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GENDER RIGHTS

Campaigners in Spain bring ‘obstetric violence’ out of the shadows

When a United Nations committee ruled Spaniard Nahia Alkorta had suffered obstetric violence during the birth of her first child, it was the culmination of a ten-year quest for justice.

Campaigners in Spain bring 'obstetric violence' out of the shadows
Nahia Alkorta poses in the Spanish Basque town of Zizurkil on July 28, 2022. - Nahia denounced having suffered obstetric violence during childbirth 10 years ago and the UN Committee on the Elimination of Discrimination against Women (CEDAW) has just condemned Spain as responsible for this case. (Photo by ANDER GILLENEA / AFP)

Alkorta was diagnosed with post-traumatic stress disorder after her treatment at a hospital in northern Spain in 2012 and turned to the UN, having failed in the Spanish courts.

The UN’s Committee for the Elimination of Discrimination Against Women (CEDAW) found in July that she had been subjected to a litany of unjustified interventions which amounted to obstetric violence, including a caesarean without her consent, with her arms immobilised and her partner barred from the room.

“Since the ruling, more than 100 women have contacted me saying this kind of thing happened to them,” Alkorta, now 36 and a mother-of-three, told AFP in an interview.

“It isn’t talked about because of the pain it causes, because of the sense of shame. There’s an idea that this is just the way it is,” she said.

The CEDAW decision described obstetric violence as “violence suffered by women during childbirth at medical facilities”, adding that it is a “generalised and systemic phenomenon”.

It said Spain should compensate Alkorta for physical and psychological damage and ensure that women’s reproductive rights are safeguarded by the health and judicial systems.

The ruling came as campaigners across Europe raise awareness about obstetric violence, which often goes unrecognised.

Some national medical associations in Europe even take issue with the term itself, saying that it cannot be applied to their practices.

But Alkorta argues: “Women are telling a different story.”

Obstetric violence refers to harm inflicted during or in relation to pregnancy, childbearing, and the post-partum period.(Photo by ANDER GILLENEA / AFP)

‘At their mercy’

Alkorta suffered nightmares, insomnia and flashbacks after an ordeal that began when her waters broke at 38 weeks.

At her local public hospital in San Sebastian, in Spain’s Basque region, she was induced with the drug oxytocin, despite having contractions and without any medical reason given, she said. Staff responses to her questions became increasingly aggressive, she recalled.

The day after she was admitted, gynaecologists decided to deliver the baby via caesarean, without seeking her consent and despite a midwife telling her that her labour was progressing, she said.

“When I asked for a clear explanation, they just said they would take out the baby and it would be over in 40 minutes,” Alkorta, who lives in the Basque town of Zizurkil, told AFP.

With her arms tied down, a protocol that some hospitals follow during caesarean births, and her husband barred from the room, she trembled with fear. “I felt completely at their mercy,” she told AFP. Alkorta was unable to hold her son, who was healthy, for the first hours of his life.

There is a lack of comprehensive data measuring obstetric violence in Europe, but advocacy groups say women are routinely denied informed consent, subjected to rude and degrading behaviour by medical staff and, in some cases, dangerous practices.

A recent “Stop Obstetric Violence” petition in Serbia gathered 70,000 signatures in five days, calling for the state to cover the cost of somebody accompanying a woman in the delivery room — currently some Serbian public hospitals require the extra person to pay, even if it is the woman’s partner.

“Many mothers in Serbia would prefer to forget the day they gave birth, because they experienced various forms of violence by medical staff,” the petition said, listing insults, humiliation, shouting, neglect and medical errors among the problems.

Some countries in Europe, including Spain and Italy, have set up obstetric violence observatories, but campaigners say legal cases are rare.

“We are approached by many mothers who have suffered a traumatic birth, but almost no one ends up filing a lawsuit,” Nina Gelkova, from Bulgarian campaign group Rodilnitza, told AFP.

“The state does not acknowledge that such a problem exists.”

Consent and respect

Observations submitted by Spain to CEDAW as part of Alkorta’s case warned that “an ‘a la carte’ birth does not exist” and backed the domestic courts’ findings that the hospital was not at fault.

Alkorta counters that what she is fighting for should not be considered a luxury.

“I wasn’t looking for an ‘a la carte’ birth, I was looking for humane treatment,” she told AFP.

“I’m not against justified interventions, I think they save many lives — but they should always be done with consent and respect.”

Lawyer Francisca Fernandez Guillen, who has worked with Alkorta since the beginning of her legal journey, explained that medical professionals and even women’s own relatives can play down traumatic experiences during childbirth.

“Sometimes even the partner or family advises the woman just to ‘forget’ about what happened,” Fernandez told AFP.

However, some medics believe attitudes are changing.

Daniel Morillas, vice president of Spain’s Federation of Midwife Associations (FAME), told AFP that in the 16 years he has been working as a midwife, he has seen increased awareness of the rights of the mother and her role as an “active participant” in childbirth, although he admits there’s still a long way to go.

“The first thing we have to do in order to combat obstetric violence is acknowledge it exists,” he told AFP.

“Many doctors and midwives already recognise that it happens and are trying to change things.”

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GENDER RIGHTS

Teens in Spain can change gender on paper without medical evaluation

Spain's Cabinet on Monday approved a transgender rights bill allowing anyone over 16, in some cases as young as 12, to easily change gender on their ID documents.

Teens in Spain can change gender on paper without medical evaluation

The legislation, which will still need to be approved in the Spanish Parliament, will make Spain one of the few countries in Europe to permit gender self-determination.

“We have approved the second reading of the trans and LGBTI rights law which will now be brought to parliament before the summer,” said Equality Minister Irene Montero  on the eve of International Pride Day.

“We are once again at the forefront and an international reference in defence of LGBTI rights and, in particular, in defence of the rights of transgender people,” she said.

“We are recognising the right to self-determination of gender identity and we are depathologising trans realities,” she said of the move to stop categorising trans-related conditions as mental and behavioural disorders.

First approved a year ago, the proposed law means any Spaniard over 16 “will be able to apply to change the sex of their entry in the civil registry office”.

They will also be able to change their given name.

The bill effectively simplifies the procedure for changing gender on official identity documents, allowing the applicant to request the change on the basis of a simple statement, dropping the requirement for a medical report attesting to gender dysphoria or proof of hormonal treatment.

Under the new law, the reregistration procedure must be completed “within a maximum of four months,” she said.

The bill allows those as young as 12 to make the change but only under certain conditions.

“Between the ages of 14 and 16, the procedure will require parental authorisation; between the ages of 12 and 14, the procedure can be carried out through voluntary legal proceedings,” Montero said.

And it will also mean trans children under 12 will “be able to change their name on their ID card,” she said, without saying how such a procedure would work.

The legislation also bans conversion therapy, the pseudoscientific practice of attempting to change a person’s sexual orientation.

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