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“Stop bawling” – Obstetric violence in Hungary

A lot of myths concern motherhood and birth in our societies. You would think – especially if you haven’t given birth in a hospital before – that birth is a natural, loving process. But the reality is far from it: hospitals are crowded, doctors don’t have time to, or cannot, respect the desires of the women giving birth. A discussion with Pálma Fazakas, a Hungarian activist for obstetric rights, on what possibilities activists see to achieve a health care system that respects the rights of women giving birth.

Pálma Fazekas

Pálma Fazakas

Throughout Europe, movements have formed to demand more dignity in obstetrics. One of these organisations is the Hungarian EMMA association, formerly known as Születésház (Birth House). In Hungary, it is also very difficult to get permission for home births, and women who come to hospitals after having had difficulties with their home birth are often not welcome.

Pálma Fazakas is the coordinator of the EMMA association. The organisation provides information concerning pregnancy and giving birth. They participate in academic research, serve as an interest group and offer workshops. Their help line is open for women and their families who encounter violence and misconduct during their time in hospital. Fazekas tells me that they cooperate with organisations and groups that work on similar issues nationally and internationally, and exchange best practices. Together, they aim to develop an obstetric system that guarantees equal access for everyone.

When and how did your association form? Who do you want to reach with your association?

Our association has been working under the name Születésház since 2010, as an active organisation providing information and representation for women. We see it as our duty to defend the rights around birthing for women and their families. In 2016 we changed our name to EMMA non-profit association. EMMA stands for us, you and me, everyone in Hungary who is in any way connected to giving birth, being born, and obstetrics more generally. We guarantee support and information. We are a place where women can freely speak about their experiences around having children and where these are unconditionally valid.

Only few people have heard of “obstetric” or “birthing” rights. What does this mean and why are they endangered in your view? Can a woman in Hungary today freely decide if, when, and how she wants to give birth?

"No lad is needed on the dam" - a woman protesting against obstetric violence in Hungarian hospitals *see bottom of this article for further explanations

“No lad is needed on the dam” – a woman protests against obstetric violence in Hungarian hospitals *see bottom of this article for further explanations

Women’s reproductive rights don’t only encompass if or when a woman wants to give birth, but also, in what conditions she gives birth to a child: where she will do it, and who will be with her.

The universal rights of women giving birth have deep roots in human rights and include the human rights to health, self-determination, and a private life. Every woman who is giving birth has the right to physical, emotional, and social health during the birthing process. She has the right to free choice around the conditions of the birth, and the interventions on her body (after getting satisfactory information on the process), to the protection of her personal data, and, finally, to always be treated with dignity and respect, without discrimination[1].

Unfortunately, the woman giving birth often faces many obstacles to a free and informed decisionmaking. Because there is no information or statistics on how hospitals treat women giving birth in Hungary, women have to trust word-of-mouth to inform themselves about the birthing process in a given hospital. The discrimination mostly happens during the process of giving birth: through negative suggestions (“it’s not going to work”, “the pain is decreasing”, “your hips are too tight”), by scaring the women (“the baby is going to die”, if she does not agree to the proceedings), humiliation and disrespect (“stop bawling”, “you didn’t cry when you made the baby”, “it doesn’t even hurt so much”, “behave already”), or by not respecting the woman’s privacy (leaving the door open during the birthing process, going in and out without permission).

In this situation, it is very important for me to note that the legal system can’t put the responsibility on the woman, but on her environment: we, the environment have to guarantee that women can exert their rights. It shouldn’t be their responsibility to fight for it.

On March 20th of this year several hundred people joined in a demonstration for the movement “Different conditions in obstetrics” (in Hungarian there is one word for “childbearing” which translates as “different conditions”: másállapotot a szülészetben). Who participated in the event? How was it represented in the media? Has your reputation also spread to other cities than Budapest?

Women and their families participated in the event. According to police statistics there were about 700 adults plus many children. But there were also many professionals present.

In this video (in Hungarian), Pálma Fazakas says:

“When my children get to the age where they want to give birth, I want that their well-being does not depend on the mood of the doctor, or on money, or on the grace of the hospital director – but that they can give birth to children just as they want.”

Three provincial cities participated in the event: Székesfehérvár, Szeged and Debrecen. The repercussions in the media were big. The Metropol, the TV channel ATV, the weekly news show Tények, the online magazine Index, and the Hungarian Medical Association reported on the event.

Here are more pictures of the event.

How do you see the chances of your organisation changing the political and societal atmosphere in Hungary? Will there be more demonstrations?

Expecting changes in obstetrics - a poster informing about the demonstration

Expecting changes in obstetrics – a poster informing about the demonstration

 “Different conditions in obstetrics” has grown to become a movement by now; we have started lobbying. In April, the organisers met up with the Deputy Secretary of the Family Ministry. We are only at the beginning of a long and difficult road. Demonstrations on the street are one part of this process, but it is just as important to openly communicate with professionals [in the health care sector], to conduct lobbying with decision makers, advocate for change in the education of future obstetric professionals and empower women.

Even before the event, many prominent professionals supported the movement with an open letter, like Dr. Károly Pap, the General Secretary of the Hungarian Obstetric Gynaecologists Association, and Dr. Róbert Póka, university professor and director of a clinic. This makes it easier to be noticed by decision makers.

How do you cooperate with hospitals? There, the problem is that often doctors and nurses don’t have enough time to offer dignified treatment to pregnant women. How can this situation be changed?

The priorities and perspectives of the women, the professionals and the political administration organising health care do not coincide. What we want, is for professionals and administrators to listen to and hear, what women deem as important. It is often a matter of time and perspective to include the desires of the woman giving birth. These two are the things that are most difficult to get, when you have already used up all the resources. But we need both time and inclusion of different perspectives to ensure dignity in the birthing process.

"How are you doing? We listen to you!" A poster of the EMMA association providing information concerning pregnancy and giving birth.

“How are you doing? We listen to you!” A poster of the EMMA association

It is important to understand that we all stand together, those of us who work in the health care sector, so that healthy mothers, babies, and families can step into life after birth. But health goes further than having a mother and newborn that are alive. With every birth, a new life, mother, and a new family are born or the existing family grows, in the physical, emotional and social sense as well. Our association believes that good care begins with the woman, the mother. Everything that helps the mother, also serves the newborn and the family, and finally, society. The mother and child are an inseparable entity, their interests should never be put against each other, neither during birth, nor after. And for the mother it is best if they include her in the right way and [that she] shapes the process, if she can be an active part of it.

This perspective is completely different from the way in which medical professionals have been and currently are trained in Hungary. At the same time we notice that many professionals feel and hear that change needs to happen. And they also see, that this change is good for the profession too, that it can bring more satisfaction.

We experience some institutions where dialogue and exchanging experiences is possible. Talking openly, directly, constructively – only this can move us forward.

Is there some sort of European cooperation? I am thinking of last year’s effective campaign for access to abortion in Spain, and other movements, that are fighting for women’s reproductive rights across Europe. Does something similar exist in the field of obstetric rights?

There is a lot cooperation around obstetric rights internationally, especially since 2010. We are part of the international network, Human Rights in Childbirth, which was created partly because of legal trials against midwifes who support childbirth outside of the institution (including Dr. Ágnes Gereb in Hungary), and partly because of the case of the European Court of Human Rights vs. Ternovszky ruling in 2010[2].

Since 2016 our association is a member of the International Cesarean Awareness Network. The network aims to uncover cases of obstetric violence and support women in their claims of violence that they have experienced.[3]

A little girl with her mother is taking part in the demonstration for obstetric rights in Hungary

A little girl with her mother is taking part in the demonstration for obstetric rights in Hungary

Since 2014, we have participated in the childbirth-related projects of the European Cooperation in Science and Technology. Part of these projects was collecting and analysing Hungarian data for the Babies Born Better survey . The study was conducted in 23 languages and 31 European countries, and aimed to research which parts of the childbirth process and care were satisfying mothers, and how. In the same project, we participated in other studies regarding obstetric violence, and the attendance to marginalised women living in underprivileged situations during childbirth.

The movement on March 20th, also called Roses Revolution, was organised with the support of an international grassroots movement of the same name. This movement aims to raise awareness of the fact that obstetric violence is a form of violence against women, and primarily a structural form of violence. It has to be treated accordingly, so that obstetric violence becomes part of the discussion around violence against women.

[1] Without discrimination means that the woman giving birth gets full information on the medical process, her health and well-being, and can make informed decisions on the birthing at any point in the process. This concept should be valid for any woman, whether able-bodied or disabled, young or old, rich or poor.

[2] In this case, the ruling introduced the right of the parent to choose the circumstances of becoming a parent, e.g. at home or in the hospital.

[3]A dedicated website gives an overview of cesarean rates in US hospitals. An article (in Hungarian) reflects on the growing rates of cesareans in the country, which have increased from 10% in 1990 to 39% in 2015.

*Explanation of the placard in the second picture: The text is a play on words with the traditional Hungarian saying “legény kell a gáton”, which means “a lad is needed on the dam” = we need someone who is not frightened by difficulties. But referring to obstetric violence, the woman holding the placard wants “no man on the dam” of the woman giving birth, ergo no violence or discrimination to the women giving birth by the (mostly male) doctors.

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