Human rights in the delivery room
Some years back, a medical student wrote a letter to the editor published in this newspaper in which she detailed her observations on the treatment of patients in a government-run maternity hospital.
The letter-writer lamented the way the residents, nurses and midwives dealt with the mothers: scolding them as they groaned and complained about their labor pains; berating them for too frequent visits to the hospital, attesting to their refusal (or inability) to space pregnancies; and sometimes even deliberately delaying treatment or inflicting pain as a form of “punishment,” especially if the staff believed the patient had resorted to an abortion.
Well, it seems the mistreatment of women at the hands of government (and perhaps even private) caregivers is not a phenomenon unique to the Philippines. In a policy brief prepared for the Population Reference Bureau (Karen Newman and Charlotte Feldman Jacobs, authors), media reports about abuses committed against mothers during labor and delivery were cited, along with accounts of how these media reports led to reforms and policy changes in the treatment of patients.
In Uganda and Malawi, for instance, complaints from the mothers spurred “actions by healthcare officials and policymakers.” Radio Buddu in Uganda gives women the chance to “voice their complaints and demand better reproductive health services.” During one show, the authors relate, “women complained that maternity nurses at the public hospital were verbally abusing and extorting money from them. Hospital officials responded and notices were posted throughout the hospital with phone numbers to call to report such abuses.”
In Malawi, a journalist published a special report and editorial on nurses’ abuse of pregnant women while the women were having their babies, leading to a meeting of the National Organization of Nurses and Midwives, while the Ministry of Health conducted its own investigations to identify the nurses responsible.
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I can’t recall how our own Department of Health responded to the medical student’s account, although I do remember hearing some government health personnel explain that staffs at public hospitals were overworked, underpaid and under pressure and may have been losing their tempers at the women when things became too much for them to bear.
My response to this was that poor women had little enough to see them through their ordeals of pregnancy and childbirth. And this is precisely the reason that hospital staffs should respect their dignity and human rights, as the women had little else to cling to in their moment of vulnerability.
I very much doubt if hospital staffs here would treat patients in private hospitals in the same way they relate with patients in charity wards or overcrowded government hospitals. The thinking is that poor patients are “charity” cases, who should accept whatever attention and treatment that hospital staffs deign to give them, no matter how fleeting, shoddy, or rude. But aren’t even charity patients citizens? Isn’t it a state obligation to meet a person’s “right to the highest attainable standard of health”? Certainly, being loudly berated, humiliated, made fun of, or shunned do not by any measure meet the “highest attainable standard of health.”
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In the same PRB paper, Lynn Freedman, in her article “Using Human Rights in Maternal Mortality Programs: From Analysis to Strategy,” is quoted as urging family planning clinic managers to regularly walk around their facilities “carrying nothing but their dignity as a human being.”
Says Freedman: “From their greeting by the receptionist, through their experience in the waiting room, interaction with clinic personnel, to their exit from the facility, by simply walking through their clinic, they may, for example, realize for the first time that they routinely make their clients walk through a crowded waiting room with a urine sample. This may seem as though it has no public health impact, but it is possible that it may make individual women feel so ashamed that they never return to the facility. If this results in an unplanned pregnancy, the public health consequences become more apparent.”
Seemingly inconsequential things like making a woman carry a urine sample for everyone to see can have a major public health impact. But is it possible that the reason so many pregnant mothers appear negligent in coming for their monthly checkups is not the expense or time requirement, as is commonly thought, but the women’s own fear and trepidation at the prospect of dealing with busy, hostile and condescending health center personnel?
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The connection between family planning (or reproductive health) and human rights was first made in response to fears about the use of state coercion in compelling women (and men) to avail themselves of family planning services and commodities.
It wasn’t until decades after population services were established in policy and practice that the human rights of individuals and couples availing themselves of family planning were highlighted. And with the acceptance of “reproductive health” as a broader term embracing a slew of health services and conditions having to do with human reproduction, so, too, was the idea that availability, accessibility, acceptability, and quality of services were cornerstones of the entire debate about reproductive health and rights.
The right to choose is fundamental in any dialogue about human rights, but so is the right to act on that choice, and to have one’s choice recognized and respected, enabled and protected.
