Gynecological and obstetrical violence in France: the politicization of a feminist struggle

Temps de lecture : 9 minutes

Gynecological and obstetrical violence in France: the politicization of a feminist struggle

Illustrator : Nato Tardieu

30.06.2020

Written by Marion Luc et Noumidia Bendali Ahcene
Translated by Kaouther Bouhi

Gynecological and obstetrical violence are part of a continuum of violence based on gender. The feminist mobilizations of these past years have helped to break the silence on an oppressive system for women’s bodies and sexualities. This article focuses on the integration of the issue of gynecological and obstetrical violence in France into the political agenda.

This set of articles aims to highlight gynecological and obstetrical violence in various regions of the world. We will define obstetrical violence as Marie-Hélène Lahaye, a feminist, jurist, blogger, and Belgian whistleblower, puts it, as follows: “the addition of two types of violence : institutional violence and gender-based violence”, characterized by “any behavior, act, omission, or abstention perpetrated by the medical staff, which is not medically justified and/or which is carried out without the free and enlightened consent of the pregnant woman or the parturient^[1]LAHAYE Marie-Hélène, Accouchement, les femmes méritent mieux, 2018, Ed. Michalon, p.187.

Gynecological violence, on the other hand, can affect all women^[2]In this article, the term “women” will refer to all the people which are considered as women by the medical community, as well as all those who define themselves as women but may be denied their … Continue reading subjected to sexist actions or sayings, humiliations, or physical violence during gynecological exams. These definitions make it possible to consider this phenomenon as a whole, that is to say, not as singular and subjective acts, but as part of an inherited whole of a patriarchal construction of medical practices and knowledge, covering diverse violence manifestations towards women’s bodies.

These two types of violence have for a long time been subjected to an omerta for two reasons. Firstly, the intimist context in which they unfold, in addition to the power relationship patient – caretaker are making it almost impossible to denounce. Also, women’s sexualities have been built as being a taboo subject to such an extent that the thought of Sigmund Freud has been largely theorized around this postulate : “We could almost say that the woman in its entirety is taboo^[3]FREUD Sigmund, Le tabou de la virginité, 1918.”. This Freudian psychanalysis has had consequences on women’s sexualities, which have long been regarded as shameful.

A feminist genesis

Discussing gynecological and obstetrical violence comes down to question women’s relationship with medical procedures. The current feminist debates highlight the existence of a continuum of violence, perpetrated by individuals, but also by political and legal institutions which leads to a social acceptance and the perpetuation of this system, despite the possible legal advances on the subject. It is therefore interesting to understand how the issue of gynecological and obstetrical violence has become a political issue in France.

This expression appears initially within feminist movements in Latin America that were demanding a greater humanization of births^[4]MICHEL Claire et SQUIRES Claire, « Entre vécu de l’accouchement et réalité médicale : les violences obstétricales », Le Carnet PSY, vol. 220, no. 8, 2018, pp. 22-33.. Afterwards, this term was inscribed in several legislations, especially in Venezuela in 2007 and Argentina in 2009^[5]MICHEL Claire et SQUIRES Claire, « Entre vécu de l’accouchement et réalité médicale : les violences obstétricales », Le Carnet PSY, vol. 220, no. 8, 2018, pp. 22-33.. This crucial step makes it possible to put on the political agenda of these countries the issue of medical treatment of women’s bodies. Even though the term went ultimately beyond the borders of Latin America, to arrive in France around 2010^[6]MICHEL Claire et SQUIRES Claire, « Entre vécu de l’accouchement et réalité médicale : les violences obstétricales », Le Carnet PSY, vol. 220, no. 8, 2018, pp. 22-33., it did not receive the same political recognition. Indeed, the terms of gynecological and obstetrical violence do not appear in French or European legislations. Alternatively, national and international legislations make it possible to protect women from all kinds of violence. They are used to provide a legal framework, that remains insufficient to cover precisely all the manifestations of these violences.

A global issue

In September 2014, the World Health Organization (WHO) decided to speak out on the necessity to prevent and eliminate the mistreatments during childbirth in facilities^[7]OMS, Prevention and elimination of disrespect and abuse during childbirth (Sept. 2014). It highlights the international aspect of such practices and invites governments to address the issue. This statement is in line with more general texts from the United Nations, especially the Convention on the Elimination of All Forms of Discrimination Against Women CEDAW of 1979^[8]OMS, Prevention and elimination of disrespect and abuse during childbirth (Sept. 2014) and the 1993^[9]ONU, Declaration on the Elimination of Violence Against Women. (Dec. 1993). declaration on the Elimination of Violence Against Women. However, gynecological and obstetrical violence relate to a much broader spectrum that these legislations are struggling to cover. That is what Maryvonne Blondin^[10]BLONDIN Maryvonne, Violences obstétricales et gynécologiques, Rapport de la commission sur l’égalité et la non-discrimination du Conseil de l’Europe. (Sept. 2019)., a French senator, deplores through a report addressed to the Council of Europe, aimed at “tackling the taboos regarding the support and care of women for reproductive and sexual health care”.

In the French law, these violences are not explicitly appointed but can be sanctioned in the light of the Kouchner law^[11]Loi n° 2002-303 du 4 mars 2002 relative aux droits des malades et à la qualité du système de santé. of 2002. It provides that “no medical act, nor treatment can be practiced without the free and enlightened consent of the person”. Nonetheless, the notion of consent is not a clear and fixed line and depends on the experiences of the patients. Lucile Queré, a PhD student of the Center of Gender Studies in the University of Lausanne, stresses that : “ The introduction of the right to consent for the patients in the French legal corpus invites to explore how this notion of consent is implemented and negotiated in the interactions, and how it shapes the experiences.^[12]QUÉRÉ Lucile, « Les formes ordinaires du consentement. Consciences du droit dans la consultation gynécologique», Droit et société, vol. 102, no. 2, 2019, pp. 413-432.”

Gynecological and obstetrical violence thus constituted a blind spot on the French political and legal agenda until July 2017, the date on which Marlène Schiappa^[13]Secretary of State for Gender Equality commissioned a report to the High Council on Gender Equality in order to “identify levers to improve the situation^[14]Haut Conseil à l’égalité entre les femmes et les hommes, Les actes sexistes durant le suivi gynécologique et obstétrical. (juin. 2018), p.38”. This change on the political agenda regarding gynecological and obstetrical violence is going to enable the politization of the subject and provide new frameworks for expression and denunciation, in the eyes of the law, but also in the way of thinking about society and our questioning of sexist practices in the medical field to build a more respectful society.

Socio-historical contextualization

Militant claims around the issue of gynecological and obstetrical violence have made it possible to put into words what is a long history of domination and violence, that were previously largely unthinkable. For instance, the medicalization of childbirth practices did not initially
emanated from women, but rather from diverse social and political factors, that have dictated the social norms viewed as legitimate. Hygienist and pasteurist practices which have developed in the 20^th century in the West have profoundly changed gynecology : “Prior to that period, giving birth in a maternity was reserved to women from the lowest social class. (…) Progressively women start giving birth in maternities, until it became the norm^[15]MICHEL Claire et SQUIRES Claire, « Entre vécu de l’accouchement et réalité médicale : les violences obstétricales », Le Carnet PSY, vol. 220, no. 8, 2018, pp. 22-33.”.

Multiple discrimination factors

The medical field is not immune to logic of structural dominations in our societies. Therefore, systemic discrimination factors may have a bearing on women in their pathway to access to gynecological and obstetrical care, thereby conditioning the relationships between patients and doctors.

In terms of gynecological monitoring, women’s age influences the therapeutic relationship since it “operates as a differentiation criterion of the patients on the basis of their procreative capabilities – both biologically and socially admitted^[16]QUÉRÉ Lucile, « Les formes ordinaires du consentement. Consciences du droit dans la consultation gynécologique», Droit et société, vol. 102, no. 2, 2019, pp. 413-432.”. It is decisive since the procreative capabilities has a significant impact on the value accorded to women by the medical profession. This fertility, real or presumed, appears as a common denominator for several types of violences. These can resemble lesbophobia, fatphobia, and ableism. Moreover, other discrimination factors can also have an impact on the relationships between patients and practitioners, such as race. They all have in common the undesirability of women and bodies that do not correspond to the established social norms, and that tend to be seen as infertile. When it comes to racialized women, it may consist of a submission to a paternalistic medical order, resulting from a history of gynecology, that was mainly built around experimentations on enslaved black women^[17]CHAMAYOU, Grégoire. « L’expérimentation coloniale », , Les corps vils. sous la direction de Chamayou Grégoire. La Découverte, 2014, pp. 341-384..

These discriminations regarding treatments application can put at risk patients. For example, forms of sexualities between women are often considered as minor sexual acts, which leads to the denying of the needs in gynecological care they may encounter. The report of the High Council on Gender Equality highlights that “the rate of sexually transmitted infections is more important within this part of the population (lesbian) than within heterosexual women as they renounce gynecological examinations following refusal of care^[18]Haut Conseil à l’égalité entre les femmes et les hommes, Les actes sexistes durant le suivi gynécologique et obstétrical. (June. 2018), p.38”.

Similarly, in 2018, the Groupe de Réflexion sur l’Obésité et le Surpoids (GROS) (Group of Reflection on Obesity and Overweight) requested to open an investigation on the relationships between overweight women and gynecologists. The report is clear: specialists seem to consider the patients’ weight as a main factor, if not the sole, in their health care journey. Violent remarks during obstetric consultations were recorded : “So you don’t see that in the state you’re in, having a child, it’s a death sentence”, or even “Don’t get fat, ma’am, or we’ll never see the baby^[19]FAVEREAU Eric, « Grossophobie: « Dans l’état où vous êtes, avoir un enfant, c’est la mort assurée »», Liberation, 2018 [online]”. In the case of gynecological consultations, the testimonies refer to violent and intrusive manipulations, if not demeaning, for the patients. The manipulations and palpations were very violent. She considered that with the fat, I wouldn’t get hurt^[20]Bondy Blog, Grossophobie médicale, quand consulter devient un cauchemar, Masisilya Haboudou, 17th December 2019”. This systematic focus on patients’ weight, as the sole cause of childbearing difficulties and health problems, help to dehumanize them and relegate them to the ranks of undesirables in a society where thinness is hegemonic.

A relationship of domination can also be exercised over migrant and/or racialized women, the lack of awareness of rights and the linguistic barrier being obstacles in the access to health care^[21]COGNET Marguerite, HAMEL Christelle et MOISY Muriel (2012) Santé des migrants en France : l’effet des discriminations liées à l’origine et au sexe, Revue Européenne des Migrations … Continue reading.

Furthermore, women with disabilities may be considered undesirable because they are presumed uncapable to procreate. In 2018, the National Consultative Commission on Human Rights (CNCDH) published a review on the abuse of persons with disabilities in the health care system^[22]CNCDH, Avis, Agir contre les maltraitances dans le système de santé: une nécessité pour respecter les droits fondamentaux. (May 2018).. Reference is made in particular to the prejudices that some caregivers may have about the sexuality of persons with disabilities. For example, some consider that the issues of sexual and reproductive rights and health “do not concern them^[23]Ibid., p. 12.” because they are seen as sexually inactive. A situation all the more serious as according to Maudy Piot^[24]Former president of the non-profit organization Femmes pour le dire, femmes pour agir., psychanalyst and feminist activist, these women “are even more silent than so-called “valid” women in the case of violence, because of a triple anguish: loneliness, rejection and exclusion^[25]Haut Conseil à l’égalité entre les femmes et les hommes, Les actes sexistes durant le suivi gynécologique et obstétrical. (June. 2018), p.41..

To conclude, gynecological and obstetrical violence find their origins in the patriarchal and paternalist culture of our societies. It is finally thanks to a collective speech on social networks that the silence was lifted. In 2014, the hashtag #payetonuterus collected more than 7 000 testimonies of women regarding their experiences, often traumatizing, with the medical professionals. Legal recognition of such violence is an indispensable step to rethink sexual and reproductive health practices. However, that cannot be enough. There is a real need to raise public awareness on these issues to sustainably improve gender relations.

Sources

BLONDIN Maryvonne, Violences obstétricales et gynécologiques, Rapport de la commission sur l’égalité et la non discrimination du Conseil de l’Europe. (sept. 2019). Disponible à: http://www.senat.fr/fileadmin/Fichiers/Images/commission/affaires_europeennes/APCE/ODJ_2019/Avis_rapports/2019_10_Rapport_Mme_Blondin_Violences_obstetricales_et_gynecologiques.pdf

Bondy Blog, Grossophobie médicale, quand consulter devient un cauchemar Masisilya HABOUDOU, le 17 décembre 2019. Disponible à : https://www.bondyblog.fr/societe/sante/grossophobie-medicale-quand-consulter-devient-un-cauchemar/

CHAMAYOU, Grégoire. « L’expérimentation coloniale », , Les corps vils. sous la direction de Chamayou Grégoire. La Découverte, 2014, pp. 341-384. Disponible à: https://www.cairn.info/les-corps-vils–9782707178350-page-341.htm

COGNET Marguerite, HAMEL Christelle et MOISY Muriel (2012) Santé des migrants en France : l’effet des discriminations liées à l’origine et au sexe, Revue Européenne des Migrations Internationales, 28 (2), pp. 11-34. Disponible à: http://journals.openedition.org/remi/5863

CNCDH, Avis, Agir contre les maltraitances dans le système de santé: une nécessité pour respecter les droits fondamentaux. (mai 2018). Disponible à: https://www.cncdh.fr/sites/default/files/180522_avis_maltraitances_systeme_de_sante.pdf

FAVEREAU Eric, « Grossophobie: « Dans l’état où vous
êtes, avoir un enfant, c’est la mort assurée » », Liberation, 2018 [en ligne], disponible à: https://www.liberation.fr/france/2018/11/26/grossophobie-dans-l-etat-ou-vous-etes-avoir-un-enfant-c-est-la-mort-assuree_1694421

FREUD Sigmund, Le tabou de la virginité, 1918.

Haut Conseil à l’égalité entre les femmes et les hommes, Les actes sexistes durant le suivi gynécologique et obstétrical. (juin. 2018), p.38 Disponible à: http://www.haut-conseil-egalite.gouv.fr/IMG/pdf/hce_les_actes_sexistes_durant_le_suivi_gynecologique_et_obstetrical_20180629-2.pdf

LAHAYE Marie-Hélène, Accouchement, les femmes méritent mieux, 2018, Ed. Michalon, p.187

MICHEL Claire et SQUIRES Claire, « Entre vécu de l’accouchement et réalité médicale : les violences obstétricales », Le Carnet PSY, vol. 220, no. 8, 2018, pp. 22-33. Disponible à: https://www.cairn.info/revue-le-carnet-psy-2018-8-page-22.htm

QUÉRÉ Lucile, « Les formes ordinaires du consentement. Consciences du droit dans la consultation gynécologique», Droit et société, vol. 102, no. 2, 2019, pp. 413-432. Disponible à: https://www-cairn-info.ezpaarse.univ-paris1.fr/revue-droit-et-societe-2019-2-page-413.htm

OMS, La prévention et l’élimination du manque de respect et des mauvais traitements lors de l’accouchement dans des établissements de soins. (sept. 2014). Disponible à : https://apps.who.int/iris/bitstream/handle/10665/134588/WHO_RHR_14.23_eng.pdf;jsessionid=6F306AEF19CE5F385A813F4871B9080A?sequence=1

ONU, Convention sur l’élimination de toutes les formes de discrimination à l’égard des femmes. (déc. 1979). Disponible à: https://www.ohchr.org/fr/professionalinterest/pages/cedaw.aspx

ONU, Déclaration sur l’élimination des violences à l’égard des femmes. (déc. 1993). Disponible à : https://www.ohchr.org/en/professionalinterest/pages/violenceagainstwomen.aspx

To quote this article : Marion Luc et Noumidia Bendali Ahcene, “Gynecological and obstetrical violence in France: the politicization of a feminist struggle”, 30.06.2020, Gender in Geopolitics Institute.