Obstetrical and gynecological violence: Towards a better understanding of this fundamental issue in women’s health

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From a legal point of view, physical damage is much easier to qualify, quantify and compensate, but socially, what we see is much more psychological and moral damage. And there, we are entering a blind spot of the law. Hello, my name is Audrey Ferron Parayre. I am a professor in the Civil Law Section at the University of Ottawa. My current research focuses on obstetrical and gynecological violence. That may sound strange, as words, but in fact, obstetrical and gynecological violence, what it aims at, is behaviours or treatments, obviously in an obstetrical or gynecological context, that will harm the integrity, the dignity of the person, either by their outright inappropriate character, but it can also be disrespectful, degrading, abusive. In short, it's quite a broad definition, but we really aim – in fact, the denunciation of this violence aims to make women's reproductive health care safer, both physically and psychologically, I think. It's probably more on the psychological side that there are issues than on the physical side. Obstetrical and gynecological violence can occur in a multitude of contexts. We often think of all that is perinatal, so pregnancy follow-up, childbirth, the care that comes immediately after childbirth – sewing up the perineum, examinations to empty the uterus following that – so it is often in these contexts that it will happen, but we also have situations that will occur with adolescents who are beginning their gynecological follow-up, for whom it is an intrusion into their intimacy, and there is a potential for violence that can occur. It can also be in the area of fertility care, so reproductive health: women, couples who want to have children and who are obliged to use medical methods for that. This can also lead to obstetrical and gynecological violence. I would say that we shouldn’t think of this as necessarily the work of doctors. That is to say, it's in contexts of care. It's not aimed at professionals. Any professional is likely to cause this kind of violence at one time or another, and I insist: the vast majority of the time, it’s completely involuntarily and unintentional. The fact remains that the perceived result for the woman will still be violent. It's interesting to study obstetrical and gynecological violence from a legal point of view because it's basically something that we see in medicine, and more and more in sociology. Legally, we don't have much, at least in Quebec. There is Louise Langevin, at Laval University, who wrote a small chapter in her book on women's reproductive health. In the United States, there are more and more jurists who are looking at the issue; in France as well. In fact, when we look at it from a legal point of view, there is no specific response to obstetrical and gynecological violence. At the moment, the only avenue is to file a professional civil liability suit against the caregiver, or to file a complaint with the College of Physicians and have it go before the disciplinary board, but these are not specific to this problem, and this is where there may be sensitivities, issues, and particularities that deserve to be dealt with specifically or, at the very least, that demand decision-makers be made aware, in the same way that judges have been made aware of sexual offences in criminal matters. I think there are parallels to be drawn between the two. The work that I am doing, and I say I am doing, but it is with a great team of researchers who come from other fields of law, but also from sexology, from sociology. I think that this is not a subject that can be approached with a single disciplinary filter. We need several if we want to keep as few blind spots as possible. What we did, was that we obtained a small grant to bring together a lot of partners. Representatives from women's organizations, patient partners, nurses, midwives, doctors, specialists, omnis. We managed to get all these people in the same room for a whole day and we said to ourselves: in spite of the sensitivity of the subject, in spite of the sometimes opposing positions that can be raised, on what are we capable of finding common ground? On what are we able to say that we really need to work on these aspects in the future? And eventually, we came up with a project that we hope will be funded where we aim to create a new theoretical model that will mix restorative justice, shared decision-making in medicine and empowerment approaches in sociology, particularly in women's sociology, to try to create something that would be specific to the study of obstetrical and gynecological violence and that would allow us to look for points of convergence and divergence in the experiences and perceptions of both women, plus, plus, plus, collateral victims and others, and of caregivers as well. It is certain that from a strictly legal point of view – and there is still a lot of research to be done on this, but in the same way that we are looking at creating courts that specialize in sexual violence – I think that there may be a need in the medical field to create a framework, a methodology specific to women's reproductive health and to the harm that can result from this type of violence, certainly in civil matters, in ethical matters. If only to raise awareness among decision-makers, this would be an important avenue.

Obstetrical and gynecological violence (OGV) is not a new concept, but it has recently attracted a renewed interest in Quebec. While OGV has been soundly denounced, it has been the subject of very little academic study, and its very definition remains elusive. The research of Professor Audrey Ferron Parayre, a specialist in legal issues related to the medical field, is filling the gap on obstetrical and gynecological violence.

Obstetrical violence experienced in health care institutions includes actions taken or the exercise of certain professional practices – or their omission – during childbirth, without the agreement and informed consent of the patient. This results in the denial of a patient’s reproductive agency. For Professor Ferron Parayre, OGV refers to behaviors or treatments – including those that are unintentional – that violate the dignity, safety, and freedom of patients because they are disrespectful, inappropriate, or degrading. Such treatments can cause distress, suffering, or power inequalities. But the lack of valid and reliable data on this topic has created a debate that, while not fruitless, has polarized stakeholders, who now find themselves speaking different languages without a common foundation.

In this video, Professor Ferron Parayre outlines the legal issues she explores in her work, including the question of free and informed consent to care, aiming to provide a better understanding of this fundamental issue in women’s health.

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