Historic judgement against the Spanish state for obstetric violence

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An international tribunal has for the first time condemned a State for mistreatment inflicted on a pregnant woman and her newborn baby, categorizing it as a form of gender violence.

The United Nations Committee for the Elimination of All Forms of Discrimination against Women (CEDAW) has condemned the Spanish State for not acting diligently to protect the rights of S.M.F. and her daughter to quality obstetric care free from violence.

Summary of the case

The ruling follows a complaint filed in 2011 by a woman who went to a public hospital with a normal pregnancy and ended up in an operating room. Her skin, muscles and nerves surrounding her vagina were cut without her permission (episiotomy) and she was separated for days from her newborn daughter. The child was admitted to the Neonatal Unit due to an infection acquired during one of the more than 10 vaginal exams that were performed during the birth, for which the mother’s consent was not sought. From her time in the delivery room, S.M.F. recalls:

Entering the hospital was like entering a car wash, an assembly line: everyone does things to you mechanically. The woman does nothing, but she comes out at the other end with a baby. In other types of medical care, such as a heart operation, the person does not have to do anything, they are prepared for passivity, but in a birth a woman is prepared physically and psychologically to give birth, not to have others give birth for her. I felt disempowered, without self-worth. I had to create a bond with my daughter rationally.

From there, S.F.M. began a journey of complaints and legal action that culminated in October 2018 when a team of lawyers, Francisca Fernández Guillén, legal director of the Observatory for Obstetric Violence, Teresa Fernández Paredes, Paloma Torres López, Lucía Maravillas Martínez Losas, Marina Morla González and Isoke Tatiana Khemet filed a complaint with the United Nations both for the actions of the Hospital as well as the ineffectiveness of the Health Administration and of the Spanish justice system in protecting S.F.M. and her daughter. In its decision, the Committee recognizes the negative effects of power dynamics in relations between health professionals and pregnant women, and gender stereotypes about the female body and its traditional role in society with respect to sexuality and reproduction.

The decision is consistent with a recent report from the UN Special Rapporteur on violence against womenand a Council of Europe Resolution from last October on obstetric violence, and it advances the recognition of this phenomenon as a form of structural and systemic gender violence that discriminates against pregnant women.

The relevance of the recognition of obstetric violence

This case is paradigmatic because, for the first time worldwide, an international tribunal has recognized that the pathologization of birth through the overuse of medication and medical interventionism are forms of violence and that women should be able to make autonomous decisions regarding their pregnancy. It also recognizes that administrative and judicial authorities still utilize stereotypical customs and practices and that they are discriminatory.

What the State must do

In addition to compensating the victims economically for physical and psychological damages, since the Committee has recognized that this pertains to a structural situation, Spain must

  1. ensure the rights of women to safe motherhood and access to adequate obstetric attention for all Spanish women;
  2. conduct studies on obstetric violence that shed light on the situation and thus guide public policies in order to combat this form of violence;
  3. train obstetric professionals in women’s reproductive health rights; and, finally,
  4. ensure access to effective remedies in cases in which the rights of women have been violated during obstetric care and provide specific training to judges and other law enforcement bodies.

This decision is key to ensuring that the authorities understand the importance of training in addressing gender stereotypes in medical care and to create health policies that do not discriminate against women and recognize their ability to make free and informed decisions regarding pregnancy and childbirth.