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ARGENTINA: Stamping Out Mistreatment of Women in Hospitals

Marcela Valente

BUENOS AIRES, Oct 18 2006 (IPS) - Cruel, inhumane and degrading treatment of women in sexual and reproductive health services in Argentina, often accepted as normal by doctors, nurses and even patients, is being closely examined by a network of organisations determined to stamp out these practices.

“The idea is to report mistreatment so that it becomes visible, but also to inform people about how women should be treated,” Susana Arminchiardi, a researcher at the Latin American and Caribbean Committee for the Defence of Women’s Rights (CLADEM) explained to IPS.

It all began in late 2003 with an investigative report titled “Baring It All” (“Con todo al aire”), based on interviews with dozens of women in the northeastern Argentine province of Santa Fe, whose testimonies revealed “treatment that denigrates the very humanity” of the doctors and nurses responsible for giving care “If you liked the fun part, put up with this part now!”, “Spread your legs and shut up, you sure liked doing that before,” “You should have thought of this beforehand,” obstetricians and nurses regularly snap at women in labour, according to the report.

In some cases the women are scolded for “dirtying the sheets” after giving birth, or told that they are “filthy” and to “go and take a bath, you stink!”

The patients are forced to remain naked and without a covering sheet while they are examined by a doctor and a group of students, who carry out manual gynaecological examinations and other procedures without even asking their permission. “I felt outraged, ashamed, about 13 students stuck their fingers inside me,” one woman said.

The report led to intervention by the Santa Fe ombudsman’s office, which called professionals and officials in the health field together to instigate a change in the way people were treated. And changes are already visible, CLADEM has reported. The report also prompted the inclusion of Health and Human Rights as a subject taught to medical students.

Arminchiardi said that the new practices, worked out by health professionals, social workers and patients, include creating spaces where a woman may have privacy and also may be accompanied by a family member, and will have her permission asked before being examined by medical students or interns.

Providing hospital gowns, and identifying women by name, have also been incorporated, in the latter case in order to overcome the custom of calling all pregnant women “Mother” or “Mum”, whether they have come to give birth or are being treated for complications after an abortion, which is illegal in Argentina.

This strategy has been adopted in other provinces where similar mistreatment prevails. With the support of CLADEM and the Institute of Gender, Law and Development, between November 2005 and June 2006 workshops have been held in the provinces of Tucumán, Neuquén, Santiago del Estero, Mendoza and Córdoba.

The workshops or seminars always begin with a dramatised version of the “Baring It All” report. Members of the audience, most of whom are involved in health care, recognise that these practices are commonplace, and many of them openly admit that they had no idea that such treatment violated human rights.

Participants in the seminars include doctors, nurses, social workers, members of women’s organisations, academics and health officials. But Mendoza, in the northwest, was the only province to offer its two largest maternity hospitals as venues for the workshop, with the aim of encouraging all staff to attend.

“Hardly any doctors besides obstetricians attended the event, but large numbers of nurses and social workers came, and they acknowledged the problem,” Dr. Ana María Andia, the director of Mendoza’s Reproductive Health programme, who organised the workshop in her district, told IPS.

“Hospital doctors have a greater resistance to training and this sort of event,” as opposed to family doctors, who have more personal contact with their patients and a greater commitment to their practice, she said.

Andia explained that in Mendoza, one of the most advanced provinces in terms of sexual and reproductive health, there are no serious complaints, but less obvious mistreatment does occur. “One doctor, after seeing the dramatised version of the Santa Fe report, said ‘This doesn’t happen here,’ but some nurses immediately contradicted him,” she said.

Scornful treatment of women who come to the emergency room after having an illegal abortion, or telling a woman in labour to control herself and not cry out when she is giving birth, are practices that are hard to eradicate unless there is a process of reflection about this kind of harsh behaviour that is accepted as normal, the experts said.

“In Mendoza, dilation and curettage (D and C) to complete a home abortion has been done under anaesthetic for many years now, but we know that in other provinces it is still done without anaesthetic to punish the woman, so that she won’t have another abortion,” Andia said.

The testimonies in the “Baring It All” report tell of this practice. “If they know that you tried to have an abortion, they do the D and C without anaesthesia,” one of the women said.

Doctor Andia said that the purpose of these seminars, which are also to be held at maternity hospitals in Mendoza’s outlying areas, is “to empower women” so that they are aware of and demand respect for their rights, and at the same time “to invite healthcare professionals to reflect about their practices.”

To bring together work of this kind being done in different parts of the country, at the end of October CLADEM is to launch an observatory on Health, Gender and Human Rights, which will incorporate the results of the seminars, research done in other provinces, and examples of best practice.

CLADEM’s work and other research that has uncovered similar treatment for pregnant women will be available there. One study in the northwestern province of Tucumán revealed that in some health centres, women in labour even have to share beds.

Another study conducted in the city of Buenos Aires also revealed a very poor quality of patient care. The study indicated that being referred to as “Mother” was only the first of many far worse humiliations.

“Mother, please shut up!” a doctor shouted at a woman in the emergency room who was haemorrhaging and complaining of great pain, or “Mother, what have you done?” a woman doctor asked a patient who came into emergency suffering from the consequences of an incomplete abortion.

The observatory will be a “virtual space” where complaints can be voiced, but also where ways of improving the treatment of people can be learned, thus shedding those practices which violate human rights, Arminchiardi said.