.
In Latin America, curfews and restrictions on transportation due to the coronavirus led to many women losing pregnancy control appointments, having to walk long distances to reach a hospital, or even being forced to deliver at home, unplanned and risky .
In Ecuador, feminist lawyer Ana Vera, from the sexual and reproductive rights group Surkuna, said that in April two women with obstetric emergencies were denied assistance several times in emergency rooms of public hospitals in Guayaquil, at that time submerged in an uncontrolled outbreak. of COVID-19.
“I had to intervene directly by calling authorities from the public health ministry” to “give antibiotics to one” and a “blood transfusion” to the other, Vera said.
Also in April, Nuria Landa, a Mexican midwife, received emergency phone calls from two women who were doing labor at home, after being rejected by a hospital that had been ‘converted’ to handle COVID-19 cases without prior notice.
Another woman in Guadalajara, Mexico, told Open Democracy that she had delivered without complications at home in April, but the next day she felt unwell and went to the hospital for a coronavirus test. At first, they didn’t want to do it.
“The doctor pushed her fingers harder and swirled them inside me”, said the woman. The doctor scolded her and assured her that she had traces of the placenta and needed a curettage. But it was not true, as a second doctor who ordered an ultrasound and a coronavirus test proved that she was positive for COVID -19.
The woman reported her case to the authorities as a violation of the rules against obstetric violence.
Human rights of women
A spokeswoman for the United Nations High Commissioner for Human Rights, Michelle Bachelet, said that her office “has also received disturbing reports on the human rights of pregnant women and girls in the context of the COVID-19 pandemic”.
“We are concerned that in the world, with overextended health systems, resources for routine services such as maternal health are frequently diverted. Documenting these incidents is a crucial first step in exposing the problem. States must adapt their practices to WHO guidelines without delay”, said the UN office.
For his part, the WHO / PAHO regional adviser on maternal health, Bremen de Mucio, said that the situations found in the Open Democracy investigation do not surprise him, “because they already existed before the pandemic and the fact that the WHO gave a specific statement on the abuse during pregnancy, childbirth and the puerperium, just goes to show that this is a reality that occurs in almost all countries”.
“The only thing that has happened in the pandemic is that some of these situations have worsened or become more frequent”, he stressed.
The expert added that “the first thing is to advocate for the issue to get the necessary visibility, this has a double effect. On the one hand, that women know that the problem exists and that the legal rights are on their side. On the other hand, to make professionals understand that practices that they consider normal are violative of women’s rights and that sooner or later they should be punishable”.
De Mucio also spoke about the resistance that the expression “obstetric violence” generates in medical personnel.
In the WHO statement, signed by dozens of institutions — he explained — “we should have talked about disrespectful treatment instead of obstetric violence. And this has not been on a whim, or because we do not want to recognize that obstetric violence exists”, but “to avoid cutting the bridges of dialogue with professional societies, because speaking of obstetric violence generates resistance that prevents discussing the issue”.
Laws against obstetric violence became necessary “in the face of the constant violation of women’s rights. Unfortunately, in some cases they have not been regulated, or the penalties implied by not respecting them have not been specified, or respect for these laws is not directly monitored”.
Even more serious — he stresses — professionals and women sometimes even ignore the existence of these standards. “A few years ago, at a gynecology and obstetrics congress, the president of a large gynecology and obstetrics federation in a Latin American country boasted that, although there was a law against obstetric violence in several states of his country, a gynecologist had never been punished for obstetric violence”.
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