One of the ongoing feminist challenges is the answer to the question of what extend women face violence and how it can be unveiled and prevented. While many forms of violence against women have risen to the social, political and legal surface worldwide, there is still a wide spectrum of uncharted ground that needs to be researched. Obstetric violence (OV) has been highlighted in the political agenda of some countries in the world, with Venezuela to be the first state which legally defined and condemned OV in 2007. OV is described by the Word Heath Organization’s statement (2014) as:
“the disrespectful and abusive treatment during childbirth in facilities”that includes “outright physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilization), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth to suffer life-threatening, avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay”(p. 1).
This definition is the result of a(n) (ongoing) research of the experiences of women who have been subjected to this kind of violence. One of the most recent and representative case of international human rights law is the SFM v. Spain, 2020 in which the term ‘obstetric violence’ is used by the decision body, giving a legitimate character to the phenomenon.
In this paper, an attempt will be made to theorize OV through three theoretical perspectives; a feminist, an intersectional and a gender neutral one. Many reasons have contributed to the choice of this form of violence as a paradigm in my analysis. OV is an under – researched form of violence towards women that only a handful of states worldwide have legally recognized. It is considered to be structural (Sadler et al., 2016) and systemic (Diaz-Tello, 2016), which shows how deep is the patriarchal (misogynistic) belief of a ‘naturally’ weak, disabled, handicapped, dependent female body (Young, 1980) that needs to be tamed “if it challenges its femininity, its condition as object, through a loud and subversive embodied subjectivity” (Cohen Shabot, 2015, pp. 234). This leads to an unquestionable authority of the medical stuff, resulting to an excessive patriarchal power over the laboring bodies. This topic has problematized me a lot during my academic years and although I, personally, look at it through a feminist perspective, this essay will approach OV within a diverse theoretical lens.
Feminist theoretical perspective: Obstetric violence as a form of gender based violence.
For this analysis I draw on Kelly (2012) and Boyle (2019) theoretical perspectives of the continuum concept of gender based violence and the continuum thinking respectively. Kelly (2012) argues that, since men’s violence is so widespread, women tend to understand specific instances of it in the context of a larger pattern of similar experiences throughout their lives. The idea of a continuum encompasses not only physical and psychological violence, but also the various forms of gendered violence that women may face even after the violent incident. For example, regarding OV, a coerced sterilization can lead to societal marginalization due to the (almost sacred) meaning fertility has for the patriarchal societies. Additionally, an unnecessary episiotomy and a following “tightening up” (the so called “husband stitch”) leads to painful sexual intercourse and to an overall diminishing of the women’s sexuality. Speaking out can also put women at risk, as the potential consequences, such as being dishonored, can even be fatal.
Boyle (2019) claims that violence against women is gendered since it targets women because they are women. If this understanding is put into a continuum, other experiences, such as interactions with whole institutions (e.g. the health care institution) can acquire a gendered character as well, illustrating the diffuse patriarchal entitlement that exists over the female body. Moreover, Jonson (2007) using the intimate partner violence as the paradigm for his argument of the intersection of gender and control, argues that violence is usually about ‘taking the overall control’ over the other person. Social norms determine the value and meaning of the violent act depending on which gender embodies the perpetrator and which the victim. In the OV case the perpetrator can be understood as the health care institution as a whole institution and not as an individual health care professional, that strives to take control over the female birthing body.
Understanding OV as a form of gender based violence is a fine line legally and politically. It presupposes a theorization of violence towards women that is deep rooted in the societal structures and institutions, which is why mistreatment and abuse towards the female birthing bodies are seen as the normative, the default. The most common counter argument by the health care professionals is the appeal to the medical necessity, which is, though, already formed into an a priori pathologization of the female body; the female body is seen in an otherness condition of the sovereign male, in which an authoritative and patriarchal discourse of bodily hierarchy is constructed (Τζανάκη, 2018). As Cohen Shabot, an academic dediacted to OV research, argues, unveiling OV and recognizing it as a form of gender based violence is an ongoing process due to “the inherent difficulty of recognizing violence that happens in an ‘essentially benevolent’ setting such as the medical one, but also, and mainly, due to the pervasive sexual reification of women under patriarchy and the pervasive shame to which women are subjected” (Shabot, 2021, p. 443).
Intersectional perspective: Obstetric violence as the result of multiple oppression.
Intersectionality is the term that describes the routinized, multidimensional and multilayered oppressive character of the women’s experiences, which leads to the formation of a new, enhanced dimension of oppression. As a result, the new constructed power relations hinder the ability of these women to find better alternatives in their lives (Crenshaw, 1991). Since Crenshaw, many academics shed light to the way in which inequalities are simultaneously interlocking oppressing positions for women due to their interdependent identities, especially when it comes to violence. Abu-Lughod (2011), through her analysis of honor crimes in the western settings, highlights the complexity and the multi-dimensional character gender based violence has. She reflects upon the way social interpretations tend to neglect certain identities, due to the dominant position institutional and structural racism, ableism, classism, homophobia etc have in the different social contexts. Knowledge does not occur in a geopolitical vacuum, thus it is important to reflect and acknowledge one’s position (and privileges) when approaching social phenomena. So, intersectionality refers to both the multilayered discriminatory experience women face and the way a discriminatory incident is understood afterwards.
OV is not an unbiased field of study, but it is rather closely tied to past instances of racist and eugenicist violence. Black and indigenous women’s reproductive and birthing experiences have been negatively affected by discriminatory practices and experimentation, and they still experience the negative consequences of racist beliefs and stereotypes today (Chadwick, 2021). “Pregnancy and birthing are not ‘natural’ events but socially, ideologically, and politically inscribed” (Chadwick, 2021, p. 6), as it is affirmed in these two notable case law of Alyne da Silva Pimentel v. Brazil, 2008 and Ms. AS v. Hungary, 2004. A stillborn gestating, African woman in Brazil not given the necessary, postpartum care had fatal consequences, while a birthing, Roma woman in Hungary was forced to a coerced sterilization. In these two cases, both sexism and racism have created a new dimension of discrimination, placing women to an even marginalized position in the relevant societal power dynamics.
Gender neutral perspective: Obstetric violence as a violation of the right to health.
A gender neutral approach could derive from a post – structuralist individualistic theoretical basis, which deconstructs the a priori, historically constructed binarism of the gender, and introduces a more fluid understanding of gender embodiment and power dynamics. Both femininities and masculinities are embodied by all (and none) genders simultaneously, thus the very strict circumscribed theorization of gender is not that relevant anymore. Both male and female individuals (and everything in between) are approached as “complex gendered beings’ that can be placed in both hegemonic and subordinated social locations (Cannon, Lauve-Moon & Buttell, 2015, p. 676). A gender neutral approach examines the power relations “based on the status of the relationship rather than the broader socio-cultural context in which that relationship – and the people in it – exist” (Boyle, 2019, p. 23). This means that, by situating violence in childbirth – which is experienced predominantly by women – in relation to patient abuse or neglect, birthing women’s experiences are examined analogously and are related to victims’ experiences in the health care system that are not marginalized due to their gender (Boyle, 2019).
If gender per se is not relevant anymore to the equation of OV, the scoping lens zoom out of the ‘identities’ argument and focuses on the violent/abusive incident with a more general perspective. Through a gender neutral approach, OV could be understood as the result of the unequal power dynamics between patients and healthcare providers, and may stem from a healthcare system that prioritizes profit over patient well-being (Briceño Morales et al., 2018). In this equation, birthing individuals are seen solely as patients that do not receive the appropriate care they need. In fact, the European Court of Human Rights has followed a non – discriminatory on the basis of gender, approach in three cases that concern coerced and forced sterilization of three Roma women in Slovakia; VC v Slovakia 2011, NB v Slovakia 2012 and IG v Slovakia 2013. In these cases, the Court found unnecessary an engagement with a gender discriminatory analysis and rejected the women’s argument (Patel, 2017).
May all three approaches share the goal of addressing and preventing OV, but they have different focus points and theoretical perspectives. There are fundamental differences between the theories, regarding which identities highlight as significant of discrimination, who embodies the victim and who the perpetrator, how is violence interpreted and by whom, and under which epistemological background the violent experience is valued. Like in other forms of gender based violence, naming and defining the phenomenon plays a crucial role in the legitimization of violence as such and at the unveiling of its epistemic, structural and institutional roots. The attempt to capture and describe the various experiences at the intersection of gender and violence has been challenging, that is why more research upon OV is required. Finally, I would like to finish this essay with a part of Carmen Maria Machado’s poetry short story “The Husbant Stitch” which I believe delineates a breathtaking illustration of the patriarchal appropriation of the female birthing body:
“There is a story about a woman who goes into labour when the attending physician is tired. There is a story about a woman who herself was born too early. There is a story about a woman whose body clung to her child so hard they cut her to retrieve him. There is a story about a woman who heard a story about a woman who birthed wolf cubs in secret. Stories have this way of running together like raindrops in a pond. They are each borne from the clouds separately, but once they have come together, there is no way to tell them apart.
(If you are reading this story out loud, move aside the curtain to illustrate this final point to your listeners. It’ll be raining, I promise.)” (Machado, 2014, p. 16).
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