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Obstetric violence.The new goal for research, policies and human rights on childbirth

Periodic Reporting for period 1 - OBSTETRICVIOLENCE (Obstetric violence.The new goal for research, policies and human rights on childbirth)

Reporting period: 2016-10-01 to 2017-09-30

In many countries, childbirth still includes a variety of routine medical interventions, such as labour-inducing drugs, the lithotomic position, episiotomies and an excess of surgical deliveries. These interventions are also used in women with low-risk pregnancies, despite WHO recommendations and the findings of evidence-based medicine on the topic.
Sometimes women can be coerced into accepting medical interventions or these interventions are performed without their consent. In some cases, this coercion can be not explicit, i.e. related to the authoritativeness of biomedical knowledge and power issues in the doctor-patient relationship. It represents at times a subtle form of limiting a woman’s fundamental right to participate actively in the process of pregnancy and childbirth and to decide in a free and conscious manner in consideration of the woman’s own body.
In Latin America, over the past decade, the term “obstetric violence” has become part of the legal framework. The concept refers to acts in the context of labour and birth categorised as physically or psychologically violent due to unjustified use of medical interventions. Specific laws against obstetric violence – a type of gender-based violence and violation of human rights – exist in Venezuela, Argentina, several States of Mexico and the State of S. Catarina in Brazil.
In Europe, the issue is raised by human rights organisations and social movements fighting for more humane and respectful births, but no country has passed legislation on the matter yet. The concept is far from receiving sufficient critical examination within biomedical practice and public policy, and it is not seen as a potential tool for rethinking and improving birth care policies and practices.

The project objective is transferring Latin American experiences on recognising and preventing obstetric violence to the European context in order to provide decision makers with an innovative tool for rethinking the quality of birth care services and providing society with new ways to discuss childbirth issues.

Specific Objectives are:
1) Analysing the historical, social and political processes that led to the legal recognition of obstetric violence in some Latin American countries, focusing on Argentina.
2) Analysing the impact that this recognition has had on birth care services and on the training of the next generation of health providers.
3) Identifying and transferring good practice and tools from the Argentinian and Latin American experience and supporting a process of social and political recognition of obstetric violence in the European context, especially in countries where medical intervention in child labour and childbirth is common, as in Italy and Spain.
4) Designing and implementing a Platform on Obstetric Violence, as an innovative point of reference on the matter for decision makers and training managers in health issues.
"To achieve the first two objectives of the project, fieldwork was performed in Argentina during the first year of research. To collect the data, qualitative instruments and techniques were used. Semi-structural interviews were conducted with a total of 33 informants. 13 public events were observed. 6 public hospitals were visited. In these hospitals a survey (questionnaire) was conducted with 70 residents and with 35 health professionals. A questionnaire was also administered to 35 students. 10 dissemination lectures were given. 9 training activities were attended. 2 newsletters and 2 publications were edited.

Main results

- The historical, social and political processes that led to the legal recognition of obstetric violence in several Latin American countries were analysed. The role of social movements fighting for more respectful births is highlighted.
- The process that led to the implementation of the legal framework regarding the care of pregnancy and childbirth in Argentina was analysed. The experiences of people who played a key role in the writing of the Law ""Ley 25929 de Parto Humanizado"" and the Law ""Ley de protección integral para prevenir, sancionar y erradicar la violencia contra las mujeres"" (defining obstetric violence in article 6) were collected, in addition to those of people who are now working for the recognition, prevention, and reporting of obstetric violence.
- The role of the Obstetric Violence Observatory (OVO) founded by Las Casildas in 2015 was analysed in its different dimensions. As a social, cultural, political, transcultural, and transdisciplinary mechanism, the instrument implemented by the civil organization represents an effective instrument for preventing and recognizing obstetric violence in the country. In addition, the OVO has become an inspiring tool for other experiences recently implemented in others countries.
- Data to analyse the impact that the legal recognition has had on birth care services and on the training of the next generation of health providers were collected.
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"The legal definition of obstetric violence refers to gender inequality, which reproduces the naturalization of female subordination to a social system that, from the feminist perspective, has been defined as ""patriarchal"". It also involves the models of organization of the health systems of nation-states. However, the legal definition does not allow us to understand and explain the historical, social, political, and economic roots that produce and legitimize it. From an anthropological perspective, we can instead place obstetric violence within its socio-historical context and unravel the many aspects that often appear when we speak of this type of violence. In this arena comes to light – among other aspects – the power relations between doctors and patients, based on who supposedly has the knowledge; the topic of medical training; the organization of health services and the working conditions of health professionals; the variables of class, ethnicity, and gender as social determinants of health. To face these processes, it is currently proposed to broaden the focus, encompassing the human rights approach. From our perspective, to affirm that childbirth without violence is a human right and a right to reproductive health that all women possess and can/should exercise whatever their origin, culture, physical and psychological state, makes it possible to insert the issue of obstetric violence in a transcultural, structural, and relational perspective: obstetric violence is not only a problem for women or the State; nor does it prove to be only a problem of the quality and organization of health services or the training of professionals. It is a broader issue that requires different perspectives of analysis and different tools of action, some of which must be promoted by the State (such as the law) and others that emerge from society, such as group militancy and associations that defend and claim reproductive rights.
It is believed that Latin American countries experiences can support a process of social and political recognition of obstetric violence in Europe. The Platform on Observatory Violence – an innovative tool at the European level – will become a point of reference on the matter for decision makers and training managers in health issues. Dissemination activities will increase general public’s awareness on the topic. The researcher will reinforce her position as an expert on reproductive health and obstetric violence.

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"Poster presented at the ""XIV Congreso de Antropología"", Valencia, Spain, 5-8 September 2017"