Global News | Human Rights in Childbirth

Forced Sterilisation during Caesarean and Informed Consent – the case of I.V. vs Bolivia

by Bashi Hazard | Mar 2, 2021 | Global News, Informed consent, Specific medical rights

This is the first time the Inter-American Court of Human Rights has analysed the foundations of the right to informed consent.

Merits I.V. BOLIVIA; August 15, 2014

This case demonstrates the difficulty, anguish and suffering experienced by vulnerable women when they are not afforded the right to bodily autonomy while accessing reproductive health services such as maternity health care.

In a landmark decision handed down on 30th November 2016, the InterAmerican Court of Human Rights held the State of Bolivia responsible for the forced sterilisation of I.V., a Peruvian refugee performed during a Caesarean Section at a public hospital. The circumstances surrounding this case are not isolated. According to data released by Peru’s Health Ministry, between 1996 and 2000, 260,874 women underwent tubal ligation procedures. It was estimated that as few as 10 percent of women consented to the procedure prior to application. Overall, thousands of women recounted being coerced, threatened, or extorted into undergoing sterilisation procedures.

The Court declared a violation of I.V.’s rights to personal integrity, personal freedom, dignity, private and family life, access to information and founding a family, recognized in Articles 5.1 (Right to Humane Treatment), 7.1 (Right to Personal Liberty), 11.1 and 11.2 (Right to Privacy), 13.1 (Freedom of Expression) and 17.2 (Rights of the Family) of the American Convention, to I.V’s enduring detriment.

The Court also examined, in the context of the right to health, the importance of the human right to informed consent and the elements required to protect that right.

This the first time the Inter-American Court of Human Rights analysed the foundations of the right to informed consent. For the Court, the informed consent rule is associated with the right of access to information in the field of health, because a patient can only give their informed consent if they have received and understood sufficient information that enables them to make a decision to fulfil their needs.

Background

I.V was a Peruvian refugee who fled, with her 2 daughters, to Bolivia after years of torture and sexual assault at the hands of the Peruvian National Police. While in Bolivia, I.V fell pregnant again and attended La Paz Women’s Hospital emergency department where she underwent a Caesarean section. The following morning, her doctor informed her that he had tied her fallopian tubes and that she would never have children again. The doctor claimed that complications arising from multiple adhesions made it necessary for him to do so and that verbal statements I.V. made during the surgery indicated her consent.

Disturbingly, while I.V (who had an epidural anaesthetic which enables her to remain conscious throughout the procedure), the doctor called upon her husband to sign the “family consent form” to perform her Caesarean section.

In response to a series of complaints, the Audit Committee of the Women’s Hospital conducted two inquiries. In the first, the Committee found that I.V had verbally consented to the procedure. In the second, the Committee concluded that the sterilisation was performed prophylactically and in the interests of patient well-being. However, the medical audit conducted by the Ministry of Health found that I.V.’s verbal statements whilst under anaesthesia did not amount to consent and that the procedure was not a medical necessity.

Peruvian authorities initiated criminal proceedings against the doctor, to which I.V joined as a civil party. When the case was declared time-barred four years later, the Ombudsman of Bolivia submitted I.V.’s petition to Inter-American Commission on Human Rights.

Findings

The Court reasoned that an individual’s health is a core component of the right to personal integrity, which includes access to quality medical services, and enables self-determination in health and information is a core component of having and making a choice. This involves the right to make a decision free from torture or non-consensual medical treatments.

As a fundamental human right, the right to health, including reproductive health, relies on a respect for an individuals’ bodily autonomy and self-determination. For the right to health to function, there must be informed consent from patient to practitioner. Informed consent is also inseparable from the fundamental human right to dignity.

Informed Consent

To afford informed consent and respect the right to health, states have a duty to guarantee the right to information on health issues and protect the right of recipients of health services to decide freely whether or not to accept medical treatment. To deny health information can create obstacles to the right to make such decisions freely.

The court found that there had been a violation of consent arising from both the doctor and the State for the following reasons:

The timely nature of obtaining consent: Consent must be granted before a medical procedure is performed. Consent cannot be deemed informed nor existent at the end of or after a procedure except during exceptional cases of genuine emergency or to mitigate serious risk to life or health of the patient. I.V.’s sterilisation operation was not an emergency.
Consent must be free and voluntary: Consent must be granted “freely, voluntarily, in an autonomous manner, without pressure of any kind, without using it as a condition to perform other procedures or benefits, without coercion, threats, or misinformation. The person may not wish to consent, and consent may be revoked at any time. Consent can only be obtained by the person receiving the procedure. Husbands cannot consent on a wife’s behalf. To do so is to perpetuate the stigma that women cannot make their own decisions and are unreliable. This stigma is exacerbated when women from low socio-economic status and education standards in Latin America seek medical assistance.
Full and informed consent: Consent can only be obtained after the person has received accessible, adequate, complete, reliable, understandable information which accounts for their level of education, culture, religion and lifestyle and had the opportunity to fully understand it. Health providers should at least inform the patients on: “i) diagnostic evaluation; ii) the objective, method, probable duration, expected benefits and risks of the proposed treatment; iii) the possible unfavourable effects of the proposed treatment; iv) treatment alternatives, including those that are less intrusive, and the possible pain or discomfort, risks, benefits and side effects of the proposed alternative treatment; v) the consequences of the treatments, and vi) what is estimated to occur before, during and after the treatment”.

It is the duty of the health professional to provide patients with the full extent of the options available and explain the risks associated with each procedure whilst considering the needs of the patient.

It is interesting to note the multiple mentions of sexism and paternalistic tendencies arising from the obstetrician-woman relationship. The Courts noted that hospitals can no longer rely on the paternalistic view that the doctor is always in the best position to make decisions on women’s reproductive organs and health.

By reasoning from a socio-gendered perspective, the court in this instance opened the doors for further discussion and decisions pertaining to the overlapping of human rights violations, consent and discrimination in childbirth.

Keywords: Forced sterilization – Health care practitioner- Informed consent – Involuntary sterilisation – Involuntary treatment – Non-consensual testing and treatment

Bashi Kumar Hazard

HRiC Board Member

Bashi Hazard is an Australian lawyer and the principal of B W Law, a legal practice established to support and assist women and children, and the Legal Director of the ANZ arm of the Human Rights in Childbirth (HRiC) International Lawyers Network. Bashi’s background is in competition and consumer law, and litigation, developed while working for several years with Allens in Sydney, immediately after graduating with first class honours in Law and Economics from the University of Sydney.

Contribute to our Second Report on Violations in Maternity Care during COVID-19

by Daniela Drandic | Jun 23, 2020 | Advocacy, Global News, HRiC In Action, UN bodies

Help us document what is happening taken in maternity care services in your country – send us a submission by Friday, 10 July 2020.

The COVID pandemic is having an enormous impact on maternity care around the world. Minute by minute, day by day, practices and norms are changing, often to the detriment of women’s rights in childbirth. HRiC has already prepared and submitted a first report on maternity care violations during COVID-19, and it has become clear that the problems continue and a second report is necessary.

Help Human Rights in Childbirth document these changes – let us know what is going on in your country, and provide us with links to reports, new guidelines, blog posts that are documenting what is happening. We will use this documentation to build a bank of information of what is happening “on the ground”. We will use your report in our advocacy work towards international organisations and bodies.

If you do not have documentation, you can leave us a short report, preferrably in English but we will do our best to translate if you are writing in another language.

Please report changes in maternity care such as:

labour and birth companion suspension
visitor suspension or bans
changes in access to pain relief due to COVID
changes in caesarean section frequency due to COVID
changes to birth centre and home birth services due to COVID
lack of personal protection equipment for maternity staff
inadequate staffing of maternity services because of COVID
moving midwives (especially those that are also qualified nurses) from maternity services to work in COVID wards
disrespect and abuse in maternity care during COVID
changes to any maternity services that have a greater impact on marginalised and vulnerable groups of women
anything else that is happening that you feel needs to be reported.

IF YOU ARE FACING MORE THAN ONE ISSUE OR HAVE MORE THAN ONE REPORT TO CITE, PLEASE SUBMIT ONE FORM FOR EACH ISSUE OR REPORT (e.g. submit a few reports intead of putting everything into one).

Please, also share examples of good practices! They exist and need to be documented.

The English submission form can be found here.

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Report on Rights Violations in Maternity Care During COVID-19

by jason | May 9, 2020 | Advocacy, Global News, UN bodies

Since the beginning of the COVID-19 pandemic, HRiC has been collecting reports of disproportionate human rights violations in maternity care. The first set of rights violations have been published in a report (available below) and sent to the United Nations.

, The world is dealing with unprecedented challenges arising from the novel coronavirus (COVID-19) and health systems are now focused on social distancing and avoidance of non-urgent, non-COVID related medical care. Unfortunately, the strains on our health systems and the difficulties are not being borne equally by the population – pregnant women in particular still require competent and compassionate labour, birth and postpartum care.

In this time of health crisis policy actors, hospital systems, and birth care providers are changing the provision of pregnancy and birth care in ways not based on scientific evidence nor in best practices endorsed by the WHO. Not only are the changes described in this document not based on evidence, the changes are arguably unnecessary and even harmful. When necessary changes are being implemented they are often done in ways out of proportion to the risks posed by coronavirus. Where necessary changes are made, such as moving to remote tele-health visits, few health systems are implementing innovative methods to reach women who lack access to technology and information, especially marginalized women who were already needed more support before the pandemic started.

Although the COVID-19 pandemic requires a swift global response to contain the virus’ spread and protect the life and health of others, this does not mean that states can use any means to achieve this. UN human rights experts have called upon states to maintain a human rights-based approach to regulating the COVID-19 outbreak and have held that the pandemic should not be used as an excuse to target the rights of particular groups, minorities or individuals, nor should it be used as cover for repressive action under the guise of protecting health.

We should be wary of any use of the pandemic to institutionalise harmful practices in maternal healthcare. Rather than an effective response to COVID-19 they are a breach of women’s human rights and a cloaked manifestation of structural gender discrimination.

If you would like to contribute to future versions of the report, you can do so here.

Read the full report here:

Pregnancy, Birth and Postpartum During COVID19 Report May 2020 (425 kB)

HRiC informs European Parliament Action on Maternity Care during COVID-19

by Daniela Drandic | Apr 23, 2020 | Advocacy, Global News, HRiC In Action

HRiC has been working with Predrag Fred Matić, a Member of European Parliament (MEP), member of the Committee on Gender Equality (FEMM Committee) and rapporteur for Sexual and Reproductive Health Rights to bring light to some of the problems women throughout Europe and the world are facing in maternity care during the COVID-19 pandemic.

Since the beginning of the COVID-19 pandemic and crisis and its effect on maternity care around the world, Human Rights in Childbirth has been working to document and advocate for the rights of families and their babies to receive evidence-based care.

Some of the problems we have documented, and we have warned human rights organisations, policymakers and professional organisations about include:

Maternity services are being de-prioritised with regards to adequate staffing, personal protective equipment for staff and access to needed resources
Community and out of hospital maternity services (including midwifery units and home birth) are being closed down without warning
Women are being forced to submit to unwanted inductions and scheduled caesarean sections with no obstetric indication
Women are being separated from their newborn infants
Women are being denied the right to a companion in labour and birth, as well as visitors

All citizens are entitled to the protection of their right to the highest attainable level of health during this crisis. Mothers and babies should be no exception to that rule. The countries that have responded well to the needs of pregnant and birthing women strongly indicate that the aforementioned restrictions are unnecessary and disproportionate to the level of the needed safety and health requirements in relation to COVID-19 prevention and protection.

There are a number of good practice examples in some countries where, through systematic human-rights based approach, due changes have been made in order to protect the right to health at the highest attainable standard, with measures in place to protect both the medical staff as well as women and children in childbirth and pre and post-natal care. For example, some countries have ensured safety by acquiring adequate staffing and protective equipment as part of the targeted actions, while others have converted hotels near maternity hospitals into temporary birth centres to support both healthy non-symptomatic women and protect maternity healthcare workers from COVID-19 exposure. This is a measure implemented to ensure access to a safe childbirth environment, thus not allowing the situation of women giving birth in medical transportation vehicles and similar, which has happened in some instances where due measures were not taken. Other countries encourage birth companions and ensure the safety of all medical staff and patients in doing so with the implementation of protective restrictions on movement within hospital facilities. Health systems should not be actively engaged in damaging the health and well-being of pregnant women, mothers and babies.

MEP Matić rallied the support of 62 fellow MEPs and sent a letter to the Commissioner for Health and Food Safety Stella Kyriakides asking her to support activities which ensure the achievement of the fundamental right to health and ask you to urge Member States to ensure that maternity services are appropriately resourced and that women’s rights are respected through a proportional response to the pandemic in accordance with the best evidence and guidelines, including those provided by the WHO. The letter is below, along with a list of MEPs that have signed on.

Some next steps regarding the protection of women’s rights in maternity care we have proposed include:

Ensuring adequate resources for maternity care, including staffing and protective equipment
Ensuring that there are policies in every country and facility guaranteeing women companionship during labour and birth, in accordance with best evidence from WHO and other organisations that are monitoring the situation in real-time (e.g. the Union of European Perinatal and Neonatal Societies, and a consortium of Royal Colleges from the UK)
Implementing, reinstating and resourcing midwifery units and home birth services
Ensuring that policies during the COVID pandemic are based on evidence and facts, not fears.

HRiC will continue to advocate for a proportional response to the COVID-19 pandemic in maternity care, one that takes into account the human rights to health and privacy for both mothers and babies.

Download the letter and see the signatories here:

Letter to EU Commissioner on Health and Food Safety on Maternal Healthcare During the COVID19 Pandemic

Daniela Drandić, M.Sc.

HRiC Board Member

Daniela Drandić holds an M.Sc. from the University of Dundee in Maternal and Infant Health and is Reproductive Rights Program Lead at Croatia’s largest parents’ NGO, Roda – Parents in Action. Daniela’s advocacy work includes organising regional and global campaigns for improvements in maternity care, working with regional and global human rights institutions and developing innovative educational tools to teach people about reproductive health, maternity care and human rights.

Midwifing Us Through the Epidemic

by Daniela Drandic | Mar 3, 2020 | Global News, HRiC In Action

The Covid-19 virus is slowly making its way around the world and hospitals pregnant women and families are worried about birthing at hospitals that might be treating infectious patients.

In many countries are cancelling non-essential surgeries to make space for a possible influx of infectious patients. This rational response will save resources, healthcare staff and space for patients that may be very sick over the next few weeks. But what about non-essential hospital births? Should the public health response include moving care for women with normal pregnancies outside of the hospital setting, to homes, birth centres and community health facilities where there risk of exposure to Covid-19 is lower?

Changes over the past fifty years

Emergencies like global pandemics, natural, humanitarian and other crises magnify the vulnerabilities in our healthcare systems – this was clear during the Ebola outbreak and epidemic in West Africa (Jones et al., 2017) and during the 2004 earthquake and tsunami in Indonesia and other countries in South-East Asia (Carballo, Daita and Hernandez, 2005). Sweeping changes in maternity care systems in high- and mid-resource countries have embraced high-intervention methods and technology without the balance of midwifery (Renfrew et al., 2014), and are more vulnerable as a result.

Facility-based birth

In many countries, public health messaging and funding has emphasised hospital facility-based obstetric care as the most important solution for improving maternal health and survival, although the evidence has shown that the safest and most sustainable type of care for the majority of women and babies is a midwifery-led service with timely access to emergency services as necessary (Miller et al.,2016). By moving the majority of births to hospitals, midwifery care and birthing at a community facility, birth centre or at home has come to be seen as an “alternative” instead of the norm. Governments have been closing rural and community maternity services and putting up barriers to the work of midwives in an attempt to save money by centralising care (Andrews, 2016), effectively creating “maternity care deserts,” even in high-resource countries like the United States (Porter, 2020). In emergency situations like the outbreaks of contagious diseases, women may not want to attend hospitals to give birth for fear of infection – for example, during the Ebola epidemic, facility births decreased by 20% in Sierra Leone (Carballo, Daita and Hernandez, 2005). All the while, the government ignored what was going on and continued encouraging “safe births in healthcare facilities” as opposed to investing in outreach or community programs (Carballo, Daita and Hernandez, 2005).

While there are women that do need specialised care at some point or throughout their pregnancy, birth and postpartum journey, evidence has shown that interdisciplinary care integrated across hospitals and community settings that includes midwifery provides the best outcomes for mothers and babies (Renfrew et al., 2014). More than this, midwifery-led services with access to emergency services as needed have proven to give the best outcomes and lowest rates of intervention, for the lowest cost (Miller et al.,2016), especially important to consider during an emergency where resources are limited and rationed.

Too much, too soon

The overuse of technology and interventions has ballooned over the past two decades and case studies from Brazil, China and India have shown that health systems that are quickly developing are more likely to adopt maternity care systems that rely heavily on medical interventions, without balancing them out by integrating midwifery (Renfrew et al., 2014). In countries as diverse as Greece, Egypt, Turkey, Iran, Brazil and Mexico one in two women give birth through surgery, and a rate of one in three women has become normal in high-resource countries (McCarthy, 2018). With so much technology and so many surgical births, effective low-tech skills that were once common, like palpating a woman’s belly to feel where her baby is, or helping a woman bring twins, or a breech baby into the world vaginally, are lost.

The drawbacks of these short-sighted policies and changes in practice become clear in emergency situations – when resources or staff are severely rationed or not available, when there is no electricity. During a natural disaster or epidemic having midwives available to serve women with normal pregnancies and births in their homes or in community or improvised facilities can free up beds and resources in hospitals that find themselves overwhelmed or under-resourced.

Workforce shortages and sustainability

In 2013, the World Health Organization estimated that there is a global shortage of 350,000 midwives (More midwives needed to improve maternal and newborn survival, 2013) – this is evident in high and low resource countries alike (Campbell, 2017; Williams, 2018). In emergencies, this is more obvious – during the 2004 tsunami in South-East Asia, the region lost 30% of its midwives (Carballo, Daita and Hernandez, 2005). Countries like Haiti, with severe midwife shortages, need to train 2200 midwives over the next few years and are implementing innovative solutions to achieve this. These include opening satellite schools to educate midwives that will work in dedicated birth centres located throughout the country and accessible to women in rural and urban areas (Williams, 2018).

No matter the outside circumstances there will always be pregnant and birthing women –

and we can’t postpone our births until the crisis is over.

The Way Forward

Midwifery care has been proven effective in extraordinary and disaster situations – in Indonesia, after the 2018 earthquake (Cooper, 2018), during the refugee crisis in Greece (Andrews, 2016), providing care to uninsured refugees in Canada (Handa, 2017). Midwives also provide other essential reproductive health services, from abortion to management of miscarriage, contraception and sexually-transmitted disease treatment. Maintaining a strong, skilled and well-supported midwifery workforce, working in communities, at birth centres and in homes is vital as part of a response to every emergency situation. Some ways we can do this include:

Increasing and retaining the global midwifery workforce using innovative, evidence-based methods;
Introducing evidence-based midwifery education programs in smaller cities;
Including midwives in planning, developing and implementing midwifery training, human resource and education programs;
Engaging the expertise of midwives in planning, developing, implementing and evaluating emergency and disaster services, but also in rebuilding health systems after disasters;
Including maternity care in emergency planning;
Ensuring that midwives have the regulatory framework and skills to work autonomously in hospitals, community facilities and in the home;
Policy and healthcare planning that ensures the existence of small maternity services and home birth, with an ambulance system to be used when needed.

It’s inevitable that the power will go out, or that there will be another storm, fire, a natural disaster, a local emergency, an epidemic or pandemic. The evidence is showing that climate change will only make these emergencies more common and more severe. Midwifery, community and home birth services are more than nice to have additions for the women who want “alternative” care – during disasters, epidemics and other emergency situations, midwifery care and out of hospital birth are vital parts of the public health response. As Covid-19 pandemic creeps around the world, we have a collective opportunity to open the discussion on how well prepared our maternity services are to handle the potential emergency.

Now is the time to press our governments and policy makers to support midwifery care in communities as part of policies to address climate change or Green New Deals that are being prepared around the world – to make sure we are well-prepared for the next emergency or pandemic. We ignore midwifery models of care, essential midwifery skills, community and home birth at our peril – future generations will depend on them as part of crisis response.

Special thanks to Nicholas Rubashkin and Heidi Dahlborg for their input and comments on this piece.

Bibliography

Andrews, M. (2016). More Rural Hospitals Are Closing Their Maternity Units. [online] Npr.org. Available at: https://www.npr.org/sections/health-shots/2016/02/24/467848568/more-rural-hospitals-are-closing-their-maternity-units?t=1583138720302 [Accessed 2 Mar. 2020].

Campbell, D. (2017). Shortage of doctors and midwives putting lives at risk – report. [online] The Guardian. Available at: https://www.theguardian.com/society/2017/aug/10/shortage-doctors-midwives-mothers-babies-lives-risk [Accessed 2 Mar. 2020].

Carballo, M., Daita, S. and Hernandez, M. (2005). Impact of the Tsunami on healthcare systems. Journal of the Royal Society of Medicine, 98(9), pp.390-395.

Cooper, L. (2018). Caring for Mothers and Babies After the Earthquake. [online] Direct Relief. Available at: https://www.directrelief.org/2018/10/caring-for-mothers-and-babies-after-the-earthquake/ [Accessed 2 Mar. 2020].

De Frutos, M. (2019). I Was a Midwife in a Greek Refugee Camp at the Height of the Crisis. Here’s What I Learned.. [online] Global Citizen. Available at: https://www.globalcitizen.org/de/content/midwife-refugee-camp-europe-greece-NHS-uk/ [Accessed 2 Mar. 2020].

Handa, M. (2017). Canada’s impending refugee crisis and how midwives can save the day. [online] The Conversation. Available at: https://theconversation.com/canadas-impending-refugee-crisis-and-how-midwives-can-save-the-day-86306 [Accessed 2 Mar. 2020].

Jones, S., Sam, B., Bull, F., Pieh, S., Lambert, J., Mgawadere, F., Gopalakrishnan, S., Ameh, C. and van den Broek, N. (2017). ‘Even when you are afraid, you stay’: Provision of maternity care during the Ebola virus epidemic: A qualitative study. Midwifery, 52, pp.19-26.

McCarthy, N. (2018). Which Countries Conduct The Most Caesarean Sections?. [online] Statista Infographics. Available at: https://www.statista.com/chart/15787/caesarean-rates-by-country/ [Accessed 2 Mar. 2020].

Miller, S. et al. (2016) ‘Beyond too little, too late and too much, too soon: a pathway towards evidence-based, respectful maternity care worldwide’, The Lancet, 388(10056), pp. 2176–2192. doi: 10.1016/S0140-6736(16)31472-6.

More midwives needed to improve maternal and newborn survival. (2013). Bulletin of the World Health Organization, 91(11), pp.804-805.

Porter, S. (2020). Maintaining Maternity Care Vital to Rural Hospital Stability. [online] Aafp.org. Available at: https://www.aafp.org/news/practice-professional-issues/20190213nrhamaternity.html [Accessed 2 Mar. 2020].

Renfrew, M. J. et al. (2014) ‘Midwifery and quality care: Findings from a new evidence-informed framework for maternal and newborn care’, The Lancet. doi: 10.1016/S0140-6736(14)60789-3.

Xinhuanet.com. (2020). Volunteer group in Hubei take pregnant women without access to vehicles to hospital – Xinhua | English.news.cn. [online] Available at: http://www.xinhuanet.com/english/2020-03/02/c_138833723.htm [Accessed 2 Mar. 2020].

Williams, S. (2018). ‘We have a shower for pain relief’: can Haiti’s young midwives save a new generation?. [online] The Guardian. Available at: https://www.theguardian.com/society/2018/dec/29/haiti-midwives-save-new-generation [Accessed 2 Mar. 2020].

Daniela Drandić, M.Sc.

HRiC Board Member

Political Ping-Pong and Women’s Health in Poland

by Daniela Drandic | Aug 9, 2017 | Global News, HRiC In Action, Uncategorized

Poland is considered the success story of Eastern Europe. This formidable country led the region adopting democracy, successfully integrated into the EU and has improved its economy and standard of living immensely over the past twenty years. The same could be said in the case of maternity care, which thanks to actors like Childbirth With Dignity has become increasingly evidence-based and has started to put the mother and baby dyad at the centre of attention. Childbirth With Dignity even received awards from the WHO and UNFPA precisely for this advocacy work in improving Polish maternity care standards.

These standards are being abolished according to new legislation. Childbirth With Dignity prepared a petition for the Polish government, sending the message that we will not stay silent while the maternity care takes steps backwards. While it was active, the petition got over 70 thousand signatures.

Why Perinatal Standards? Why Now?

This past year has been particularly contentious regarding reproductive rights in Poland, beginning in the summer and culminating in the autumn with Black Monday, an EU-wide protest on the Polish Government’s attempts to even further limit access to termination of pregnancy services. But as we all know termination of pregnancy and rights in maternity care aren’t really on the same radar – or are they? Governments who say that they care about family values and population policies (an important issue on a continent with falling birth rates), which means that they must care about the rights and dignity of pregnant persons in maternity care?

Poland is proof that the rhetoric used by politicians who say they want to limit access to abortion in order to protect families, religious values and fertility rates is too often not reflected in their actions. Limiting one reproductive right does not mean that they are working to protect the rights and dignity of those who decide to become parents.

Being Pregnant in Poland

In 2007, Childbirth With Dignity began a collaborative process with the Polish Ministry of Health and their national professional bodies (midwifery, obstetrics and paediatrics) to form a set of maternity hospital standards known as the Perinatal Standards which had to be respected by every hospital offering maternity services.

These standards set out the minimum that hospitals had to provide women and included standards for obstetric and perinatal care, physiological birth standards, pain management standards, miscarriage standards and others. Poland was the only country in Eastern Europe with such standards, and alongside Britain and the Netherlands was only the third country in Europe to have them.

The standards were not perfectly upheld in every maternity service but improvements in services were evident and palpable, and dignified care that put the mother and baby at the centre of attention became all the more present in the healthcare system.

Abandoning Care

All this changed in June 2016 when the Minister of Health acted on pressure from Polish physicians’ groups and signed a decree that would remove the standards as of 2018, destroying a consensus among professional organisations, policymakers and the public for the interest of a single group.

The summer was to be very busy for reproductive rights in Poland. On 1 June legislation annulling all state insurance coverage of medically assisted reproduction services was cut, meaning that couples dealing with infertility were now responsible for paying for all treatments out of pocket. These services had previously been partially covered by state insurance, meaning that infertility treatments, required for 1 in 6 couples in Europe, was now available only to the rich. Quite fitting given that the Polish government has been working on marketing Poland as a health tourism destination offering world-class care, foreigners who can pay for it anyway.

As the Polish government moved to vote on severe abortion restrictions in October under the scrutiny of Europe and the world, behind the scenes the Minister and the government were quietly continuing to hide the fact that they were working not only to restrict the rights and health of women who wanted to terminate pregnancies, but also of women who wanted to become and stay pregnant. This silence was a move of political pragmatism – it is difficult to defend your family and Christian values before your electorate if you have already made moves to restrict medically-assisted fertility and services for pregnant persons and their families. Abortion proves the perfect polarising facade as the government’s words and actions collide behind the scenes.

What’s Next?

Poland cannot be a microcosm of what is to come in other countries regarding reproductive rights. Women’s bodies must not be used as political pawns to gain face before the electorate only to have governments then work to limit all our choices about our bodies. Women’s lives are more important than short-term political gains. Keep a watchful eye out for what will be going on in your country in the coming months, and keep us posted.

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Merits I.V. BOLIVIA; August 15, 2014

Background

Findings

Informed Consent

Bashi Kumar Hazard

Read the full report here:

Download the letter and see the signatories here:

Daniela Drandić, M.Sc.

Daniela Drandić, M.Sc.

Why Perinatal Standards? Why Now?

Being Pregnant in Poland

Abandoning Care

What’s Next?

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