Jette Aaroe Clausen

Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence

Abstract During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices. Résumé Ces dernières décennies, un excès croissant et préoccupant d’interventions médicales pendant l’accouchement, même dans des naissances physiologiques et sans complications, parallèlement à une multiplication de pratiques violentes et irrespectueuses à l’égard des femmes pendant l’accouchement, a été rapporté de par le monde. En dépit de recherches et de décisions politiques pour corriger ces problèmes, il s’est révélé difficile de changer les pratiques obstétricales. Nous avançons que le taux excessif d’interventions médicales et le manque de respect à l’égard des parturientes devraient être analysés comme conséquence de la violence structurelle et que le concept de violence obstétricale, tel qu’il est utilisé dans l’activisme latino-américain de l’accouchement et dans les documents juridiques, peut être un outil précieux pour s’attaquer à la violence structurelle dans les soins maternels, comme les taux élevés d’intervention, les soins non consentis, le manque de respect et d’autres abus. Resumen Durante décadas recientes, se ha reportado un creciente y preocupante exceso de intervenciones médicas durante el parto, incluso en partos fisiológicos sin complicaciones, junto con un preocupante aumento de prácticas abusivas e irrespetuosas hacia las mujeres durante el parto en todo el mundo. A pesar de investigaciones y políticas formuladas para tratar estos problemas, ha resultado difícil cambiar las prácticas relacionadas con el parto. Argumentamos que las tasas excesivas de intervenciones médicas y la falta de respeto hacia las mujeres durante el parto deben analizarse como una consecuencia de la violencia estructural, y que el concepto de violencia obstétrica, tal como se utiliza en el activismo relacionado con el parto y en documentos jurídicos en Latinoamérica, podría ser una herramienta útil para abordar la violencia estructural en la atención materna, tales como altas tasas de intervención, cuidados sin consentimiento, falta de respeto y otras prácticas abusivas.

Women on the move in search for preferred birth services

BACKGROUND Women and midwives travel long distances, or abroad, to receive or provide birth services. Travel for birth services is not represented in the existing literature, despite the wide scale research available on medical travel. AIM We explored the perspectives of women who were seeking better services outside their places of residence and midwives who travel to provide these services. METHOD We followed a qualitative descriptive approach. We conducted 13 qualitative interviews with women from various European countries, four travelling midwives and one activist. Principles of thematic analysis were used. FINDINGS Deciding whether to travel is the result of a long-term process, influenced by various push and pull factors. Travelling women and midwives share values; they trust the capacity of women to give birth; they value respect and equality in communication; they search for trusting relationships and friendly environments without unnecessary treatments. Trust and distrust on interpersonal and institutional levels influence womens decisions and frame narratives about their experiences. CONCLUSION To a great extent, travelling women and midwives share the values embedded in the midwifery model of care. Women and midwives are willing to take matters into their own hands to achieve their expected birth experiences.