Women in Montenegro experience obstetric violence, as evidenced by almost 70 percent of women who participated in a survey conducted by the research agency Defacto.
However, the people who spoke to Vijesti from health institutions stated that such forms of violence had not been reported to them. The only ones who did were from the Ministry of Health, headed by Vojislav Šimun, said that two cases were reported to them through the non-governmental sector, based on which internal procedures were carried out.
The survey on obstetric violence was conducted by the Defacto agency for the needs of the NGO SPES, from November 6 to December 12, 2024, on a sample of 384 respondents. Among them were 365 women with experience of childbirth and pregnancy, two women who have experience of pregnancy but not childbirth, and 13 women who have no experience of either pregnancy or childbirth. Four men also participated in the survey.
Rudeness, physical and verbal violence
"I remember my birth as one of the ugliest experiences of my life", "The doctor told me that even if I died, I would still give birth naturally", "I felt like everything was forced on me, I wasn't asked about anything, and when my birth didn't go well, they criticized me", some of the respondents stated.
In addition to the fact that almost 70 percent of women experienced obstetric violence (66,3 percent), according to the research results, almost as many women stated that their needs and requests were ignored. The number of those who stated that they experienced humiliation, rude and inappropriate speech from medical staff is similar. They also claim that during a medical examination they experienced at least one rough handling or procedure…
"I had a curettage of my uterus performed after a miscarriage at 18 weeks, live, without anesthesia due to the whim of the gynecologist on duty, who did not want to ask for an anesthesiologist," is one of the testimonies.
“The midwife says: 'Shut up, you didn't protest when your husband jumped on you.' Another time, while stitching, the doctor said: 'We'll give you this back for screaming, you see how it hurts when you don't listen to us,'” says another.
"The doctor and midwives jumped on my stomach to push the baby out. After that, the baby had a broken collarbone and a hematoma on his head", "During labor, the midwife cut my perineum with scissors without any warning outside of contractions, which was a terrible pain and trauma that I will remember for the rest of my life", "I was ignored, when the baby's head came out I had to call the midwife because there was no one around. I was alone in the room most of the time", "The doctor commented that children on formula are less intelligent than children who are breastfed, while my baby was drinking formula at that moment", are some of the experiences that the respondents shared during the research.
Participants in the interviews also highlighted cases of physical and verbal violence, as well as violations of their privacy and intimacy.
"Respondents particularly emphasized that their needs and requests were ignored (64,9 percent of them), while 62,7 percent of respondents stated that they had experienced humiliation, rude and inappropriate speech from medical staff. Additionally, a total of 59,1 percent of respondents stated that they had experienced rough handling or manipulation at least once during medical examinations," according to research by the Defacto agency.
"I was forced to undergo forced gynecological examinations so that my doctor would not refuse to continue my pregnancy", "Forced opening of the water, pressing on the stomach until the baby came out, which resulted in the vagina tearing up to the cervix", "Episiotomies and examinations by at least 10 different people without asking questions or my consent", "Rough vaginal examinations by a male doctor at the KBC and the Kotor hospital. The female staff was always much more gentle", "Gynecological examinations were very rough and painful, without any explanation as to why they were necessary", are the experiences of the respondents who stated that they had experienced some form of rough handling or procedure.
A large percentage, 54,8 percent, of respondents assessed that communication with medical staff during pregnancy, childbirth, and postpartum was poor.
"Absolute ignoring, lack of empathy and comments like 'I'm not in pain', 'what can I do, just be patient' and the like", "When the induction started working they commented 'here it is, you can only hear it now'", "The midwife insulted me because I chose an epidural as an option", "The doctor said: 'I'll have you while you're still fresh'", "Doctors making comments like: 'I'm going to give birth to some 1.500 gram baby'", are some of the testimonies of the women interviewed.
On average, respondents rated the quality of care and support better when it comes to pregnancy than when it comes to the quality of care and support during childbirth, with 42,2 percent of them stating that care and support was at a good level during pregnancy, while 37,6 percent of women gave the same rating for care and support during childbirth.
"Baby friendly" only on paper
Only 35,4 percent of respondents said they felt adequately supported after childbirth by medical staff, while 64,3 percent said that this was not the case.
"The baby friendly program does not allow mothers to recover well after childbirth. Especially after a cesarean section", "The idea of the 'baby friendly' program is good, but it was not implemented properly", "I believe that the 'baby friendly' program in this form is counterproductive", "The help from the nurses was minimal and they only came when they were on a visit", are the comments of the respondents about the "baby" system.
Similarly, participants emphasized during interviews that the postpartum experience is often more traumatic than the birth itself.
The authors of the study state that respondents who gave birth in the previous two to five years are more likely to report experiencing some form of obstetric violence compared to other groups.
"While respondents who gave birth in the previous year report this in 29,2 percent of cases, respondents who gave birth in the previous two to five years report this in 41,3 percent of cases."
"Finally, respondents who gave birth in the last five to 10 years report this in 16,7 percent of cases, and those who had experience with childbirth before in 12,9 percent," they say.
The authors of the study also add that respondents who gave birth in the previous year most often reported that they were not sure whether they had experienced obstetric violence - as many as 42,9 percent of them.
The Center for Investigative Reporting in Montenegro (CIN CG) published a questionnaire in 2022 regarding obstetric violence. The questionnaire was filled out by 709 respondents who had given birth naturally in Montenegro in the previous five years. A large percentage of them testified that they had experienced at least one of the harmful practices that are often done without the consent of the mother, which is a type of obstetric violence and is legally sanctioned in many countries.
They encourage patients to file complaints
Hospitals and health centers contacted by "Vijesti" claim that no cases of obstetric violence have been reported to them. At the same time, they encourage women and their families to report such cases. Responses were submitted by the Hospital in Barane, the Hospital "Danilo I" in Cetinje, and the Health Center and Clinical Hospital Center in Kotor.
The Ministry of Health said that no cases have been reported to them.
"However, we had a report from the non-governmental sector for two cases, based on which internal procedures were carried out. We would like to point out that the Ministry of Health did not have the personal data of the patients who contacted the non-governmental sector, so we were not able to contact them and find out the details of the events," they stated.
As with health institutions, the health department is appealing to women who have experienced verbal or other forms of violence and injustice in maternity wards to contact the patient rights ombudsman, or that department.
In the case of the Ministry of Health, this is the Directorate for Quality Control of Health Care and Human Resources Development.
"Maternity hospitals are places where life is born, maternity hospitals must be places where women feel safe, dignified and respected without the slightest possibility of inappropriate treatment by healthcare workers or staff in healthcare institutions," said the Ministry led by Vojislav Šimun.
Only a few complaints of a technical nature were received at the gynecology department of the Clinical Hospital last year.
There were no complaints about obstetric violence at the Clinical Center of Montenegro (KC), the health institution told "Vijesti".
They point to the role of the protector of patients' rights, to whom insurers can submit suggestions, proposals and possible objections.
"Patients or their partners can report suspected obstetric violence to the director of the KCCG or the Ombudsman for Patients' Rights, and during hospitalization to the director or head nurse of the Clinic for Gynecology and Obstetrics. Also, during hospitalization, each patient can anonymously fill out a survey questionnaire related to satisfaction with the medical services received or submit their complaint to the KCCG through the compliments and complaints boxes," they state.
They added that last year, out of 2.713 anonymously surveyed patients at the Clinic for Gynecology and Obstetrics, 2.656 (98 percent) expressed satisfaction, and two percent of them were dissatisfied.
"The dissatisfaction expressed by patients undergoing hospital treatment was not about the quality of the health service provided, but was mainly of a technical nature, a significant number of which was unjustified or even subjective in nature. We are pleased that not a single case of obstetric violence was recorded in our institution, although the most deliveries are performed in the KC of all Montenegrin maternity wards annually, on average around 3.300," they state.
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