Violence Against Women: Gynecologic and Obstetrical Violence in France

KEY TAKEAWAYS

Gynecologic and obstetrical violence includes physical, verbal, and psychological abuse during reproductive health care.

This violence can involve guilt over reproductive choices, maternity pressures, refusal of health choices, sexualization, and paternalistic attitudes.

Rooted in patriarchal norms, this violence often disregards informed consent and patient autonomy.

The Kouchner Law mandates informed consent, but violations are common, leading to severe psychological impacts.

Healthcare providers should inform patients, respect choices, seek consent, and actively include patients in the decision-making when it comes to their treatments and care.

Gynecologic and obstetrical violence is a pervasive issue that has been recognized for over two decades in Latin America and Anglo-Saxon countries. This form of violence gained significant attention in France in 2014, largely due to social media campaigns such as #PayeTonUtérus (BuyYourUterus) on Twitter. Within just 24 hours, over 7,000 testimonials flooded the platform, highlighting the widespread nature of this problem.

Understanding Gynecologic and Obstetrical Violence

Gynecologic and obstetrical violence encompasses a range of harmful practices and attitudes that women face during reproductive health consultations. These include:

Guilt and Control

Women often experience guilt regarding their reproductive choices, with healthcare providers questioning their decisions and exerting control over their bodies. This can manifest in various ways, such as:

Questioning Reproductive Choices: Women may feel judged for their decisions about contraception, pregnancy, or abortion.
Control Over Women’s Bodies: Healthcare providers may impose their views on women’s reproductive health, disregarding the patient’s autonomy.
Norms Around Sexuality: Negative judgments about women’s sexual behavior, such as having multiple partners, are common. This perpetuates harmful stereotypes and stigmatizes women’s sexuality.

Maternity Injunctions

Women are often pressured to conform to societal expectations of motherhood, with comments on their bodies and beauty standards that valorize pregnancy over the postpartum period. This can include:

Comments on the Body: Women may receive unsolicited advice or criticism about their physical appearance, especially during and after pregnancy.
Beauty Canons: Societal expectations of how a pregnant or postpartum body should look can lead to feelings of inadequacy and self-doubt.
Valuing the Pregnant vs. Postpartum Body: Pregnancy is often celebrated, while the postpartum period is overlooked or criticized.

Refusal of Health Choices

Women’s choices, such as opting for tubal ligation, are frequently disrespected. Healthcare providers may refuse these requests, citing heteronormative views that a woman might change her mind if she meets the “right” man. This can involve:

Refusal of Tubal Ligation: Women may be denied the right to undergo sterilization procedures, with providers insisting they might regret the decision later.
Heteronormative Vision: The assumption that all women want to have children and will change their minds about sterilization if they find a suitable partner.

Sexualization and Blackmail

Inappropriate sexualization of women’s bodies and genitals, as well as blackmail for care, are prevalent issues. This can include:

Inappropriate Comments: Healthcare providers may make sexualized remarks about a woman’s body or genitals.
Blackmail for Care: Women may be coerced into agreeing to certain treatments or procedures under the threat of being denied care.

Infantilization and Paternalism

Women are often treated in an infantilizing manner, with healthcare providers making decisions for them rather than engaging in shared decision-making processes. This can manifest as:

Infantilizing Language: Using condescending or patronizing language when addressing patients.
Paternalistic Medical Framework: Making decisions on behalf of the patient without considering their preferences or autonomy.

The Patriarchal Framework

The underlying issue is a patriarchal vision of women’s bodies, where control over sexuality and reproductive health is seen as a norm. This paternalistic medical framework often overlooks the importance of informed consent and shared decision-making, leading to a power imbalance between healthcare providers and patients.

Types of Sexist Acts

According to the HCE report of 2021, sexist acts during gynecological and obstetrical care include:

Disregard for Patient Discomfort: Failure to acknowledge the patient’s discomfort during intimate consultations.
Judgmental Remarks: Comments about sexuality, dress, and weight that reinforce sexist norms.
Sexist Insults: Derogatory language directed at patients.
Non-Consensual Acts: Medical interventions performed without obtaining the patient’s consent or respecting their choices.
Medically Unjustified Acts: Performing or refusing acts that lack medical justification.
Sexual Violence: Including sexual harassment, assault, and rape.

Legal Framework and Consequences

The Kouchner Law of March 4, 2002, stipulates that healthcare providers must respect patients’ rights and obtain informed consent before any medical procedure. However, this law is often violated in the context of obstetrical and gynecological care, leading to severe consequences such as PTSD, anxiety, and depression.

Patients who experience such violence may develop a fear of seeking healthcare, leading to decreased use of medical services and a reluctance to disclose their health issues honestly. This can have profound impacts on their professional, family, and social lives.

Prevalence and Awareness

The prevalence of gynecologic and obstetrical violence is alarming, yet there is a lack of awareness among the general public and healthcare professionals. The 2016 VIRAGE survey by INED revealed that 15% of women and 4% of men (aged 20-69) have experienced sexual violence in their lifetime.

Objectives and Best Practices

The objective is to promote personal autonomy and informed decision-making. Healthcare providers should:

Inform, Not Convince: Provide patients with the information they need to make free and informed choices.
Respect Choices: Always leave the choice open and ensure that patients understand they are not obligated to follow any particular course of treatment.
Avoid Domination: Be mindful of power dynamics and avoid paternalistic attitudes.
Seek Consent: Ask for permission before performing any procedure and respect the patient’s right to refuse.
Adopt an Empathetic Attitude: Use understandable language, introduce yourself, and ask open-ended questions to encourage patients to express their concerns.
Include the Patient Actively: Engage patients in the decision-making process, ensuring they feel heard and valued. This involves:
Shared Decision-Making: Collaborate with patients to make decisions that align with their values and preferences.
Active Listening: Pay attention to the patient’s concerns, questions, and preferences without interrupting or imposing your views.
Provide Options: Present all available options, including the risks and benefits, and allow the patient to choose the one that best suits her needs.
Encourage Questions: Create an environment where patients feel comfortable asking questions and expressing their thoughts.
Follow-Up: Ensure that the patient’s decisions are respected and followed through, and provide support throughout the process.

Gynecologic and obstetrical violence is a complex issue rooted in patriarchal norms and paternalistic medical practices. Addressing this problem requires a concerted effort to promote informed consent, respect patients’ autonomy, and foster a more equitable healthcare environment. By adopting best practices and raising awareness, we can work towards eliminating this form of violence and ensuring that all women receive the respectful and compassionate care they deserve.

Sources: Rapport HCE 2018 https://www.haut-conseil-egalite.gouv.fr/IMG/pdf/
hce_les_actes_sexistes_durant_le_suivi_gynecologique_et_obstetrical_20180629.pdf

SARGENIUM Women’s Health • The French Way