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ARGENTINA: Systematic Mistreatment of Low-Income Pregnant Women

Marcela Valente

BUENOS AIRES, Jan 12 2005 (IPS) - “If you liked the fun part, put up with this part now!” and “Don’t shout, put a pillow over your mouth” are a couple of the less cruel remarks by nurses and doctors heard by low-income women about to give birth in public hospitals in the northeastern Argentine province of Santa Fe.

Reports by several non-governmental organisations in Argentina have drawn attention to the systematic mistreatment of expectant mothers in public health facilities in several provinces of this south American country of 36 million.

“We heard from other women that the same mistreatment occurs in (the northern provinces of) Tucumán, Santiago del Estero, Salta, Jujuy, Chaco and Formosa, as well as other areas, and for that reason we are planning to launch a campaign this year to work in six different provinces,” lawyer Susana Chiarotti told IPS.

Chiarotti is the regional head of the Latin American and Caribbean Committee for the Defence of Women’s Rights (CLADEM), which along with the Gender, Law and Development Institute in Rosario, Argentina produced a report on the “cruel, inhuman and degrading treatment” received by pregnant women in Santa Fe.

Similar results were found by the New Citizenship organisation in the northwestern province of Tucumán.

Both reports were based on the accounts of women from poor neighbourhoods or rural areas who have given birth in public maternity wards and hospitals, and have been subjected to mistreatment by the hospital staff.

“These are remarks that denigrate the very humanity of those who utter them, who are mainly female obstetricians and other doctors, as well as nurses,” states the report on Santa Fe.

In Argentina’s northern provinces, and even in Greater Buenos Aires, many of the lower-income women who receive treatment at public health facilities are of mixed-race (indigenous and European) descent.

Many of the women quoted by the Santa Fe report said they had been forced to give birth completely naked, or to sit nude during gynaecological exams, without any respect for their privacy.

“More or less 13 students stuck their hands in me”, “I felt outraged, ashamed”, “They stuck their fingers inside me as if I was some kind of freak” are other quotes taken from the report.

Since public hospitals are teaching hospitals, the women end up being “guinea pigs”, says the report, and their permission is not asked when medical students take part in the exams.

In some cases, not only are they left stark naked, without a hospital gown, but they are not even given a sheet for their bed.

In their defence, the medical staff argue that these things occur because of shortages.

The investigation, and the risk of being reported to the Geneva-based U.N. Committee Against Torture and Other Cruel, Inhuman or Degrading Treatment or Punishment, prompted public health authorities in the province to adopt measures aimed at improving conditions in public health facilities and modifying university training courses.

The campaign announced by CLADEM will be carried out in Tucumán and Santiago del Estero, which Chiarotti considers “the provinces that are lagging the most, in terms of legislation and feudal-style” systems and treatment.

It will also be extended to two provinces that she described as “more advanced” with respect to health care, Neuquén and Mendoza (in the west), and in two “intermediate” provinces, Misiones and Santa Fe (both of which are in the northeast).

But IPS has also heard reports of similar mistreatment in hospitals in the city of Buenos Aires.

A middle-class woman who gave birth in a public hospital in the capital said her obstetrician complained incessantly about the lower-income expectant mothers, referring to them as “rabbits” if they had many children, or complaining because they ran a greater risk during childbirth as so many of them were overweight.

“I’ll practice a caesarean in your case, but I told her that I wouldn’t, so she would get scared and take care of herself, because she’s a pig, she has diabetes and others problems and just keeps eating,” the doctor told the source, who was better off economically than many of the other patients in the Rivadavia Hospital where she gave birth two years ago.

CLADEM was one of the organisations that brought the case of María Mamérita Mestanza, an indigenous Peruvian woman who died after government officials in her country coerced her into sterilisation, before the Inter-American Commission on Human Rights (part of the Organisation of American States system) in 1999.

In 2002, the Peruvian government finally agreed to take responsibility for Mestanza’s death and compensate her family. The agreement also paved the way for major legal and policy reforms aimed at improving health care for expectant mothers in Peru.

In Santa Fe, the CLADEM investigation was triggered by the case of a 16-year-old girl who was admitted to a public hospital in 2001 after she shot herself in the abdomen to put an end to her seven-month pregnancy.

Although the teenager survived, she received “extremely cruel treatment” at the hands of the hospital staff, according to the report.

The patient, who spent several days in intensive care after surgery, was unable to move. Nevertheless, the nurses ignored her requests for pain-killers, water or a bedpan (“Use it yourself, kid!” one nurse would shout at her), and they did not adequately tend to her wounds.

After hearing about the case, the activists began to contact women from poor neighbourhoods who had given birth in the same hospital or other public health centres in Santa Fe.

Once their initial reticence and sense of shame was overcome, the women shared their own stories of “cruel, inhuman and degrading treatment,” as described by the report.

But the interviewees saw the mistreatment as natural or normal, and believed that since they were receiving treatment free of charge, they had no right to protest.

Many also admitted that they were afraid that if they protested, they would be treated even worse if they ever had to go back to the same health facility.

CLADEM planned to present the report in Geneva, before the Committee Against Torture. But after it was released locally, the Defensoría del Pueblo (ombudsman’s office) took up the issue, public health authorities expressed a willingness to introduce changes, and the group modified its original plans.

“We had already achieved the effect we were seeking,” said Chiarotti, referring to awareness-raising and educational seminars for hospital staff.

She was also talking about gradual changes that are occurring with respect to allowing pregnant women to be accompanied by their partners or their mothers or sisters during labour and birth, which was not permitted in many public maternity hospitals in the past on the grounds that the wards were not set up for the presence of family members.

“At first, the staff argued that the hospitals lacked the economic means to provide better treatment. But we insisted that respect doesn’t cost a thing,” she said.

Nevertheless, Chiarotti believes that the mistreatment of pregnant women from low-income sectors has become so widespread that it is not even seen as such.

She thus believes it is still necessary to denounce such cases as human rights violations, to give the problem greater visibility.

The mistreatment is even worse in the case of women who are admitted to the hospitals for complications resulting from abortion, which is illegal in Argentina.

“If they know you had an abortion, they scrape you out without anaesthesia,” said one source.

The practice of post-abortion dilation and curettage, which involves the scraping of the uterus, without anaesthesia was confirmed by hospital staff interviewed for the report.

The personal accounts also reflect the health professionals’ tendency to put little stock in what the poor patients tell them, as shown by the case of a pregnant woman who was ignored when she warned ahead of time that she had blood clotting problems.

And a woman who was on the verge of passing out was told “You have to sign here,” after the doctors decided to sterilise her by means of tubal ligation.

“If you’re coming here to get treatment, it’s because I’m the doctor…if you know more than I do, stay home and treat yourself,” responded a physician to another patient who made a suggestion.

Similar cases were reported on by the New Citizenship organisation in a study conducted in the Maternidad Nuestra Señora de las Mercedes in Tucumán, the country’s largest maternity hospital (based on the number of births).

There are an average of 14,000 babies born in that hospital every year, and an almost equal number of horror stories.

For example, women in labour or who have given birth are often forced to share hospital beds.

“One night after I came back from the bathroom, I found that a girl with a high fever who had come into the emergency room had been put in my bed. I got mad and called the nurse, but nobody came, and out of humanity I left her in my bed and sat up all night,” said one pregnant woman quoted by the Tucumán report.

The study also states that phrases like “Spread your legs and shut up, you sure liked doing it before”, “You should have thought of this beforehand”, or “You filthy thing, go and take a bath, you stink” are frequently heard in the maternity ward.

One woman told the researchers that she gave birth alone in her bed, without being wheeled into the delivery room. “Wait, I’m having my afternoon snack,” the nurse told her when she asked for help because she was having strong contractions.

After her baby was born, another nurse scolded her for “not notifying us” and for “getting the bed dirty”.

When asked by IPS why the health professionals and other personnel, who are mainly women, mistreat other women at a moment of such vulnerability and emotional need, Chiarotti said “mistreatment is a manifestation of the contempt for and discrimination against women that persists in Argentine society, which is aggravated when the women suffer from other causes of oppression, like class, ethnic or racial questions.”

“And it is telling that the reproaches they spit out at them are loaded with moral judgements,” said Chiarotti. “The idea that ‘you sure liked it at first’ is as if they were being punished for having ‘sinned’.”