One Year Later: Human Rights in Childbirth
Today marks the anniversary of the 2012 Hague Conference on Human Rights in Childbirth. Those of us who organized that conference sought to gather consumers of maternity care, care providers, lawyers, and other disciplines into a room to discuss human rights in birth care. The conference drew participants from 50 nations. Discussions about the human rights concerns of birthing women around the world revealed the international need for activism around women’s rights in birth care, and the existence of organizations and motivated individuals on all continents working for improvement in this area. After the conference, we started hearing more from these groups about their work, the issues in different birth care systems, and their need for connection to the international community as they worked to understand the problems and solutions. And so the Hague conference became a grass-roots organization: Human Rights in Childbirth.
This organization is committed to ensuring that all healthcare systems and providers respect the basic decision-making authority of every birthing woman about what will happen to her body and her baby during childbirth. The individual nature of women’s needs in childbirth demand that healthcare systems preserve the option for individualized care. Whether healthcare systems seek to improve maternity care, in the developed world, or implement it, in the developing world, every healthcare system can acknowledge the fundamental human rights of the birthing women it aims to serve.
The need for activism in this area stems from the fact that, in both the developed and developing world, birthing women report the routine violation of their rights to be supported in decisions around childbirth. In the developed world medical protocol often channels women into systems of care that deny their autonomy. The protocols themselves vary from region to region, and from practitioner to practitioner, but the assumption in institutionalized birth care is that a woman should submit to the directions of whichever provider is standing in front of her.
This assumption is especially concerning in light of the ongoing escalation of cesarean rates around the world. Pregnant women face providers who cut the babies out of 20, 30, 50% of their clients saying, “I have decided that you are having a planned cesarean section. If you insist on giving birth vaginally, I will tell the judge, or Child Protective Services, that you are a mother who puts her baby at risk.” Every legal system needs to make clear that women have the right to refuse an offer of cesarean surgery. Yet the right to refuse is complicated by the fact that many providers and hospitals simply withdraw care from women who choose vaginal over cesarean section delivery, a denial that is not based in evidence. With rates of cesarean section 5 or 10 times higher than they were a generation ago, all women should be concerned with the suggestion that they do not have the right to refuse a surgery that they consider unnecessary, and that can actually cause their death.
Monopoly, Suppression, and Persecution
Laws that operate to enforce a medical monopoly over childbirth violate the human rights of birthing women. Woman’s ability to turn away from abusive hospital care depends on their ability to get birth support outside the hospital. In legal systems most protective of a medical monopoly over childbirth, this monopoly is preserved through the heavy legal sanction of home birth midwives. Over the last year, we have heard from midwives and doctors from a wide range of legal and healthcare systems, facing legal challenges for birth care provided outside the hospital that can fairly be said to go beyond prosecution to persecution.
The essential allegation in many of these cases is that the birth professional should have made the woman go to the hospital, including sometimes the charge that the professional should have recognized earlier a symptom requiring medicalization. In medical malpractice, these allegations would be called “failure to intervene,” and “failure to diagnose.” Because the deaths of babies are painful tragedies, and because bad outcomes are unavoidable in obstetric care, obstetrician-gynecologists are among the most sued specialists in medicine. But doctors face legal challenges in civil and regulatory settings, with civil and regulatory consequences. Due to the illegitimate status of home birth midwifery in systems of medical monopoly, allegations of negligence against midwives play out in ways, including criminal prosecution, that could foreseeably dissuade any midwife from offering services for childbirth outside the hospital. For this essential claim that a midwife should have made a woman go to the hospital, midwives are charged with manslaughter, homicide, murder, quackery, fraud, and cannibalism (this last for the encapsulation of placentas). They are subject to home raids (in one American state this year, with cadaver dogs searching the midwives’ gardens), house arrest, and imprisonment. When no midwife is willing to risk such treatment in the event of a stillbirth, home birth services disappear. Women in those systems thus face a choice between unnecessary surgery or unassisted home birth.
We at Human Rights in Childbirth believe that the use of coercion and force against birthing women, including the frightening threat of Child Protective Services against women who make healthcare choices of which their providers disapprove, stems from a failure to understand and recognize that pregnant women retain the rights of all citizens. The birthing woman is the person with the right to make the decisions that will affect herself and her baby around childbirth. We have committed ourselves to supporting the clarification of that fact wherever necessary.
Since the Hague
Our first step has been to simply observe and gather information about global activism concerning birth care. In September, the film Freedom for Birth reported on the Hague conference and raised awareness about legal issues in birth care in over 1000 screenings worldwide. From Japan to California, India to Israel, Bulgaria to Uruguay, movie theaters and living rooms filled with people eager to discuss local concerns and plans for action. Over the last year, regional conferences modeled on the Hague conference convened consumers, birth and legal professionals, and interested scholars to discuss human rights in birth care in Finland, Australia, Ecuador, Israel, and Croatia, among others.
In April, Human Rights in Childbirth held a joint conference with Midwifery Today in Eugene, Oregon, USA, for consideration of the legal treatment of homebirth midwives. A panel of a dozen birth professionals working in the U.S. and Canada shared stories that demonstrated that the sanction of home birth professionals as a human rights issue transcends debates about licensure and regulation. Consumers, activists, lawyers and birth professionals exchanged information and strategies that generated hope in the face of systemic injustice. The Eugene event illuminated the value of a Human Rights in Childbirth conference as an opportunity to get people together and strengthen the connections necessary for mutual support and political action in this area. Among midwives, as among activists, there is more that unites than divides, namely a shared appreciation for woman-centered care and a belief that all women deserve respect and support around childbirth.
On November 4, we will host another one-day conference with Midwifery Today, this time after their international conference in Belgium. This event will examine legal actions across Europe that evoke the human right to choose the circumstances of childbirth. From the denial of home birth services in rural Sweden, to forced episiotomy in Italy, from the regulatory annihilation of home birth midwives in Western Europe, to the criminal annihilation of home birth midwives in Eastern Europe, panels will consist of mothers, midwives, and lawyers whose cases have pointed to Ternovszky v. Hungary since last year’s Hague conference. The conference will be held at a beach resort on the North Sea, and many of the great minds in modern childbirth will be present. We hope to see you there!
The need for respectful and individualized birth care certainly extends beyond the western world, with its plentiful infrastructure and resources. Together with colleagues across South Asia, we are also planning a conference in India during 2015 for discussion of the role of human rights in developing birth care systems. To that purpose, we will bring together the world’s leaders in obstetric care, midwifery, ethics, pediatric care, law and consumer groups, in a nation working to reduce maternal and fetal mortality across a vast population, in a healthcare system that lacks funding and is often understaffed. The country that has the most diverse groups, socially as well as culturally, that harbors many challenges and has many resources and a wealth of ancient and modern knowledge and wisdom, is India. On this fertile ground we propose to put our hearts and minds together.
Advancing HRiC Together
The fact that our conferences focus on legal issues in birth care has connected lawyers working in this area, and has given rise to a network of legal professionals communicating about developments in this area. Human Rights in Childbirth is working to connect these lawyers and scholars both regionally and internationally. National Legal Defense Networks can educate the public about legal issues and rights, share information and strategy, and collaborate for legislative action and strategic advocacy. By connecting these networks at the international level, we can track developments in this area and further explore the fundamental human rights at stake across national borders.
The last year has therefore revealed a purpose for Human Rights in Childbirth: to connect and advance both political activism and legal advocacy relating to the rights of birthing women. We are now ready to take the organization from its embryonic state as a grass-roots network of international volunteers to a foundation in The Hague with the ability to do meaningful work in this area. We are therefore taking this anniversary as an opportunity to invite support for the formation and advancement of Human Rights in Childbirth. We would like to offer the following Hague Conference materials to express our gratitude for contributions toward HRiC.
– 20€: A pdf copy of the Hague Conference Papers
– 50€: A printed book copy of the Hague Conference Papers
– 75€: A pdf copy of the Hague Conference Papers and access to the video recordings of the full Hague Conference.
– 100€: A printed book copy of the Hague Conference Papers and access to the video recordings of the full Hague Conference.
– 500€: in addition to the above, you or your organization can demonstrate your alignment with birthing women around the world by sponsoring Human Rights in Childbirth. In honor of your contribution, we will publicly acknowledge your support in our next newsletter and through various social media shout-outs over the next year.
– 1,000€: in addition to the above, HRiC will publicly acknowledge your contribution and distribute your marketing material at every HRiC conference through 2014.
The year since the Hague Conference has revealed a global demand for a rights-based approach to problems in maternity care. Human Rights in Childbirth is prepared to facilitate the political movements and legal revolutions necessary to ensure that every pregnant woman receives the respectful healthcare support that she, personally, needs in order to bring new life into the world. We would like to thank all those whose ongoing support and encouragement has carried our work forward over the last year.