UN Human Rights Expert Recognizes Obstetric Violence as a Human Rights Violation

Reproductive Rights Prof Blog (Nov. 12, 2019): UN Human Rights Expert Recognizes Obstetric Violence as a Human Rights Violation by Lara Russo:

On October 5^th, 2019, the United Nations Special Rapporteur on violence against women, its causes and consequences presented a report to the UN General Assembly that looked at obstetric violence globally. The report entitled, “A Human Rights-Based Approach to Mistreatment and Violence Against Women in Reproductive Health Services with Focus on Childbirth and Obstetric Violence,” marks the first time an international human rights body has identified obstetric violence as a violation of human rights.

The term "obstetric violence" is widely used in South America, though is not commonly used in the international human rights community as of yet. The term broadly refers to mistreatment and violence experienced by pregnant people during facility-based childbirth. Internationally, violence against women is defined as “any act of gender-based violence that results in, or is likely to result in, physical, sexual or psychological harm or suffering to women, including threats of such acts, coercion or arbitrary deprivation of liberty, whether occurring in public or in private life.” 

The report details the numerous ways that women’s human rights can be violated in the birth context including: forced or non-consensual procedures, torture or cruel and inhuman or degrading treatment from use of restraints or lack of anesthesia during painful procedures, use of medically unjustified procedures, and violations of privacy, confidentiality, humiliation and harassment by health care providers.

Informed consent is highlighted in the report as a fundamental human right that can act as a safeguard against obstetric violence. Pregnant people are frequently denied their right to make informed decisions about their care during childbirth, which the report identifies as a human rights violation. Examples of violation of informed consent include presentation of consent forms to a pregnant person while in labor when it is difficult or impossible to understand the forms or formulate questions about treatment and when a doctor makes decisions on behalf of a pregnant person because the doctor’s medical knowledge is deemed superior to a woman’s entitlement to information and autonomous decision-making. 

The United States was explicitly criticized in the report for the common usage of non-consensual procedures and restraints of pregnant people during birth. In the U.S. it is legal in many states for doctors and medical students to perform pelvic exams on unconscious women who are under anesthesia for another procedure, who do not require a pelvic exam, and who have not explicitly consented to one. Despite recent reforms, pregnant people who are incarcerated in prison, jail, and immigration detention continue to be shackled and restrained during labor, delivery, and the post-delivery recovery period. The Committee Against Torture also has expressed concern about the shackling of incarcerated pregnant people in the U.S.

In addition to the obstetric mistreatment in the United States highlighted in the report, other forms of violence and mistreatment also occur. A recent study found that 1 in 6 pregnant, laboring, and postpartum women in the United States experienced mistreatment by medical providers.  This number rose to 1 in 3 when narrowed to deliveries in hospitals rather than freestanding birth centers or at home and disparately impacts black women and people of color. This mistreatment includes being yelled at or scolded, ignored or refused assistance when asking for help, being coerced into interventions, such as induction or epidural, and threatened with having treatment withheld.

Among the recommended actions to address the issue of obstetric violence, the Special Rapporteur includes increased budgetary resources devoted to quality reproductive health care, ensuring professional accountability and sanctions by professional associations in cases of mistreatment. The report recommended addressing intersectional discrimination or compound stereotypes stating that

Some women experience intersecting forms of discrimination, which have an aggravating negative impact, and gender-based violence may affect some women to different degrees, or in different ways; appropriate legal and policy responses are needed in this regard.

One’s experience of intersectional discrimination or compound stereotypes can increase the likelihood of experiencing obstetric violence. The United States could do better in all of these realms.  

The position of Special Rapporteur on violence against women, its causes and consequences was created in 1994 as a means of integrating the rights of women into the human rights mechanisms of the United Nations. The mandate of the special rapporteur is to seek and receive information on violence against women, recommend ways in which to eliminate such violence, and work collaboratively with the other United Nations humans rights mechanisms.