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Resolution 2306 (2019)
Obstetrical and gynaecological violence
1. The European Union Agency for Fundamental
Rights reports that one in three women in Europe is a victim of
gender-based violence. This violence is a violation of human rights,
a manifestation of gender discrimination and has long-term consequences
on the lives of victims. No area is spared by this scourge, which
has been recognised as a public issue for which authorities have
a clear responsibility following the adoption and entry into force
of the Council of Europe Convention on Preventing and Combating
Violence against Women and Domestic Violence (Istanbul Convention,
CETS No. 210).
2. The Parliamentary Assembly reiterates its unwavering support
for the Istanbul Convention, confirmed in Resolution 2289 (2019) “The Istanbul
Convention on violence against women: achievements and challenges”. It
supports the prevention of and fight against all forms of violence
against women and recalls that awareness-raising activities for
the general public are essential in order to put an end to such
violence.
3. Obstetrical and gynaecological violence is a form of violence
that has long been hidden and is still too often ignored. In the
privacy of a medical consultation or childbirth, women are victims
of practices that are violent or that can be perceived as such.
These include inappropriate or non-consensual acts, such as episiotomies
and vaginal palpation carried out without consent, fundal pressure
or painful interventions without anaesthetic. Sexist behaviour in
the course of medical consultations has also been reported.
4. Obstetrical violence is recognised and punished by law in
Argentina and Venezuela. Article 39 of the Istanbul Convention specifically
condemns forced abortion and forced sterilisation, but it does not
generally address obstetrical and gynaecological violence. Back
in 2014, the World Health Organization (WHO) strongly criticised
the disrespectful and abusive treatment that women may suffer while
giving birth in hospital. In August 2019, Dubravka Šimonović, United
Nations Special Rapporteur on violence against women, its causes
and consequences, submitted a report entitled “A human rights-based
approach to mistreatment and violence against women in reproductive
health services with a focus on childbirth and obstetric violence”
to the United Nations General Assembly.
5. In a few Council of Europe member States, awareness-raising
campaigns have been conducted on social networks and numerous testimonies
have been collected in recent years. This greater willingness to
talk about the problem and the sharing of experiences have enabled
women victims of gynaecological and obstetrical violence to realise
that these were not isolated cases. This violence reflects a patriarchal
culture that is still dominant in society, including in the medical
field. The Assembly reaffirms its commitment to promote gender equality
in all areas, which will make it possible to prevent and combat
all forms of violence against women, including obstetrical and gynaecological
violence.
6. The Assembly commends the work and commitment of health-care
personnel. It acknowledges that their working conditions in health-care
institutions can be difficult, owing to staff shortages, limited
resources and excessive workloads that can have an impact on the
way patients and women about to give birth are treated. Nevertheless,
it deplores all forms of violence against women, including gynaecological
and obstetrical violence, and calls for all necessary preventive
measures to be taken and for the human rights of all to be upheld,
in particular in the health-care context.
7. The prevention of and fight against gynaecological and obstetrical
violence are not yet considered priorities, but caring and compassionate
practices can be promoted in order to ensure humane, respectful
and dignified reception of and support for patients and women about
to give birth. The Assembly fully supports the good practices identified
by WHO and encourages their dissemination within Council of Europe
member States.
8. In the light of these considerations, the Assembly calls on
Council of Europe member States to:
8.1. prevent and combat discrimination on whatever grounds
in access to health care in general;
8.2. ensure that care is provided in a manner that respects
human rights and human dignity, during medical consultations, treatment
and childbirth;
8.3. call on the ministries responsible for health and equality
to collect data on medical procedures during childbirth and cases
of gynaecological and obstetrical violence, to undertake studies
on this subject and to make them public;
8.4. disseminate the good practices promoted by WHO and ask
national medical associations to discuss this issue and make recommendations
to prevent gynaecological and obstetrical violence, in particular
through a commission to promote a caring approach in gynaecology;
8.5. conduct information and awareness-raising campaigns on
patients’ rights and on preventing and combating sexism and violence
against women, including gynaecological and obstetrical violence;
8.6. enact and implement legislation on the informed consent
of patients and their right to information at the various stages
of medical procedures, if this has not yet been done;
8.7. ensure appropriate funding for health-care facilities
so as to ensure decent working conditions for care providers, respectful
and caring reception of patients and women in labour and access
to pain relief;
8.8. provide specific training for obstetricians and gynaecologists
and raise awareness of gynaecological and obstetrical violence as
part of this training;
8.9. ensure that the training of doctors, midwives and nurses
attaches particular importance to the relationship between care
providers and patients, the concept of informed consent, equality
between women and men, the reception of LGBTI persons, persons with
disabilities and vulnerable persons, communication, the prevention
of sexism and violence, and the promotion of a humane approach to care;
8.10. propose specific and accessible reporting and complaint
mechanisms for victims of gynaecological and obstetrical violence,
within and outside hospitals, including with ombudspersons;
8.11. provide for a mechanism to examine complaints about gynaecological
and obstetrical violence excluding any mediation, and provide for
sanctions, if this is not yet the case, against health-care professionals
when a complaint about this kind of violence is proven;
8.12. offer a support service to victims of gynaecological and
obstetric violence and ensure that care is provided;
8.13. for those States that have not yet done so, sign, ratify
and implement the Istanbul Convention;
8.14. implement Recommendation CM/Rec(2019)1 of the Committee
of Ministers on preventing and combating sexism.
9. The Assembly also calls on national parliaments to discuss
the protection of patients’ rights in the context of care and gynaecological
and obstetrical violence in order to contribute to public debate
and the lifting of taboos.
10. The Assembly encourages non-governmental organisations to
continue their efforts to raise awareness and inform public opinion
in order to prevent and combat all forms of violence against women,
including gynaecological and obstetrical violence.