Maternal mortality and obstetric violence during the birthing process have long been organizing issues for the women’s movement in Venezuela. This struggle has intensified recently on account of the grave impact that the economic crisis is having on women’s health and reproductive rights. In a bid to resolve these pressing issues facing the country’s female population, the national government launched a new national Humanized Childbirth Plan earlier this year to revolutionize the entire experience of childbirth through training thousands of community activists as doulas. VA takes a look at this pilot program in the following video.
Though no official statistics around maternal mortality in Venezuela have been published since 2015, many revolutionary women’s and feminist movements assert that maternal deaths have risen sharply in the last few years.
According to Virginia Martinez of the popular feminist movement Mujeres Por La Vida (Women for Life), her organization has received “very alarming statistics” in relation to maternal fatalities over the last few years. Though this peak began in 2014, she told Venezuelanalysis that these figures are “getting even higher in the period of 2015, 2016 and 2017 as the economic war has deepened in our country.”
Martinez says that the lack of access to medicines and contraceptives is one of the main reasons for the increasing amount of high-risk pregnancies in Venezuela, which in turn has fuelled this worrying wave of maternal mortality. But she also recognizes that a series of conditions that affect pregnant women today have always existed. Not least, the violation of women’s rights and the jeopardizing of their safety in maternity wards during the birthing process. She says that these underlying issues, as well as new problems, must be addressed.
Like most of the Western world, maternity wards in Venezuela have historically been places of systemic violence and abusive conditions for women. The excessive medicalization of childbirth, and the incursion of the private market into the health sector, often mean that women’s rights are sacrificed on the birthing table for profit and doctor convenience. For Venezuelan women, being shouted at, spanked, forcibly shaved, and even being pushed into a cesarean are all sadly part of the birthing process.
This situation has led revolutionary women’s movements to take the issue of maternal mortality to the streets. On March 8th 2017, as part of the International Women’s Strike, feminist and women’s organizations demanded action from the national government to reduce maternal mortality, provide adequate contraception and guarantee women’s rights to pregnancies free from obstetric violence. The same groups had previously organized and written a bill for humanized childbirth in 2015, in a bid to enshrine women’s birthing rights into law. Though this bill was approved in first discussion in Congress, the proposed law was subsequently abandoned by lawmakers once Venezuela’s opposition won a parliamentary majority at the end of 2015.
The demands of the women’s movements however, did not go unheard. Following a six month investigation, Venezuela’s Ministry for Women and Gender Equality unveiled the National Plan for Humanized Childbirth, promising to revolutionize healthcare during pregnancy and childbirth.
The Humanized Birthing Plan is aimed at creating humane conditions for women before, during and after their birthing process, and requires collaboration between the Women’s Ministry and the Ministry of Health. The plan includes some of the suggestions outlined in the humanized birthing bill, including the construction of pre-birthing centers, shelters for pregnant women living in extreme poverty, community outreach and training for medical professionals and public officials. Its overall objective is to change how childbirth is viewed, and to move away from medicalized procedures and towards a natural process where women are in control.
Asia Villegas, the Vice-Minister for Gender and Equality in the Women’s Ministry, explains the proposal in the following way:
“This proposal was born with the intention of accompanying our pregnant women. We have understood that those 500,000 pregnant women are the state’s responsibility, and as a revolutionary government, we are responsible for accompanying them. And accompanying them means guaranteeing that they have a happy, wanted and safe pregnancy.”
For Villegas, one of the main challenges that the government must confront is the amount of cesareans which make-up more than 52% of births within the public sector. Villegas emphasized that this is not just a question of decreasing cesarean interventions, but of guaranteeing that women are well informed of their options and that cesarean procedures are carried out only with the woman’s consent.
This consent, she says, means providing women with “ample and acceptable information in simple terms”.
One of the main elements of the Humanized Childbirth Plan is community outreach. Experienced doulas and midwives were recruited to design the training program for thousands of community activists, who will go on to accompany women in their communities, before, during and after their pregnancies as part of this new government plan.
Maritiza Torres, one of the birthing facilitators chosen to create the training program, explains that maternal death in childbirth is often due to the cultural practice of disempowering women during the process.
“[That] experience of defenselessness, where everyone else decides for you and there is no one to give you a hand, to hug you, or to sustain you, those are the principal causes of maternal death because the woman enters in a personal, psychological, and emotional situation that does not help the process and could end fatally,” she explains.
The purpose of training community organizers is to ensure that women have access to humane accompaniment, necessary information and support during their birthing process, and to avoid the complications and sense of defenselessness that Torres describes.
The Women’s Ministry says the goal is to train 10,000 female community activists as doulas to provide support to circles of 50 women during and after their pregnancies. Through this network of newly qualified, women-focused birthing facilitators, the ministry is hoping to be able to revolutionize care for the approximately 500,000 women that are pregnant in Venezuela at any one time.
According to Vice-Minister Villegas, the fact that all of the activists are women is hugely important.
“This is based on a subjective element, but a very important one, which is that women take care of other women,” she states.
The training, which is based on theories of popular feminist education, will also allow the women activists to build on and bring their own experiences as women into the health system to support and empower other women.
It’s a simple objective, but a powerful one that goes to the heart of nurturing collective agency amongst women.
“It’s about empowered women, who share that empowerment with others,” comments Villegas.
The training consists of three major phases. In the first phase, activists become empowered over their own bodies through a series of exercises where they learn to trust their own needs and emotional and physical signals.
During the second phase, the activists delve more deeply into the theory of humanized childbirth, and specifically into women’s health and sexual and reproductive rights. Through exchanges, they learn and explore how these issues can be extended to humanized birthing and in the health sector as a whole.
The final phase, which is now being executed by activists in Caracas, marks the beginning of community outreach. During this stage, the newly trained activists inform their local community of their role, and create a census of all the pregnant women within their communities.
Though only recently implemented, the new recruits say the plan is already yielding positive results.
Saily Gimenez, a new community organizer for the Humanized Childbirth Plan in the community of Santa Rosalia in Caracas, says she feels satisfied with her experience so far.
“We have been deployed since we finished our training, it has been a very satisfying experience. We already have six circles of women, among them we have pregnant women and women who are breastfeeding. We facilitate everything like body consciousness, training in sexual and reproductive rights, in breastfeeding, and we give them support,” she told Venezuelanalysis.
“They count on us for support from when they get pregnant until they finalize their gestation. If they have to go to the doctor, if they have to go the National Institute for Nutrition, if they need massages, we also connect them with the medicine distribution system, so that they aren't thrown around. We make all of those connections so that they don't have to face all of that trauma which some have had to face in other pregnancies,” she added.
Though there remain huge challenges for the revolutionary government to tackle, such as women’s limited access to contraceptives as a result of US economic sanctions, pharmaceutical importer fraud, and a drop in government imports due to the post-2014 drop in global oil prices, the Humanized Childbirth Plan is seen as a huge win for women’s sexual and reproductive rights in Venezuela.
For Valentina Fagundez, a Humanized Childbirth community organizer from the populous neighbourhood of 23 de Enero in Southwest Caracas, the plan is not just an achievement for women, but for society as whole.
“This plan is an excellent tool to sensitize all of us, not just as human beings, but as a country. If we are born with violence, then we will be violent people. If other countries could copy this system, then humanity would be much more loving,” she concluded.
*Special thanks to the Ministry of Women and the Vice-Ministry for Gender and Equality for providing interviews and supporting images, as well as Rachael Boothroyd-Rojas and the entire VA team for their valuable contributions in the elaboration of this video.