COVID-19: Escalating the Threat to Autonomy and Rights during Childbirth

In ‘Human Rights and Gender Stereotypes in Childbirth’ I focus on how harmful gender stereotypes and related power dynamics in the health system, particularly between provider and patient, play a role in fostering human rights abuses during childbirth. While the contributions in the book were written prior to Covid-19 and the recent Black Lives Matter protests, it raises many issues that are reflected and indeed are exacerbated by the pandemic and by the systemic racism and other forms of discrimination prevalent in our health systems and in our societies. This blog attempts to weave these concerns into the discussion.

The Covid-19 pandemic and the health crisis it ignited has exposed the breadth and depth of the nature of the challenges and abuses pregnant people face. As with all crises, the persons who are impacted the most are those that are already marginalised or in situations of vulnerability. Pregnant persons are no exception. In fact, their experiences are made worse because the already existing hierarchies between providers who hold medical knowledge and patients who are dependent on the health system to obtain information and care are further entrenched and compounded due to the pandemic. Ranging from excluding partners of choice from the birthing room to the disproportionate negative impact that Covid-19 and responses thereto have had on racial and ethnic minorities, persons living in poverty, persons with disabilities, and LGBTQ persons. The interrelationship between the racial justice movement and Covid-19 further highlights these tensions, where racial and ethnic minorities, whether health workers or birthing persons, are rendered more vulnerable to the virus or to the negative impact of its responses.

Covid 19 should be a wake-up call. Current circumstances demand deep reflection on whether health systems are serving the public, especially in relation to those who are reliant on the health system, including pregnant people. As noted in my chapter, power structures that favour provider control and passive roles for pregnant people must be challenged. This is not to argue that medicine and doctors should play no role in childbirth. Nevertheless, the patriarchal approach that views women as objects of care must be revised to one in which women’s agency is THE model of quality care. Assumptions and stereotypes that frame women as having no knowledge of their own bodies, desires and needs, have long disempowered women and other marginalised groups. They must be interrogated and dismantled because they strip people of their autonomy and decision-making agency and violate their human rights. Recognition of the diversity of women and other pregnant people and the universality of human rights in the context of diverse needs and desires must be central to any reform for this shift to truly make a difference in people’s lives.

The inherent discrimination in childbirth practices, as well as the intersectional nature of the discrimination that many pregnant persons face, is an ongoing challenge and is reflected in a case taken by the Center for Reproductive Rights, pending before the Inter-American Commission on Human Rights. Eulogia, an indigenous Quechua-speaking woman from Peru, was physically forced from a traditional squatting birthing position onto a hospital bed while giving birth to her son, Sergio. Despite her protests and request for support, she was forcibly hoisted to the bed as Sergio emerged, and he ‘violently crash[ed] into the cement floor, hitting his head and cutting the umbilical cord’ rendering him unconscious. Due to this traumatic brain injury at birth, Sergio lived with severe disabilities, and which ultimately led to his death at the age of 10.

Furthermore, Eulogia’s case illustrates how ‘medical necessity’ is used to override the informed choice of patients and is used to justify direct contravention of their express wishes. As noted in my chapter, during this vulnerable time, women are perceived to be unable to make rational decisions and untrustworthy, reinforcing a prevailing stereotype in reproductive health care contexts that women are incapable of exercising agency and in need of being controlled by medical authority.

Covid-19 has exposed these long-standing issues and has demonstrated their devastating consequences. This pandemic has underlined the need to further interrogate and dismantle harmful discriminatory stereotypes and the power structures within our economic, legal, and health systems which have oppressed women’s agency and autonomy. It has brought the potential for significant changes in our health systems; how change is affected will depend on the degree to which we design systems which are more participatory and inclusive of the experiences and needs of women in all our diversity and in all our circumstances.

Read more from Women’s Birthing Bodies and the Law: Unauthorised Intimate Examinations, Power and Vulnerability