Cristina Britez and the Many Faces of Obstetric Violence

By Alma Beltrán y Puga

This past weekend marked the 25^th of November, a day to remember that all manifestations of gender-based violence should be prevented and eliminated in health procedures.

Unfortunately, one of the most prevalent forms of gender-based violence — obstetric violence — has not been sufficiently addressed by health practitioners.

Obstetric violence occurs when pregnant persons are not provided with reproductive health services that respect their dignity before, during, and after labor. A wide range of physical and psychological mistreatment during childbirth in public and private hospitals can constitute obstetric violence. Manifestations may include “an excess of medical interventions during childbirth, even in physiological and uncomplicated births,” and “abusive and disrespectful practices towards women during childbirth across the world.”

Obstetric violence can also be a consequence of discriminatory gender-stereotypes and a lack of relevant medical information — withheld by doctors and nurses — that impede pregnant persons from making decisions over their health and life during labor and postnatal care. Doctors tend to question women’s reproductive choices and usually do not respect their decisions on how they want to deliver a baby. Hospitals do not have adequate infrastructure to conduct non-medicalized childbirths. Thus, doctors often suggest having a caesarean section (C-section) as the best way to deliver a baby. The World Health Organization has advised that C-sections should only be performed when medically necessary on a case-by-case basis, such as in high-risk pregnancies, identified by preeclampsia symptoms (high blood pressure, protein in the urine, swelling, headaches, and blurred vision). Preeclampsia can develop into eclampsia, which is characterized by seizure activity. In these cases, going into labor can be life-threatening.

In 2022, the Inter-American Court of Human Rights (IACtHR) analyzed the case of Cristina Britez vs. Argentina, considering whether she faced obstetric violence given her doctors’ decision to induce labor even though the fetus had died and Britez had several signs of a high-risk pregnancy, including high blood pressure, fever, and lumbar pain. Despite being at high risk, Cristina Britez was induced to labor without being provided sufficient information of the associated risks. She also was left sitting in a chair of the labor room for two hours during the initial stage of labor. Delivering a dead fetus caused her excessive anguish, anxiety, and stress. She died five hours after labor was induced. The Court concluded that the State of Argentina had violated her rights to life, personal integrity, and health protected under the Interamerican Convention of Human Rights.

Obstetric violence can have many faces, but its common feature is an inhumane treatment that violates a person’s dignity during labor and postnatal care. Pregnant persons are in a state of vulnerability during childbirth, prone to suffering discrimination and violence. Consequently, doctors, nurses, and other health providers should give them complete information regarding the risks implied in the medical procedures, and alternatives available, so that they can make their own reproductive choices. Informed decisions can only be made where conditions of trust and respect are set beforehand by health providers.

The WHO guidelines on intrapartum care underscore the importance of promoting and ensuring “a positive childbirth experience” as one “that fulfils or exceeds a woman’s prior personal and sociocultural beliefs and expectations, including giving birth to a healthy baby in a clinically and psychological safe environment with continuity of practical and emotional support from a birth companion(s) and kind, technically competent clinical staff.” This must apply to all persons that can become pregnant regardless of their gender or sexual orientation.

Understanding obstetric violence as a human rights violation is one step along the way to recognizing this kind of gender-based violence as contrary to the protection of the highest standards of reproductive health.