In November 2018, the United Nations Special Rapporteur on the Right to Health, Dainius Pūras of Lithuania, visited Canada on a country mission. During this visit, he met with authorities, civil society and other stakeholders to assess the state of health rights and access across the country. In Montréal, the Special Rapporteur’s meeting included the following presentation from Regroupement Naissance-Renaissance.
November 13, 2018 - “My name is Lorraine Fontaine and I am coordinator of the grassroots umbrella organisation : Regroupement Naissance-Renaissance. More information on our work is in the written document we will submit.
Thank you very much, Mr. Pūras, Special, for taking the time to hear us today.
Before I begin, I acknowledge, that I am an educated white woman of privilege, that we are here today on unceded Mohawk territory and that as a rights advocate around issues related to birth, my role is to amplify the voices of those whose voices are often ignored or cast aside. I speak to you today from the authority of their experiences. When women speak to me of disrespect and abuse, of mistreatment and rights violations, I believe them and I have a responsibility to bring their stories of injustice, inequality and inequity to the attention of caregivers, policy makers, politicians and allies so that together we can effect change.
In recent years, scientific research, as well as women’s testimonials about childbirth care have pointed to a systemic problem perpetuated in health care facilities around the world : Some are calling it “disrespect and abuse, others lack of respect and dignity, while still others are calling it obstetrical violence.
No matter what framework you use, the basic problem is that fundamental human rights in childbirth are being violated on a daily basis around the world. In North America, in Canada and in the province of Quebec human rights are being violated as well. I speak to you today of the specific rights to health which should be guaranteed to all women and birthing people.
The 7 articles of the Universal Charter for Respectful Maternity Care on which I had the privilege to collaborate as a member of the Global Council for Respectful Maternity Care aims to give access to women and all stakeholders a clear understanding of the rights regarding maternity care as well as to call us all to recognize the mutual accountability and responsibility in ensuring that these rights are respected for all.
I put it to you that when we look at birth in a rights framework it becomes clear why many researchers and rights advocates are describing the disrespect of fundamental human rights and abuse in a systemic framework and naming it as, obstetrical violence : a systemic gender based violence which perpetuates inequality and inequity. More than 10 years ago, Venezuela enacted a law which defines obstetric violence as “…the appropriation of the body and reproductive processes of women by health personnel, which is expressed as dehumanized treatment, an abuse of medication, and converts the natural processes into pathological ones, bringing with it loss of autonomy and the ability to decide freely about their bodies and sexuality, negatively impacting the quality of life of women.”.
Organic Law on the Right of Women to Be Free from Violence
I am haunted and inhabited by the testimonials I have heard in the past 16 years as a rights activist in the area of birth. Each new story, fills me with the determination to end this disrespect once and for all. I have heard of multiple vaginal exams done by several different health care professionals without consent, inductions of labor done in coercive and intimidating manners, condescending and contemptuous attitudes that have made women feel inadequate and caused them to internalise an incapacity to give birth. The words, “lazy uterus, incompetent contractions, let’s give you some real contractions, failure to progress” are part of trivialized language that is not empowering. I have heard women report being described as too small, too old, too overweight, too young, too pushy etc. And the reasons for birth being considered a high risk seem to be increasing exponentially causing the high risk definition to close in like a vice on VBAC’s, and home births. A whole generation has been influenced to view birth as a dangerous, risky, life-threatening, pathological medical event.
When I look back at 40 years of birth advocacy work having been done by women and folks here and elsewhere in the world, I realize the change we’re calling for may well be the work of many lifetimes.
Allow me then, to share with you some of these stories:
Isabelle, a woman living with physical disability, realised her dream of giving birth last year after a long battle against society’s disapproval. She had high hopes of how childbirth would be an empowering moment in her life and instead she tells us how the healthcare system and the healthcare professionals failed her and her newborn in those first precious moments.
“If only I had given birth.
This year I felt life unfold within me. I was awaiting with fascination, the moment when this life would glide out of me. Unfortunately, that moment never came. 22 hours earlier, my doctor decided to induce labour for fear that one more week of pregnancy would tire me out… or was it out of fear of my handicap? However, an induction with an undilated cervix is a perilous enterprise which most often results in a cesarean. Unfortunately, the fear of the unknown, of a body that transgresses the norm, got the better of my childbirth. In 22 hours of induced labour my cervix did not budge. They gave me a second dose of hormones despite the fact that my medical dossier clearly stated that my body is highly sensitive to medication and that it should be used sparingly. My uterus went into catatonic spasms.
The foetal heart is not doing well, it’s now an emergency.
Now here I am with my newborn in my arms, wondering if I really gave birth to him. I’ve just been through a relay race moving into three different rooms. I was now in a fourth room of an old wing of the hospital not at all adapted to my “disabled mother-body. They had promised me I could stay in the renovated unit. I manage as well as I can, watching my wheelchair, parked at the door. Between spasms of pain, I try to care for my son, without the proper assistance needed to support a disabled woman.
(For further reflections of this birth https://materniteetdignite.wordpress.com/2018/05/15/si-javais-accouche/
Si j’avais accouché, j’aurais été avec mon fils pour son passage entre deux mondes.
Mais voilà, je n’ai pas accouché. On m’a accouchée)
Monique has just received the decision of the College of physicians regarding her formal complaint for unacceptable sexual impropriety on the part of a physician during a first appointment for pregnancy care.
The new president of the College of Physicians has publicly announced he will work harder to protect the public. We await with bated breath the sanctions which will be announced in the spring of 2019.
I first met Dr Allan Climan, in his office, 10 weeks into my second pregnancy (April 2015). Within the first few minutes of that meeting he told me that it looked like I ‘had a great little body’ and that he ‘couldn’t wait to see me naked and examine me’. As the conversation went on, he made repeated references to wanting to see my ‘beautiful vagina’. I tried to redirect the discussion, telling him that my first pregnancy had ended in a c-section and that I really would have preferred to have had a vaginal birth. I told him that I would like to try and have a vaginal birth this time. I told him about how the c-section and the recovery had been traumatizing for me. His response was to tell me that ‘the first thing I needed to know is that sex is never the same after a vaginal birth’. He then looked at my husband and told him ‘it won’t feel as good for you anymore’. Most references to my vagina were in relation to sexual intercourse. Very little attention was given to my health and my wishes for my pregnancy. After a rough pelvic exam, undertaken without forewarning, he said “ Look when you’re having sex, you lift your buttocks and clench your vagina around the penis and that’s good for sex and it makes your partner say Oh my God baby I love you’, but you’re making it difficult for me to examine you.”
There was no room left for question – there was no way we would return to this doctor. It took me a few minutes to compose myself before leaving the office with my husband. I felt violated, sad and discouraged. On the way out of the office I was struck by the many women sitting and waiting to see the same doctor. Heavy bellies suggested some of those women were only weeks away from giving birth. I couldn’t imagine that they might have spent their entire pregnancy having checkups with that same doctor.
Within hours of that appointment I wrote my letter of complaint to the Collège des Médecins du Québec. It has taken more than 3 years to pass before the judicial hearing committee of the CMQ. The committee believed me. The doctor has been found guilty of violating a number of sections of the CMQ code of conduct. It will be several months before a penalty or punishment is decided.”
Ariane, gave birth to her four children by cesarean. Each time, she was told that her body could not give birth naturally. Before her first cesarean, she was told her pelvis was too small. After receiving an epidural, when the surgeon was about to begin the operation, she told them that she still had sensation in her lower body. They tested and realized it was true. They then gave her another dose and told her it would take another 5 minutes but did not verify before beginning the operation. As they cut into her body, she screamed in pain and that’s when they put her under general anesthesia...
She has since become a doula, organised events for afro-Québec women to learn more about the long standing myths that persist about black women’s bodies and birth. And her work has led her to become a recognised birth advocate.
Through you, we hope that our call to vigilance will be heard by political leaders, policy makers, institutional health care decision makers, educational institutions and civil society leaders and that they will begin to listen fully to citizen’s voices speaking out about the violations of human rights in childbirth. These issues urgently need to be addressed because they have a long term impact on women’s and their children’s lives and on the quality of their physical and psychological health and well being. The choices we are making today will impact the lives of women and communities for years to come.”
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