Gender-based violence in medical care during pregnancy and childbirth – women – life

“They put me on a stretcher and while they were preparing for an abortion, there was a woman in labor next to me. Weeks ago, on the day I was told my baby’s heart wasn’t beating, I was listening to an ultrasound of another pregnant woman with whom I shared the office at full sizes. I don’t know if we all feel the same, but to me, a lack of tact is a human tendency.”

A mixture of feelings, between pain and indignation, gripped Claudia Melina Gonzalez as she recalls the unfortunate episodes she experienced during her two pregnancies. In the first, at the sixth week, she learns that her baby’s heart has stopped, and she has missed an abortion, that is, when the fetus dies, but the mother’s body does not expel it on its own.

On that day, when she received the news listening to the heartbeat of another woman’s son, Claudia Melina started A series of situations in which I felt violated and had serious psychological consequenceswho is still trying to recover.

“A missed miscarriage has an even greater emotional impact, because as mothers we know we are carrying our dead baby in the womb, but we still have hope that his heart will work again. I read online cases of other women in which the creature responded after a few days and this uncertainty was killing me,” As Gonzalez says.

Due to the burden of losing her pregnancy and the consequences of the abortion she had to undergo, the new mother repeatedly requested psychological support, but according to her account, the service was provided too late. also, He received “disrespectful, unsympathetic and even degrading” treatment by health professionals, adding to his burden.

The abortion pill was already offered and I was hoping to expel the fetus, under constant threat from the specialists that if I didn’t, they would have to do a scraping.

“The abortion pill had already been introduced and I was hoping to expel the fetus, under constant threat from the specialists that if I didn’t, they would have to do curettage—a kind of uterine curettage—. Once the obstetrician and gynecologist on duty came in, and asked me what had happened, and while I was telling her , she asked me to say, “Why didn’t you wait a bit? Perhaps his heart was beating.” She completely collapsed.

Years later, the news of her second pregnancy had a bittersweet taste for Claudia Melina, because the trauma of the previous loss was still fresh. Unfortunately, after passing the first trimester of pregnancy, they discovered an infection in the amniotic fluid which, although treatable, threatened the happy end of pregnancy. However, the nightmare repeated itself when When trying to find solutions to the problem, he developed rejection, insensitivity, and little information about alternatives to saving his daughter.

“I remember that in a crucial test to decide what to do, the doctor who treated me on my arrival told me: ‘Sit down, don’t talk to me during the procedure because it is distracting and in the end I will answer three questions.’ The ultrasound was painful. He pressed me hard and when I told him He told me it was essential that I could see the picture well. But I felt he was abusing me. In the end, the answers were monosyllables and left me with more doubts than certainties,” says Gonzalez.

Three EPS obstetricians ordered Claudia Melina to wait for a miscarriage or offered her futile options, including a scan whose results were delivered a month later, putting them at risk of losing the baby during that time. Finally, the patient decided to pay privately, as she received a high-quality service and was able to successfully terminate the pregnancy. Today she is the mother of an eight-month-old girl who is in good health.

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Like this testimony, there are hundreds of stories of women who have gone through traumatic experiences in maternity wards and gynecological clinics, many of which have not had a happy ending. The World Health Organization (WHO) and the Colombian Institute for Family Welfare (ICBF) themselves have classified these malpractices as Birth violence, a term that the medical profession doesn’t quite feel comfortable with, but is undoubtedly a reality that must be combated.

phenomenon characteristics

For feminist groups, this type of abuse is nothing more than a reproduction of the structural machismo in women’s medical care, which, When interfering with their sexual and reproductive health – a weak side – they need a different gender approach.

Maria Paula Toro, of 7 Paulas, one of these movements, asserts that the common denominator of childbirth violence is the abolition of women’s autonomy in decision-making that includes their bodies. “We received verbal abuse, with inappropriate comments; psychological with manipulation and misinformation; and even physical, in practicing invasive measures that we did not authorize or were not necessary,” the activist adds.

This definition matches the one provided in the ICBF, which also warns that “these are facts that go unnoticed when they are naturalized by patients, who, in most cases, are unaware of their rights, do not know how to recognize attacks and are not empowered to take Actions in this regard.

Claudia Melina stresses precisely that this is the struggle she faced as a victim of this violence. “Doctors are in a difficult position to contest it. We end up accepting abuse because we see it as part of the health protocol And by not having enough of their knowledge or information about the operations, we blindly comply with their decisions,” he points out.

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The aforementioned normalization, together with the intimacy that surrounds states that are part of a woman’s sexual and reproductive health, prevents this phenomenon from arising, and new standards of care are created that guarantee the full well-being of the life in question, which is the ultimate goal of medicine.

“The Physicians Syndicate works so that the pregnant woman and the newborn in this condition can enjoy good health. This is their social function that cannot be ignored. However, There is a limit where the professional transcends his role and uses his power over the patient to restrict her independence, infringe on her privacy, or violate her as a woman.”refers to a feminist spokesperson for 7 Polas.

How is it recognized?

With the aim of cutting off naturalization that perpetuates childbirth violence, The International Federation for the Care of the Family (ICBF) has listed a series of situations that could be considered such that women have tools to enforce their rights.

Among them are the “development of prompt and humane few controls, omissions of informed consent, reprimands, criticism or inappropriate comments by health professionals, failure to ensure optimal conditions of privacy – particularly for procedures such as dabbling, examinations and vaginal injections – as well as as unjustified supply of medication and induction of precipitated labor” .

Once a patient identifies herself as a victim of violence in her medical care, as provided by the Ministry of Health, she can file a petition, complaint or claim with EPS, local secretariats, departments or the National Oversight Authority.

There is a limit where the professional goes beyond his role and uses his or her power over the patient to limit her independence, infringe on her or her privacy as a woman.

Now, this is the same protocol indicated for failures in administrative actions, such as delays in authorizations or non-compliance, and does not consider the gender-differentiated treatment that this type of violence requires. This fact also prevents the registration of cases, despite the fact that the certificates are present and clearly defined.

To give more weight to women’s complaints, work is currently underway in Congress that would impose penalties to prevent bad practices in obstetrics and gynecology services.

Senator Nadia Bell is the initiator of this initiative that recognizes legal loopholes that increase patients’ vulnerabilities and creates mechanisms to defend their rights, not only as an administrative measure, but backed by law.

“It is important that in Colombia we have a strategy that requires clinicians to include a gender approach in careEspecially in the specialties of obstetrics and gynecology, so that all decisions about the woman’s body are one hundred percent consensual, and violence of all kinds is avoided,” says the conservative congresswoman.

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Belil adds that it is not about unfairly generalizing the work of health professionals, but rather about finding deficiencies in the system that continues to reproduce these harmful scenarios and reaching agreements with the union to turn this reality in the interest of fairness.

The other side of the coin

Although the medical community recognizes that there are difficulties in care, it considers childbirth violence a pejorative term towards their work, as it qualifies them as offenders and ignores many factors that can influence patient mismatch.

“As specialists, we have tried to change this expression, because we By referring to the physician as an aggressive agent, it limits the embodiment of solutions by producing defensive reactions in health workersJimmy Castaneda, director of the education department at the Colombian Federation of Obstetrics and Gynecology (Fecolsog).

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The professional acknowledges that he is not aware of cases of abuse in gynecological care, which – in agreement with Senator Belle and activist Toro – he believes stem from a violation of patient autonomy.

We as specialists have tried to change this expression, because by referring to the doctor as an aggressive agent, it limits the embodiment of solutions.

“Pregnant women are in a vulnerable position and are legally part of a defenseless segment of the population. For this reason, their care and treatment should be more sensitive. The doctor should always explain all the activities they are doing and get your consent. Perhaps the limit is crossed with aggression when it is done Ignore that, except for urgent cases, she makes her own decisions,” warns Dr. Castaneda.

Reversing this reality is the common goal of rights protection organizations, women’s movements, health workers and civil society. A Fecolsog spokesperson stresses that the way to achieve this is through education. For this reason, he assures that they as a union are promoting various academic activities to raise awareness and prevent any kind of abuse.

Currently, Maria Paula Toro highlights the importance of Women are informed of all processes related to their sexual health, pregnancy and childbirth. “This is the most powerful weapon for asking the necessary questions and not losing the ability to make the decision that ends up with the patient in the relationship with her doctor.”

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