Episode 01

Violence in the Labor Ward

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Too often, treating women with respect is seen as a luxury. It is not. Violations of human rights during childbirth are all too common in labor wards, hurting women’s chances of surviving pregnancy and childbirth. This episode of White Ribbon Alliance’s Brave Voices, Bold Actions podcast explores Article 1 of the Respectful Maternity Care Charter, and the human right to give birth free from harm and ill treatment – one component of the top request from the What Women Want campaign: respectful, dignified care.

We hear from Sabina Jankovičová, who bravely shares her birth story and the damage caused by the disrespectful treatment she received at the hands of her healthcare providers, and Kate Gilmore, former UN Deputy High Commissioner for Human Rights, who helps examine how violations of women’s rights in childbirth are part of the continuum of violence that women and girls experience throughout their lifetimes. Together, we have the power to destroy the structures that harm women during pregnancy and childbirth!

Topics

  • NHow are violations of women's rights in childbirth part of the continuum of violence that women and girls experience during their lifetime?
  • NWhat is the Respectful Maternity Care Charter?
  • NWhat can governments and individuals do to ensure all women and newborns receive the respectful, dignified care they need during childbirth?

Resources

Kate Gilmore (00:05): Law matters. It's not just about personal opinion. It's about right and wrong, what is lawful and what's not lawful.

Diana Copeland (00:15): Too often, treating women with respect is seen as a luxury. It is not. Respectful care and a life free from abuse is due to every woman and every health system around the world. On White Ribbon Alliance's Brave Voices, Bold Actions podcast, we'll be taking a close look, episode by episode, at the 10 basic rights women and newborns are due in childbirth. We'll use the Respectful Maternity Care Charter as our guide. Every episode, we'll dive into one of 10 articles, exploring what respectful care really looks like.

Diana Copeland (00:47): My name is Diana Copeland and I work with White Ribbon Alliance, a locally led, globally connected grassroots movement, advocating for the health and rights of women and newborns. White Ribbon Alliance's groundbreaking What Women Want campaign asked women worldwide what they want most for their reproductive and maternal health care. The number one request across 114 countries and from 1.2 million women was respectful and dignified care. In each episode of the Brave Voices, Bold Actions podcast, I'll be joined by White Ribbon Alliance colleagues from around the world, global human rights advocates and community leaders creating real change. Together, we'll show you how to advocate successfully for yourself and for others.

Diana Copeland (01:43): Sabina is a 43 year old art historian from Slovakia.

Sabina Jankovičová (01:49): You don't talk anymore because you are so ... your body is so full of pain. You can't talk anymore. You can't do anything.

Diana Copeland (01:57): She has two healthy children, but her experience giving birth was unfortunately immersed in violence.

Sabina Jankovičová (02:03): Every time I needed an obstetrician, I was a victim of violence.

Diana Copeland (02:09): During the birth of her first child, Sabina's doctors went against her wishes several times, including by subjecting her to an unwanted episiotomy, which is a surgical cut at the opening of the vagina used to create more space for the baby or to facilitate a quicker delivery. Sabina's forced botched episiotomy would go on to cause years of pain and complications.

Sabina Jankovičová (02:30): It's the worst feeling I ever felt, especially in the moment when the episiotomy was done, and I tried to say no, and my husband tried. This moment when I really saw he will harm my body, and he will destroy my health.

Diana Copeland (02:55): Throughout her stay, Sabina frequently had to ask for pain medication, which was doled out sparingly. During her first week in the hospital, the nurses took her child at night. Sabina says she saw a nurse act so roughly with her baby right in front of her.

Sabina Jankovičová (03:09): There was a really bad nurse there. She was [inaudible 00:03:14] against my child before my eyes. She was putting the bottle of formula with violence into his mouth and I was standing there, so I knew what she was doing at night when I wasn't there.

Diana Copeland (03:29): Sabina said she tried to act like a compliant prisoner.

Sabina Jankovičová (03:32): So I was playing nice, good woman, not complaining because I knew the child is in their hands. I tried to be a good patient. Good prisoner.

Diana Copeland (03:50): On today's episode, we're talking about article one of the Respectful Maternity Care Charter and the freedom from harm and ill treatment. Article one says that no one is allowed to physically hurt you or your newborn. You should receive compassionate care and help one in pain. Sabina did not. We'll explore what compassionate care means in real life in our interview with human rights leader, Kate Gilmore. After that, I'll chat with human rights lawyer and our resident expert on Respectful Maternity Care, Elena Ateva. We'll share her insights. We'll discuss what your rights are in childbirth and how to advocate for those rights.

Diana Copeland (04:28): Joining us on our discussion on the right to respectful care is Kate Gilmore, a true leader in the human rights field. Kate has served the United Nations at the most senior of levels, including as Deputy Executive Director for Programmes with the United Nations Population Fund and, more recently, as the UN Deputy High Commissioner for Human Rights. Kate helped to lead efforts to mainstream human rights across the UN development system, and acted as an Inter-Agency Standing Committee “champion for change” on sexual abuse and exploitation. She is currently a Fellow at the Carr Centre for Human Rights at the Harvard Kennedy School.

Diana Copeland (05:01): Welcome, Kate!

Kate Gilmore (05:03): Thank you.

Diana Copeland (05:04): It's wonderful to have you on the podcast.

Kate Gilmore (05:06): It's great to be here. Thanks so much, Diana, and congratulations on the initiative.

Diana Copeland (05:10): Thank you very much. We were very proud and excited about what we're going to be able to share about human rights and child or through this effort. So Kate, you have over 30 years of advocacy experience focused on human rights and women's rights. What led you down this career path?

Kate Gilmore (05:25): Well, I suppose I am now so old because it's almost difficult to recall any other option. That's the problem with 30 years of experience. Oh my god. What I know is that from my teen years, that burning sense of the inexplicably of race and gender discrimination set in really hard. Those things really fired me up as a young person. In a way I would say that throughout the many years since, I've tried hard not to lose touch with that 16, 17 year old and her outrage.

Diana Copeland (06:13): I'm so glad that you're still fired up because you have been able to do so much around the world, through your work with the UN and also beyond. That brings us really to the idea of this podcast and the foundation of human rights in childbirth. Why do you think there's such a disconnect when people talk about human rights and they talk about human rights and childbirth? It's not actually a conversation that many people are having. So I'd like to know why you think that is, and also what exactly human rights in childbirth means to you.

Kate Gilmore (06:42): I think that we've been slow to elaborate the full detail of what rights means for the lives of women particularly. We've absolutely failed to uphold rights in the broad area of sexual reproductive health, with specific consequences for women and access to health, dignity, and well-being in the course of when they're pregnant, how often they're pregnant, what happens while they're pregnant, the sort of care and treatment they receive in the course of their pregnancy, and specifically at the point of labor as well. So it's not as if the human rights framework is without direct relevance. It is, and it's not rocket science to say how it's directly relevant to the experience of a woman as she goes through pregnancy and childbirth. It's just that we haven't thought it important enough to treat it as a rightsful project, and a shame on us. Shame on us.

Diana Copeland (07:48): The most vulnerable and important time in a woman's life, and we're not giving it the due respect that it deserves.

Kate Gilmore (07:54): The amazing thing about it, of course, is we all come from pregnancy with very few exceptions. I'm trying to think what would be the exception. Not only do we all come from pregnancy, we all had, in one form or another, a mother who went through pregnancy in order that we come into our existence. Yet we have not seen fit to treat it with a robust respect that's worthy of all that it means and all that it represents and how precious indeed it is to each and every one of us and specifically to women.

Diana Copeland (08:37): No, and to further that idea, how are human rights in childbirth part of this continuum of violence that women experience across cultures, across the world? It is so ingrained in the way that we live this abuse of women that it make sense that it would then make its appearance as well in childbirth.

Kate Gilmore (08:56): Well, I think there are three main ways that, sadly, sexual reproductive health and well-being specifically in the course of childbearing, is contaminated by violence. I mean, first and gravely troubling is overt and explicit gender based violence directed at women who are pregnant. So the protection against domestic and sexual violence, against family violence, these things have been neglected. They're essential and they're even more needed than it seems research tells us when a woman is pregnant. The second problem I think is more subtle, but as hidden, and that is much of our language around women who are pregnant is in and of itself diminishing their rights to physical and mental integrity, which is a slippery slope, therefore, on the way to emotional and physical abuse.

Kate Gilmore (09:58): The most obvious example is the sense that somehow the woman becomes separated from her body. It's not uncommon for people to approach women who are pregnant in the street and imagine a right to start laying hands on the swelling of her pregnancy, even without her permission.

Diana Copeland (10:17): It's so normal.

Kate Gilmore (10:18): It's so normal. People imagine, they're well meaning, and they're appreciative of pregnant ... but the woman is deleted in the act of it. This business of treating the woman as if she's just an object is how we go about the business of somehow tolerating acts of abuse, assault, and violence against her. The third thing I'm deeply troubled by, and I think many of us have got examples of this. I worked for 10 years in an obstetric and gynecology hospital and bore witness to this, is the way in which the health care system is effected by those same norms. The ways in which orthodox medicine has managed to regard the woman merely as a fetus carrier. I mean, I myself have been in examination rooms where I've watched the doctor come in with a gaggle of students behind him and take his clipboard of medical records and rest it on the belly of the woman.

Diana Copeland (11:22): Oh my goodness.

Kate Gilmore (11:22): And then speak across the belly of the woman to the partner, usually the male partner who was with her, as if, and I repeat this, she's merely a container.

Diana Copeland (11:37): It's shocking to imagine, but you know it's happening every day.

Kate Gilmore (11:41): You know it's happening every day. That, again, is at the softer end. The yelling, the dismissing of pain, the failure to respond to complaints and anxieties with seriousness, the absence of information and presentation of information so that the woman has a sense of choice and can voice her preferences. The discrimination that women of ethnic minorities, that women with disabilities, that women with refugee status are subjected to. All these show their ugly heads in instances where the health system does other than a care for her health, but becomes part of the problem. And that's horrendous.

Diana Copeland (12:33): Also, one of the tools used to advocate for respectful women centered care is the Respectful Maternity Care Charter. Why is the charter important in changing the way we view women's rights during pregnancy and childbirth?

Kate Gilmore (12:45): The beautiful thing of the Respectful Maternity Care and its various articles is it saying very clearly to people, "Look, you can't say you didn't know. It's not as if there's any question of doubt or any ambiguity here. Here, said plainly and clearly, are the minimum standards that every woman is entitled to enjoy as she goes through the experience of being provided care and support." Each of the articles in the Respectful Maternity Care framework is grounded in law. As we were talking earlier, law matters. It's not just about personal opinion.

Kate Gilmore (13:33): It's about right and wrong, what is lawful and what's not lawful. If you take the convention against torture and apply it to the provision of medical care for a woman who's pregnant, of course you come up with article one of the Respectful Maternity Care, which has everyone has the right to be free from harm and ill treatment. That's not something snatched out of plain air. That is rooted in the convention against cruel, inhumane and degrading treatment and against torture. I think we have to call on all obstetricians, all gynecologists, all midwives, all health administrators, all healthcare workers to sign up to that as their basic operating code. It should be as important as hand washing is today in the context of the pandemic and sterilization of instruments is in a surgical theater. You cannot provide good care, quality care, legitimate care if you're not upholding the standards.

Diana Copeland (14:38): But also thinking about the COVID-19 crisis and trying to build a better world post the pandemic. If you had all the freedom in the world and you had all the power, what would you do to improve health and health care now for women and girls?

Kate Gilmore (14:54): I mean, to put it positively and simply, whilst the scientists are working how to figure out what a vaccination is, what the rest of us can do is dismantle the inequality that is the progenitor of the sort of flow of contamination, morbidity, and mortality that we've seen in these recent months. It cannot be acceptable and it's not at all acceptable in terms of assessing success of the response to the virus to have people of ethnic minorities falling sicker and dying at greater rates. It cannot be acceptable. It can't be success to have people with disability left without specific attention. But imagine if you said, "The greatest thing we could do now is solve inequality on the basis of race, on the basis of status, on the basis of gender, on the basis of disability, make that our project and build a world that treated people with equal regard and equal respect."

Diana Copeland (16:07): What do you think someone could do at home to actually create this better world that you're envisioning? What's a take home that they could do right now that can make their world and their community during childbirth, beyond, what can we do to try to build a stronger, more beautiful and more equal world?

Kate Gilmore (16:30): The idea of each of us doing something is enormously precious and there's probably nothing too mystical about it. We all have local members of parliament to write to, but further, I think we have a duty to own our own privilege where that privilege exists and to think deeply about what we would be willing to forgo and what we'd be willing to offer in order that a fundamentally different world could emerge, or at least that the dice would be rolled in favor of a fundamentally better world. I think there's some deep soul searching for us all to do around consumption, around travel, around use of vehicles, around our expectations of purchase and commodification and so on that we all need to be doing relative to our degrees of privilege so that we are minded to support policymakers who really want to build a world less unequal, more just, more sustainable, and make sure that we're on the side of enabling and supporting that rather than resisting it.

Diana Copeland (17:46): You were basically this incredible light and positive in the world, doing everything you can to make it better, but I'd really like to know how do you personally stay so positive and committed in a world which feels so unequal and sometimes so unchanging?

Kate Gilmore (18:04): Well, I don't recognize myself in your beautiful words, but gosh, I treasure them. What I want to say is that I have been in a deep struggle myself to find what I would call courage to be unrelenting. What I want to hear and what I want to be committed to myself is courage. The courage to have less, the courage to be inconvenienced in order that somebody else's dignity is ratcheted up slowly, surely, closer to where it should be. The courage to shut up and let other people take center stage and the courage to risk all sorts of costs and claim to one's profession and standing in order to keep saying what needs to be said.

Kate Gilmore (19:01): So my own view is the question is not how do I remain hopeful? How do I stay courageous, or how do I become courageous?

Diana Copeland (19:10): I love that. How can I be courageous? I want to thank you, Kate, for joining us and showing us how. It was a real honor.

Kate Gilmore (19:18): Thank you for the privilege. More power to you. Thanks so much and bless White Ribbon Alliance for fantastic leadership.

Diana Copeland (19:24): Thank you, Kate. Thanks so much.

Kate Gilmore (19:25): Really inspiring.

Diana Copeland (19:26): I'm going to be introducing my friend and colleague Elena Ateva, who is a human rights lawyer, as well as the convener of the Respectful Maternity Care Council. Welcome, Elena.

Elena Ateva (19:41): Hello, Diana.

Diana Copeland (19:42): Hi.

Elena Ateva (19:42): Thanks for having me.

Diana Copeland (19:44): It's wonderful to have you on. It's also wonderful to have your expertise on Respectful Maternity Care, as well as human rights. Can you tell us a little bit about why human rights matter in childbirth?

Elena Ateva (19:53): It is really important to focus on a moment when a person might feel vulnerable, where they need somebody else to stand up for them because they are focused on what is essentially very hard work. Labor is very, very hard work. It's really critical to make sure human rights are not just protected, so not infringed upon, but they're respected and they're upheld to the fullest extent that they can.

Diana Copeland (20:26): Why exactly do these abuses happen and how come they're so widespread and universal?

Elena Ateva (20:32): It has to do with how we view women in society in general terms, but especially when they become pregnant. So if we don't value women, if we don't respect them, but there's something else when a woman becomes pregnant and we see that around the world where women's bodies are appropriated by the state and viewed as state property. This is especially true in childbirth. The instances where you have somebody else thinking that they know better, and they have the best interest of the child and not the woman that's carrying that child. That is really the crux of the problem, so to say.

Diana Copeland (21:12): Well, let's talk about article one. Everyone has the right to freedom from harm and ill treatment.

Elena Ateva (21:16): Absolutely. This is such a fundamental human right. If you look at the universal declaration for human rights, if you look at other human rights instruments, this is usually the first thing that you will see. You have the right to be free from harm, to not be harmed, and you have to the right to not be abused. This is really universal. What that means in childbirth is that nobody can physically hurt you, or your newborn baby, and you should really be taken care of in a gentle, compassionate way so that you can receive assistance for what could be a painful or unpleasant experience. So you have the right to be treated in that way and not to be harmed. Even the fact that we have to articulate it is really sad.

Diana Copeland (22:14): If you are abused, how likely are you to even return or tell anyone you know to return and get the care that they would need?

Elena Ateva (22:21): Exactly. Exactly. This is absolutely critical because we know that birth assisted by skilled birth attendant increases your chance to survive childbirth and for your newborn to be born healthy. At the same time, if this is also the place where you're being slapped or pinched or hit, how likely is it that you'll go back? When you think about normal circumstances and people being abused-

Diana Copeland (22:54): You're returning to the abuser.

Elena Ateva (22:55): Exactly, returning to your abuser. They also are less likely to take their children then for subsequent appointments. Because again, this is a place that they will connect with a very bad experience. So that puts the rights and the health of the newborns and the children at risk.

Diana Copeland (23:15): I think as we're also talking about human rights in general, this podcast, we'll be going through the 10 articles that are numerated in the Respectful Maternity Care Charter. I'd really like to know from you why those 10 were chosen.

Elena Ateva (23:28): It's really important that the charter rests on universal human rights principles that have been adopted by countries around the world. We point to specific conventions that countries have already signed on to so need to respect those rights. These are not new rights that we're introducing. We have just explained how they apply it to maternity care in particular, because of course they apply to every person everywhere. These 10 were the ones that we felt are universal. There were stories on violations coming from almost every country around the world, referring to most of those rights. Although human rights are very often seen as a theoretical framework, this is really a practical approach. This charter is a way to explain in simple terms, both to women and families and to their healthcare providers, the rights at stake in maternity care and give examples of how those can be upheld and also how those should not be violated.

Diana Copeland (24:49): The Respectful Maternity Care Charter is also not that old. Why do you think it took so long for this idea of human rights in childbirth to come not only to our consciousness, but to the wider, greater world?

Elena Ateva (25:01): I'm not sure. That's a very pertinent question to ask because everybody we've spoken with and even generations past, our mothers, our grandmothers, they would say this actually happened to me. I think it was so normalized at some point that people didn't regard it as violation. Providers didn't regard it and still some of them don't regard things as violations. So it is quite telling that it had to come to that to actually articulate a charter of sorts to protect what should be essential fundamental human rights.

Diana Copeland (25:47): What can people do at home to ensure that human rights are respected in their own communities, in their own households and in their own countries?

Elena Ateva (25:58): I think the most important thing a person, an individual can do is to start and challenge that narrative, the normalization of disrespect and abuse in maternity care. You can start anywhere. You can start at home with your relatives. When you hear stories of childbirth that don't sound okay, you need to say so. You need to do that with your friends also who might be giving birth, with your neighbors, with your relatives. As Eleanor Roosevelt famously once said, "Human rights begin in small places, close to home. They're so close and so small that they cannot be seen on any maps of the world." Yet they're the world of the individual person. Unless this rights have meaning there, they don't really have meaning anywhere. So we rely on all of you to stand up for human rights and to challenge the normalization of disrespect and abuse in maternity care.

Diana Copeland (27:03): That's wonderful, and also the entire podcast, every episode, we'll be giving hands on tips for the listeners at home to turn Respectful Maternity Care into action. Thanks so much, Elena.

Elena Ateva (27:16): Thank you, Diana. I thank you for having

Diana Copeland (27:21): White Ribbon Alliance's What Women What campaign is the largest ever survey into women's and girl's opinions of their health needs. It was also an inquiry into values, into how women and girls value themselves, how they're valued by others and how we value the evidence supplied by their voices. The top request for respectful and dignified care shows us that women are demanding respect and dignity. Realizing what women want and a life free of harm during childbirth requires action from governments, health providers, women, girls, and their families and neighbors.

Diana Copeland (27:55): Women's and girl's agenda must become everyone's agenda. You can download the What Women Want action agenda from our website and take action within your community today. Special thank you to Kate Gilmore for joining us and to Sabina Jankovičová for sharing her story. This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Nina Garcia Wright, Kendra Hanna, with support from the entire White Ribbon Alliance team.

Diana Copeland (28:25): Our theme song is called "Mama" by Eric Wainaina and can be found on White Ribbon Alliance’s Advocacy in Audio. Learn more about the Respectful Maternity Care Charter, the What Women Want Action Agenda and find links to more resources at WhiteRibbonAlliance.org/bravevoicespodcast.

Episode Team

This episode produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Nina Garcia Wright, Kendra Hanna, with support from the entire WRA team. Special thanks to Zuzana Krišková from Ženské kruhy, Slovakia.

HOST

Diana Copeland

Senior Communications Officer

Diana Copeland joined White Ribbon Alliance in 2016 as the Communication Coordinator, working to strengthen and disseminate the organization’s message on its website and social media platforms, and was promoted in 2018 to Senior Communications Officer in order to oversee and grow White Ribbon Alliance’s digital and offline presence.

GUEST

Kate Gilmore

Fellow at the Carr Centre for Human Rights at the Harvard Kennedy School

Kate Gilmore has served the United Nations at the most senior of levels, including as Deputy Executive Director for Programmes with the United Nations Population Fund and, more recently, as the UN Deputy High Commissioner for Human Rights. Kate helped to lead efforts to mainstream human rights across the UN development system, and acted as an Inter-Agency Standing Committee “Champion for Change” on sexual abuse and exploitation.  She is currently a Fellow at the Carr Centre for Human Rights at the Harvard Kennedy School. Follow Kate on Twitter at @gilmoreksure.

CONTRIBUTOR

Elena Ateva

Advocacy Manager

Elena Ateva is the Advocacy Manager at White Ribbon Alliance and the Maternal Health lead for the USAID/Health Policy Plus Project. She is responsible for facilitating the work of the Global Respectful Maternity Care Council, leading global advocacy efforts to strengthen the midwifery workforce and providing assistance to WRA National Alliances that campaign to improve reproductive, maternal and newborn health and rights. Elena is an attorney and a human rights advocate who has been involved in the movement for respectful care in her home country, Bulgaria, and throughout Eastern Europe. Prior to joining WRA, Ateva was the Eastern Europe Legal Advocacy Coordinator for the international non-profit Human Rights in Childbirth and later served on the board of the organization. Her work has also focused on prevention of other forms of violence against women, including domestic violence and trafficking in Bulgaria and the United States.

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