Costa Rica, despite having a robust healthcare system, we face an alarming reality: 57.7% of women of reproductive age who gave birth between 2016 and 2018 reported having experienced some type of obstetric violence. This problem is not limited to the moment of delivery, but persists even after, before hospital discharge.

In the analysis, a troubling finding is that women’s levels of wealth are statistically associated with the prevalence of obstetric violence. It is surprising that as the level of wealth increases, so does the reporting of obstetric violence. This leads us to reflect on possible disparities in treatment based on economic status.

Social commotion and demands for institutional change

Obstetric violence not only affects women’s physical health, but also violates their human and reproductive rights and their right to non-discrimination. This problem must be addressed to ensure a health care environment that respects the integrity and fundamental rights of women.

The struggle against this type of violence has generated significant social unrest in Costa Rica. Various institutions, such as the Ombudsman’s Office, the University of Costa Rica and the Constitutional Court, have intervened to effectively address this problem. As a recent criminal complaint filed by the executive president of the CCSS and the Minister for the Status of Women in response to Isabella’s death exemplifies the gravity of the situation.

Maternal Rights: Towards Respectful Care

The tragic story of Isabella, whose mother denounced the denial of medical care at the Nicoya Hospital, highlights the urgency of addressing obstetric violence. Although efforts to save her were evident, her death illustrates the need for institutional change to ensure adequate care for all women, regardless of their economic status.

They don’t want to do anything because the hospital protocol is that I have to wait for my baby to die because they can’t do anything. And I don’t want to and I’m not going to allow anything. I need someone to please help me, because I need to get my baby out of here.

 Angie Herrera Guzmán, madre de la menor. 

From this perspective, it is clear that medical actions, especially when it comes to women and obstetric violence, evidence the existence of this particular form of domination, discrimination and social exclusion. The relationship between the doctor and the “patient” needs to be changed. Also, it would not be a bad thing to go back to the roots and use those ancient practices that, with health in mind, allow the patient to go through this stage without being treated as if she did not matter, without respect and avoiding that cold, rude and humiliating treatment that sometimes comes with an obvious ignorance of medical practice. Now is the time to put a little more humanity into the matter and change the rules.

The denial of the benefit of traditional practices and knowledge related to childbirth places health professionals as the only ones authorized to intervene in women’s bodies. Asymmetry between doctor and patient, then, is rooted in social practices. On the other hand, the institutionalization of reproductive processes displaces women from the leading role in their own pregnancy, at the time of childbirth and even during the puerperium, a place that is now occupied by the authority of professional knowledge.

Laura Belli

Obstetric Violence and the Right to be Free from Cruel, Inhuman and Degrading Treatment

Cruel, inhuman and degrading treatment experienced by women during childbirth and obstetric care is unacceptable. This includes verbal or psychological abuse, as well as the denial of basic care. From a human rights perspective, it is clear that obstetric violence reflects a form of domination and discrimination that must be eradicated.

The State, by concentrating maternity care in the medical field, has relegated women’s traditional knowledge, objectifying them and diluting their rights as persons. It is essential to question and transform this hierarchical relationship, demanding respect for women as subjects of rights during pregnancy, childbirth and postpartum.

Under this context, obstetric violence becomes a violation of rights that goes beyond health, affecting the dignity and equality of women. It is time for an institutional and social change that guarantees respectful, dignified treatment free of obstetric violence for all women in Costa Rica.

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