3 out of 10 women experience obstetric violence in Mexico

By Marcela Nochebuena. Itzel Soto/ Civic Data. Janet Oropeza and Matilde Pérez/ Fundar 
Three out of 10 women who had a birth in the last 5 years in our country suffered an incident of obstetric abuse, according to the National Survey on the Dynamics of Relationships in Households (ENDIREH) 2021. 
This means that of the 7 million 810 thousand 538 women aged 15 to 49 who had a son or daughter between 2016 and 2021, 2 million 455 thousand faced some form of violence in obstetric care during their last birth, that is, 31.4%, according to the results released by the National Institute of Statistics and Geography (Inegi). 

Some of the acts of obstetric violence reflected in the ENDIREH range from yelling or scolding them at the time of delivery, ignoring them when they ask questions about their pregnancy or their baby or forcing them to remain in uncomfortable positions, to making offensive, humiliating or degrading comments. In addition, serious forms of obstetric violence prevail, such as performing cesarean sections and placing devices to avoid having more children without consent or explanation. 
Although obstetric violence is typified as such in the local laws of 28 states, the survey uses the concept of “abuse in obstetric care” to encompass, according to its own glossary, different forms of violence against women in reproductive health services that can manifest themselves in threats to withdraw their treatment by health professionals, suffer physical violence or obtain poor health outcomes if they do not obey. They also contemplate blaming, as well as humiliation and verbal abuse, that is, phrases expressed during labor when they manifest pain or other emotions, concerns or needs.
Regardless of the amount of population they serve, according to the results of the ENDIREH the highest percentages of abuse are in the public health services, which register prevalences of between 27 and 40% depending on the institution. Meanwhile, in hospitals and private services the prevalence ranges from 15 to 19%.

Obstetric Violence
By state, the highest percentage of women who reported having experienced abuse in obstetric care is located, according to the survey, in San Luis Potosí (38.9%), Tlaxcala (38.5%) and Mexico City (38.5%), while the lowest rates were registered in Tamaulipas (25.4%), Tabasco (24.4%) and Chiapas (18.8%).
According to an analysis of the results of the ENDIREH carried out by Data Cívica, in the group of women aged 15 to 24 years is where more incidents of obstetric violence were reported. In this same age group, when analyzing by situation of abuse, the highest percentage (11.3%) corresponds to those who said they had suffered screams or scolding, followed by having been pressured to accept some contraceptive method (9.6%) and having been ignored when they asked about their delivery or about their baby (9.4%). The next group that reported the most abuse is the 25 to 34 years old, with the same forms of violence in the first places. 

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In addition, the ENDIREH reflects that the percentage of women who experienced situations of obstetric abuse is more or less the same between those who self-ascribe as indigenous and those who do not. Screaming and scolding were reported to a greater extent by the non-indigenous population (10.6 versus 8.7%) but the pressure to accept some contraceptive method is greater in the case of indigenous women (9.5 versus 8.6%).
The level of schooling of women aged 15 to 49 who experienced events of violence during their last birth also reflects some differences around the reported incidents: for example, the screams or scolding in women with a bachelor’s or postgraduate degree (10.8%), at the same time as the pressure to accept some contraceptive method towards women without schooling (10.1%), higher than in any of the other degrees of study.
According to the World Health Organization (WHO), maternal health is an essential component of women’s sexual and reproductive health. It refers to the fact that in pregnancy, childbirth and the puerperium the health and well-being of women and their babies is guaranteed through respectful, culturally acceptable and quality treatment. 
Obstetric violence 2
Read more | 1 in 3 women suffer abuse in childbirth; Mexico exceeds orCaesarean section vel advised by WHO
Forced contraception and caesarean sections without consent
Regarding unauthorized medical treatments, Inegi reports that 23.7% of women who had a cesarean section experienced this type of violence, while it was also exercised towards 16.9% of those who had a birth. In the first case, there is a reduction compared to 2016 (25.9%).
For the survey, it was considered as unauthorized medical treatments not to inform women in a clear way why it is necessary to do a cesarean section, not to have obtained their consent or authorization to do it, to be pressured to accept a device or surgery to no longer have children or to do so without asking them, to deny them anesthesia or blockage to reduce pain without explanations or to force or threaten them to sign a paper without informing them of the objective. 
Between 2016 and 2021, 3 million 718 thousand 900 women had a son or daughter by cesarean section, among which 319 thousand 319 did not give permission to have them performed, that is: 8.6% of women who had a cesarean section in the last five years did not authorize it. 
On the other hand, 759,505 women, representing 9.7%, were pressured to accept some device or surgery as a contraceptive method, while 333,284 women were placed some contraceptive method or operated or sterilized to no longer have children without their consent, that is, 4.3%. According to the Shadow Report of civil society organizations to the UN, this practice is considered torture and other forms of cruel and inhuman treatment. 
In our country, the General Law on Women’s Access to a Life Free of Violence does not yet explicitly define obstetric violence as a form of gender violence, but contemplates figures such as psychological, physical and institutional violence, in which it can be framed. So far, according to the report “Forgotten Justice: Violence and Impunity in Reproductive Health” by the Information Group on Chosen Reproduction (GIRE), 28 states have incorporated definitions of obstetric violence into their state laws.
In its own glossary, the ENDIREH includes in the definition of obstetric abuse acts of violence for which no data were collected, such as threats or lack of confidentiality. In addition, unlike other areas of the survey, no information is included regarding with whom they shared the situation of violence they suffered or in which cases and before which instances they denounced it, so it is not possible to know the responses and actions to this form of violence. 
According to the analysis and research center Fundar, the data revealed by ENDIREH in its 2021 version are alarming because they show that obstetric violence in our country is structural, generalized and perpetuated from the public health institutions themselves, without the authorities taking measures to address or eradicate it.
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Original source in Spanish

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