• Obstetric violence refers to the abuse of pregnant women by healthcare providers.
• This includes physical abuse like assault, and psychological abuse like coercion.
• In this article, Dr Jess Rucell addresses the importance of understanding your rights and knowing the power you hold when it comes to consent.

Do you know what obstetric violence is? You may not be familiar with the term, but chances are, you’ve come across people who have experienced it. Who knows, maybe you’re one of those people.

Prior to working on this series, I had never heard of the term. Yet, when I listened to the stories shared, it sounded all too familiar – cases of forced sterilisation, negligence, and ill-treatment of pregnant women, expectant mothers suffering miscarriages on cold waiting room chairs or giving birth on hospital floors. This is obstetric violence.

The term “first originated from [female] activists who had been abused, and social movements, in Latin America,” explains Dr Jess Rucell, a researcher and advocate who works with the gender justice team at the Centre for Applied Legal Studies. 

“It refers to the abuse that healthcare providers carry out on pregnant women when the women are seeking care from hospitals or clinics.”

Obstetric violence can take two forms: psychological and physical.

This includes medical staff “insulting and ridiculing girls and women for their pregnancies and denying them healthcare.”

“Obstetric violence also refers to the physical assault of pregnant girls and women, including during childbirth, by healthcare providers. And it also focuses on issues of informed consent and coercion,” adds Dr Rucell. 

Rucell said:

Forced sterilisation

Bongie Msibi had a rude awakening in 2016 when she visited a doctor and found out she had no uterus. According to the mother-of-one, she was sterilised without her knowledge at Baragwanath Hospital in Johannesburg while giving birth via C-section in 2005.

“I think it’s very important to recognise that forced sterilisation is a violation of women’s rights,” says Dr Rucell.

“Particularly when someone is vulnerable and when they don’t have someone going to the hospital with them. When they’re giving birth alone, this is something that increases vulnerability.”

Bongie was just 17 at the time of her C-section – too young to provide consent. Her mother, who was at the hospital with her, denies agreeing to the sterilisation of her daughter. In fact, she claims she was not informed at all.

You should be included in discussions about your body

I’ve been in situations where medical staff discuss information about my body with me on the sidelines. Filled with anxiety, I want to speak up and ask to be included, but I’m intimidated. It feels like the information is handed out on a need-to-know basis. And although it’s my body, I don’t make the cut. But this is not the way it should be.

“Whenever a healthcare provider is examining someone or discussing a particular procedure or even a medication, they are supposed to inform the patient of what that is,” says Dr Rucell.

“They’re supposed to say, ‘This is the option that we’re proposing because of a certain condition.'”

READ | Forced sterilisations: ‘Sensitive’ talks under way two years after release of report

In the case of a C-section, for example, the medical team should explain why they’re proposing the procedure to the patient. Following that, you should then be notified of the risks involved in the procedure. The information should be explained to the patient in a clear manner so that she is “able to make a choice of what she wants for her healthcare experience and to deal with whatever problem she is having”, says Dr Rucell.

The same should happen when healthcare providers discuss contraception with patients. This includes sterilisation, which is a form of contraception.

“When it is being discussed and introduced by healthcare providers or patients, the healthcare provider is supposed to discuss the positives and the negatives and how this might be something accessed by the service.”

Understanding consent – you’re allowed to ask questions and say ‘no’

When discussing your health with a medical professional, it’s essential to realise that you are not expected to give up control of your choices or your body. So why is it then so easy for us to give in to the suggestions made by healthcare providers even if we know they may not be in our best interest? It’s all about the power dynamic, says Dr Rucell.

“It’s really important for all of us, me included, to recognise that when you’re going before a doctor, you have a need, you have a concern, and there’s a power dynamic there – I know less than they do [or] they know more than I do, so they can help. I can’t help myself, right? So we’re already feeling vulnerable because we are vulnerable, especially when you’re in a context of a very busy public hospital, and the nurses don’t have time because they have too many patients, etc.”

Rucell added:

READ | Sethembiso Mthembu: a victim of forced sterilisation whose experience inspired a doctorate

If you feel uncomfortable during a medical examination or you’re confused about what’s taking place, it’s important to ask. “The nurses, I believe, would just behave in this manner without asking because it’s so routine for them – this is what they’re doing all day long, every day for dozens and [even] hundreds of women a month.”

If a healthcare provider suggests invasive procedures like a C-section or sterilisation, for example, they need to be clear about why they think it is in the patient’s best interest, says Dr Rucell.

If you feel you are being coerced into the decision or threatened, “that’s something where basically you need to try to get help and get away from that healthcare provider, is what I would say.”

She acknowledges that this may be easier said than done. “Often, in these cases, that’s not something that a woman would be able to do. Again, because of the vulnerability or her particular health circumstances at that moment. So these are really serious and terrible circumstances that women can find themselves in.”