Project Update #20: Research on ‘Institutional Violence’

February 18, 2019

Part of: World Bank & Sexual Violence Research Initiative Project: ‘Combating Sexual Violence in Kyrgyzstan through Innovative Education and Information Technology (Kyrgyzstan, Central Asia)’

By: Dr. Elena Molchanova and Fatima Karakai

Building on the project’s other research component related to ‘Virginity for Sale’, our team is working to address issues of institutional violence against women, focusing specifically on issues of violence in the field of Obstetrics or OBGYN. This update will provide an overview of the project, its goals, and some of the issues that it aims to address.

Violence in the healthcare system is endemic worldwide. While violence in healthcare is a problem writ large, the realities of violence in the field of Obstetrics (OBGYN) is even more paradoxical in that, instead of helping women and attempting to decrease the pain and fear at what is arguably one of the most critical moments in a woman’s life in healthcare, medical staff can often amplify these issues.

The available studies show that violence in obstetrics is caused by processes and practices of dehumanization and objectification in healthcare institutions, often associated with the likening of human to animals, automata, or objects. Kelman’s (1973) research suggested that the dehumanization process is a critical factor in justification of aggressive actions, as this dehumanization erases moral attitudes or supposed responsibility to the individual for the violence caused to them.

Violence in the field of obstetric can take various forms. These include: denying care, disregarding women’s needs and pain, verbal abuse, physical violence, unnecessary use of medication, forced medical interventions, and dehumanizing treatment. According to statistics of the Ministry of Health of the Kyrgyz Republic within the period from 2008 up to 2017, 702 women died during labor in Kyrgyzstan. The highest mortality rate among women in labor has been registered in 2009 – 102 women died (National Stat Committee of of the KR, 2017).

The situation in Kyrgyzstan’s health system is urgent enough, and society and healthcare authorities are generally aware about violence in obstetrics, and moreover, violence is not perceived as extraordinary, and at the moment, little is being done to address this issue. The Ombudsman of the Kyrgyz Republic Kubat Otorbaev mentioned: “Maternity mortality is the result of grave human rights violation. The State authorities, as well as the whole society should make their efforts to prevent the above violation” (Otorbaev, 2016).  One of the main reasons of maternity mortality is neglect of medical staff and apathy toward own health of women.  The parliamentarian Alfia Samigullina is sure that “the fault or mistreatment from doctors composes 10% of maternity mortality” (Samigullina 2016).

Women who have suffered from institutional violence during the childbirth process try to highlight their experience in Kyrnet forums. It seems that their main goal is to provide a feedback about particular obstetricians, gynecologists, and clinics that have committed the violence on them.

Addressing violence in the field of Obstetrics, this project sees this not simply as individual or one-on-one violence, but as part of a broader pattern of violence that is part and parcel of the institution. In this sense, this is institutional violence in the system itself that recognizes and supports – in some fashion – these violent actions and results. These are preliminary and initial anecdotes that this research project will build on and complicate through the primary data collection period.

The research team has already received IRB approval for this research project and has begun conducting primary data collection. We are using a snow-ball sampling method, because women suffered in labor are often aware of the existence of similar cases. In this study, the team is evaluating literature to explore the definitions of violence towards women in labor and to explore methods used in previous research to assess best practices for gaining deep understanding of violence towards women in labor, the way this is related to broader forms of institutional violence, and how this relates to the particular context of Kyrgyzstan. Our first participants were three women whose pregnancy had been rather pleasant and who would not shown any negative prognosis up to the their delivery. While their pregnancies had been smooth, all three women indicated that the medical facilities and individuals had caused negative impacts during the pregnancy itself.

One of our respondents, a thirty five year old woman, faced with violence in maternity hospital. After application of an unjustified procedure by her obstetrician, she experienced a severe life-saving surgery, which then was complicated by a renal failure. During her state in the maternity hospital, she was isolated from any information about her condition, diagnosis and treatment.

When she occasionally saw herself in the mirror, she says she did not recognize herself:

“I did not know this woman in the mirror. She was swollen, she was not me. Her hands were covered in bruises. My husband said that bruises appeared as a result of how doctors were handling me, throwing me from one bed to another…”

Another respondent, a thirty year old woman, faced inappropriate conditions in maternity hospital. These were a toilet without doors, an obstetrician without a white coat, no towels on the gynecological examination chair. While sharing her experiences with us, she was crying. She said:

“A doctor without a white coat asked me to come in for a vaginal examination and I asked for towel for the gynecological examination chair and she gave me a disposable gloves wrap… The swabbing was so painful, I was weeping, and this doctor noticed my tears and said that she is surprised and wondered why all pregnant women are so thin-skinned. After that, the spotting started”.

These are two beginning quotes that demonstrate some of the main issues that this project will seek to address.

As the team moves forward, we will continue to share updates and the results of the research. We are excited about this project and gaining better information on the role of institutional violence in the field of Obstetrics and, importantly, the impact that this has on women and their experience of healthcare more widely.

Bibliography:

Kelman H.C. (1973). Violence without moral restraint: Reflections on the dehumanization of victims and victimizers. Journal of Social Issues; 29 (4):25-61.

National Statistics Committee of the Kyrgyz Republic, 2017. Retrieved from http://www.stat.kg/ru/opendata/category/142/

Otorbaev K, 2016, retrieved from  https://knews.kg/2016/12/23/institut-ombudsmena-zhenshhiny-kyrgyzstana-ne-znayut-o-svoih-reproduktivnyh-pravah/).

Samigullina A, 2016, retrieved from https://rus.azattyk.org/a/28197593.html)