Chamber of Deputies
Legislative Proposal by the Deputy
Norms for the Protection of the Rights of Women and Newborns in Childbirth and Regulation for the Promotion of Physiological Birth
(link to the original document in Italian)
Submitted on 11th of March 2016
Honorable Colleagues! – The present legislative proposal is aimed at promoting the respect of the rights and the dignity of the childbearing woman and newborns during facility based and out of hospital childbirth.
The proposal stems from the recent WHO Statement on “The prevention and elimination of disrespect and abuse during facility-based childbirth”. The WHO Statement reports of disrespectful and abusive treatments during childbirth in healthcare facilities that include “outright physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilization), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglecting women during childbirth to suffer life-threatening, avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay. Among others, adolescents, unmarried women, women of low socio-economic status, women from ethnic minorities, migrant women and women living with HIV are particularly likely to experience disrespectful and abusive treatment”.
The WHO highlights that abuse, neglect or disrespect during childbirth can amount to a violation of a woman’s fundamental human rights, as described in internationally adopted human rights standards and principles. More specifically, mistreatments during childbirth violate the constitutional right to health of women and newborns. It is considered that individual or public health outcomes cannot be reached without the acknowledgment and protection of fundamental human rights of the human being.
In order to promote maternal and infant health at the national level, it is our duty to promote the respect of women’s rights, acknowledging that women are subjects of care and not passive objects of healthcare treatments. At present day, too many medical treatments are carried out without involving the woman in the decisional process regarding her body. The informed consent still represents uniquely a formal signing of documents, while women that give birth in the healthcare facilities are forced to inappropriate practices that are violating their human dignity. A positive childbirth experience strengthens physical and mental health of the mother, generating positive outcomes for her babies, her family and the health of a population as a whole.
In Italy, the medicalisation of childbirth has been increasingly leading to the growth of c-section rates, without clinical justification, that may affect women’s and babies’ health in the short and long term, as stated in the WHO declaration on c-section rates. The official inquiry of the former Minister of Health, Mr Balduzzi, in 2013 has highlighted that, in Italy, high c-section rates were not based on the appropriateness of care and true necessity. The conclusions, publicly disclosed by the Minister, highlighted that there were violations of women’s right to health and substantial damage to the Italian public treasury.
The investigations conducted by the National Institute of Health (Istituto Superiore di Sanità – ISS) on maternal mortality in Italy showed worrying figures. These investigations and further evidences highlight that maternal death rates are proportionally growing as c-section rates increase. Recent maternal death cases in Italy have shaken the public opinion. We need to draw a lesson from these tragic events and deeply rethink and reshape the maternity model of care that cannot be based on emergency measures. In order to do so, we advocate for appropriate investigations about what happened in the recent maternal death cases, reconsidering the national maternity healthcare in a systematic and systemic ways, involving all the governamental institutions, researchers, civil society and affected families. We can take example from similar situations in the UK, where thorough investigations have been made and valid proposals for change have been advanced from the top and from the bottom of the society (Morecambe Bay Investigation, National Maternity Report).
Within the frame described above, the present proposal of law, First Chapter, Article 1, promotes the respect of fundamental human rights and personal dignity of the childbearing woman and newborn, the appropriate use of medical interventions with the aim to reduce the c-section rates, to reduce the surgical vaginal birth and to reduce all the harmful practices damaging physical and mental integrity of women, including verbal humiliation.
The Second Chapter is dedicated to women’s rights and the right to free, conscious and informed consent to medical treatments during labour and childbirth. Art 2 defines women’s rights during childbirth and statues the principles that women’s fundamental rights cannot be restricted in reason of labour and childbirth. Under no circumstances can a woman be deprived of her fundamental and constitutional rights.
The following articles identify healthcare practices that offend the dignity and integrity of the woman, establishing the indemnities related to the offences.
The offence of obstetric violence has been introduced as a category of violence against women, already regulated by several South American Countries. The obstetric violence is defined in the South-American legislations as the appropriation of a woman’s body and her reproductive processes by health personnel, in the form of dehumanizing treatment, abusive medicalization and pathologization of natural processes, involving a woman’s loss of autonomy and of the capacity to freely make her own decisions about her body and her sexuality, which has negative consequences for a woman’s quality of life.
The Chapter III is dedicated to the newborn’s rights with the ban on the donation of cord blood since it biologically belongs to the newborn.
The Chapter IV states that Regions and the Autonomous Province of Trento and Bolzano have to provide, trough the healthcare system plans, and according to economic and available human resources, appropriate information to the woman about physiological birth (through the Family Counselling Units, “Consultori Familiari”) and they have to carry out models of maternity care aimed to enhance the health and the wellbeing of the mother and the newborn, in the frame of the present law.
Art 23 statues the obligation for the Healthcare Trusts to provide open, transparent, easy to access public accountability systems for Healthcare Trusts and single hospitals, trough the use of on line forms, publications and dedicated web pages. Furthermore, the Healthcare Trusts have to provide on-line and paper methods for the evaluation of the healthcare received, and for the documentation of the health outcomes.
The Healthcare Trusts have to provide the healthcare personnel with adequate tools for the evaluation of the healthcare carried out in their Trust, particularly in difficult cases, with unfortunate health outcomes. To decrease litigation, lawsuits and defensive medicine, the Healthcare Trusts have to use the method of open disclosure, with emphasis on a transparent, respectful and compassionate communication between families and healthcare givers involved in unfortunate events. The reports of the users’ and healthcare providers’ evaluations have to be published annually on the web site of each Healthcare Trust.
Healthcare Trusts have to provide models of birth plan available for the users of the maternity care services. The users should be able to draft and update their birth plan throughout pregnancy with the help of a midwife. Every Healthcare Trust should designate the local network of “Family Counseling Units” to give support with the birth plan models, enhancing the existing services. Family Counseling local networks should be improved and supported to provide adequate information to childbearing women offering pregnancy, birth and breastfeeding courses regularly. The positive outcomes of the Family Counseling Units services have been confirmed since decades, as stated in the Ministry of Health Decree, dated 24th of April 2000, published in the Gazzetta Ufficiale n. 131, 7thJune 2000, on the subject of “Maternal-Infant Goal Project” (“Progetto Obiettivo Materno-Infantile – POMI”). Healthcare Trusts have to promote the dialogue with the civil society at local level involving the volunteers’ associations and enhancing the role of the peer-to-peer volunteer mothers. Healthcare Trusts have to create multidisciplinary dialogue tables, inclusive of the civil society, with regular half-yearly meetings.
Finally, the Art 25 states the obligation for the Ministry of Health to present to the Parliament an annual report on the status of implementation of the present law.
Translation by Alessandra Battisti and Elena Skoko