The human rights in childbirth revolution is gathering global momentum and support, yet birthing women in rural Tanzania still die alone, indigenous Australians must labour 500km from their communities and 73% of women in Cyprus juggle new motherhood with unnecessary cuts to their perineums.

Their UK and US counterparts report un-consented procedures, coercion, judgement, scrutiny and constraints that strip women of decision-making powers in the labour room and beyond. From the refusal of requests for caesarean sections or homebirths, to charging vulnerable migrant women for their maternity care, court-ordered caesareans and social services or police involvement, the devastating effects of a negative birth can last a lifetime. 

In her book, Why Human Rights in Childbirth Matter, Rebecca Schiller, author and chief executive of childbirth charity Birthrights, advocates for the human rights of childbearing women around the globe, telling real stories and exploring the cultural and political forces surrounding birth in 2016. She exposes the dangers of the fight between natural and medicalised birth campaigners, and shows how neglecting birth rights can have serious implications for all women’s rights at home and abroad. Here she shares an exclusive extract from her book that explains why human rights in childbirth are so vitally important… 

On 6 October 2013 I caught my second baby as he slid out of me. There he was, my newborn son. The misshapen head that often characterises vaginal birth. The still-separate plates of his soft skull moulded to the shape of my birth canal. There was no point being made, no ethos being followed, no agenda. Just life happening. A huge experience in my life. The first in his. It was very quiet in the half-second until he cried. Just my husband and me, somewhat shellshocked, alone in the house. Then he opened his mouth and eyes looking for my face. My personal kaleidoscope had turned and all that was in view was the two of us.

For a birth in the UK mine is unusual. No one told me what to do or what not to do. Like 48 million women around the world each year, according to Save the Children,1 I had given birth without a skilled attendant. Unlike the majority of them, I had an independent midwife racing through the countryside towards me. In contrast to two million women each year across the world I was not completely alone. Twenty minutes before I gave birth I turned to my husband and said: ‘It’s going to be just you and me.’ Out of nowhere, minutes after labour had started, my body was efficiently pitting out the baby it had kept safe until its ‘due date’. I felt a little afraid as the world shifted inside me at an incredible pace. I knew the baby was fine, but I wanted my midwife and doula by my side to look me in the eyes and tell me I could do this impossible task. I didn’t plan it this way.

He came twisting and turning through my pelvis into the world. Everyday, staggering, amazing and awful all together. This was something that happened to me and him. In ways he is unaware of, his birth may shape parts of his life. In more obvious ways, it will be marked on my body and woven into my personal narrative.

As a mirror to society, childbirth, the attitudes to it, practices around it and experiences of women going through it, reflect the progress that has been made in advancing women’s rights. This reflection also shows us that there’s still a long road ahead. But right then I wasn’t looking in the mirror. I was gently holding a little purple body against my skin and stroking his damp face. A birth is as private as you can get. My baby’s birth. My birth. Ours. His. Mine.

Like so many of us, I became interested in human rights quite simply because injustice makes me angry and I care about people. Later, I had my first baby and I thought I had found a different vocation: supporting women and their families through pregnancy and birth. It didn’t take long to realise that my two career pathways were linked in a number of ways. Childbirth and human rights have taken time to find each other, despite the fact that our humanity, and the rights conferred on us by it, is ignited in the moment our mothers push us out of their bodies. It is hard to be confident about freedom and safety when we are born in a context of disrespect, abuse or neglect.

However, the rights of individuals in childbirth are not simply reflective of broader attitudes. They are fundamental to protecting our freedoms, and both birth and feminist campaigners are beginning to see how powerful getting it right or wrong in birth can be. Researching this book, along with my wider work supporting women and campaigning, has convinced me that we cannot progress a women’s rights agenda without tackling the particular rights within this unique experience. After all, birth can only happen to someone with female reproductive organs, and 84 per cent of women get pregnant and give birth at some point in their lives. Lynn Paltrow, of the US organisation National Advocates for Pregnant Women (NAPW), believes that ‘advocating for pregnant women is advocating for all women and their human rights’. After all, she continues, ‘It is women’s capacity for pregnancy that is used as the excuse for differential treatment.’ Whether or not pregnancy and birth are on our individual radar, the position of women in society – often playing a different and lesser role in political, social and economic arenas – stems from this capacity.

Our ability to become pregnant is the root excuse for treating women as second-class citizens. The punishments, control, surveillance and barriers to full and equal participation in society are imposed disproportionately, says Paltrow, on those who are vulnerable for economic, racial or other reasons. As maternal and neonatal mortality statistics and the experiences of women in the forthcoming chapters show, some are more prone to discrimination than others. They face more physical and emotional dangers within the pregnancy and child-bearing process, which are reflective of, intertwined with and in some ways propel the difficulties they face in their other interactions with society. 

Getting it right in the birth context could provide a strong platform from which to assert how vital it is that all women are treated as humans at all times, with the rights this should afford them. By contrast, childbirth also provides the perfect opportunity to undermine those rights. Looking across the developed and developing world it is clear that the broad spectrum of women’s freedoms is undermined daily in birth. If we don’t value their experiences in an act that is particular to them, we make it an easy access point for those who seek to disrupt feminist progress.

Assumptions that would be challenged in other contexts seem to persist in childbirth. The spectre of foetal rights is an ill-conceived yet easily wielded tool to distract from punitive measures that target vulnerable pregnant women strategically to undermine women’s rights more broadly. An anti-woman culture promotes an antagonistic discourse around birth and motherhood. It turns our eyes from serious back-pedalling on basic reproductive freedoms, and exploits the emotive experience of identity and mothering to our disadvantage. There is much to be concerned about and I am not being hyperbolic when I say that what is happening in the US to women’s reproductive rights, often via the back door of undefended birth rights, is terrifying. There is also much cause for hope, with grassroots action rising up to meet topdown recognition of these issues with some real effect. 

This book is about birth, but beyond that it is simply about the human rights of women. Feminism has touched on birth across its history but, as Human Rights in Childbirth founder Hermine Hayes-Klein notes, it is only now that progress has been made in other areas that the current wave of feminists is able and beginning to engage with it fully. To succeed, we must all see human rights in childbirth as fundamental to protecting the entire spectrum of reproductive freedoms. I will argue that we all need to take note of childbirth; whatever our gender, whatever our plans for children, whatever our past experience. I will talk about it as an essentially personal event and will tell some of those individual stories from around the world. In highlighting the individual nature of the experience, I hope to show why it is childbirth’s very individuality, and the protection of that, which should prompt us to engage with it collectively, and how the human rights framework can be used to navigate the tension between personal and societal needs.

At the heart of this is a question about the statement that is frequently the mantra of contemporary, developed world birth: is all that matters a healthy baby? Say it often enough and perhaps it becomes true. Pregnant people say it when explaining their birth choices. Some doctors and midwives lightly tack it on to coercive discussions. Friends and family say it, often in consolation, after a difficult birth. In the moments after my son’s birth, it was all that mattered to me. Of course, it is true in many moments for many women. There’s little research on the matter, but Mary Nolan, professor of perinatal education, believes that most women who decide to continue with their pregnancies are driven to keep their babies safe. Be it biological programming or cultural conditioning, in most circumstances women are determined to see their babies happily into the outside world. A healthy baby may be all that matters to them in certain moments. Yet when I, in my immediate post-birth, mammal-like state, had zoomed in entirely on my new son, it was in an important context. When I say ‘my healthy baby was all that matters’, I am leaving out much, expecting it to be taken as read. That I am incredibly privileged in so many ways. That I had consented to the sex that conceived the baby. That I had access to contraception if I had wanted it. That I decided I wanted to continue with the pregnancy and had access to free, safe abortion if I hadn’t. That I lived in a country that offered me free, expert maternity care should I want it. That I could, just about, afford to pay an independent midwife when I realised the system might not work for me. That I would retain autonomy to make the decisions that I felt were best for me, my baby and my family. That no one would intentionally hurt me while I was in labour, or threaten me, or bully me, or take me to court and strap me against my will to an operating table and cut me open if I declined a suggested course of action. That after my baby was born I would be cared for, offered support, have access to life-saving drugs in case of haemorrhage. That I would matter.

The myth that ‘a healthy baby is all that matters’ needs to be unpicked. It cannot be left as read because, where the assumptions go unchallenged, a frightening and reductive world begins to appear. A world in which so many individuals cannot expect all the things I have listed above, and where backwards steps in women’s rights to freedom and justice are being made, often couched in the flawed logic of protecting the unborn but failing by their very nature to do so. I want to say that a healthy baby is not all that matters and that, resoundingly, it all matters. Human rights in childbirth matter. This is the story of women, of why they matter too, and the things that happen when they are pushed to the bottom of a hierarchy in birth.

Extracted from Why Human Rights in Childbirth Matter by Rebecca Schiller, Pinter & Martin £6.99

Join Birthrights, the human rights in childbirth charity, and help start a new chapter for childbirth by hosting a book club in October. For more details visit the Birthrights website.