Obstetric Violence in Chiapas, Mexico

A: Before we get into obstetric violence, I would like to address a bit of information on this topic and define a few medical terms. Obstetric violence is physical abuse of someone being in labor or giving birth including, failure to meet their rights, lack of treatment and proper care. Women across the world have reported physical and verbal abuse during labor or giving birth. It’s typically women who are young, uneducated, or unmarried facing a higher risk. A medical screening examination is checking the health of an individual to identify whether a condition is occurring. A cesarean delivery, also known as C-section, is a surgical procedure for delivery of a baby through the mother abdomen and uterus. 

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A: Maria is a mother of three who’s been a victim of obstetric violence during her first pregnancy in Chiapas, Mexico who describes how every mother would imagine having their birthing experience. However that's not always been the case. 

Interview: It was going to be my first child so I imagined that my whole labor experience would come out great, I will receive good treatment and that my baby would be healthy.  

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A: Chiapas, Guerrero, Mexico City, and Veracruz are a few states in Mexico to have high rates of obstetric violence. This could be from living in low-income communities, lack of knowledge between doctors, or simply because of being a woman. In 2015, worldwide, every 100,000 children born, 216 women died from the most common factor of violence which is lack of attention to pregnancy and birth.     

19:00 Interview: When I arrived at first, the doctors wouldn’t attend me and I was at the point where I was to have my baby. They didn’t want to attend me because they would say that I could still wait longer since 2 other women are in labor. But I couldn’t wait because … um.. my water already broke, I was bleeding, like I was ready to give birth but the doctors kept saying that I could wait…. Well, At that moment, my husband was getting furious, he went to talk to the doctors because I knew they didn’t have the right to not attend me. Not only that my baby could die but myself as well. 

A: Maria had just arrived at the hospital and she’s already not receiving the proper treatment. According to The American College of Obstetricians and Gynecologist, it’s hospital policy for doctors to perform a medical screening examination to determine the health condition of the mother and fetus. After the examination, the doctors can determine the next step for the mother. For example, if the examination shows symptoms of the mother going into labor, then it’s best to have a delivery room prep. Otherwise this could lead towards maternal and infant death. But if it shows that the mother still has time until her delivery date, it's best to give her proper documentation of what has been treated and when she should come back to the hospital to deliver her newborn. 

1:18 Interview: There was a small complication when people arrived wounded, and they didn’t want to attend me… like they prefer helping them and leaving me. But the doctors didn’t seem to notice that I could also die... just like the baby. I'm not wounded but in my situation, the baby was about to be born and my water had already broken.  

A: Most clinics in Mexico are full of medical students who are doing a year of service but, according to government officials and women advocates, medical students are not sufficiently trained by failing to speak the local indigenous languages, and are arrogant towards the women who they are helping. 

1:50 Interview: in the room, there were 4 beds and 4 women who also were giving birth. There was one doctor attending all of us and there were also nurses.. Like about 3 nurses. 

A: But also having lack of sufficiently trained staff can lead towards crowded rooms, not having enough beds for everyone and limited resources. Women in Mexico are forced to give birth outside of the hospital or parking lots when there’s no room inside. In 2014, news reporters from USA Today stated that women’s rights advocates sought international help for poor indigenous mexican women being forced to give birth outside of the hospital in Mexico City. The hospital received 20 cases of women giving birth outside when doctors claimed there were not enough beds.

2:55 Interview: After giving birth the next day, they lifted me up and told me that I needed to get up and start walking. At that time, I still had pain...they forced me. They were like “now, it's time so get up now to walk or to do some movement.” It’s like they never gave me time to recover, never. In that, I do see myself receiving lack of attention. Not only to myself but for the other women in the room since the doctors were forcing them as well. 

A: The most common abuse during childbirth is violence against womens’ rights. According to the WHO, women of low income or women belonging to ethnic minorities have a higher risk of receiving disrespect and abuse. Health-care professionals interviewed women experiencing health discrimnation from their characteristics such as low income, failure to understand instructions and being a woman. They reported both physical and psychological abuse such as lack of respect, being strapped onto the bed, frequently being hit or screamed at and being forced against their will. 

3:33 Interview: In my situation, the baby was ready in my womb and apparently she wasn’t going to be normal. At first, I wasn’t opening all the way, I was only a few inches dilating and my baby wasn’t going to be born naturally…. If the doctors have pushed me into a natural birth,... either one of us could’ve lost our life. One doctor earlier told me that I wasn't going to have a natural birth and that I would need a c section. 

Mexico has high rates of cesarean deliveries across the world. According to the WHo, Over 60% of first-time mothers received cesarean delivery compared to 37% of first-time women who receive vaginal delivery. Having rates that high causes concern on these cesarean deliveries since it can impact the mother, the baby and high consequences of using harmful treatment during birth. The appropriate time to perform a cesarean delivery is when the cervix isn’t wide enough and your current has strong contractions. High social class women would say that cesarean deliveries are more modern and convenient while high income women would predict an older and first-time mother to be at higher risk of cesarean delivery. 

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(4:03) Interview: For a mother who gave birth to their first child and didn’t receive good experiences, one should be careful of which hospital they choose to give birth. I don't think all Mexico hospitals are the same. It's an experience that someone receives but never expects. One would think that I would be okay, having my child here as quickly as possible and everything is going to be fine and blessed to meet my child. I was not lucky enough to get a good experience.. 

A: As of today, women are still facing obstetric violence in Mexico as well as other countries across the world. Health providers in different cities in Mexico or different countries have provided their own set of procedures to reduce obstetric violence. A health ministry in Mexico published a set of guidelines for proper procedure of cesarean surgeries and strategies of how to reduce cesarean surgeries. This encouraged the Mexican Social Security Institute to publish their own procedures and strategies for cesareans deliveries. As of 2016, Mexico’s national policy has updated guidelines to reduce cesarean practices. In Guatemala, oncologists have created a “care navigation” to avoid the chances of receiving abusive care. Care navigators are women who are professional trained to improve care experiences. In hospitals, care navigators provide assistance in medical procedures, develop communications skills and can be used as translators. This makes it more reliable for indigenious communities. If a care navigator witnesses abuse towards the mother, they offer emotional support, companionship and privacy when in need. 

This podcast was produced by Anahy for the Spring 2021 Global Health class at Guilford College.