Obstetric Violence and the UN Special Rapporteur for the Right to Health

I became a patient advocate sort of by accident. My own experience of obstetric violence that led me to this work left me completely traumatized and struggling to function. On paper, the birth of my child appeared perfectly uneventful; the kind of birth for which many hope. I had a “normal” vaginal delivery following an induction at 41 weeks. There were no instruments required, I had minimal tearing, delayed cord clamping, and immediate skin-to-skin with my beautiful healthy baby. Despite the positive physical outcome, some of the treatment I’d received left me in a very dark place. When I returned home from the hospital, I was unable to separate vivid flashbacks of the non-consensual procedures and cruel attitude of hospital staff from my previous experiences of violence and abuse. Well-meaning friends, family, and professionals to whom I reached out to for help in those early days implied that a healthy baby was all that mattered; that I was selfish and ungrateful for expecting more support from my healthcare providers, even at such a vulnerable time. I was told to make peace and move on, not to complain because it was unlikely to change anything. Instead of quietly making peace with the trauma, I began to connect with others in my community and online who’d been through similar experiences who had never spoken up, or had tried to speak up but felt silenced, gaslit, and dismissed. There are so many of us.

Knowing that these problems are widespread not just in childbirth, but in other forms of reproductive healthcare as well, I created a website called The Reproductive Justice Story Project. The project centres on a story-sharing platform, the Community Story Blog, which serves as a public body of evidence to expose mistreatment and abuse in reproductive healthcare, first in my home province of Ontario, and now across Canada. Many folks have already written in to share their personal experiences not just of obstetric violence and birth trauma, but disrespect, discrimination, threats, and coercion from healthcare providers during prenatal and postpartum care, abortion care, pregnancy and infant loss, and much more. It is the hope that sharing these stories loudly and publicly will be one small way to help hold harmful systems accountable and influence change in policy and in the culture of reproductive healthcare.

When the UN Special Rapporteur on the Right to Health, Dainius Pūras of Lithuania, visited Canada this past November, Human Rights in Childbirth reached out to suggest that I try to share my work on obstetric violence with him during the mission.

The role of a UN Human Rights Special Rapporteur is to visit countries around the world and meet with a variety of stakeholders to get a sense of the state of human rights issues in each one. They engage with governments, organizations, and civil society to hear about the strengths and areas for improvement, then prepare a detailed report on their findings. Their final report has the power to launch issues into the national spotlight and spark real policy change. I was grateful for the tip about the Special Rapporteur’s visit, and emailed the office right away using every bit of advice I’d been offered from Human Rights in Childbirth. It was pretty short notice and their trip had already begun, so I was incredibly lucky to receive an invitation to give a brief presentation in Ottawa a few days later. I crowdfunded a last-minute plane ticket from Toronto for myself and my nursing toddler and stayed with a family friend in the city so I could give my presentation.

The meeting was hosted at the offices of Action Canada for Sexual Health and Rights, an organization doing invaluable work around sexual and reproductive rights here in Canada and globally. I arrived early and sat in the conference room anxiously looking over my notes; I am very new to advocacy work and this was my first opportunity to speak for a group of this nature. The other presenters arrived one-by-one and took their place around the conference table. They all looked like experts: well-spoken, well-dressed, and all from such well-established organizations. I felt like I’d snuck in somewhere that I didn’t belong! When it came my turn to speak, I managed to silence my imposter syndrome long enough to get through my presentation. I shared the final report from the patient feedback survey I conducted earlier this year as a case study in mistreatment and abuse in childbirth, and spent my few allotted minutes highlighting, specifically, the issue of obstetric violence in Canada.

Obstetric violence is truly a reproductive justice issue, and therefore, a human rights issue. It impacts women, trans, two-spirit, and gender non-conforming folks across demographic lines, but has a disproportionate impact on people experiencing marginalization and vulnerable life circumstances. The Special Rapporteur seemed to echo these sentiments in his preliminary findings at the end of his visit on November 16, 2018:

“I observed and discussed many additional issues related to the in-focus themes of my visit on which I will elaborate further in my report. For example, I received information about additional challenges including, inter alia, criminalization of both sex work and of HIV non-disclosure; access to contraceptives and abortion services, access to HIV medication, remaining practices of obstetric violence and forced sterilization amongst indigenous women, and the situation of vulnerability of incarcerated women, among whom indigenous and Afro-Canadian women are disproportionately represented.”

The final report on this mission will be released in June 2019. It will likely elaborate further on issues including obstetric & reproductive violence based on the presentations given by other organizations doing this important work across the country. These issues and the ways they intersect with social determinants of health have profound implications on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and I hope this report will be a step towards meaningful change here in Canada.