The Fight Against Obstetric and Gynecological Violence from a Latin American Perspective

CONSTANZA EVANS
COMMISSIONED AND EDITED BY LISSELL QUIROZ
TRANSLATED FROM SPANISH BY VALENTINA SARMIENTO CRUZ

Lissell Quiroz: The Funambulist is a magazine that covers a wide range of topics. In its 10 years of existence, it has not addressed issues related to sexual and reproductive health. That is why I am proposing this article by Constanza Evans, philosopher, producer of the podcast “Ma(más)” and co-founder of the collective “Mi parto mi decisión en Perú” (My birth, my decision in Peru), which covers the fights against obstetric and gynecological violence. I found it particularly interesting, given that people in Latin America are pioneers in the debate and mobilization against this form of violence, which has already been incorporated into the legislation of some countries in the region.

Far from the universal health coverage systems that exist in many countries in the global north, childbirth in Peru and other countries in the region is experienced in a wide array of situations, where all elements may shift and vary: from infrastructure and equipment to the personnel attending the birth, their qualifications, and their philosophy. In this mosaic of care, the decisive element is the user’s pocketbook. Thus, depending on her economic situation, sociocultural background, and geography, each woman is directed toward a very different model of childbirth care. The wealthiest socioeconomic classes tend to seek care in clinics, where hierarchies of institutional and social prestige are also in place. In these spaces, unnecessary interventions during childbirth (i.e., without real medical justification) are frequent, especially cesarean sections, whose rate exceeds 70% in the Peruvian private sector (when the WHO recommends a maximum of 21%).

The public system, on the other hand, is organized into facilities with different levels of capacity, where pregnant people (cis women, trans men, non-binary, and intersex people) covered by social health insurance are cared for and, in most cases, cannot choose which facility they will be cared in. In this system, users are subject to strict protocols for hospital space management, where there is little or no room for privacy, pain management, the presence of a family member or friend, or even physical movement. In these spaces, the autonomy of the pregnant person is minimal, and decisions during childbirth are made based on protocols and equipment, thus exercising strict control over the body.

In remote rural contexts, where public services are more limited, there is also support from traditional midwives, who perform their practice outside the health system and often fear persecution and reprisals—both for the pregnant person and for the midwife.