Content warning: This story contains graphic stories of violence against women who give birth.
Annick Nonohou Agani, 51, from Benin, is a midwife, jurist, and human rights activist. She founded the Network of Patient-Friendly Caregivers (Réseau des Soignants Amis des Patients) and coordinates an initiative to reduce obstetric and gynecological violence in French-speaking Africa.
She is an award-winning midwife and has delivered around 3,000 babies. She is campaigning for childbirth practices that respect human rights in collaboration with Amnesty International.
Amnesty International Benin and its partners are working to educate public and healthcare professionals about patients’ rights, gynecological and obstetric violence, as well as access to healthcare for prisoners.
“My mother suffered obstetric violence. I was five or six years old at the time, and we were living in Niger. My father and I took my mother to the health center to give birth, but they wouldn’t let him in, so I stayed alone with my mother.
She was in a lot of pain and tried to call the health workers by raising her upper body on the delivery table, which was not wide. Unfortunately, she fell off the table. She wasn’t responding, so I called the health workers, who, without properly checking her breathing, declared her dead. An hour later, she started moving and talking again so I ran to get the health workers… They laughed at me and insulted me, saying that a dead body doesn’t talk! So, I went outside to call for help. In the end, my mother gave birth to my brother and they both survived. But her mistreatment by the clinic workers had a lasting impact on me… I told myself that whatever I became later in life, I would defend the rights of women who give birth.
Defending women’s rights
During my midwifery studies, I was already defending women’s rights. I didn’t want them to be mistreated. I started practicing in 2000, and began working with Amnesty International, conducting awareness-raising sessions with communities in northern Benin. In 2005, I decided to enroll in my first year of law school and completed my master’s degree in public law on the right to health.
Being both a midwife and a jurist allowed me to better assert myself in defending women. I was an activist, but I realized it was difficult to do it alone. I started working with women’s groups I knew through awareness raising sessions. I realized that we could bring about behavioral change through setting up women’s networks. I did internships in Morocco and Japan, where I learned how to deliver babies without violence. In 2013, I founded the Network of Patient-Friendly Caregivers, and today I am an activist at a regional level.
Even today, in some delivery rooms in Benin, there are straps to whip those who are not pushing properly.
Annick Nonohou Agani
Obstetric violence is widespread
Obstetric violence occurs in almost every country in the world. The first form of violence is denying the father access to the delivery room. It also includes not allowing the woman to choose the position in which she gives birth. There is what is known as abdominal pressure, where staff continue to climb on women’s stomachs and thus bring the baby out. Childbirth is highly medicalized. Unnecessary C-sections are sometimes imposed. Naked women are also subjected to repeated touches by numerous students, and no one asks for their consent. On several occasions, I have supported women victims of obstetric violence who had been left alone on very narrow delivery tables without mattresses, as was the case for my mother.
There is normalized violence because it is part of our care protocols. This is institutional violence, such as episiotomy, the overuse of vacuum extraction and forceps to deliver the baby… Violent deliveries are normalized and women are objectified.
Women are also beaten during childbirth, they are slapped. Even today, in some delivery rooms in Benin, there are straps to whip those who are not pushing properly. Sometimes, when you have a relative with you during childbirth and the midwife hits you, your relative may hit you and slap you in turn.
Protecting patients is paramount
One case that struck me was that of a woman who lost her baby during childbirth. The health workers refused to give her the body because they wanted to extort money from her. The government is fighting against these racketeering practices, as well as the illegal sale of medicines, but it continues.
We need to review midwifery training curricula. They must include human rights-based obstetric practices. It is also essential to update care protocols and make available all the tools and equipment necessary for non-violent childbirth. However, due to the patriarchy that prevails in our health centers, midwives who would like to practice non-violent childbirth face opposition from doctors.
People ask why we, as midwives, would talk about human rights. But we have a vision, we have a goal.
Annick Nonohou Agani
Previously, in Benin, there was no legislation to protect patients. Then, in 2021, the law on the protection of human health was passed, which states that the patient’s consent must be sought and renewed during care. But no law mentions obstetric violence.
The 2012 law on the prevention and punishment of violence against women did cover childbirth, but everything else was missing. There is no mention of the specific cases of pregnant women, women in labour, and women in the postpartum period, even though women must be protected at each of these stages. There are no criminal provisions to punish obstetric violence.
Specific legislation is needed for the prevention and punishment of gynecological and obstetric violence.
Bringing about change
We have detractors. People ask why we, as midwives, would talk about human rights. In their minds, we have nothing to do with that. But we have a vision, we have a goal. A paradigm shift is needed.
Most women do not know their rights, including those who have been to school. With social media today, some are beginning to be informed. An informed woman will not let herself be pushed around! Violence is beginning to decline, but we are not yet seeing public denunciations or complaints being filed… As a midwife, jurist, and activist, I am speaking out. Violence persists. It must be eliminated.”
Gender-based violence affects us all, but together we can create a safer world for everyone.
Enroll on Amnesty’s online course on confronting and countering gender-based violence.
Future Trends in Obstetric Rights and Safety
The fight against obstetric violence isn’t static; it’s evolving. Several key trends are poised to shape the landscape in the coming years.
Increased Legal Scrutiny and Legislation
Following the momentum of movements like #MeToo, there’s a growing demand for legal frameworks specifically addressing obstetric violence. We can expect to see more countries drafting and enacting legislation that criminalizes abusive practices during childbirth, similar to France’s 2018 law recognizing childbirth as a process requiring consent. The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW) will likely be increasingly invoked to pressure states to protect maternal rights.
The Rise of Patient-Centered Care Models
Traditional, hierarchical healthcare systems are slowly giving way to patient-centered models. This means empowering women to actively participate in decisions about their care, choosing birthing positions, refusing unnecessary interventions, and having continuous support from partners or doulas. Telemedicine and remote monitoring technologies could also play a role, allowing for greater patient autonomy and access to information. A 2023 study by the World Health Organization (Improving maternal and newborn health through respectful maternity care) highlights the importance of respectful maternity care as a cornerstone of quality healthcare.
Technology and Data Collection for Accountability
Mobile apps and digital platforms are emerging that allow women to document their birth experiences, report instances of abuse, and connect with support networks. Data collection on obstetric violence – currently limited – will become more sophisticated, enabling researchers and advocates to identify hotspots, track trends, and evaluate the effectiveness of interventions. Blockchain technology could potentially be used to create secure and transparent records of consent and care provided during childbirth.
The Role of Midwifery and Skilled Birth Attendants
Investing in the training and empowerment of midwives and skilled birth attendants is crucial. These professionals are often on the front lines of care and can advocate for women’s rights. However, as Annick Nonohou Agani points out, training must incorporate human rights principles and challenge patriarchal norms within healthcare institutions. The International Confederation of Midwives (ICM) is actively promoting respectful maternity care globally.
Increased Awareness and Advocacy Through Social Media
Social media platforms are providing a powerful voice for women to share their stories, raise awareness about obstetric violence, and mobilize support for change. Online campaigns and hashtags are helping to break the silence surrounding these issues and challenge harmful cultural norms. However, it’s important to address the spread of misinformation and ensure that online advocacy translates into real-world action.
FAQ: Frequently Asked Questions
What exactly constitutes obstetric violence?
Obstetric violence encompasses any act of disrespect or abuse during pregnancy, labor, and postpartum care. This includes physical abuse, verbal abuse, denial of care, lack of informed consent, and unnecessary medical interventions.
Why is obstetric violence often underreported?
Fear of retaliation, stigma, lack of awareness about rights, and distrust in the healthcare system contribute to underreporting. Many women believe their experiences are “normal” or that reporting will be futile.
What can I do if I experience obstetric violence?
Document the incident as thoroughly as possible. Seek support from trusted friends, family, or advocacy organizations. Consider filing a complaint with the healthcare provider or relevant authorities. Legal assistance may also be available.
How can healthcare providers prevent obstetric violence?
Prioritize patient autonomy and informed consent. Provide respectful and compassionate care. Challenge harmful cultural norms. Implement training programs on human rights and respectful maternity care.
Did you know? Amnesty International estimates that globally, hundreds of thousands of women experience obstetric violence each year, but accurate data remains scarce.
Pro Tip: Prepare a birth plan outlining your preferences for labor and delivery. Share it with your healthcare team and advocate for your rights throughout the process.
What are your thoughts on this critical issue? Share your experiences and insights in the comments below. Explore our other articles on women’s health and human rights to learn more.
