Addressing disrespect and abuse during childbirth in facilities.

Abstract

Global policy attention to maternal health only began in the mid-twentieth century, and has had a controversial past. While the promotion of maternal and child health and welfare was included in the World Health Organisation’s (WHO) Constitution (Article 2(l)) in 1948, international cooperation for maternal health began seriously only in the mid-1960s. In the 1970s and 1980s, instrumental rather than intrinsic rationales for maternal health came to the fore. As pointed out in Rosenfield and Maine’s influential paper, “Maternal mortality – a neglected tragedy. Where is the M in MCH?”, child health was the engine driving attention to pregnant women, not women’s own health, let alone human rights. More questionably, family planning programmes in this period typically used prevention of maternal mortality as a key justification for their aggressive expansion and intensification. Even where women’s own health gained intrinsic attention, much of it was technical and medical, focusing, for example, on the relative importance of antenatal versus intrapartum care, the best methods for reducing micronutrient deficiencies in pregnancy, and the role of traditional birth attendants in maternal care. It was the push by feminists for sexual and reproductive health and rights (SRHR) at the International Conference on Population and Development in 1994, preceded by almost two decades of mobilisation, that brought women’s human rights to the centre of maternal health. Alongside the technical controversies, there arose political contention about the impact of gendered and intersecting power structures, and the deeper societal roots of sexual and reproductive ill-health, and violations of human rights. Feminist concerns were many. They included, among others, the physical and mental health effects of early marriage, female genital cutting and mutilation, intimate partner violence during pregnancy, maternal ill-health and deaths due to unsafe abortion, and unavailability and inaccessibility of health services, especially for poor marginalised women. Debates at and around ICPD laid the basis for greater attention to sexual and reproductive rights and wrongs, including in the context of pregnancy. Mistreatment, abuse and violations of girls’ and women’s human rights during pregnancy and childbirth are all too common and occur in households, communities, work-places and in health and other institutions. This Special Issue focuses specifically on what happens when pregnant women approach health institutions to deliver babies. Its importance derives from recent policy drives in lowand middle-income countries (LMICs) to increase the number of institutional births. Unfortunately, as the papers in this Special Issue argue, disrespect and abuse of women in the maternal care provided by health institutions is wide-spread. Far too often, and especially if they are poor or otherwise marginalised and oppressed, women suffer violations of their dignity, unnecessary procedures, harmful practices, and physically and psychologically abusive treatment. In the 1980s and 1990s feminists in Latin America, responding to excessive medicalisation of maternal care in the region had begun calling to humanise childbirth in institutions and to prevent obstetric violence. EDITORIAL