REPRODUCTIVE JUSTICE

MEDICALIZATION IN MATERNAL HEALTHCARE

**NOTE**  Medical advancements have saved the lives of women and babies at risk for injury or death during pregnancy and birth.  This site is not about the doctors who properly use interventions to save lives; it is about those who use them unethically for profit or convenience.   Improperly used interventions have led to harm and death of women and babies and obstetrics  is the only field in which mortality rates are rising and non-medically needed interventions such as c-sections are related to 66% of maternal deaths. 

**NOTE**  This site is designed to share valid evidence for those working to change the maternal healthcare system who do not have access to databases of peered research. 

**NOTE** Chronological order allows users to find new data.  It also begs the question of why, when we have known for decades that such practices are harmful, do they not only continue to be used but are increasingly used.

GLOBALIZATION

(See table of contents for list of individual continents)

WHAT DOES THE LITERATURE SAY?

GLOBAL (see below for sources for specific regions)

As western ideas are adopted in developing nations, the outcome for maternal healthcare is often negative.  There is no doubt that sharing medical advancements for high or at-risk women and the babies does save lives and has reduced mortality for them; however, the same is not always true for low risk women.  For instance, in poor countries such as Bangladesh, the western idea that the only safe place to give birth is in a hospital with an obstetrician has led to the demise of midwives.  Women in rural areas are often left with no local healthcare for pregnancy and forced to travel great distances to give birth.  The lack of prenatal care often leads to preventable health issues and the travel to cities where hospitals are located often puts the family deeply in debt.  Many women are forced to give birth at home with no trained medical person in attendance.

2022

United Nations (2022)  Mistreatment in childbirth, a human rights and healthcare problems, new study warns.  Accessed https://news.un.org/en/story/2022/03/1114512

• Advancing that mistreatment of “pregnant women, adolescent girls, and persons, as well as newborns” is a “pervasive problem around the globe”, WHO alerted for women everywhere facing violations of their rights – including rights to privacy, informed consent, and the right to have a trusted companion of choice throughout childbirth.    Among the serious violations of human rights, standards of care and basic humanity faced during childbirth, include those in labour being wheeled into surgery for caesarean delivery without informed consent, and postpartum mothers being detained for days after childbirth, to extort payments for care.

2021

Wrede S, Novkunskaya A, et al, Glob. libr. women's med.,ISSN: 1756-2228; DOI 10.3843/GLOWM.415183   Accessed https://www.glowm.com/article/heading/vol-1--pregnancy-and-society--birth-systems-across-the-world-variations-in-maternity-policy-and-services-across-countries/id/415183#.Y8_75-jMKTR

• In the USA, where the health care systems builds largely on private insurance, dominant national policies tend not to recognize childbearing as a social issue. Rather, maternity care and health care policies treat childbearing as a medical issue and the provision of services is much more focused on a medical model of pregnancy and childbirth than a more social one

2020

Zampas, C., Amin, A., O'Hanlon, L., Bjerregaard, A., Mehrtash, H., Khosla, R., and Tuncalp, O. (2020). Operationalizing a human rights-based approach to address mistreatment against women during childbirth.   Health and Human Rights, vol 22(1).   Accessed hhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC734

• From abstract: "A growing body of evidence reveals that the mistreatment of pregnant women during facility-based childbirth is occurring across the globe. As human rights bodies have increasingly recognized, numerous human rights are implicated in the context of mistreatment of women in childbirth, including the rights to be free from torture and other ill-treatment, privacy, health, non-discrimination, and equality. This paper builds on a previous paper published in this journal by Rajat Khosla, Christina Zampas, and others, and the new body of evidence describing the types of mistreatment that occur during childbirth, to unpack the drivers of the mistreatment of women during childbirth and how they are understood and addressed within human rights."

Betrán AP, Ye J, Moller AB, Zhang J, Gülmezoglu AM, et al. (2016) The Increasing Trend in Caesarean Section Rates: Global, Regional and National Estimates: 1990-2014. PLOS ONE 11(2): e0148343. https://doi.org/10.1371/journal.pone.0148343

• CONCLUDED: "Current rates of CS, except for the least developed countries, are consistently higher than what is considered medically justifiable [23, 42]. The scientific, public health and medical community have raised concern about this global epidemic while the search for ideas and interventions to reduce unnecessary CS is on-going [33, 34]. However, the rational and responsible reduction of unnecessary CS is not a trivial task and it will take considerable time and efforts. Monitoring both CS rates and outcomes is essential to ensure that policies, practices and actions for the optimization of the utilization of CS lead to improved maternal and infant outcomes."

• CONCLUDED: "As a consequence, the range of mistreatment that women may experience has not been adequately addressed or analyzed under international human rights law. Identifying human rights norms and standards related to the full range of documented mistreatment is thus a first step towards addressing violations of human rights during facility-based childbirth, ensuring respectful and humane treatment, and developing a program of work to improve the overall quality of maternal care. This article reviews international human rights standards related to the mistreatment of women during childbirth in facility settings under regional and international human rights law and lays out an agenda for further research and action."

Bohren, M., Vogel, J., Hunter, E., Lutsiv, O., Makh, S., Souza, J., Agular, C., Coneglian, F., Luiz, A., Diniz, A., Tuncalp, O., Javadi, D., Oladapo, O., Khosla, R., Hindin, M., & Gulmezoglu, A.,. (2015). The mistreatment of women during childbirth in health facilities globally: A mixed-methods systematic review.  PLoS Med 12(6): e1001847.  Doi:10.1371.journal.pmed.1001847 .  Accessed:  https://journals.plos.org/plosmedicine/article?id=10.1371/journal.pmed.1001847

• CONCLUDED: "This systematic review presents a comprehensive, evidence-based typology of the mistreatment of women during childbirth in health facilities. Moving forward, we propose this typology of the phenomenon be used to develop measurement tools and to inform the discourse and further research on policies and programs to prevent the mistreatment of women during childbirth.  We must seek to find a process by which women and health care providers engage to promote and protect women’s participation in safe and positive childbirth experiences. A woman’s autonomy and dignity during childbirth must be respected, and her health care providers should promote positive birth experiences through respectful, dignified, supportive care, as well as by ensuring high-quality clinical care. The development of validated and reliable tools to measure the mistreatment of women during childbirth, as well as interventions to prevent mistreatment and promote respectful care, is a critical next step. Future research and interventions addressing quality care during childbirth must emphasize that high-quality of care is respectful, humanized care"

United Nations Human Rights (2013). Maternal mortality and morbidity and human rights.  Accessed https://www.ohchr.org/sites/default/files/Maternal_mortality_morbidity.pdf

• With well over a quarter of a million pregnant women and girls dying every year, and another 10- 15 million daily suffering life-changing disabilities as a result of complications during pregnancy and childbirth, becoming pregnant can be one of the most dangerous things that happens to a woman. As many as 98 percent of these deaths are estimated to be preventable.  Health professionals have long known what it takes to ensure that women and girls survive childbirth in good health. But preventing maternal mortality and morbidity is not simply a fact of medical know-how. It requires the elimination of discrimination and violence against women -- in short it is a matter of human rights.

Maternal Health Task Force of the Harvard Chan School (2011). Respectful maternity care: The universal rights of childbearing women (2011). Accessed https://www.mhtf.org/document/respectful-maternity-care-the-universal-rights-of-childbearing-women/

• Growing Evidence of Disrespect and Abuse Imagine the personal treatment you would expect from a maternity care provider entrusted to help you or a woman you love give birth. Naturally, we envision a relationship characterized by caring, empathy, support, trust, confidence, and empowerment, as well as gentle, respectful, and effective communication to enable informed decision making. Unfortunately, too many women experience care that does not match this image. A growing body of anecdotal and research evidence collected in maternity care systems from the wealthiest to poorest nations worldwide paints a different and disturbing picture. In fact, disrespect and abuse of women seeking maternity care is becoming an urgent problem and creating a growing community of concern that spans the domains of healthcare research, quality, and education; human rights; and civil rights advocacy.   

Cabal, L and Stoffregen, M. (2009) "Calling a Spade a Spade: Maternal Mortality as a Human Rights Violation." Human Rights Brief 16, no. 2 (2009): 2-6. Accessed https://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1040&context=hrbrief

• Being pregnant should not be a game of Russian roulette. But for too many women around the world, it is. Globally, over a half a million women die each year due to complications during pregnancy and childbirth, with 99% of these deaths occurring in the global south.1 For every woman who dies a pregnancy-related death, another thirty suffer injury, infection, and disability. Nearly all of these deaths are preventable because the majority of deaths are caused by hemorrhages, sepsis, hypertensive disorders (particularly eclampsia), prolonged or obstructed labor, and unsafe abortions.2 Maternal death exposes a range of disparities and inequities. Of all health indicators, maternal mortality ratios reveal the greatest gap between developed and developing countries. They also point to huge discrepancies between rich and poor women within countries.3 It unmasks gender disparities as well: no single threat to men aged 15 to 44 approaches the enormity of maternal death and disability.4

Stanton, C. and Holtz, S.  (2006). Levels and trends in cesarean birth in the developing world.   DOI https://doi.org/10.1111/j.1728-4465.2006.00082.x  Accessed  https://pubmed.ncbi.nlm.nih.gov/16570729/ 

• Abstract: "Evidence suggests that cesarean birth rates are high and increasing in some developing countries. The objectives of this study are to compile the best current estimate of cesarean birth rates for developing countries, to estimate regional rates, and to document trends nationally and by urban/rural residence where data permit. A database of cesarean birth rates was compiled representing 90 percent of births in the developing world, resulting in an estimated cesarean birth rate for the developing world of 12 percent, with regional rates ranging from 3 to 26 percent. Data representing 45 percent of births in the developing world show that a majority of countries experienced increases in cesarean birth rates during the 1990s, except in sub-Saharan African countries, where little if any change occurred. Cesarean birth rates must be monitored routinely to call attention to rapidly changing practices. These data can, in turn, trigger investigation into the appropriateness of the rate in a given context."