Obstetric and gynaecological violence in the EU :Prevalence, legal frameworks and educational guidelines for prevention and elimination

Table of Contents

• List of Abbreviations 8
• The Health and Social Care Inspectorate 8
• LIST OF BOXES 10
• LIST OF TABLES 10
• EXECUTIVE SUMMARY 11
• 1. INTRODUCTION 13
• 1.1. Methodology 13
• 1.2. Key challenges in collecting and analysing the data 13
• 1.3. Structure of the study 14
• 2. UNDERSTANDING OBSTETRIC AND GYNAECOLOGICAL VIOLENCE 15
• 2.1. Defining obstetric and gynaecological violence 15
• 2.1.1. A violence that occurs at the intersection of two structural issues 17
• a. The medicalisation of women’s bodies as an historical product of modern medicine 17
• b. Structural issues of the healthcare system, a breeding ground for violence 18
• 2.1.2. Consequences of obstetric and gynaecological violence 19
• 2.2. International and European legal and policy framework recognising obstetric and gynaecological violence 21
• 2.2.1. International framework 21
• 2.2.2. European framework 22
• 3. MEASURING OBSTETRIC AND GYNAECOLOGICAL VIOLENCE IN THE EUROPEAN UNION 23
• 3.1. Prevalence51F of obstetric and gynaecological violence across the 27 EU Member States 23
• 3.1.1. Data collected reveals widespread forms of violence 23
• 3.1.2. Limited data on prevalence rates of gynaecological violence 34
• 3.2. Understanding women’s experiences through qualitative research 35
• 3.3. The impact of institutional structures on prevalence of obstetric and gynaecological violence 36
• 3.4. The impact of COVID-19 on prevalence of obstetric and gynaecological violence 37
• 3.5. Adopting an intersectional approach to identify women most at risk 39
• 4. PUBLIC AWARENESS AND ATTITUDES TOWARDS OBSTETRIC AND GYNAECOLOGICAL VIOLENCE 45
• 4.1. Initiatives to raise awareness on the issue have been identified in the majority of EU 27 Member States 45
• 4.2. Initiatives to collect women’s voices have emerged on social media 49
• 4.3. Alternative spaces to support women in understanding and denouncing this violence 51
• 4.4. Initiatives emerging from healthcare professionals 52
• 4.5. Impact of those initiatives on media 53
• 5. LEGAL AND POLICY RESPONSES TO OBSTETRIC AND GYNAECOLOGICAL VIOLENCE 56
• 5.1. Applicable legal framework to obstetric and gynaecological violence in EU Member States 56
• 5.2. Towards a better recognition at Member State level 63
• 5.2.1. Legislative proposals to legally frame the issue 63
• 5.2.2. Policy developments 65
• a. Strategic documents on gender equality 65
• b. Initiatives promoted by decision-making institutions to better understand the issues 68
• c. Health-related policy documents and guidelines 71
• 6. IMPROVING ACCESS TO JUSTICE 73
• 6.1. Existing mechanisms at Member State level 73
• 6.1.1. Judicial avenues: civil and criminal proceedings 73
• 6.1.2. Extra-judicial avenues 74
• a. Filing a grievance with the hospital 74
• b. File a complaint with the healthcare system344F 74
• c. Disciplinary proceedings before the medical board, the board of gynaecologists, or midwives347F 75
• d. Compensation for damages via specific funds348F 75
• e. Mediation349F 75
• 6.2. Limited data on effectiveness of mechanisms to access to justice 76
• 6.3. Identified barriers that women face when seeking justice 77
• 6.3.1. Difficulties for women (and practitioners) to recognise those practices as ‘violence’ 77
• 6.3.2. Structural barriers 77
• 6.3.3. Organisational obstacles 79
• 6.3.4. Barriers faced by specific groups of women 79
• 6.4. Role of CSOs in fostering better access to justice 80
• 7. ADDRESSING RESISTANCE AND IMPROVING AWARENESS OF HEALTHCARE PROFESSIONALS 83
• 7.1. A difficult recognition of the phenomenon among healthcare professionals across the EU 83
• 7.1.1. Reject of terminology ‘violence’ and underlying power structures 83
• 7.1.2. Pushing for an alternative frame 86
• 7.1.3. An emerging preoccupation among obstetric and gynaecological professionals 87
• 7.2. Initiatives to improve awareness and understanding among medical professionals 89
• 7.2.1. Awareness raising initiatives 89
• 7.2.2. Working groups 90
• 7.2.3. Training 91
• a. Limited integration of those issues in regular curriculum of healthcare professionals 91
• b. Training carried out in collaboration with CSOs 92
• c. Small-scale initiatives at local level 93
• d. Training for non-medical professionals 94
• 7.3. Emerging initiatives to improve obstetric and gynaecologic care 95
• 7.3.1. Improving practices towards evidence-based care 95
• 7.3.2. Promoting alternatives to over-medicalisation of obstetric and gynaecological care 97
• 7.3.3. Initiatives to address specific needs and inclusive care 99
• a. Migrant women 99
• b. Initiatives aiming at improving specific groups of women’s access to gynaecological care 100
• 8. CONCLUSIONS AND RECOMMENDATIONS 101
• 8.1. Conclusions 101
• 8.2. Recommendations 102
• 8.2.1. Recommendations to improve understanding and recognition of obstetric and gynaecological violence 102
• 8.2.2. Recommendations to improve the legal framework applicable to obstetric and gynaecological violence and access to justice 107
• 8.2.3. Recommendations to improve prevention and obstetric and gynaecological violence 109
• Annex 1. Overview of data and information collected in the 27 EU Member States 112
• Annex 2. Country case studies 136
• Annex 3. List of EU and international interviews 183
• References 184