Advocacy on the Challenges Women Encounter in Childbirth

When I was pregnant for the first time, my notion about my rights was something like a quote from Law&Order episode: „You have a right to remain silent..." Now, after years of working as an activist, I know much more about women's human rights and I call their violations abuse and disrespect.

I also know that the situation is not the same around the world. Women's rights are violated in many different forms and ways. Access to health care, discrimination based on their age, race, religion or sexuality, forced medical interventions – or lack of them. Since the situation is quite different in each country, I chose to talk about one major challenge, that is – in my opinion - present everywhere.

The Normalization of abuse and disrespect

When we talk about disrespect and abuse we often talk about good doctors and bad doctors, good midwives and bad midwives. Yes, it is true that many violations of women's human rights are results of personal mistakes or failures, and some – not all - but some providers are power hungry and knowingly hurt women in the most vicious ways in order to punish and discipline them. But in many other cases, violations are rather results of institutional influences and they are happening despite the good character and intentions of the provider.

People often say: "This is how we do it here". For them, this is the norm.

There are more than eight definitions of the word "normal". One of the meanings, according to dictionary, is "common, regular, frequent, customary, and consistent with practices and directives."

So the normal for many women, providers and institutions actually means that the care is abusive and disrespectful and yet it is seen as good, acceptable and required. On the other hand, care according to evidence based medicine and human rights principles is seen as dangerous, forbidden or silly.

The question is, how to change these practices. How to change perception? There is no easy answer to that.

First of all, we must recognize our own bias. We are not immune to normalization. In our organization, when we were working on the first internal report about disrespect and abuse in Slovak hospitals, we wrote that according to our experience, we have not observed a sexual form of abuse or disrespect. The truth is, we did. We just did not see it, we were not able to address it properly. In our society, this behavior is seen as normal, even funny.

Women are often seen as unfit to be part of the conversation about the change of current status quo. They are emotional, wounded, traumatized, taking care of small children – which is a demanding and time-consuming full-time job. When women speak up about their experience, they are often silenced, their experience is diminished.

When looking for solutions, we must first know what the problem is. The solution is to bring the women to the table. They must be part of the conversation. One consumer representative is not enough. We need women from all societal groups.

Therefore, I think that the strongest advocacy groups are multidisciplinary and intersectional. They are able to push both from top to the bottom and from the bottom to the top. The diversity of such advocacy groups may help us see our own bias and a very much needed different perspective.

With strong diverse advocacy groups we can get good quality data, use story-telling and start a society-wide discussion. We can spark government-led changes in education, institutional organization of healthcare and empower both women and providers. Major change needs to be done in public perception and in the de-normalization of disrespect and abuse. I hope that one day, the message to all women about their rights will be: "You have a right to speak – and we will listen."

Zuzana Krišková is a cofounder and currently serves as chairwoman of the Slovak NGO Ženské kruhy (Women's Circles). She studied financial management and has PhD in accounting. After her first pregnancy and childbirth she became passionate about natural childbirth and later about human rights in childbirth which lead her to make a significant career change. In her work for Ženské kruhy she focuses on disrespect and abuse in childbirth. She believes that every doctor, midwife and nurse is capable of provide respectful maternity care. In her future work she wants to address the "victim blaming" phenomenon between maternity healthcare providers, doulas and activists.