South American legislation against obstetric violence: results from early mobilisation

Temps de lecture : 6 minutes

South American legislation against obstetric violence: results from early mobilisation

22.07.2020

Written by Lola Favre
Translated by Bianca Wiles

The term ‘obstetric violence’ (violencia obstetrica) emerged in Latin America at the start of the 2000s, ten years earlier than it did in France. It was popularised following historical events and global activism lead by medical staff, NGOs, and local feminist movements alike. As a result, this region seems to have taken a head start in terms of obstetric violence, notably through the passing of related legislation. So, what do these laws combat? Why did they develop primarily in Latin America? How efficiently are they applied ? These are some of the central interrogations that will guide this article.

The South American legal status quo

Several South American countries have legislated on obstetric violence with the precise aim to combat them. Venezuela was the first to take action in 2007 creating an impetus and leading countries such as Argentina, Brazil, and several Mexican States (the Durango, the Veracruz, the Guanajuato and the Chiapas) to follow suit.

In Venezuela, a law on “women’s right to a private life free from ^[1]BOUBAKRI Basma, HENRION Caroline, LAZARD Alexandre, Nouvelles femmes : ce qui change, available … Continue reading »declared that “the appropriation of women’s bodies and reproductive processes by health professionals through dehumanising treatments, abuses in medicalisation, or the pathologising of natural processes, leading to loss of autonomy and decision-making capacity over their bodies and sexuality, negatively affects women’s quality of life^[2]BOUBAKRI Basma, HENRION Caroline, LAZARD Alexandre, Nouvelles femmes : ce qui change, available at … Continue reading ».

The same notion can be found in the 2009 Argentinian law stating that “obstetric violence is violence perpetrated on women’s bodies and reproductive processes by health professionals. This is reflected through dehumanising treatments, abuses in medicalisation, and pathologising of natural processes^[3]BOUBAKRI Basma, HENRION Caroline, LAZARD Alexandre, Nouvelles femmes : ce qui change, available at … Continue reading ».

The Brazilian law on the subject differentiates itself from the above-two examples as it specifies that obstetric violence may also be committed by family members or companions.

Since 2011, the Mexican State of Chiapas also has a “law for women’s access to a life free from violence^[4]EL KOTNI Mounia, “La place du consentement dans les expériences de violences obstétricales au Mexique”, Autrepart, 2018, n°85, pages 39 à 55». It defines obstetric violence similarly to previous examples, but also places an emphasis on the consent women in labour can give, establishing that any person “altering the natural process of labour, through techniques seeking its acceleration,  without the voluntary, explicit and informed consent of the woman in question^[5]EL KOTNI Mounia, “La place du consentement dans les expériences de violences obstétricales au Mexique”, Autrepart, 2018, n°85, p. 39-55 ».

These pieces of legislation are proof of the innovative and forward-looking attitudes in these countries compared to others. In France, for instance, no such legislation provides women with explicit protection against obstetric violence.

Why has this issue emerged in Latin America?

Upon observation, it would seem that the movement against obstetric violence emerged in Latin America in the 1990’s and intensified in the 2000’s. It originated in the importation of the “zero death objective^[6]CUSSET François, “La camisole biopolitique”, in Le déchainement du monde : logique nouvelle de la violence, Paris, La Découverte, 2018 », an impetus created in North America and Europe. This objective seeks to take all necessary measures to decrease the death rate at birth and entails a high rate of medicalisation these Latin American movements seek to counter. While the introduction of modern treatment methods for Latin American women was welcomed, it was the overmedicalisation and the pathologising of the natural process of labour that raised concerns. This movement in favour of the humanisation of motherhood was initiated by public health authorities, particularly in public maternity hospitals, as the latter were the first ones affected by the progress in childbirth techniques. This is all the more uncommon considering that actions protesting obstetric violence were often led against the existing public health systems. In Latin America, in contrast, these contestations were coming “from inside” the medical system and were supported by civil society and NGOs activist actions. It is in the fight against the importation of European and American standards of childbirth care that the Latin American and Caribbean Network for the Humanization of Childbirth was created, simultaneously to a movement against obstetric violence. It is through these actions that activists created a transnational movement on a South American scale.

This movement rejects the view that childbirth is dangerous, pathological and implicates a certain level of technicality and high levels of medicalisation. It seeks to return to more natural methods of childbirth. In practical terms, this mobilisation for the humanisation of childbirth has allowed for the creation of measures such as the right to have an attendant present during the process of labour, the father’s right to visit outside authorised hours, or the introduction of midwives during childbirth. The promotion of breastfeeding was also central to the movement’s claims as this resulted in a decrease in infant mortality. More recent legislative evolution from the above-mentioned countries has also undoubtably emanated from these mobilisations.

How efficient are these laws ?

Due to lacking French sources as to the application of these Latin American laws against obstetric violence, we will focus on the Mexican law from the State of Chiapas for which the work of Mounia El Kotni^[7]EL KOTNI Mounia, “La place du consentement dans les expériences de violences obstétricales au Mexique”, Autrepart, 2018, n°85, p. 39-55 et EL KOTNI Mounia, “Maltraitance des corps et mépris … Continue reading, provided us with sufficient data.

While the presence itself of a law protecting women from obstetric violence constitutes a big step in the right direction, it remains to be seen how efficient it is in practice. As mentioned earlier, the Mexican law from Chiapas emphasises the need for women’s consent in order to fight violence. However, it would seem that the application of this provision is difficult. This is mainly due to barriers to expressing and obtaining consent from women in childbirth.

Firstly, the language barrier constitutes a considerable hurdle to obtaining consent in Chiapas, a State that counts a large number of indigenous people. This diversity may lead to many doctors and patients not speaking the same language.

Furthermore, for consent to be duly given under this provision, the patient must knowingly consent. This is not the case in most instances where women living in poverty give birth in public maternity hospitals without any knowledge of necessary information (the State of Chiapas is among the poorest in Mexico).

Finally, indigenous patients are also confronted to systemic racism which is often a vector of violence. These women are subjected to social and cultural contempt with regards to
their traditional birthing practices. Maya women, for example, give birth near a fire and as clothed as possible, a practice that seems radically opposed to the coldness of hospitals and women’s nudity in front of health personnel. Also, Mayas do not perform any vaginal examinations as they are seen as aggressive and can be perceived as acts of violence in Mexican public maternity hospitals. The lack of consideration of any cultural differences, sometimes accompanied by blatant disdain from medical staff, entails violence that the law does not take into account. To tackle this issue, a new generation of midwives, whose aim is to create a bridge between patients and doctors, is being trained.

In this sense, it is regrettable that the law in the State of Chiapas focusses on obtaining consent. Where this consent is so easily manipulated and does not eliminate risks of violence, it would be preferable to seek a material and relational improvement in patient care.

Conclusion

It is undeniable that the legislative strides in Latin American countries on issues of obstetric violence is the result of large mobilisation from a variety of actors. It is likely that this early mobilisation in this region was due to cultural differences. In fact, occidental culture is characterised by a general wish to keep pushing medical knowledge and techniques further, which is not the case in South America. This would explain the wish to avoid the medicalisation of childbirth. This legislation is also telling of a rejection of the western neo-colonial custom of exporting its knowledge to other countries with the underlying assumption of its exclusive validity.

Sources

BOUBAKRI Basma, HENRION Caroline, LAZARD Alexandre, Nouvelles femmes : ce qui change, disponible sur https://www.irasf.org/wp-content/uploads/2018/11/Emergence-violences-obstetricales-IRASF-SEXOGYN.pdf, consulté le 15/07/2020

CUSSET François, “La camisole biopolitique”, in Le déchainement du monde : logique nouvelle de la violence, Paris, La Découverte, 2018

EL KOTNI Mounia, “La place du consentement dans les expériences de violences obstétricales au Mexique”, Autrepart, 2018, n°85, pages 39 à 55.

EL KOTNI Mounia, “Maltraitance des corps et mépris des pratiques culturelles”, Actualité Sages-Femmes, n°93, 2018

FAYA ROBLES Alfonsina, “L’« humanisation de l’accouchement et de la naissance au Brésil » : de nouveaux dispositifs de régulation des corps des femmes pauvres ?” Lien social et Politiques, 2009, n°59, pages 115 à 124

FRANECZECK Marie-Laure, “Violence obstétricale : essai de définition à partir de la littérature scientifique”, Gynécologie et obstétrique, 2018, Dumas-01946490

GAUTIER Arlette, “Les violences de genre : théories, définitions et politiques”, Autrepart, 2018 , n°85, pages 3 à 18.

MACIAS Amandine, “Perception du débat sur les violences obstétricales par les professionnels, sages femmes et gynécologues-obstétriciens”, Gynécologie et obstétrique, 2019, Dumas-02301776

To quote this article: Lola Favre, “South American legislation against obstetric violence: results from early mobilisatione”, Gender in Geopolitics Institute, 22.07.2020.