Motherhood in Chains: Detention and Other Violations of Liberty
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 7 of the Respectful Maternity Care Charter, and the human right to liberty, autonomy, self-determination & freedom from arbitrary detention during pregnancy and childbirth.
We start with the story of Marie who was detained in a rural Haitian health center for two months after giving birth. Then we chat with Kay Sandberg and Amanda Coslor from the Global Force for Healing and the Compassionate Birth Network about what needs to be done to ensure every mother, everywhere, receives quality, equitable healthcare during pregnancy and childbirth – no matter what.
Together, we have the power to destroy the structures that harm women during pregnancy and childbirth!
- Why does the right to liberty & freedom from arbitrary detention matter for women’s health?
- What happens when the human right to freedom from arbitrary detention during pregnancy, childbirth, and after is abused?
- Why is childbirth & maternal & infant care often excluded in funders’ agendas for women’s human rights?
- How can the Respectful Maternity Care Charter save the lives of women across the world?
What Women Want Action Agenda | What Women Want | Respectful Maternity Care Charter endorsement | When Hospitals Become Prisons: Marie’s Story | Read Funding Equity: Birth Justice and Human Rights in Maternal and Infant Health | Learn more about the Global Problem of Hospital Detention Practices | Learn more about MamaBaby Haiti | Read Kay Sandberg’s “Funding Equity: Learning from the Global Grassroots to Save Mothers & Newborns” blog | Support the Global Force for Healing’s COVID-19 Rapid Response Fund
Diana Copeland (00:05): 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. No matter what. Not only is respectful care a right, it is also vitally important to improving women's chances of surviving pregnancy and childbirth. On White Ribbon Alliance's Brave Voices, Bold Actions podcast, we're taking a close look episode by episode at the 10 basic rights women and newborns are due in childbirth.
Diana Copeland (00:41): We're using the respectful maternity care charter as our guide. Every episode, we'll dive into each one of the 10 articles exploring what respectful care really looks like.
Diana Copeland (00:51): 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. 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.
Diana Copeland (01:15): Together, we'll show you how to advocate successfully for yourself and for others wherever you are. Today, we are examining Article Seven of the Respectful Maternity Care Charter and the right to liberty, autonomy, self-determination, and freedom from arbitrary detention, with special guests, Amanda Coslor and Kay Sandberg from the Global Force For Healing, as well as chatting with human rights lawyer and our resident expert on respectful care, Elena Ateva.
Diana Copeland (01:47): But first what happens when the human rights of freedom from arbitrary detention during pregnancy, childbirth and after is abused? To protect her privacy, we're going to call this young woman who had an incredibly traumatic birth experience in rural Haiti, Marie. After her first baby tragically passed away, Marie was kept in the hospital against her will.
Marie (02:12): [Speaking in Creole 00:02:17].
Marie (02:16): My husband tried to get me out of the hospital, but they wouldn't let me leave until we paid the bill. He called some of his friends in order to get help, but it was for nothing. The leaders of the hospital asked me for much money and my husband couldn't find anything. I couldn't go home and see my family. I had to sit and talk to my family through the window.
Diana Copeland (02:44): Marie would have to rely on her family every day to bring her food or else she would go hungry.
Marie (02:52): [Speaking in Creole 00:00:02:53].
Marie (02:52): I used to sleep on the ground. So cold. Then I cried so much that the members from the hospital locked me inside a room and wouldn't let me out or I would be arrested by the security guard.
Diana Copeland (03:09): After two months, she was finally freed. Thankfully, the organization, MamaBaby Haiti learned where Marie was and paid her remaining bills. However, this should never have happened in the first place. No one should have to fear imprisonment while giving birth. This practice is sadly too common in Haiti, but it's also widespread throughout much of the world. A study of one rural health facility in the Democratic Republic Of Congo showed that more than half of mothers who had given birth were detained for at least a day, while another recent study found that hospital detainment reports could be found in 46 countries across Africa, Asia, South America, Europe, and North America. And recently a whistleblower complaint was filed alleging mass hysterectomies being performed on refugee and immigrant women detained in an Immigration and Customs Enforcement detention center in the US state of Georgia.
Diana Copeland (04:04): Clear and abhorrent violations of these women's human rights that is sadly part of a long history of forced sterilization of women of color in the United States. Forced and coerced sterilization has happened all over the world - against minority religious and ethnic populations, women with disabilities - basically anyone who the state has decided should not reproduce. Article Seven of the Respectful Maternity Care Charter says that everyone has the right to liberty, autonomy, self-determination, and freedom from arbitrary detention. How can we make sure that other women and their newborns are not treated in the same disrespectful way?
Diana Copeland (04:46): Joining us in our discussion on the human right to autonomy and self-determination are Kay Sandberg and Amanda Coslor from the Global Force For Healing. Kay is the founder and director of Global Force For Healing and convenes The Compassionate Birth Network, collaborating with marginalized grassroots communities in Africa, Asia, and the Americas. She helped midwife and coauthored Funding Equity, Birth Justice and Human Rights in Maternal and Infant Health alongside Global Force For Healing board member, Amanda Coslor.
Diana Copeland (05:17): Amanda is a home birth midwife, a donor and donor organizer for Birth Justice work, both in the US and globally. She also serves on the board for The Groundswell Fund and Global Force For Healing. Welcome Kay and Amanda.
Kay Sandberg (05:30): Thank you.
Diana Copeland (05:31): It's great to have you both on. So Kay, as the founder and director of The Global Force For Healing, you have truly dedicated your life to helping women and girls around the world. So what exactly does The Global Force For Healing do?
Kay Sandberg (05:44): So The Global Force For Healing is primarily focused now on The Compassionate Birth Network, which is an autonomous group of community led programs that are all centered on midwifery model of care for those that actually have birth centers, midwifery centers and for those that are sexual reproductive health and rights focused, that again, center the empowerment of women and girls. So we mobilize resources of all kinds for affordable, respectful and accessible care, which in the underserved areas where we work around the world in now 11 countries and 16 partners, access to care that's affordable and respectful, it is sometimes really hard to come by.
Kay Sandberg (06:41): So capacity building, technical assistance, whatever each individual partner program needs to be sustainable and thrive.
Diana Copeland (06:51): Amanda, can you let us know what led you to midwifery and birth work?
Amanda Coslor (06:55): So what drew me to home birth midwifery just as my education path is that I really value relationships based on trust. So I look back and I'm deeply shaped by my home birth midwifery education. That trust is really centered in the midwifery model of care. That trust as a midwife is the same strategy I apply to the relationships with grassroots groups. When I started midwifery, I was going to national conferences and hearing from midwives of color and hearing about the amazing care they were giving to their community and having really positive impacts in the maternal infant health disparities.
Amanda Coslor (07:54): From that those talks with midwives and being in relationship with them, Birth Justice Fund grew out of that. I was the seed funder to that.
Diana Copeland (08:08): What kind of global trends have you been seeing lately in terms of global funding?
Kay Sandberg (08:14): Well, the funding has gone down in the last 10 years. I think there was a perception in about the early 2010 to 2015 that maternal health and birth had been solved. That this was not an issue anymore. It turns out that's actually not the case. Also we need to work harder as a field I think to measure. It's hard to measure funding trends when there's no common definition, for example, of what maternal health is or often it's subsumed under women's health. So it's been very hard to tease out exact numbers.
Diana Copeland (08:56): That's so interesting. So there's no official definition for mental health within the global funding fields?
Kay Sandberg (09:03): No, no. The strategies also are all over the board.
Diana Copeland (09:10): When we talk about quality care that women should be receiving, it seems like funders have an extremely strong influence on how these outcomes are going to play out, but they don't seem to actually value the idea of including childbirth and maternal health within their agendas. Is there a reason for that and what do you think that is?
Amanda Coslor (09:36): Yeah. So in the donor organizing spaces that I've been involved in, they have really focused more on reproductive rights, keeping abortion front and center in the fight for reproductive rights. It hasn't included maternal health or midwifery model of care options. I think because I've been involved in organizing donors since 2011, and I think there's been a lot of misconceptions and there's tensions in the field of funding reproductive rights, partly birth is medicalized.
Amanda Coslor (10:16): The medical system is there to solve the issues of maternal and infant health disparities. Yes that's true, but it really leaves out the quality respectful care. I think that funders and donors want to fund that, but there is a real lack of education because once funders and donors hear about the work, they want to fund it, but it just seems to be that it's been marginalized, partly because the fight for reproductive rights. It's so under attack. It does need to continue to be funded and birth options need to be funded with that. What if we actually brought them together and integrated them? Where would we be in the reproductive rights fight? I wonder if we'd be a lot further along.
Diana Copeland (11:04): As we heard from Marie, we know women are unlawfully detained if they can't pay their hospital bills, but what are some other ways that abuses of a woman's right to liberty, autonomy, self-determination, and freedom from arbitrary detention can manifest?
Kay Sandberg (11:19): You know, sometimes it's much more subtle than that. It could be coercion about birth position, denying women food and water, even if they request it during labor, even if it's a very long protracted labor. One of our midwives in southern Mexico unfortunately lost a baby and in the process, she also was given a hysterectomy without her knowledge let alone permission.
Kay Sandberg (11:54): So it happens all over the place, even to people like midwives that really are not being protected by healthcare systems that are not serving them. Arbitrary detention is a default practice if you will, in many public hospitals in places like Uganda, Indonesia, Haiti, where if a family cannot pay the bill and this could be an emergency C-section, that would cost, if the family had the money to begin with an entire year's wages, then the mother and/or the baby, if the baby lived would be held at the hospital and food, water, everything completely at the expense of the families during this time.
Kay Sandberg (12:47): I'll give you an example. One case in the Amazon. We were there just in case a woman, an indigenous woman ended up having to have a C-section and just in case there were issues and indeed they were threatening to detain her until her bill was paid. Well, it turned out that there was a government rule that said that they had to actually provide subsidized care that they didn't tell us about until one of our advocates who knew that law said, "Wait a minute, first of all, you have to release her from a human rights point of view. Secondly, we have paid more than what she is designated to pay." Those are just some examples. I mean, they really are all over the place. I could tell you some from Indonesia, from Uganda, et cetera.
Diana Copeland (13:42): So it's a really global abuse that's happening.
Kay Sandberg (13:47): It's global. Yes.
Diana Copeland (13:47): So what can funders and advocates do about these kinds of giant societal structures that are causing these types of abuses if it's truly so global?
Kay Sandberg (13:56): Right. Well, I think first, we all have to keep educating ourselves and the general public. Look what a big difference I think finally, maybe with the Black Lives Matter Movement in the United States that the disparities, glaring disparities in access to care and the very unfortunate outcomes that come with that.
Kay Sandberg (14:19): It's the same thing in the global environment. So I think education is a big part of it. Again, that's why we put so much time and effort into funding equity, which covers both US and global examples of both disparities in access to quality care and respectful care, but also some solutions, especially solutions aimed at the donors.
Amanda Coslor (14:43): I think with Global Force For Healing and The Compassionate Birth Network, Kay down to the groups themselves bring in human rights perspective. Capacity building always has human rights at the foundation of the work.
Diana Copeland (15:03): I also would like to talk about Funding Equity - Funding Equity, Birth Justice and Human Rights in Maternal and Infant Health. It's this absolutely fantastic anthology of position papers on the critical role of funders in promoting women's rights in childbirth. You're behind that. Let's talk about it. What does funding equity tell us?
Kay Sandberg (15:23): Well, I think some of the points that we've already talked about, that basically funders play a critical role. That's our basic purpose for doing it is we believe that funders play a critical role in promoting birth justice, both in the US and worldwide. It's getting lots of positive examples of the innovation, the resilience, some of the really creative ways that folks at the grassroots are using to better their own societies, almost despite lack of funding and other resources.
Diana Copeland (16:04): What action do you want people to take after reading Funding Equity?
Kay Sandberg (16:08): So I would say besides the self-education and raising our own awareness and that's sort of an endless lifelong commitment that we're privileged to do, I would say looking at our own privilege and rather than getting analysis paralysis, rather than that stopping somebody from acting actually motivating somebody to get involved in human rights related endeavors, whether it be Global Respectful Maternal Care Council or again, influencing other funders.
Kay Sandberg (16:43): I think that's huge. I think we'll be seeing more of that. Listening. We talked about listening, the importance of letting those who are closest to the issues tell us what they need and also showcase them, bring their voices to the table and showcase their brilliance.
Diana Copeland (17:02): If you could do anything right now to improve health and healthcare for women and girls, what would you do so that we could listen to this brilliance?
Amanda Coslor (17:10): I think that my dream of dreams would be funding grassroots led solutions to scale in this country, but also globally. If we could just really center parents and their rights, infant maternal rights at those grassroots solutions and fund them at the same level we fund other parts of our healthcare system. I really just feel like that'd be a game changer right there.
Kay Sandberg (17:46): If I could do anything I would say is to educate more girls and also to protect them from sexual predation. Whatever it takes.
Diana Copeland (17:59): That's excellent. Listeners can find links to support The Global Force For Healing's COVID-19 Rapid Response Fund, as well as Funding Equity, Birth Justice and Human Rights in Maternal and Infant Health in this episode's show notes. I also want to say, thank you Amanda and Kay. It's been absolutely incredible to be able to talk to you about human rights and childbirth, and to learn more about the work that you're doing.
Kay Sandberg (18:20): You're welcome.
Diana Copeland (18:24): Now we turn to Elena Ateva, a human rights lawyer and the convener of The Respectful Maternity Care Council to learn more about the human rights to liberty, autonomy, self-determination and freedom from arbitrary detention during pregnancy and childbirth. Welcome Elena.
Elena Ateva (18:40): Hi, Diana. Great to be with you.
Diana Copeland (18:43): It's wonderful to have you here and also to talk about the right to liberty, autonomy, self determination, and freedom from arbitrary detention. Can you tell us a little bit more about this right?
Elena Ateva (18:52): Yes. So this is really a compound right. It's packed with individual rights. So we can't really talk about just one right here, but this article includes several different rights. I'd like to explain them in more detail. I'll start first with the right to liberty and freedom from arbitrary detention. These are really fundamental human rights. Your liberty cannot be taken away except in circumstances that are clearly defined by law and after a legal process is observed.
Elena Ateva (19:24): Arbitrary detention or arrest for example, when somebody decides they don't like you for what you have done are unlawful. The law needs to specify the circumstances in which a person can be arrested or detained. Normally that doesn't include nonpayment of hospital fees. Yet this is a very, very common occurrence affecting especially women after childbirth and their newborn babies. There are many examples from countries from around the world.
Elena Ateva (19:55): So we can't really say this is an isolated phenomenon or the exception. It's rather a standard practice. What is really causing for that brave human rights violation to be so pervasive. I honestly don't believe that there are doctors or nurses who entered the profession thinking that they'll have to serve as jail wardens. One theory is that this is born out of desperation. When the healthcare system is not addressing pervasive problems, like lack of universal health coverage and when there's consistent underfunding of the system, doctors, nurses, administrators turn to the weakest link in the system and that's the woman and her family, and then detain the woman or the newborn so they can get paid for their services.
Elena Ateva (20:40): This is how professionals might justify this practice, but there's absolutely no justification for violating somebody's right to freedom. But if we want to address the problem, we need to understand and we need to look for the root causes. We need to understand why does this is so. We also need to unite together to address them.
Elena Ateva (21:00): It's not up to an individual woman or an individual provider to fix the system of care, but they do need to raise their voices. They need to speak up and say what is happening. I would like next to address the right to self-determination. This is an integral right to the realization of indigenous people's rights. Childbirth, we shouldn't forget is a social event and should be respected in its entirety.
Elena Ateva (21:29): For indigenous people, childbirth and its connection to the people and the lands they're inhabiting are very important. For indigenous people, colonialism and birthing practices that were forced on them have severely interfered with the transfer of knowledge and experience between generations and that interrupted an important practice of self-determination. That's true around the world.
Diana Copeland (21:53): So I'd like to know what can the average person do about this if you find yourself detained, you're given birth, you do not have the money to pay. What can you expect to do?
Elena Ateva (22:04): This is so much bigger than what an individual organization or individual intervention could fix. Because I'm sick of people going, especially Western organizations or others going into another country, doing one interventions like introducing curtains or introducing companion and basically saying, "Okay, we did something." No, it's not. You didn't. Sometimes maybe it might be worse actually if you didn't take into account those structural issues, you didn't take into account the history, the local knowledge and practices and if you didn't really take the time to understand the root cause of the problem, you might be masking it.
Elena Ateva (22:49): You're not really resolving it. You're masking it. If you or your newborn baby have been detained, you need to find help. This is your first priority. Maybe there are local community groups that come together to raise funds for your release or your baby's release.
Elena Ateva (23:05): There might be also local attorneys, local advocates, certainly the media, either locally or at the national level in your country who might be interested in supporting you in your fight to access recourse for these violations. If you're a provider and you're put in a position to detain women and newborns, you need to find support as well. You need to reach out to local advocacy groups and join hands with them in advocating for freedom for women and newborns and for respectful working conditions for yourself and other providers and find groups that you can support, indigenous women's groups that you can support because they're the ones who are working so hard to uphold those rights.
Diana Copeland (23:48): Thanks so much, Elena.
Elena Ateva (23:50): Thank you, Diana.
Diana Copeland (23:54): Special thanks to Kay Sandberg, Amanda Coslor, and Carmelle Moise from MamaBaby Haiti for helping Marie share her story with us. This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Marissa Ware, Nina Garcia Wright, Kendra Hanna with support from MamaBaby Haiti, The Global Force For Healing and the entire White Ribbon Alliance team.
Diana Copeland (24:20): 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 and find links to more resources, including information on MamaBaby Haiti and The Global Force For Healing at whiteribbonalliance.org/bravevoicespodcast.
This transcript was exported on Sep 21, 2020 - view latest version here.
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Episode Team: This episode of Brave Voices, Bold Actions was produced by Diana Copeland, Elena Ateva, Stephanie Bowen, Marissa Ware, Nina Garcia Wright, Kendra Hanna, with support from MamaBaby Haiti, the Global Force for Healing, and the entire White Ribbon Alliance team. Special thanks to Carmelle Moise from MamaBaby Haiti for helping Marie share her story with us.
Senior Communications Officer
Founder and Director of Global Force for Healing
Kay Sandberg is the Founder and Director of Global Force for Healing and convenes the Compassionate Birth Network, collaborating with marginalized grassroots communities in Africa, Asia, and the Americas. She helped midwife and co-authored “Funding Equity: Birth Justice and Human Rights in Maternal Health” alongside Global Force for Healing Board member Amanda Coslor. Follow Kay and the Global Force for Healing on Facebook.
Amanda Coslor is a home birth midwife, a donor, and donor organizer for birth justice work both in the US and globally. She serves on the board for The Groundswell Fund and Global Force for Healing and is the co-author of “Funding Equity: Birth Justice and Human Rights in Maternal Health.
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