“Too little” done to fight against obstetric and gynecological violence against women

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In the wake of #MeToo, France has seen a wave of poignant testimonies from women across the country denouncing cases of harassment or sexual abuse they have faced while in the maternity ward or at the gynecologist. Now that a well-known practitioner is under investigation for rape, what is being done to stop the mistreatment? AXADLETM investigation.

In a sea of ​​purple banners, one of the colors used by suffragists to represent loyalty and dignity, tens of thousands of protesters took to the streets of Paris to condemn violence against women on Saturday.

Among those calling for more government action was Sonia Bisch, founder of Stop Violence Obstétricales et Gynécologiques (StopVOG), a feminist organization fighting against obstetric and gynecological violence. Their presence in the march comes at a critical moment.

Since September, a total of seven women have filed official rape complaints against famous Parisian gynecologist Émile Daraï, who stepped down as head of the endometriosis center at Tenon Hospital on October 8. In addition to the complaints, Stop VOG received an avalanche. testimonials from various women on their social media accounts.

But while a judicial investigation is underway, little has been done to curb obstetric and gynecological violence in France.

Illicit

“The rape does not only take place in a dark subway by a stranger holding a knife”, explains Bisch to AXADLETM. “It takes place in families, couples, and in gynecological offices or maternities by doctors themselves … Unfortunately, medicine is not exempt from the things that happen in society.

Obstetric and gynecological violence occurs when a health care professional engages in behaviors or practices that are not medically justified or consented to by the patient. “It can take place during an abortion, IVF procedure, pregnancy or childbirth – and it can be physical, psychological or verbal,” Bisch explains.

For Aurore, 32, it happened on her very first visit to the gynecologist. She was 16 at the time and her GP told her to get checked out after reporting that she had itchy and itchy skin. Already feeling nervous about being examined under such intimate circumstances, she was greeted with haste. “The gynecologist was obviously very annoyed that I hadn’t seen someone sooner. When he entered the room he said ‘Hello’ and immediately told me to undress, ”she said.

“I took off my pants, sat on the examination table and started to cry,” she explained, remembering how scared and stressed she felt at the time. “He started and I hugged my knees, I didn’t want to continue. He examined me with a swab to take a sample and performed a vaginal exam with his fingers. All the while I was crying, shaking my head, saying no. I didn’t understand what was going on. I was not prepared.

The doctor continued despite Aurore’s repeated attempts to stop the consultation. Years later, when asked for his record, she found out that he had also performed a vaginal ultrasound. “I was so shocked at the time, I didn’t even notice what was going on,” she said. It turned out that Aurore had a simple yeast infection and only realized years later that she could have bought some medicine at a pharmacy. But more importantly, she understood that she had been raped.

According to the Kouchner law of 2002, doctors must seek consent from patients before performing any medical procedure. If they fail to do so and perform an act of sexual penetration “by violence, coercion, threat or surprise”, this is considered rape in France, according to article 222-23 of the penal code.

A systemic problem

Cases of obstetric and gynecological violence made headlines in France in 2014, when women used the hashtag # PayeTonUtérus to denounce the harassment or sexual abuse they faced during checks or procedures, in the wake of the movement. #MeToo.

Three years later, the former equality secretary Marlène Schiappa commissioned a report on these types of abuse which was published in June 2018. The report found that the violence committed by obstetricians and gynecologists in France was systemic and were not limited to a few isolated cases.

Some forms have been found to be more common than others, such as performing episiotomies (surgical incision of the perineum) without the patient’s consent, vaginal stitches without anesthesia, and the use of fundal pressure (application of pressure on the uterus) to speed up the delivery process, a practice strongly discouraged by the High Authority for Health (HAS) since 2007.

The report also revealed a general disregard for women’s pain and a lack of communication for procedures – something Sandrine *, 40, experienced before the birth of her second child. When her due date was approaching and she still had no contractions, she started seeing her new gynecologist regularly to monitor the baby.

During one of these visits, Sandrine suffered a painful vaginal examination, without warning. “It hurt me a lot,” she said, remembering a former midwife in Paris who always asked before performing the procedure. The gynecologist then continued with her examination and did something Sandrine said “was not feeling well at all”.

“She moved her fingers, trying to stretch things out but didn’t tell me what she was doing… I really couldn’t take the pain and felt like something was different. I told her to stop whatever she was doing and she did it immediately, ”she said. Sandrine discovered that, without her consent or any communication, the gynecologist had tried stripping the membranes to induce labor since her baby was late.

“I think the biggest problem is not asking women for their approval and not mentally preparing them for the pain they are going to feel,” said Sandrine, echoing Bisch’s claim that, in 2021, women in France should not leave doctors. practices or maternities feeling “tortured or violated”.

Too little, too late

Since the publication of the 2018 report, the French government and other medical authorities have done little to combat obstetric and gynecological violence. To make matters worse, the Order of Physicians – the body responsible for drafting the code of medical ethics and processing complaints – was criticized in 2019 by the Court of Auditors for its disastrous treatment of patient complaints.

“Three and a half years later, nothing happened. It’s not enough. There is a charter and that’s it, ”said Bisch, referring to a charter of good practice published by the National College of French Gynecologists and Obstetricians (FNCGM) in response to the allegations against Darai.

Asked by AXADLETM if the institution plans to do more, its president, Dr Isabelle Héron, said that the charter was “only part of the answer”. The report aims to remind doctors how to perform a gynecological examination, by putting “the notion of consent at the center of the consultation”, and will be pasted in the waiting rooms so that patients “know that this charter has been published”, Heron said.

“But above all,” she said, the best solution was “to teach our young people”.

For Bisch, this is not enough. “If the violence could be stopped by sticking pieces of paper on the walls, there would be no need (for feminist associations) to campaign against femicide. All we would have to do is stick a piece of paper on the walls of abusive husbands telling them not to kill their ex-spouses, ”she said.

“We need to control medical practices… We need health professionals, students, police and lawyers to be trained in this matter, so that they can understand the consequences of this violence”, concluded Bisch. . “Expressing yourself is not enough. We need people to listen. When you don’t listen to the victims, it’s as if they don’t speak at all.

* Name has been changed to ensure anonymity

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