gms | German Medical Science

The rights of women to dignified, respectful healthcare are emphasised in the WHO statement (2014) on the prevention and elimination of disrespect and abuse during facility-based childbirth [17]. In July 2019, the UN Special Rapporteur on Violence against Women presented a report on violence during childbirth based on over 130 submissions from around the world as well as regional reports [15]. As the report illustrates, around the world women’s rights, which are also basic human rights, are systematically violated during childbirth, both within and outside hospitals. Following this report, in October 2019, the Parliamentary Assembly of the Council of Europe adopted Resolution 2306: Obstetric and gynaecological violence [12]. In this resolution, the member states are called on to take targeted action to guarantee that women’s rights are fully respected everywhere, thus granting all women humane, respectful support that upholds their dignity in pregnancy and during and after childbirth.

Experiences of disrespect and abuse during childbirth can result in a traumatic birth experience [8], [13]. This can lead to serious long-term health impacts for the woman and consequences for her relationship with her newborn as well as her family [1], [4], [5], [6], [7]. Midwives can also suffer from long-term psychological effects as a result of witnessing or participating in an abusive situation while attending a birth [9].

The DGHWi condemns all forms of disrespect and violence in childbirth and emphasises that healthcare personnel have a duty to always provide care that is sensitive and respectful. Midwives must accept responsibility for any of their actions or inactions that may – wilfully or otherwise – be disrespectful or violent towards birthing mothers, their newborns and birth companions.

The WHO commissioned a research group to develop an evidence-based typology of obstetric violence based on a systematic review of 65 largely qualitative studies [2]. According to this typology, obstetric violence should be categorised into physical and sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards of care, poor rapport between women and providers, as well as conditions and constraints in the healthcare system, in general. There were reports of physical and verbal abuse, humiliation, degrading treatment, neglect and even complete abandonment and discrimination; pain relief is refused, birthing mothers are not included in decision-making and obstetric interventions are conducted without the consent of the birthing mother [2]. Disrespect and abuse in childbirth can also relate to newborns and relatives [14].

Currently, the available data on obstetric violence in high-income countries is scarce. In a survey on women’s experiences during pregnancy and childbirth conducted in 2016 in the USA [16], 17.3 percent of the 2,138 respondents reported having experienced one or more forms of mistreatment during childbirth. African American or Hispanic women who are disadvantaged due to their socio-economic status or health, and women who gave birth in hospitals were particularly effected. For Germany too, there are various reports on obstetric violence (http://www.gerechte-geburt.de/wissen/gewalt-in-der-geburtshilfe). Since 2013, the “Roses Revolution Deutschland” platform has also provided women with an opportunity to write about their experiences (http://www.facebook.com/RosesRevolutionDeutschland). The results of a social media survey conducted among 2,045 participants in November 2018 show the high relevance of different forms of in-facility disrespect and violence in Germany [10], [11].

Based on the 1948 Universal Declaration of Human Rights, article 1 of Germany’s Basic Law sets out the inviolability of human dignity, article 2 guarantees the right to physical integrity and article 3 prohibits any form of discrimination. Standards of obstetric care are derived from the 2013 Patient Rights Law: The treating personnel must provide clear information on all circumstances relating to the planned birth (section 630c), must explain the planned procedures in detail and in a timely manner, both verbally and in written form (section 630e), and must obtain the informed consent of the pregnant woman regarding the planned measures (section 630d).

The DGHWi advocates woman-/family-centred and human rights-based care at birth in compliance with the 9^th German national health objective “Health and Childbirth” (Gesundheit rund um die Geburt) [3] and the principles of respectful care at birth [18]. The DGHWi calls for those responsible for health policy to ensure that a strategy is devised to facilitate the full, nationwide implementation of these principles of care during childbirth.

The DGHWi advocates increased cooperation between all relevant professional societies and associations to develop interdisciplinary measures to ensure respectful, trauma-sensitive, non-violent care for pregnant and birthing women, new mothers and their newborn babies. This includes additional training on caring for particularly vulnerable women, such as women with previous experience of violence or extreme fear of childbirth, as well as the development of evidence-based, health-related information and decision-making aids on obstetric interventions.

The DGHWi calls for research on the prevalence and prevention of disrespect and violence at birth to be stepped up. Funding programmes are needed for both qualitative and quantitative research designs.

The DGHWi considers the following measures to be necessary in order to prevent disrespect and abuse during childbirth in Germany and to combat its existence:

1.

Establishment of respectful care in obstetrics as a quality criterion

2.

Regular and systematic evaluation of women’s birth experiences at the national level

3.

Easily accessible complaints mechanism for those effected by obstetric violence as well as support structures ensuring appropriate care/therapy for those effected

4.

Improvement of the conditions to enable woman-/family-centred care in obstetrics, for example the provision of sufficient resources for one-to-one midwife care during childbirth

5.

Implementation of institutional protection concepts to prevent and combat in-facility violence, including additional training for professionals involved in obstetric care

This position paper was made available to members of the DGHWi for comments from 03.03.2020 to 15.04.2020 and was revised based on the comments received. This position paper is scheduled for revision by 31.07.2024.

The authors declare that they have no competing interests.