lunes, 3 de diciembre de 2007

Institutionalized Violence Against Women in Mexican Hospitals

As a volunteer for Nueve Lunas, a Oaxacan non-profit with a midwifery school for indigenous youth, I have had the unique opportunity to attend several of their midwifery training workshops. At a recent midwifery workshop, I was tasked with interpreting for an American Obstetrician who had just moved to Oaxaca and wanted to help with the workshop. As we broke for lunch he spoke with one of the non-profit directors, explaining that he had been volunteering as an obstetrician in a public hospital in Oaxaca. He said that the Mexican obstetrician with whom he had worked would often sterilize women during cesarean sections, performing tubal ligations without their knowledge or consent, and without advising them afterwards. “But he didn’t charge them,” said the American. The Mexican obstetrician rationalized that he was doing this for the woman’s own good, supposedly because she had already had so many babies, because she would have consented had her husband not been there to pressure her not to agree to sterilization. Despite the fact that the obstetrician had not talked to these women and knew nothing about them, the American doctor seemed swayed by the Mexican obstetrician’s logic. Hearing these stories made me feel ill, but not surprised. I began researching the human and reproductive rights violations that took place in hospitals, and they seemed ubiquitous. It became overwhelmingly clear that women’s human and reproductive rights are systematically violated in hospitals throughout the Mexico on a daily basis.

I found numerous reports of forced sterilization in Mexico, especially upon poor and indigenous women. For example, beginning in 1998 numerous Indigenous Mexican women receiving services at an Omaha, Nebraska clinic learned that they had been sterilized or had an Intra-Uterine Device (IUDs) inserted without their knowledge while living in Mexico. Another report I found documented 200 cases of forced sterilization of women in the state of Puebla, between 1994 and 2000. In Veracruz there have been documented cases of women deceived into getting sterilizations, told that they would die if they had another child, or that they would receive a free operation to prevent cervical cancer, neither of which was true. Even the US State Department’s Bureau of Democracy, Human Rights and Labor acknowledges that there have been numerous complaints of forced sterilization of women in Mexico. The actual number of women who have been sterilized is impossible to tell, as it is grossly underreported.

These accounts of human and reproductive rights abuses by medical professionals highlight the institutionalized violence against women by the medical establishment. Medical professionals create an atmosphere of disrespect during hospital births, which make more grave violations of human rights possible, if not likely. Much like in an abusive intimate relationship, doctors use different tactics in order to maintain power and control in the doctor/patient relationship: emotional abuse, blaming, withholding information, making women marginalized throughout the birth process, coercing women to have IUDs implanted or be sterilization. A recent study details the violations of reproductive and human rights during hospital births in Cuernavaca. The article suggests the most hospital births “fall along a continuum of mistreatment or abuse.”
During these hospital births in Cuernavaca, the laboring women did not play the central role in the birth; the doctor did. Doctors controlled everything about the birth, and women were acted upon, having little agency in their own birth. Women were passive participants in their own labors, their sole function was to cooperate and help the physician. Women could then be blamed for a difficult labor for not “cooperating” sufficiently. Laboring women were threatened directly and indirectly, told that if they did not obey the doctor, they would face “serious consequences.”

When women complained of pain, their suffering was invalidated and ignored, or they were blamed and reprimanded for crying out during labor, told to “control themselves.” Women who continued to cry out or who disregarded doctors’ orders were ignored until they submitted to orders or shut up. Doctors frequently made inappropriate comments, implying that the pain of childbirth was a consequence of women having enjoyed sex, making statements such as: “But you enjoyed it before, didn’t you,” and “You wanted to, now put up with it.” When a doctor was asked if he would give a woman an episiotomy, he replied, “Of, course: to all of them, as punishment.”

Doctors and hospital personnel believed they possessed total knowledge regarding childbirth; therefore a woman’s statements about her own experiences were discounted. During childbirth, women were often given the bare minimum of information about their own birth, increasing their fear, and giving doctors more power. They were systematically denied access to their own medical files.

Nearly 40% of babies born in hospitals in Mexico are born by caesarean, giving Mexico one of the highest cesarean rates in the world. A study about cesarean sections in Mexico City explored obstetricians’ attitudes and treatment towards patients during childbirth. The high rate of cesareans can be attributed to the many benefits that the doctors gain, and to how much power doctors have over the childbirth. Doctors gain complete control over a birth, save time, earn more money, and gain more practice with the cesarean surgery. As one doctor explains, “It’s more of an effort for a gynecologist to wait for normal birth, which takes more time and more effort. For my own professional security, I operate without waiting for complications.” The wide reliance on cesareans also underlies the fundamental view that women are not capable of giving birth without a doctor’s medical interventions.

This same study found that obstetricians and hospital staff often coerced and intimidated women to consent to having surgical sterilizations performed during a cesarean, or to have IUDs inserted immediately following birth. Performing these procedures immediately after birth is not recommended by international medical guidelines. The high rate of sterilization during cesareans may be due to the fact that women undergoing cesareans received more pressure to be sterilized, since they were already cut open. For this reason, forced sterilization often takes place immediately following a cesarean. In some cases, if women did not want to be sterilized, physicians made them sign a waver saying that they refused to be sterilized, against the advice of the physician. Sterilization becomes the norm and women who do not want to be sterilized must actively refuse the procedure in the haze following a cesarean.

The attitudes and abuses found in these studies are by no means unique to Cuernavaca and Mexico City. For example, a recent survey of Oaxacan women of childbearing age about their experiences in hospitals found that 20% of the women interviewed complained that they had experienced verbal and emotional abuse in the hospital and 5% complained that they had experienced physical violence from hospital staff. While these abuses do not seem unique to a particular area of Mexico, they do seem to be more common in areas where women are more marginalized, poor, have lower levels of education, are indigenous, or speak limited Spanish. The institutionalization of violence against women in hospitals is far-spread, and deeply ingrained in medical institutions, whish are highly depend upon gender hierarchy, and are proponents of medical modernization, promoting the idea that more interventions in birth is better. Government officials and doctors alike buy into the developmental model of modernization, which views Western, highly technological medicine as the ultimate goal for all births, and views indigenous midwives as dangerous and archaic. So long as medical institutions invalidate women’s experiences and view women’s bodies as incapable, these sorts of human and reproductive rights violations in hospitals will likely continue.

Works Cited

Castro, Arachu, Heimburger, Angela and Langer, Ana ”Mexico City Cesareans, Working Paper on Latin America, Published by the David Rockefeller Center for Latin American Studies, Harvard University, 2000.

Castro, Roberto and Erviti, Joaquina “Violations of Reproductive Rights during Hospital Births in Mexico” Health and Human Rights, Vol 7. No. 1 (2003)

Mexico- Country Reports on Human Rights Practices, Released by the Bureau of Democracy Human Rights, and Labor. Unites States State Department, February 23, 2000.

Diebel, Linda “Mexico’s Indians Target of Sterilization Sweep” Toronto Star, March 26, 2003.

Informe Red DeSER, Violaciones a Derechos Sexuales y Reproductivos, 2000. Oaxaca.

Davis-Floyd, Robbie. “La Partera Profesional” Medical Anthropology (Vol 20, Nos. 2/3-4) December 2001.

2 comentarios:

steetoa dijo...
Este comentario ha sido eliminado por el autor.
steetoa dijo...

It is amazing, disgusting, and so disconcerting! Thanks for taking the time to research this and spread the word - this year in Mexico sounds like a really eye-opening and unique experience