In-depth | Gender

Violence at the doctor’s office

By - 06.05.2021

Although an everyday occurrence, gynecological and obstetric violence is seldom made public in the region.

“Five years ago, when I was giving birth to my second child, a nurse took me to the labor room, but left me outside. A colleague of hers popped out of the room, sat me on the bed and called the doctor. As soon as he entered the room, he asked me with a disgruntled frown: ‘How many fingers?’”

“‘I don’t know.’ I struggled to answer since the pains had already become unbearable.

“‘What on earth is happening today? This one doesn’t even know how open she is,’ he snapped at the nurses before he dropped some equipment on a metal table.”

“‘The child’s pulse is too high,’ one of the nurses said. ‘It’s got to come out.’”

“I was starting to panic as I felt all alone.”

This is a story Adisa M. from Sarajevo told K2.0 about her labor. This could also be a story of a substantial number of women who have given birth in Bosnia — a country where the public rarely talks about how female patients are treated by male doctors. 

According to women’s associations and activists from the region, plenty of women have encountered both verbal and physical mistreatment at the gynecologist, and even violence. However, seldom do they speak out about these experiences. If they do speak out, they do so online for the most part, anonymously, or they talk about it with their female friends.

“Gynecologists feel uncomfortable.” “When sex is mentioned.” “If it is not for conception.” Photo: Courtesy of collective Vala, Ljeposava.

Reports that are filed against institutions are rare, sanctions are even rarer, but things might change in the future.

Tearing down the wall of silence

In Croatia, gynecological and obstetric violence was first discussed in public by Ivana Ninčević Lesandrić, who — in 2018, while still an MP — shared how she had received a dilation and curettage with no anaesthesia in Split hospital. The association Roda (“Stork”) responded shortly afterward and kicked off a campaign titled Prekinimo šutnju (“Let’s break the silence”), where they aimed to bring into the public eye how women are treated daily by medical staff.

Serbia was recently taken aback by Mina Smiljanić’s story; earlier this April, the journalist revealed that an anaesthesiologist had harassed, beaten and insulted her during her delivery. “The first thing he told me — no sooner than I had greeted him — was: ‘Oh, you journalists sell yourselves for 50 euros,’” Smiljanić recounted.

"Three months have passed, my child has grown a bit and the physical pains have subsided, but I still feel ashamed and powerless."

Mina Smiljanić, journalist from Belgrade.

“Despite my best efforts to take it as a joke, he called me a fatso and told me I was useless. He also hit me on the back and my right shoulder quite heavily, in order to show me how I should get in position so he could give me a jab right in the center of my spine. I told him he wasn’t being considerate. So, three months have passed, my child has grown a bit and the physical pains have subsided, but I still feel ashamed and powerless when I remember some of the scenes from my seven-hour-long delivery.”

Sarajevan writer and journalist Nermina Omerbegović told K2.0 that she has not had any similarly dreadful experiences, but she did once come across a doctor who commented on the fact that she didn’t have a baby yet. “She asked me: ‘So, what, journalists don’t wanna have kids?’ This was accompanied with the traditional ‘What are you waiting for?’” The author recalled, looking back on painful gynecological check-ups where doctors would be rude to her. 

She has not considered filing any complaints against medical staff, in part because instances like these are far outnumbered by the positive ones; but also because she believes that [abuse] is not taken seriously at all within Bosnian society.

“The reason is perhaps the fact that generations and generations of us women have gotten used to being asked: ‘When do you think you’ll be getting married?’ ‘When are you going to have kids?’ “When…?’ However, I still think a big problem is that people don’t go to the doctor as often as they should, and not only to the gynecologist,” Omerbegović says. She adds that — in her opinion — if women heard stories of other women who have had bad experiences, and if doctors were penalized, it would trigger a change.

Some months ago, a platform called Nisam tražila [“I didn’t ask for it”] was created in Bosnia, enabling women to share their stories related to various types of abuse that they have survived. Many comments are evidently discouraging as well as insulting and it seems that the perception of violence in the country is still very problematic.

A somewhat different approach was adopted by a Montenegro-based feminist collective that raises numerous concerns in public through their Facebook platform Vala, Ljeposava [“By God, Ljeposava”]. The group uses satire as the form to express their criticism toward the government, but also to draw attention to some of the issues women in Montenegro are faced with daily. It draws inspiration from an old Yugoslav TV series ( called “Vala, Ljeposava”) from the 80s; “Đekna još nike umrla, a kad će ne znamo” (Đekna is not dead, yet, and we do not know when she gonna die”) is one of the catchphrases, which shows patriarchy in one rural family in Montenegro.

“What else did the gynecologist tell you?” One of the images the collective Vala, Ljeposava used with their campaign to end gynecological and obstetric violence. Photo: Courtesy of Vala, Ljeposava.

By the end of last year, this collective publicly called on women to speak out about gynecological and obstetric violence.

“Ergh, get dressed so you don’t get pregnant for the third time!” 

“Why have you squeezed your legs together — want Brad Pitt to come and open them for you?” 

“Oy, you look like you used to stand on the roadside!” 

“Why are you whining? You didn’t really whine while you were making it [the baby], did you?!” 

“So beautiful on the outside, so foul on the inside,” 

“Haven’t you got a boyfriend? Well, make him crank it up for a bit, to burst these cysts,” 

“We all know what those who use tampons and birth control are like.”

These are only some of the remarks that women had heard from doctors and decided to share on the Facebook page. As they contributed en masse, the entire discussion went viral. And soon, another platform was started, this time on Instagram; Kritički [“Critically”] now sheds light on a pattern of abuse connecting women in the region in yet another way.

“The page has given space to those women who want to say something. But this is no heroic act,”  the women from Vala, Ljeposava point out. According to them, if it were not for the widespread contribution, if a large number of women had not decided to tell their stories, there would hardly be any awareness-raising in terms of this issue.

The violence has been brushed off for years

Delila Hasanbegović-Vukas, a staff member of the Sarajevo Open Center (SOC) and author of works focused on various aspects of human rights, says that she is certain that the people who survive any form of violence believe that they have a lot to lose if they stand up against it.

“It’s necessary to come forward and speak about the so-called gynecological violence, to give voice to the many who aren’t even aware of what has happened or has been happening to them because they think that it should and could be that way,” Hasanbegović-Vukas says, adding that all available channels ought to be used in order to bring the issue up for discussion — from schools and the media to the very places where violence takes place.

"As a general rule, the attitude toward women’s reproductive health is problematic."

Tanja Stupar-Trifunović, author

Banja Luka-based author Tanja Stupar-Trifunović believes that Bosnia is flooded with verbal violence against women, which is reflected in the public discourse, social media and many comment sections, but also in the way people communicate in the street and public spaces. “As a general rule, the attitude toward women’s reproductive health is problematic,” she says, reminding that HPV vaccines — for example — are not available, which is another problem that fails to be mentioned.

“All of it is just a long-term, insidious and detrimental social violence, the consequences of which have been ignored for years,” claims Stupar-Trifunović. As for the inappropriate comments from gynecologists’ offices specifically, she describes them as a reflection of how women are treated in general.

However, in recent years, several NGOs in Banja Luka have been setting up initiatives geared toward raising awareness about women’s reproductive health. In 2015, the DRIP association — short for Djeca, roditelji i porodilje (“Children, parents and women in labor”) — was founded by a group of women determined to bring attention to the fact that the current situation in maternity hospitals needs to change. Alongside the Oštra nula (“Hard zero”) organization, they launched a public action where they set up a cooperation with healthcare facilities.

Two years of advocacy later, they managed to cut the prices of epidural anaesthesia and ensure that a trusted person would be allowed to be present while mother is in labor.

“Why did you come when you do not want to give birth? We will not treat you for nothing.” Courtesy Vala, Ljeposava.

“In order to bring it about, the intended change should be pushed forward in every segment of society. It’s important to include these issues in the education process,” Stupar-Trifunović says, noting that the Bosnian society is not mature enough to grasp what type of violence is at hand; physical acts are still the only ones considered violent.

Amila Ždralović, a doctor of sociology and an assistant professor in the Sarajevo University Faculty of Law, agrees, reminding that although we are hardly tolerant toward violence as societies, a more prevalent issue lies in some forms of violence not being recognized as such. According to her, the cure is to discuss the aforementioned forms of violence in public.

“It’s precisely discussion that helps and makes us aware of what’s wrong,” Ždralović told K2.0. “The idea of equality is based on respecting each individual. All verbal aggressions — including inappropriate comments — that women experience in different places (that includes gynecologists’ offices) are a form of discrimination.”

Judgment and harassment of those who have survived any sort of abuse are faced with on social media play a big role in this respect.

“We’re not able to comprehend the severity and frequency of the more subtle / less visible forms of violence: Psychological, economic or online violence; violence within the welfare system, public institutions or healthcare; and many other hidden forms of violence. Not to mention how severely these forms of violence impact survivors and the entire society,” Stupar-Trifunović asserts.

What does the law say?

Feminists should talk about these issues, but the burden cannot be imposed on women’s/feminist associations alone. So far, public condemnation and criticism seem to have been the only sanctions for gynecological violence in Bosnia.

When asked about disciplinary measures related to the mentioned forms of violence, several Bosnian healthcare facilities tersely responded that patient complaint and report forms are readily available, but noted that female patients do not complain about gynecologists. As a matter of fact, no health center or hospital that we have contacted — Banja Luka, Sarajevo, Mostar, Goražde, Livno, Zenica, Tuzla etc. — has received any such report. If such reports are received, healthcare facilities handle them in line with the [Federal] Law on Rights, Obligations and Responsibilities of Patients.

In line with this law, patients may make a complaint by submitting it to the director of the healthcare facility in question, either in writing or in person. In case a breach of duty is established, the penalty due to be laid down ranges from a written warning to dismissal.

A large number of women are discouraged from filing complaints, after finding out that they cannot prove what happened without witnesses.

Even the Montenegrin Law on Patients’ Rights provides penalties for inadequate treatment of patients, as well as malpractice, refusal to provide healthcare and other violations. The Law defines safeguard officers and/or directors of healthcare facilities as competent for receiving and processing complaints and then imposing penalties — that are in most cases fines — to staff.

In both countries, however, most complaints are still just words on paper. A large number of women are discouraged from filing them, after finding out that they cannot prove what happened without witnesses. They become discouraged even further upon learning that few doctors who have had complaints filed against them have been sanctioned.

“As for women, this gives way to a reasonable fear that if they file a complaint, they will have it worse next time they need similar medical treatment because they complained — and a couple of women have written to us precisely about such occurrences,” the Ljeposavas say.

The same issue is observed by the Women’s Rights Center in Podgorica. The Center provides necessary information, offers confidential psychological and legal assistance free of charge and works toward raising public awareness about all forms of violence against women. Maja Raičević, the executive director of the Center, says that women’s negative experiences vary from sexual comments made at check-ups or during medical procedures; insults and degrading treatment; or even physical violence, to procedures being carried out without the clear and informed consent of the patient and without any medical reason.

As one example of a procedure that doctors often do not ask consent for, Raičević lists episiotomy: A once routine intervention reserved for all women delivering, but eventually deemed unnecessary — except in specific cases. The Women’s Rights Center points out that any mistreatment or failure to uphold the patient’s rights constitutes obstetric violence, including procedures done against her will.

“Something pierced me on my back.” “It will be OK when you give birth.” Courtesy Vala, Ljeposava.

“If men could give birth, I’m sure that maternity hospitals would look completely different and get far larger amounts of funds,” Raičević concludes, adding that healthcare facilities across the region lack hygiene products, which led to infant deaths in a hospital in northern Montenegro a few years ago.

“Meanwhile, the government headed by men had a vehicle fleet worth millions of euros. Let me remind you that epidural anaesthesia is still a commercial service in the Clinical Center of Montenegro, costing 125 euros per treatment.”

Concrete actions

Social media is widely regarded as an effective platform for breaking the silence. According to the women’s collective Vala, Ljeposava, if it were not for the widespread contribution, there would hardly be any awareness-raising of this issue.

“Many forms of violence against women remain perceived as ‘normal stuff’ and the patriarchy wants us to believe that it’s the pain women have to experience and put up with because they’re women,” the feminist collective asserts, describing gynecological and obstetric violence as an open secret of sorts.

“We all know what’s happening, but still insist it’s normal. Due to internalized patriarchal patterns, even the women who’ve had negative experiences would tell other women to bite the bullet, or they would say it’s just the way things are, or that maternity hospitals are not some hotels, that we don’t go there to have a good time, etc.,” the Ljeposavas say.

"We believe the only appropriate response would be a fundamental reorganization of the system."

Vala, Ljeposava, Montenegrin feminist collective

Having gone beyond Facebook discussions, the activist group wrote to Montenegro’s Ministry of Health, demanding a detailed explanation of concrete steps aimed at addressing the issue of gynecological and obstetric violence. Minister Jelena Borovinić Bojović and the Montenegro Clinical Center director Ljiljana Radulović were first to respond. Both voiced their support for the campaign and promised to put effort into solving the problem.

However, not all reactions were of positive intentions and support. The head of the Clinical Center’s Gynecology and Obstetrics Clinic, Vesna Čolaković-Popović, has made an attempt to deny the shared experiences by referring to statistics that are off-limits to the public. In response, the Ljeposavas offered to mediate communication between the ministry of health and healthcare beneficiaries.

“Considering that this is a systemic problem, deeply ingrained in all institutions, we believe the only appropriate response would be a fundamental reorganization of the system, which is to be followed up by educating medical staff as well as patients,” the Ljeposavas say.

In the opinion of both the collective and other women who have spoken out, gynecological and obstetric violence is a complex issue that cannot be solved overnight, but it is important to have it addressed — as soon as possible.

Feature image: Courtesy of Vala, Ljeposava.