Birth activists in many countries around the world celebrate the International Week for Respecting Childbirth in May every year to bring attention to a particular topic related to respectful and dignified care in childbirth for all women. The 2013 edition of IWRC is just wrapping up, held from May 20 to May 27 on the theme: 

The IWRC was initiated in 2004 by Alliance française pour l’accouchement respecté (AFAR), a French non-profit society entirely free from philosophical, medical, religious and political lines of thinking. Since 2011 its coordination has been handed over to the European Network of Childbirth Associations (ENCA). IMBCI region and country representatives, especially in Europe, have been connecting the IMBCI: 10 Steps to IWRC and actively using IMBCI documentation to promote and advocate for respectful care.

In Greece, Maria Andreoulaki shared with us that events and demonstrations were organized as early as mid-April in prelude to the IWRC. The IMBCI: 10 Steps were central to these conversations. 

Lucie Ryntova shared that in the Czech Republic, the Active Motherhood Movement organized events geared toward informing women and their families about physiologic and respectful care during pregnancy, labour and birth, the postpartum period, and beyond...

Events celebrating IWRC 2013 in Quebec, Canada focused in on physiologic care in childbirth and even approached the theme quite literally with one session on "hands off" vs. "hands on" practice in the 2nd stage of labour (or the pushing stage).

The International MotherBaby Childbirth Initiative: 10 Steps to Optimal MotherBaby Services was established in 2008 upon a foundation of basic principles that recognize women and children’s rights and access to healthcare as human rights. Although the UN Human Rights Council acknowledges maternal health as a human rights issue, physical morbidity and mortality remain the most cited results of rights violations. For example, the recently released US Country Reports on Human Rights Practices provide summaries of each country’s respect of human rights and highlight access – or lack thereof – re skilled prenatal, intrapartum, postpartum, and emergency obstetric care. Omitted from these reports, however, are the treatment of women and the circumstances surrounding childbirth.

“Who decides how a baby is born? Who chooses where a birth takes place? Who bears the ultimate responsibility for a birth and its outcome? What are the legal rights of birthing women? What are the responsibilities of doctors, midwives, and others  in childbirth? What are the rights and interests of the unborn, and how are they protected?”

On May 31st-June 1st, three IMBCO board members – Debra Pascali-Bonaro, Robbie Davis-Floyd, and Hélène Vadeboncoeur – joined some 300 participants and 50 panelists in addressing these questions and more at the Human Rights in Childbirth Conference (HRiC), hosted by the Bynkershoek Research Centre for Reproductive Rights at The Hague University of Applied Sciences, The Hague, in the Netherlands. The aim of the conference was three-fold. With an international focus, the organizers wished to to engage attendees in discussion on the implications of the European Court of Human Rights’ 2010 holding that women have a human right to choose the circumstances and location in which they give birth. Then narrowing in on the Netherlands, stakeholders in the obstetric system were convened for meaningful dialogue about the legal status, efficacy, and future of birth options in this country. Finally, the objective was also to publish a collection of legal and scholarly materials on human rights in childbirth, authored by conference participants.

Implications of the Ternovszky v. Hungary Holding
Over the past few months, the world – of birth professionals and activists at the very least – has been watching Hungary closely to see how the case of Dr. Agnes Gereb will unfold. Midwife and obstetrician, Gereb was taken into custody in October 2010 for reasons that are still unclear. Over the course of 20 years, she had functioned most of the time as the only care provider for home birth in Hungary, attending the births of over 3500 babies.

After Gereb’s arrest, faced with the difficulty of finding a provider who would attend her home birth, Anna Ternovszky, with the help of attorney Stephanie Kapronczay, brought her case to the European Court of Human Rights. Based on the European Convention of Human Rights’ Article 8, the ECHR ruled that the right to privacy includes “the right of choosing the circumstances of becoming a parent” in addition to the decision to become – or not – a parent and that “giving birth incontestably [forms] part of one's private life” (Ternovszky v. Hungary, no. 67545/09, 14 December 2010, pp. 22). What does this decision mean for birthing women in Hungary, their providers, and Dr. Agnes Gereb? Despite the Convention of Human Rights and the court decision officially applying as domestic law to all European countries, the regulation of home birth continues to be highly restrictive in Hungary. As for Gereb, she remains under house arrest.

While conference attendees were urged to consider bringing their own cases before domestic courts, in Europe, if out-of-hospital birth is not truly accessible for women, other ways of affecting change were also explored and discussed. On Day 1 of the conference, Robbie Davis-Floyd moderated Panel 2: Risk, Safety, Costs & Benefits: Weighing Choices in Childbirth, during which Hélène Vadeboncoeur mentioned the work on Respectful Maternity Care by the White Ribbon Alliance for Safe Motherhood and of course the International MotherBaby Childbirth Initiative. Robbie also described a successful care model, the all-risk Albany Midwifery Practice in London, which was shut down in 2009 after achieving a homebirth rate of 48%; she highlighted that is often the fate of such models as they fall victim to their own success.

On the morning of Day 2, Robbie gave a short introductory presentation on the Dutch system of maternity care, noting that although its high homebirth rates have caused others to call it a premodern vestige of the past, the Dutch system is in fact a postmodern vanguard of the future.

Robbie also noted that the Dutch system is in danger—the homebirth rate in The Netherlands, sustained for three decades at 30%, has fallen in the past three years to 20% due to many factors combining all at once. These include an effort by the Dutch government, in alliance with the medical and insurance industries, to move birth into tertiary care hospitals by shutting down many small community hospitals. Dutch law has long stated that midwives can only provide homebirth care when the home is no more than 30 minutes from the hospital. When nearby community maternity hospitals no longer exist, women lose the option for homebirth. On the positive side, Robbie noted, the Dutch government is building many birth centers staffed by independent, autonomous midwives close to or inside of hospitals to continue to provide the option of “out-of-hospital” birth.

Other central topics of the Human Rights in Childbirth conference that the IMBCI prioritizes included:

Evidence-based care and informed decision-making: In addition to presentations and discussion on some of the most recent evidence on childbirth practices, conference attendees participated in consensus building. Some results were that:

• Women have the right to choice of birth place, manner, and birth assistants.
  
• Women should never be forced or coerced to accept any medical interventions
  

A continuum of collaborative care: Debra Pascali-Bonaro, Chair of the IMBCO and a DONA certified doula trainer presented aspects related to continuous companionship of doulas and the importance of their support. The consensus among participants was that:

• Partnership and collaboration should characterize all aspects of maternity care.
  
• Midwives should be autonomous practitioners caring for autonomous women.
  
• Women and midwives should not be criminalized for supporting normal birth.
  

The MotherBaby dyad: In a discussion on the rights of the baby, panelists mentioned a mother’s interest in protecting her child – rather than needing an outside authority to protect her child from her – and a baby’s rights to good circumstances surrounding birth, as well as to safety. In other words:

• The rights of the fetus should never be placed above those of the mother because when they are, the mother’s own rights are always jeopardized.
  

IMBCO’s Commitment to Advancing Human Rights in Childbirth
Honored to have members of the Board attend the conference, the IMBCO is committed to advancing human rights in childbirth through the promotion of optimal MotherBaby maternity services. The first step of the Initiative: Treat every woman with respect and dignity, is at the very heart of our efforts. The other steps and respect for human rights of women and children naturally flow from respectful and dignified care when appropriate systems and support are in place. And it isn't the first time that the IMBCI and human rights have been discussed together!

It is through a vast network of supporters that optimal MotherBaby maternity services, as outlined in the Initiative, are being implemented. We now count 8 demonstration sites and 13 MBNets throughout the world, as well as 25 region and country representatives who advocate for improvements locally.

Actions for the Future
As the deadline for the Millennium Development Goals (MDGs) approaches and we look toward post-2015’s potential ‘Sustainable Development Goals’, conference attendees called for a replacement of the biomedical model by the human ecological model. They propose that international guidelines on maternity care should be written with a human rights approach and that women’s needs and the physiologic process of birth hold a central position.

Did you attend the Human Rights in Childbirth conference, in The Hague or somewhere else in the world through the Webinar? What were your impressions of the conference? How might the discussions resulting from the conference affect MotherBaby care in your part of the world?

Visit www.humanrightsinchildbirth.com for more on the conference and resulting actions!