16 Days of Activism
The 16 Days of Activism against Gender-Based Violence runs from 25 November to 10 December annually. It begins each year on the International Day for the Elimination of Violence against Women, and runs until Human Rights Day. The aim is to call for the prevention and elimination of violence against women and girls.
“Not all disrespect towards women results in violence. But all violence against women starts with disrespectful behaviour”.
It’s such an important message for all working in maternity care, as they have an obligation to safeguard dignity as compassion and respect sit at the very heart of good care and preventing harm.
Maternity Services often forget the significance of maternity for women. As one woman told us:
‘This may just be another routine day at work for the doctor or midwife, but for me this is not just an ordinary day…this day has changed my life…turned it upside down…I don’t think they remember that’.
The care that a woman receives during maternity has the potential to affect her – both physically and emotionally, in the short and longer term – as well as the health of her baby.
Disrespectful maternity care represents a dimension of violence against women and remains a significant public health issue. Disrespect in maternity is part of continuum of violence that women experience across their life. Violence is so ingrained in our society, that it makes sense that it would then make its appearance in childbirth.
This mistreatment is a complex problem that is a form of sex-based discrimination. However, due to harmful gendered stereotypes about women’s bodies and their inferior status within society, this behaviour is often normalised and rendered invisible. In 2019, the United Nations (UN) Special Rapporteur on Violence against Women report on Obstetric Violence called Australia out as a particularly poor performer.
This abuse, can vary from verbal insults to a refusal of information, not being listened to and not being engaged in decisions, authoritarian behaviour, such as forced immobilisation, forced monitoring, an unwanted vaginal examination or episiotomy, or a refusal of pain relief – that is any act that forces the pregnant woman to undergo something against her will or which strips her of her dignity, including the problem of obstetric violence that arises in the context of over-medicalising birth & coercive control.
We need to remember that a woman is not a vessel for carrying a baby, she is a living human being with rights. Yet, treating the woman as an object – a vessel – enables the professionals to dissociate and tolerate acts of abuse, assault, and violence against women and direct the focus of care to the foetus and the woman becomes invisible. As one woman told us:
“It’s not just enough to get the baby out we need to consider how it impacts on the health and wellbeing of the mother both mentally and physically.”
But where does the responsibility for this lie? Ensuring dignity and compassion in care requires commitment at all levels. The truth is while everyone thinks they have a right to dictate a woman’s choices in pregnancy and birth, no one considers it their responsibility to pick up the pieces afterwards, particularly when even with the best of intention, things go wrong.
We, other community and consumer organisations, health experts and the United Nations have identified obstetric violence (obstetrics – relating to childbirth and the processes associated with it) as a public health epidemic that requires a co-ordinated prevention and response strategy, with focussed specialised responses required for women in diverse, indigenous, refugee and other cultural settings.
Far more importantly, prioritising prevention is an absolute moral imperative. If we do not protect women’s safety during maternity, we fail as a society.
Australian women start with many advantages, but these don’t continue once a woman become pregnant. Our society does not set mothers up to be equal. And this is a problem if we want mothers to be valued, successful, healthy and safe. The transition to motherhood appears to be a critical “tipping point” on the road to gender equality and therefore a crucial focus for policy-making at different levels to address the well-being of mothers.
Multiple actions are required and include:
With genuine political will, we can succeed. But without it, we are doomed. We require our leaders to be bold, brave and determined. This includes political will to direct finances to reliable evidence informed maternity care by redesigning the system and ensuring accountability through embedding Respectful Maternity Care in health service accreditation.
A comprehensive public health approach
We need strategically weighted approaches to all three dimensions of prevention: primary, secondary and tertiary. This includes early intervention and effective responses to the root causes of obstetric violence.
- Primary prevention
Strategies to prevent violence at the population level is the foundation and must be the priority. This includes steps to achieve structural gender equality, educate the public, enhance social norms, strengthen legal prohibitions and improve social determinants of health with sensitivity to culture.
- Secondary prevention
Structural, community and individual factors intersect to increase the risk of violence. We need adequate services for those most in need, targeted prevention and early intervention. Support is crucial for those with mental health needs, substance abuse and addiction, economic stress and intergenerational trauma. To achieve this will require workforce education and reform – for example midwife led maternity care.
- Tertiary prevention
Strategies to respond to violence and limit its adverse impacts are the apex of the public health pyramid. Appropriate protection of women is essential seeking maternity care. We must prioritise trauma-informed, culturally sensitive and least-intrusive interventions wherever possible.
Confront the gender problem
Overwhelmingly, violence is inflicted in patriarchal systems, with persistent shortcomings in professional’s knowledge and attitudes that facilitate violence.
To prevent violence long-term, we need educational programs, beginning in early childhood, to help develop cognitive knowledge (such as knowledge of women’s rights, gender bias, and sexual literacy), affective attitudes (towards equality, away from entitlement) and behavioural and psycho-social skills (like self-regulation, kindness and compassion).
Change social norms
Australia’s pervasive weakness is to allow violence in maternity to remain untouched. The recent history of maternity care is a study of disrespect, discrimination, bias, abuse and control. Violence against pregnant women is enabled when women’s rights are not sufficiently recognised. This happens when laws do not prohibit and prosecute serious offending, gender inequality persists, professionals emphasise dominance and control, and social determinants of health are unfavourable.
Data holds the key
Nationally, we lack reliable data on the prevalence of obstetric violence and care out comes. We need to rigorously measure the prevalence of obstetric violence and monitor its prevalence over time to see if it is declining.
Institutional leaders need to know and understand the factors influencing obstetric violence, the nature and effects of obstetric violence, and respond empathically.
We need leaders to question the status quo and implement maternity care services that focus on the needs of women not providers.
Governments can use their purchasing power to include this in all funding agreements.
Knowledge is power
Education is a cornerstone. We can educate all school aged children about consent, relationships and violence prevention. School-based sexual abuse prevention programs have been shown to improve children’s knowledge, their retention of that knowledge, self-protective behaviours, and disclosures. This knowledge will serve women well when receiving maternity care
Education of health professionals – in their initial studies, in workplace orientation and competency maintenance. Health professionals require and trauma-informed education about the nature and effects of violence and abuse.
Effective legal systems
A robust national public health law approach requires government to make our laws consistent, coherent and conceptually robust – for example, based on sound definitions of concepts like human rights, informed decision, consent, disrespect and abuse.
Thank you to Ben Mathews Professor, School of Law, Queensland University of Technology, for inspiring this article – https://theconversation.com/10-things-australia-can-do-to-prevent-violence-against-women-and-children-167277