Birth Pangs

生育之痛

 

Latin America ponders how to fight “obstetric violence”

拉美各国正在思考如何抗击“产科暴力”

 

“Come on, smile! This is the most important day of your life.” The midwife was upbeat. But Agustina, a 38-year-old comedian and brand-new mother, was shaken. It was 2012; she had just undergone a Caesarean section at a hospital in Argentina. Her obstetrician, she believes, had made the surgery more likely by inserting hormones into her vagina during a check-up, without explanation.

 

助产士乐观地说道：“来吧，保持微笑！今天是你生命中最重要的一天。”但38岁的喜剧演员、准妈妈阿古斯蒂娜却感到震惊。那是在2012年，她刚刚在阿根廷的一家医院接受了剖腹产手术。她认为，她的产科医生在一次检查中没有向她做任何解释便给她注射了激素，从而使她有更大的概率要做剖腹产手术。

 

Two men performed the dangerous Kristeller manoeuvre, pushing down on her belly. She fainted. An assistant lightly slapped her face to keep her awake. Another tied her arm to the bed. None of it felt right. But, she says, “I thought the doctor is like your boss: you do what he tells you.”

 

在她生产时，两名男子对她采用了危险的克里丝特勒手法，按压着她的腹部。她随即晕了过去。一名助产士拍打着她的脸庞，使她保持清醒。另一人则把她的胳膊摁在床上。这一切都让她感到不对劲。但她说：“我感觉医生就像你的老板一样：你只能按他说的去做。”（注：克里丝特勒手法是德国妇产科医生塞缪尔·克里斯特勒于1867年发明的一种助产方式，是指通过按压腹部的方式帮助难产妇女顺利生产，该方式具有一定的危险性，通常情况下不建议使用。）

 

Her ordeal was not unusual. Surveys in Latin American countries have found that between a quarter and a third of women who give birth suffer abuse at some point in the process. In one from 2016, 24% of Mexican women reported abuse in their last childbirth and 17% reported non-consensual care.

 

她的遭遇并不罕见。在拉美国家开展的调查发现，25%至33%的产妇都曾在生育过程的某个阶段遭受过虐待。2016年的一项调查显示，24%的墨西哥女性自称在最近一次生育时受到了虐待，17%的女性自称受到了非自愿的护理。

 

A common form of mistreatment was humiliating comments by staff, reported by 7% of women. Other bad practices were withholding of painkillers without explanation (which 5% of women experienced) and forced contraception and sterilisation after childbirth (4%).

 

据7%的女性表示，医护的言语侮辱也是一种常见的虐待方式。其他的虐待方式还包括未经告知就停用止痛药（5%的女性表示有过这种经历）以及生育后被强制施以避孕或绝育措施（4%的女性表示有过这种经历）。

 

A tenth of women who had C-sections said they had not given consent. Very young, unmarried and poor women in public hospitals were likeliest to suffer. Activists denounce what they call “obstetric violence”, a term they apply not only to violent acts.

 

有10%接受剖腹产的女性表示，她们在未经同意的情况下就被强制做了剖腹产。公立医院里的年轻、未婚以及贫穷的待产女性更有可能受到虐待。活动人士对他们所谓的“产科暴力”（这个词不单单是指暴力行为）表示谴责。

 

Such abuse is, perversely, a consequence of progress. Better health care reduced maternal and infant mortality. Yet it also reinforced a culture that treats doctors as infallible, patients as passive and medical intervention as the first resort, even when harmful or against a woman’s wishes. Covid-19 may make the problem worse.

 

说来反常，这种虐待反而是进步的产物。医疗服务水平的提高使得母婴死亡率有所下降。但这也促进了一种文化观念的形成，即医生是绝对正确的，病人只能够言听计从，医疗干预往往被视为首选，即使这种方式有害或有违女性的个人意愿。新冠肺炎疫情的爆发或将使这一问题愈发严重。

 

Mistreatment of expectant mothers is not confined to Latin America. A fifth of recent mothers in Italy report abuses. In Ethiopia three-quarters do. What makes the region unusual is decades of activism that have led to laws that seek to reduce abuse. In Brazil, a movement to “humanise childbirth”, led by feminists and public-health experts, has been active for at least 30 years.

 

虐待孕妇的现象并不仅仅存在于拉丁美洲。在意大利，20%的初产妇自称（在生产时）受到了虐待。在埃塞俄比亚，75%的初产妇同样自称如此。但与众不同的是，该地区持续数十年的激进主义推动了旨在减少产科虐待的法律的出台。在巴西，由女权主义者和公共卫生专家共同领导的“人性化生育”运动已经开展了至少30年。

 

Later campaigns sought to “educate by law”, says Roberto Castro of the National Autonomous University of Mexico. Statutory changes would make people more aware of the problem, and therefore more likely to put pressure on doctors and other carers to behave well.

 

墨西哥国立自治大学的罗伯托·卡斯特罗说，后期的运动更多地是在推动“法律教育”。法律的改变更能让人们意识到这个问题的存在，因此也更有可能给医生及其他护理人员施以压力，从而使他们能够改善暴力行为。

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