A Foucauldian Approach to Obstetrical Violence

A historical analysis of medical practice and the creation of medical knowledge has shown that violence, while it has often not been labeled as such, is intrinsic to the current modes of medicine. Medical discoveries, such as the pill, gynecology, or many pharmaceutical advancements are made through structured violence, whether coerced or by a lack of consent. While obstetrical violence is in itself gendered, links between the law, autonomy, and power relations show that the cases of OV cannot be tackled through women-centered programs, or the law solely, but through power discourse. Medicalized violence is enacted due to medical professions’ authoritarian positioning and patients pathologizing, infantilizing, and victimizing positions. While much-medicalized violence has often occurred on the marginalized, which are often women of color, disabled, and or queer people. Men are also victims of this violence, unfortunately, possibly more than is accounted for due to fears of speaking out (Sable et al, 2006, p.160; NCADV, 2015). Misconceptions, stereotypes, and the framing of women are also impacting the ways pregnant people receive care, but the focus on sexism and discrimination may not be the most yieldable to end obstetric violence. Through a critique of the current studies on obstetrical violence in the United States and Europe, it may be shown how violence is not only enacted because of the perception of social categories, but due to an overmedicalized power relation reflected in the law and pathologizing medical paradigms of today.

A study on midwives in Spain found that 26 % of them had seen instances of OV regularly. Strangely, 74.2% of participants did not consider OV as a form of professional malpractice, which is both intriguing and contradictory (Martínez-Galiano et al, 2023, p.8). This could also be a cite to create transformative discourse, Meyer and her colleagues found that the term ‘mistreatment’ during childbirth offered a wider and more inclusive notion of obstetrical violence (Meyer et al, 2021, p.2). This study from Switzerland found that 20.9% of patients felt a lack of professional care, and poor rapport, including a lack of autonomy (pp.7). Mistreatment, violence, and malpractice should be under the same umbrella, especially when what could be considered a mistreatment or violent act is not regarded as such in different norms and environments (Diaz-Tello, 2016, p.60). This would allow for better categorizing and therefore better control of forms of OV. Informal coercion is present in almost all studies on OV and often takes the form of threatening or intimidation focused on the unborn child (pp.8; Villarmea and Kelly, 2019, p.516). Among midwives in Spain, 67.4 % of them found that treating a pregnant woman like a child is not a form of grave violence (Martínez-Galiano et al, 2023, p.6). Similarly, half of the participants did not think it was considered abusive to reprimand a pregnant women’s behavior (pp.7).

These findings are alarming as 92% of the midwives did report OV in their careers, however, if the scope of what is contemplated as OV is too small and subjective, then the instances are much greater than the recorded data (pp.9). Researchers in Switzerland found that 28 % of their 3,547 participants reported informal coercion. Amongst a loss of autonomy is a loss of communication, whereby several women report not being listened to or being spoken to like a child (pp.8). Out of more than 17,500 women, 38% of them had experienced suffering from OV. Between 41 to 46 % of them were not asked for consent and were not provided with information (Mena-Tudela, 2020, p.8). In Spain, 44% of 17,541 women had perceived unnecessary painful procedures during their childbirth and 90 % of them were not asked for consent during these painful procedures (Mena- Tudela, 2020, p.7). Further, 1 in 5 births in France ended with episiotomies and 50 percent of them were unconsented. Spain and Italy also have high numbers of unconsented practices, verbal abuse, and physical abuse (Perrotte et al, 2020, p.1553). All of these numbers show the urgent need for a universal reform of maternity care.

Europe and the United States, similar to most countries across the globe, are discriminatory to different social categories, namely black, queer, immigrant, and disabled women. Due to the common theme of autonomy and consent in instances of OV, there seems to be an added layer of nuance when it comes to disabled individuals. “Obstetric violence against disabled women becomes even more “normalized” and institutionalized than violence against non-disabled women” (Wudneh, 2022, p.2). Research on women with disabilities found that physical abuse was the most common source of violence, while abled women sought coercion and lack of consent was the highest form of violence (pp.9). In their study, an alarming number of participants found that slapping was an understandable way of establishing cooperation as long as there was no “desire to harm” (pp.7). This shows the danger of a lack of awareness of OV and the internalizing ideology that the doctor always knows best. A study in France from 2022 has shown that out of 2,135 women, 70 percent of those women self- reported an overall positive experience of childbirth (Arthuis et al, 2022, p.4). While this is not an alarming number statistically, further data showed other significant numbers. 24.6% of these women had induced labor, 13.5% had an episiotomy, 17.1% had instrumental aided vaginal deliveries, and 14.9% of these births were done by cesarean section. This does question the nature of medical practices. In the study, these were not perceived as negative either by the researchers or the participants, which is logical as it was a self-reported analytical study. One year prior, Salles reflected on the onset of denouncing French obstetrical violence, including the dangers and or lack of comfort in speaking out about the trauma (Salles, 2021, p.661).

Discussions of OV inevitably lead to questions of gendered violence. As Diaz-Tello eloquently states, “In a society where women’s capacity for pregnancy has been historically used to sanction their exclusion from full citizenship, is more than a simple battery. It [forced surgeries] is a form of gender-based violence” (Diaz-Tello, 2016, p.57). She argues that because of this historical violence, solutions centered on civil law or the state are not efficient. Amongst the main issues of focusing on the law as a solution, is the difficulty in finding an attorney who will accept such cases of OV, the legal access women have, and the financial means of these women. The overarching critique she has of the civil system is that obstetrical violence is either considered a one-time personal occurrence that is ignored or considered insignificant financially, or it is considered a medical error (Borges, 2018, p.837). The concept of “obstetric logic” is used against claims of battery, reinforcing the power doctors already have (Perrotte et al, 2020, p.1557). In the United States, childbirth facilities are not required to disclose their standards of care and practices. This means that the number of c-sections or use of tool intervention during birth is not made public. Courts have also argued that if a woman decides to give birth in a hospital, it translates to her consent of the hospital’s practice (pp.841). This is a dangerous misconception of ‘consent’.

While men are told to keep quiet about their pain, women are told their pain is normal (Grace and MacBride-Stewart, 2007, p.49). This has shaped a society and a medical system where when men do happen to express pain, although it may be quite late, they will receive medical attention. Women’s expression of pain, on the other hand, may be ignored or solved by male-focused remedies taken from male studies. Grace and MacBride-Stewart’s study have found that women perceive their chronic unresolved pelvic pain as something that women have and should accept (pp.53). This happens interpersonally through discourse around menstruation and hormonal changes (pp.57). On a systematic level, hormones are often what people use to downplay or ignore women’s feelings. If one is too angry, one is on their period, and a too-emotional woman is considered a normal, hormonal woman in comparison to the posed, rational, male. Further, as Kukura writes, motherhood today revolves around the idea of sacrifice and maternal instincts, which are to care for and love their child unconditionally. To be a good mother and wife is to submit yourself to others’ needs physically and mentally, which is an argument often used in the courtroom and in the private, interpersonal sphere (Kukura, 2018, p.776).

The question of gender and OV is interlocked. As noted previously, a midwife’s acceptance of treating women like children reflects a bigger issue. Often, pregnant women are not seen as being at full capacity. This may be true in some instances but rarely actually reflects reality (Villarmea and Kelly, 2019, p.517). Analyzing the relationship between the essentialization of women as reproductive ovens, control, and the irrationality, emotional, hysteric woman is important to the possible ways women are treated while giving birth. 34.5 % of the birthing women had received ironic or discrediting remarks and 31.4% had been associated with children (Mena-Tudela, 2020, p.7). This is also important because it was found that women have come to normalize and internalize essentialist forms of sexism and discrimination (pp.10). This is not surprising if one lives in a society that normalizes pain for women, normalizes their passivity, and normalizes medical violence and authority. Delay and Sundstrom relate to Cohen’s paper on obstetric violence which pushed a focus on the controlling of women’s bodies through the maternal body. In their historical account of symphysiotomies in Ireland, Delay and Sundstrom argue that this procedure was done to restrain the female body during childbirth in unnecessary and painful ways, but also the long- term effect of the procedures “caused extensive, and sometimes life-long, pain, disability, and infirmity, thus immobilizing women, or at least hindering their mobility and thus their agency, for decades” (Delay and Sundstrom, 2020, p.209). The history of the womb and medical practice haunts the medical doctrine of maternity care today, where a woman is reduced to her uterus in emotional and physical ways.

"Modern maternity care rests on the paternalistic views of male physicians in the nineteenth and early twentieth centuries who declared themselves experts in childbirth and introduced a variety of interventions on the assumption that female weakness required pain medication and other interference with the body’s natural labor process" (Kukura, 2018, p.775).

The question of the medical paradigm resides in the continuity of exacerbated control and amount of power placed in medical hands.

Medical violence, for the sake of this essay, refers to the ways the medical system is on the giving end of violence either physically, mentally, or structurally. Policymaking and other institutional structures surrounding health are considered another source of violence that can also affect access to care. Notions of autonomy and consent become blurred in individual subjectivities but also within the laws and the reinforcement of a particular kind of violence towards disabled bodies. Keeping in mind the complexity of disablement is important in figuring out solutions to medical violence as it leads to an often-ignored gray area in medicine (Dowse and Steele, 2016, p.195). One where acts of violence are not considered violent due to the mental and or physical state of the patients, in a society that attributes negative connotations to being disabled and a woman, ignoring the lived experiences of ‘the other’.

In this realm of social outcasts, we find that the medical sphere can “sterilize its violence” (Malatino, 2019, .138). Medical violence may come from the attention given too much on the physical rather than the emotional or psychological (Mena-Tudela, 2020, p.9). Science revolves around hypothesis, testing, and training. To test solutions to medical problems, humans are logically the best subject samples. Ethical considerations of human testing have been a hot topic for decades. Today, unconsented pelvic examinations are debated on their necessary and ethical considerations. This paper aims to push forth the idea that any unconsented acts cannot be legitimized in any way, sadly, this is not the case. Many policies and hospitals have not yet ceased these practices. Some practitioners have called to end intimate medical exams altogether as 54.4 % of 2.6 million intimate medical exams have been deemed unnecessary in the United States alone (Bruce, 2020). Little institutions in the US have regulations on these practices, and when they do, they explicitly target women and not men, which are also victims of unconsented medical exams (Bruce, 2020). The problem with these practices, apart from the psychological trauma of the patients, is the ways it is reinforced through each generation of young students.

Students are often pushed to please their supervisors or to gain experience and do not want to refuse a learning experience. Once a student does an unconsented medical exam, the notion of consent becomes less important in their future, as they are in an environment allowing such practices (Bruce, 2020). Bruce’s understanding of consent was also questionable and did not go far enough in questioning the issue. He highlights that a doctor does not equate pelvic exams with sexual activity, yet a patient might, therefore “unconsented intimate exam may feel like a sexual violation to patients” (Bruce, 2020).

However, any unconsented touch is a violation, an unconsented pelvic exam is therefore inherently a sexual violation related directly to the sexual organs. When there is no specific consent, or there is an unconscious person, there is simply no consent, therefore there should not be any discussion on the legitimization of it. Further, birth under these conditions causes women to reasonably relate their experience to sexual assault due to “the bodily harm being imposed on them by perpetrators with physical and emotional power over them” (Perrotte et al, 2020, p.1554). The James Burt case strengthens the notion of superiority and protection given to medical staff (McClellan, 2023, p.56). Burt was able to perform violent, unconsented surgeries for more than two decades without anyone in the hospital reporting him. Many instances occur of medicalized authority being the sole factor in ambiguous and unnecessary practices. The Bowery series (pp. 131), black women in the making of gynecology (Cooper, 2017), the making of the contraception pill (Pendergrass and Raji, 2017), and understanding evil psychology in the Milgram experiment (Eldridge, 2022) are just small accounts of the many instances of medical violence. While these cases have come to light in order to question ethics, it also allows one to assume that many more instances have not been brought to the public eye, and when they do, they may be easily dismissed. Obstetrical violence has come to surface as a systematic issue through social media, but not through common sense or empathy from the medical sphere (Salles, 2021). It is this ignorance and this silence that suggests certain medical norms of today should be questioned and brought to the surface.

“And we felt like, really like part of a production system, you know. We felt in a rush, like everything has to be in a rush, and it’s ta ta ta ta ta, and we really felt extremely bad with this, it was terrible for us.” (Meyer et al, 2022, p.10)

Little of the literature around OV has called out the hyper-medicalization of birth explicitly enough, except for Kukura’s in-depth overview of OV. “Hyper-medicalization refers to the ‘overuse or misuse of medicine and technology in health care’” (Perrotte et al, 2020, 1556). This hyper-medicalization has many negative impacts, namely a technological divide between doctor and patient, rendering the process less humanistic (Kukura, 2018, p. 770). Most importantly, women are seen as even less important because doctors and technologies are more intelligent and accurate. Yet, why is childbirth considered part of the medical arena altogether? This is not to say that childbirth should not occur in medicalized settings or that one should not have access to medical practice, which can be lifesaving, reassuring, and extremely helpful. I argue, however, that the framing of childbirth has become so medicalized in a particular medical setting, that it inhibits any form of transformative change regarding OV. Seeing childbirth as a ‘condition’ rather than as an empowering act dehumanizes and medicalizes the experience.

Implementing Foucault’s work allows for a broader contextualization of OV due to three of his theorizing. One of which is his theory of biopower, a term indicating the regulation of society through the body. The second is his emphasis on the shift of the medical gaze and medicalized power structure between the Middle Ages to the 20th century. A third point is his historical account of the hospital and the original use of these facilities.

"Il est clair que l’internement, dans ses formes primitives, a fonctionné comme un mécanisme social, et que ce mécanisme à jouer sur une très large surface, puisqu’il s’est étendu des régulations marchandes élémentaires au grand rêve bourgeois d’une cité our regnerait la synthèse autoritaire de la nature et de la vertu" (Foucault, 1972, p.92).

In his historical analysis of the asylum, the hospital, and medicine, Foucault describes the original link between the rejects of society who were sent to internment far from the ‘normal’ masses. These internment facilities were gradually also focused on imprisoning the insane until they became asylums and then, hospitals. He writes that while medicine is independent of internment and hospitalization, there reigns a discourse of control, associated with the same discourse used in the alienation of the hysterics and ‘insane’ of the medieval days (pp.325). The notion of the hospital as a way to control citizens is important and far more elaborated in his book The Birth of a Clinic. The clinic now is part of a production system whereby the medical professional has the same allocated power as the clergy from the century before, “the myth of a nationalized medical profession, organized like the clergy, and invested, at the level of man’s bodily health, with powers similar to those exercised by the clergy over men’s souls” (Foucault, 1963, p.31). This shift, also known as a shift in the medical gaze, has allowed for a distancing between people and healers, the patient, and the doctor. The doctor is seen as the one with the most power, eliminating the “sensible” individual.

The “truth” of the body is seen by the doctor’s eye, not through the patient’s mind (pp.115). While a full analysis of the Foucauldian perspective on the medical paradigm today is beyond the scope of this essay, the reality is that obstetric violence can only be tackled once the environment it thrives in is dismantled. The participant’s quote of feeling like a production system reflects a chain-like commanding approach to childbirth. This production system is quite significant for women’s history where they have been painted as mere reproductive systems, ovens of society’s babies. An essentialization useful for the control of women. Biopower in the analysis of gendered OV, is reflected in the internalization nature of this abuse of medical authority. As Diaz-Tello writes, the fact that the law is not on women’s side in these contexts is often because it is considered a medical error. This medical error is often disregarded as not being systematic, or of any significance (pp.60). This is not solely because women are so often disregarded or discredited, it is also because the medical sphere is unquestioned.

Similarly, to Sara Shabot’s take on obstetrical violence, this paper pushes for an enlargement of the solution so as to deviate the attention away from women to a bigger societal issue. Shabot argues that one cannot solve the factors that lead to obstetrical violence without moving away from a discourse that still does not resonate with an appropriate birth for the human species; one that allows for the necessary “shared and communal” aspect of birth (Shabot, 2020, p.10). This focus, although not stated in her paper, inevitably calls into question the current framework of medicalization today, which involves a focus on the body and the body parts, rather than a holistic approach, as Foucault analyzes.

Childbirth, although it can be dangerous and is rather a significant act, does not have to be considered part of the pathologizing discourse, and yet it is. This is mainly because everything that is part of the medical sphere is inherently pathologized. Childbirth violence cannot be solved because it is in a violent and unfriendly environment. OV has become a problem within a problematizing, unquestioned, and sometimes invisible sphere. As Foucault wrote, power often works best and the most efficiently when it is invisible (Foucault, 1975). Nonetheless, this should not take away from the gendered experience of pain and the body due to being a woman, “objects within patriarchal society, prone to shame, alienated from their bodies, and expected to remain passive” (Shabot, 2020, p.2).

The passive attribution of women is even more prominent in issues regarding reproduction. From discourse around the egg to menstrual pain, to the desired state of women during sex, to the overemphasis on medical needs rather than the mothers’ needs in childbirth, femininity seems to be synonymous with passivity (Campo-Engelstein and Johnson, 2012, p.203; Hrdy, 1999, p.132; Kinsey, 1975, p.575). This particular approach to targeting obstetrical violence is significant as it questions how rights such as autonomy have been construed around neoliberal strategies (Shabot, 2020, p.3). It probes at tackling the problem to move away from one’s body, towards one’s environment and support network, two aspects crucial to a positive birth.

Salles’ paper proposed to reinstate the body and lived experience as proof of violence in order to stop the process of invisibility and ignorance that victims of obstetrical violence often face to put an end to the practice altogether (Salles, 2021, p.661). The creation of non-hyper-medicalized spaces for pregnant women has also been proposed, such as home births, and a return to “the roots of midwifery” (Perrotte et al, 2020, 1557). Bruce’s analysis of intimate exams proposes that the medical school curriculum be changed to better understand consent, the necessity for IME and the ways we practice on patients. Focusing on education is a priority in addressing these issues both in Sex ed classes which could focus on how to advocate women’s rights, but also in the medical student’s courses.

Covid-19 has shown that a lack of care towards women, and too much power given to the medical sphere, led to the detrimental ways pregnancy and childbirth were handled during Covid 19 lockdown phases. Women in France lacked access to care, appointments, and personnel which led them to change their decisions surrounding their pregnancy out of fear (Doncarli et al, 2021, p.7). Although more research is needed, there were harmful effects on the birth and pregnancy process throughout Covid 19 lockdowns, for example, the lack of partner and social support allowed during birth (Lavender et al, 2020). Similarly, forced mask- wearing during birth became very controversial (Hird, 2020; Oppenheim, 2021; Summers, 2021). This negatively reflects multiple aspects of social norms, considering that pregnancy and childbirth are physically harder than most, if not all, sports (Miller et al, 2015; Thurber et al, 2019). This does reflect the overarching theme that women are deemed as less than the rest of the population (men). They are seen as more passive, and their labor, both physically and mentally, is considered less than males. The consequences of Covid restrictions, albeit made in a time of urgency and uncertainty, were not labeled as violence within academia or medical protocols. This may be due to the recentness of the events, or due to the constraints of an urgent situation.

While the impact of Covid was hard for almost everyone, pregnancy and birth are a particular time of stress and vulnerability for women. This essay proposes more research into the deconstruction of a coercive, abusive, medical authority, to return to a more holistic and healing approach to individuals. Education and awareness as well as more solidarity among pregnant individuals on a horizontal power axis may lead to transformative activism towards more just maternity care.

References

Allers, K. S. (2020, February 5). Perspective | obstetric violence is a real problem. Evelyn Yang’s experience is just one example. The Washington Post. https://www.washingtonpost.com/lifestyle/2020/02/06/obstetric-violence-is-real-problem- evelyn-yangs-experience-is-just-one-example/

Armstrong, E. M., Markens, S., Waggoner, M. R., Delay, C., & Sundstrom, B. (2019). The Legacy of Symphysiotomy in Ireland: A Reproductive Justice Approach to Obstetric Violence. In Reproduction, health, and medicine (Vol. 20, Ser. Advances in Medical Sociology, pp. 197–218). essay, Emerald Publishing. Retrieved May 9, 2023, from https://web-p-ebscohost- com.proxy.aup.fr/ehost/ebookviewer/ebook/ZTAwMHh3d19fMjIyNDcyN19fQU41?sid=0af 94a7c-4670-4adc-841e-ecc7dabd7f07@redis&vid=0&format=EB&lpid=lp_195&rid=0.

Arthuis, C., LeGoff, J., Olivier, M., Coutin, A.-S., Banaskiewicz, N., Gillard, P., Legendre, G., & Winer, N. (2022). The experience of giving birth: a prospective cohort in a French perinatal network. BMC Pregnancy and Childbirth, 22(1), NA. https://link-gale- com.proxy.aup.fr/apps/doc/A705094374/AONE?u=aupl&sid=bookmark- AONE&xid=9224dbb7

Borges, M. T. R. (2018). A Violent Birth: Reframing Coerced Procedures During Childbirth as Obstetric Violence. Duke Law Journal, 67(4), 827+. https://link-gale- com.proxy.aup.fr/apps/doc/A529490695/AONE?u=aupl&sid=bookmark- AONE&xid=f38a83a0

Bowser, D. and Hill, K. (2010) Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth: Report of a Landscape Analysis. Harvard School of Public Health and University Research, Washington DC.

Bruce L. (2020). A Pot Ignored Boils On: Sustained Calls for Explicit Consent of Intimate Medical Exams. HEC forum: an interdisciplinary journal on hospitals' ethical and legal issues, 32(2), 125–145. https://doi.org/10.1007/s10730-020-09399-4

Campo-Engelstein, L., & Johnson, N. (2014). Revisiting “The fertilization fairytale:” an analysis of gendered language used to describe fertilization in science textbooks from middle school to medical school. Cultural Studies of Science Education, 9(1), 201–220. https://doi- org.proxy.aup.fr/10.1007/s11422-013-9494-7

Castañeda, A. N., Hill, N., & Searcy, J. J. (Eds.). (2022). Obstetric Violence: Realities, and Resistance from Around the World. Demeter Press. https://doi.org/10.2307/j.ctv2b11ppk

Cooper Owens, D. (2017). Medical Bondage: Race, Gender, and the Origins of American Gynecology. Athens: University of Georgia Press., doi:10.1353/book.64082.

Dekker, R. (2022, October 11). The Evidence on: Birthing Positions. Evidence Based Birth. https://evidencebasedbirth.com/evidence-birthing-positions/

DiFranco, J., Curl, M. (2014). Healthy Birth Practice #5: Avoid Giving Birth on Your Back and Follow Your Body's Urge to Push. The Journal of Perinatal Education, 23(4), 207-210. https://doi.org/10.1891/1058-1243.23.4.207

Doncarli, A., Araujo-Chaveron, L., Crenn-Hebert, C., Demiguel, V., Boudet-Berquier, J., Barry, Y., Gomes Do Espirito Santo, M.-E., Guajardo-Villar, A., Menguy, C., Tabaï, A., Wyndels, K., Benachi, A., & Regnault, N. (2021). Impact of the SARS-CoV-2 pandemic and first lockdown on pregnancy monitoring in France: the COVIMATER cross-sectional study. BMC Pregnancy and Childbirth, 21(1), NA. https://link-gale- com.proxy.aup.fr/apps/doc/A686391795/AONE?u=aupl&sid=bookmark- AONE&xid=98da490d

Eldridge, S. (2022). Milgram experiment. Encyclopedia Britannica. https://www.britannica.com/science/Milgram-experiment

Elvander, C., Ahlberg, M., Thies-Lagergren, L., Cnattingius, S., & Stephansson, O. (2015). Birth position and obstetric anal sphincter injury: A population-based study of 113 000 spontaneous births. BMC Pregnancy and Childbirth, 15(1). https://doi.org/10.1186/s12884- 015-0689-7

Farah Diaz-Tello, J. D. (2016). Invisible wounds: obstetric violence in the United States. Reproductive Health Matters, 24(47), 56–64. https://www.jstor.org/stable/26495891

Fish, & Karban (2015). Lgbt health inequalities. Policy Press. https://ebookcentral-proquest-com.proxy.aup.fr/lib/aup/detail.action?pq-origsite=primo&docID=2005988#

Foucault, M. (1963). The Birth of the Clinic: An Archaeology of Medical Perception. (A. Sheridan, Trans.) Monoskop. Presses Universitaires de France. Retrieved May 14, 2023, from https://monoskop.org/images/9/92/Foucault_Michel_The_Birth_of_the_Clinic_1976.pdf.

Foucault, M. (1972). Histoire de la Folie à l’âge classique. Gallimard.

Foucault, M. (1975). Discipline and punish: The birth of the prison. Monoskop. Vintage Books (1995). Retrieved May 12, 2023, from https://monoskop.org/images/4/43/Foucault_Michel_Discipline_and_Punish_The_Birth_of_t he_Prison_1977_1995.pdf.

Frank M. McClellan. (2020). Healthcare and Human Dignity: Law Matters. Rutgers University Press.

Grace, V. M., & MacBride-Stewart, S. (2007). “Women get this”: gendered meanings of chronic pelvic pain. Health, 11(1), 47–67. http://www.jstor.org/stable/26649811

Green, A. (2022). Obstetric violence: Hidden in silence. EVN Report. https://evnreport.com/raw- unfiltered/obstetric-violence-hidden-in-silence/

Hird, A. (2020, October 17). Women in France recount trauma of wearing masks during childbirth. RFI. https://www.rfi.fr/en/france/20201017-women-in-france-recount-trauma-of- wearing-masks-during-childbirth

Kinsey, A.C., Pomeroy, W. B., & Martin, C. E. (1975). Sexual Behavior in the Human Male. Indiana University Press. http://www.jstor.org/stable/j.ctt173zmh5

Kukura, E. (2018). Obstetric Violence. Georgetown Law Journal, 106(3), 721+. https://link-gale- com.proxy.aup.fr/apps/doc/A537719095/AONE?u=aupl&sid=bookmark- AONE&xid=bffe0c61

Lavender, T., Downe, S., Renfrew, M., Spiby, H., Dykes, F., Cheyne, H., Page, L., Sandall, J., & Hunter, B. (2020). Rapid Analytic Review: Labour and Birth Companionship in a Pandemic Companionship of Choice for Asymptomatic Childbearing Women in Hospital throughout Labour and Birth. The Royal College of Midwives. https://www.rcm.org.uk/media/3951/birth-companionship-in-a-pandemic-master-27-04- 2020-002.pdf

Malatino, H., & Malatino, H. (2019). Black Bar, Queer Gaze. In Queer embodiment: Monstrosity, medical violence, and Intersex experience (pp. 129–158). University of Nebraska Press. Retrieved May 9, 2023, from https://ebookcentral-proquest- com.proxy.aup.fr/lib/aup/detail.action?docID=5703156.

Martínez-Galiano, J. M., Rodríguez-Almagro, J., Rubio-Álvarez, A., Ortiz-Esquinas, I., Ballesta- Castillejos, A., & Hernández-Martínez, A. (2023). Obstetric Violence from a Midwife Perspective. International Journal of Environmental Research and Public Health, 20(6), 4930. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph20064930

Hrdy, S. B. (1999). The woman that never evolved: With a new preface and bibliographical updates, revised edition. Harvard University Press.

Mena-Tudela, D., Iglesias-Casás, S., González-Chordá, V. M., Cervera-Gasch, Á., Andreu-Pejó, L., & Valero-Chilleron, M. J. (2020). Obstetric Violence in Spain (Part I): Women’s Perception and Interterritorial Differences. International Journal of Environmental Research and Public Health, 17(21), 7726. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph17217726

Meyer, S., Cignacco, E., Monteverde, S., Trachsel, M., Raio, L., & Oelhafen, S. (2022). 'We felt like part of a production system': A qualitative study on women's experiences of mistreatment during childbirth in Switzerland. PLoS ONE, 17(2), e0264119. https://link-gale- com.proxy.aup.fr/apps/doc/A694210684/AONE?u=aupl&sid=bookmark- AONE&xid=fd73511b

NCADV: National Coalition Against Domestic Violence. The Nation’s Leading Grassroots Voice on Domestic Violence. (2015). https://ncadv.org/STATISTICS

Oppenheim, M. (2021, May 14). Hundreds of women forced to “wear face masks while giving birth.” The Independent. https://www.independent.co.uk/news/uk/home-news/women-birth- face-masks-hospital-b1846395.html

Pařízek, A., Janků, P., Kameníková, M., Pařízková, P., Javornická, D., Benešová, D., Rogalewicz, V., et al. (2023). Laboring Alone: Perinatal Outcomes during Childbirth without a Birth Partner or Other Companion during the COVID-19 Pandemic. International Journal of Environmental Research and Public Health, 20(3), 2614. MDPI AG. Retrieved from http://dx.doi.org/10.3390/ijerph20032614

Pendergrass, D., & Raji, M. (2017). The bitter pill: Harvard and the dark history of birth control: Magazine: The Harvard Crimson. Magazine | The Harvard Crimson. https://www.thecrimson.com/article/2017/9/28/the-bitter-pill/

Perrotte, V., Chaudhary, A. and Goodman, A. (2020) “At Least Your Baby Is Healthy” Obstetric Violence or Disrespect and Abuse in Childbirth Occurrence Worldwide: A Literature Review. Open Journal of Obstetrics and Gynecology, 10, 1544-1562.doi: 10.4236/ojog.2020.10110139

Sable, M. R., Danis, F., Mauzy, D. L., & Gallagher, S. K. (2006). Barriers to Reporting Sexual Assault for Women and Men: Perspectives of College Students. Journal of American College Health, 55(3), 157–162. https://doi-org.proxy.aup.fr/10.3200/JACH.55.3.157-162

Salles, C. (2021). Le rôle des représentations visuelles et audiovisuelles dans la reconnaissance de la notion de « violences obstétricales » en France et en Belgique. Santé Publique, 33, 655- 662. https://doi-org.proxy.aup.fr/10.3917/spub.215.0655

Shabot, S. C. (2021). We birth with others: Towards a Beauvoirian understanding of obstetric violence. European Journal of Women’s Studies, 28(2), 213–228. https://doi- org.proxy.aup.fr/10.1177/1350506820919474

Steele, L., & Dowse, L. (2016). Gender, Disability Rights and Violence Against Medical Bodies. Australian Feminist Studies, 31(88), 187–202. https://doi- org.proxy.aup.fr/10.1080/08164649.2016.1224054

Summers, H. (2021, May 14). UK women forced to wear face masks during labour, Charity finds. The Guardian. https://www.theguardian.com/lifeandstyle/2021/may/14/uk-women-forced-to- wear-face-masks-during-labour-charity-finds

Thurber, C., Dugas, L. R., Ocobock, C., Carlson, B., Speakman, J. R., & Pontzer, H. (2019). Extreme events reveal an alimentary limit on sustained maximal human energy expenditure. Science Advances, 5(6). https://doi.org/10.1126/sciadv.aaw0341

Villarmea, S., & Kelly, B. (2020). Barriers to establishing shared decision‐making in childbirth: Unveiling epistemic stereotypes about women in labour. Journal of Evaluation in Clinical Practice, 26(2), 515–519. https://doi-org.proxy.aup.fr/10.1111/jep.13375

Wudneh, A., Cherinet, A., Abebe, M., Bayisa, Y., Mengistu, N., & Molla, W. (2022). Obstetric violence and disability overlaps: obstetric violence during childbirth among womens with disabilities: a qualitative study. BMC Women's Health, 22(1), NA. https://link-gale- com.proxy.aup.fr/apps/doc/A710745889/AONE?u=aupl&sid=bookmark- AONE&xid=396f9a46