A post by former doctor and filmmaker Omnia Sweidan revealed horrific violations against female patients, which she said she witnessed in the obstetrics and gynaecology department of El Shatby University Hospital during her training as an intern doctor 6 years ago, including bullying, sexual harassment and violence during childbirth, unnecessary medical interventions without the patients’ consent, or threats to withhold medical care.
Following that, a wave of testimonies from victims of obstetric violence by healthcare providers circulated on social media in Egypt. The World Health Organization defines it as a violation of the rights and dignity of women and their bodies, and it includes physical and verbal abuse, the failure to obtain informed consent for medical interventions, and neglect in healthcare facilities.
On 16 June, rights and feminist circles in Egypt were shocked by the arrest of Omnia Sweidan from inside her home in the city of Damanhour, and by the loss of contact with her for several hours without her place of detention being known. Following that, hashtags were launched: (#Where_is_Omnia_Sweidan, #Freedom_for_Omnia_Sweidan).
The following day, the doctor appeared before the East Alexandria Plenary Prosecution, and she was faced with charges of spreading false news on Facebook and misusing her account. The prosecution later explained that the investigation came on the back of a complaint submitted by the lawyer for Alexandria University Hospitals. The Public Prosecution then issued its decision to release Omnia on bail of EGP 20,000 pending the case, according to her lawyer, Mohamed Ramadan Abu Bebars.
16 rights organisations and initiatives, political parties and public figures demanded her immediate release without conditions or charges, stressing that her detention represents a violation of freedom of expression, and calling for an independent and transparent investigation into the incidents raised by her testimony, and for the protection of women and health sector workers from prosecution or retaliation when they report violations.
Rights lawyer Azza Soliman considers that the charges brought against Dr Omnia Sweidan carry a negative message to anyone thinking of reporting violations or exposing them to public opinion, considering that what happened may be understood as an attempt to silence witnesses and those who report incidents of violence or mistreatment inside various institutions.
“Pursuing those who speak about violations instead of seriously investigating the reported incidents may create a state of fear among victims and witnesses, and push many to hesitate to give their testimonies or to file complaints about the abuses they are subjected to or witness,” she tells Zawia3.
She stresses that guaranteeing the protection of whistleblowers and witnesses is an essential condition for exposing violations and holding those responsible for them to account, emphasising the importance of providing a climate that allows victims and workers in various institutions to report incidents without fear of being subjected to prosecution or punishment.
For her part, Gawaher El-Taher, director of the Access to Justice programme at the Center for Egyptian Women’s Legal Assistance, stresses that the incident raises questions about the way the relevant authorities deal with complaints related to healthcare violations, since the priority should be to investigate the incidents and testimonies contained in her post, rather than to take action against the person who revealed them.
She explains that the complaint submitted regarding the post did not aim to accuse the doctor, but to demand an investigation into the incidents she spoke about, as the lawyer who submitted the complaint considered, and confirmed during the investigations, that Omnia Sweidan was a witness to those incidents and not accused of them.
She tells Zawia3: “The relevant authorities could have formed fact-finding committees and listened to the women who spoke about their experiences, and reviewed the records and incidents linked to the period the doctor referred to, which would help in arriving at a more accurate picture of the truth of what happened.”
She stresses that obstetric violence is not a new phenomenon, but has long remained outside the circle of public debate because of the sensitivity of the subject and the difficulty women have in speaking about what they are subjected to during childbirth, noting that the Center for Egyptian Women’s Legal Assistance has received, over the years, complaints from women who spoke of being subjected to verbal insults, reprimands or inhumane treatment while they were in delivery rooms.
Gawaher believes that what the doctor raised does not represent an isolated incident concerning El Shatby Hospital alone, as the publication of the post was followed by numerous testimonies from women who spoke of being subjected to various forms of obstetric violence inside government and private hospitals in different governorates, calling for these testimonies to be treated as indicators that warrant research and investigation, and not merely as isolated individual accounts.
Omnia’s detention did not stop the wave of testimonies; Dr Alaa Walid Ghorab published on “Facebook” incidents she said she witnessed during her training in the obstetrics and gynaecology department of El Shatby University Hospital in Alexandria, including accusations that some patients were subjected to degrading treatment during abortion or childbirth, including reprimands and neglect despite their suffering from pain or bleeding.
She accused a doctor of performing a tubal ligation on a woman during an abortion procedure without a clear medical justification, adding that she witnessed one of the ovaries falling into the abdominal cavity as a result of an error during a hysterectomy, before it was fixed back in place.
Dr Farida Mahgoub appeared in a video on her personal “Facebook” account to confirm that, since 2013, she had begun preparing a series of theses and field research studies focusing on the postpartum stage, and the indicators at the time showed that 13% of the study sample (which represented about 75% of all participants) suffered severe psychological harm and acute psychotic symptoms after childbirth as a result of the traumas they had been subjected to.
A doctor named Bosy Ali wrote her testimony about incidents of harassment and violations to which women were subjected inside operating theatres during the internship she spent in the obstetrics and gynaecology department at the 6th of October Health Insurance Hospital, accusing one of the workers of entering the operating theatre while the patient was being prepared, at a time when she is completely naked, and of deliberately touching the bodies of some patients and harassing them in front of members of the medical staff, amid a state of indifference and the treatment of the matter as material for mockery and joking.
The young doctor added, in a post of hers on Facebook: “I personally witnessed other forms of violence, including insulting, cursing and shouting at patients during childbirth, and at times it even reached pinching and beating, and most of the victims were ordinary women who had no means of defending themselves other than silence.”
Lack of Awareness and Fear of Reporting
Obstetric violence is one of the forms of medical violence to which women are subjected during pregnancy and childbirth and the medical procedures associated with them, and it is not a new or recent phenomenon; rather, it has previously been documented and discussed in press reports, studies and testimonies collected by feminist and rights organisations over the years, according to Mayar Makki, founder of the “Barr Aman” initiative.
She explains that obstetric violence includes a wide spectrum of practices and violations, among them the absence of “informed consent” and the failure to involve women in decisions relating to their bodies and healthcare, as well as verbal insults and degrading treatment during childbirth, or subjecting women to painful or unnecessary medical procedures without sufficient explanation or their genuine consent.
She tells Zawia3: “Some common practices, such as performing caesarean deliveries without clear medical justification or without giving the woman sufficient opportunity to understand the available alternatives and make the appropriate decision, also fall within the forms of obstetric violence, because they strip the woman of her right to make decisions about her body and her reproductive health.”
The feminist activist points out that any medical intervention or examination carried out without clear medical necessity, or without respecting the patient’s privacy and her right to know and to consent, can represent a violation of her rights and her human dignity, stressing that many documented testimonies that have emerged in recent years have addressed such practices.
She believes that the testimonies raised regarding El Shatby Hospital opened the way for other women to speak about similar experiences about which they had remained silent for long periods, because most of them did not realise that what they had been subjected to constituted a violation, owing to the lack of awareness of the concept of obstetric violence and its limited circulation.
She believes that part of the problem is linked to prevailing social perceptions of medical authority, as the doctor is seen as the only party able to make decisions, while the patient, male or female, is excluded from actual participation in determining the course of treatment or assessing the practices they are subjected to. Many women also hesitate to report the violations they are subjected to out of fear or a feeling that what happened is normal or does not merit a complaint, alongside the physical and psychological conditions accompanying childbirth, which sometimes make it difficult for women to perceive or document the violations they are subjected to at the time, especially with severe pain or the effect of anaesthesia.
She stresses that confronting obstetric violence requires institutional recognition of the existence of the problem and the opening of serious investigations into the testimonies and complaints submitted, along with strengthening accountability mechanisms within health institutions, spreading awareness of patients’ rights, and ensuring respect for informed consent, privacy and human dignity at all stages of healthcare related to pregnancy and childbirth, noting that pursuing those who expose these incidents leads to the continuation of violations without accountability.
Meanwhile, Magda Soliman, director of the Health and Reproductive Rights programme at the Center for Egyptian Women’s Legal Assistance, believes that the controversy stirred by the recent testimonies on obstetric violence has reopened the file of violations and mistreatment within some reproductive and sexual health services, a long-standing problem related to the quality of healthcare and respect for women’s dignity and rights, which is not limited to a particular institution but has been documented in a number of government and university hospitals.
She tells Zawia3: “During childbirth or while receiving reproductive health services, women may be subjected to multiple forms of verbal insult, mistreatment and the degradation of their human dignity, along with the absence of privacy at times.”
She explains that part of the problem is linked to an entrenched societal culture that includes prejudices and demeaning views of women, perceptions that may be reflected in the way patients are treated inside health institutions; they are not limited to men but also come from some female workers in the health sector, and they go beyond gender to encompass a wider institutional and societal culture.
She points out that the most prominent forms of obstetric violence that recur in complaints are the absence of privacy in some service delivery settings, along with exposure to insults, reprimands or hurtful comments during childbirth, as well as the inhumane treatment of women at moments when they are in the most extreme state of physical and psychological weakness, stressing that obtaining healthcare is an inherent right of female citizens that must not be affected by the patient’s economic or social status.
She stresses that the absence of effective oversight and clear accountability mechanisms contributes to the continuation of some of these practices, emphasising the need to activate patients’ rights standards within health institutions and to follow up seriously on compliance with them, and calling for clear healthcare standards that take rights and human dignity into account, for strengthened supervision and oversight by the competent authorities affiliated with the Ministries of Health and of Higher Education and Scientific Research, along with developing the mechanisms for selecting and evaluating health sector workers in terms of the professional, psychological and humane aspects of dealing with patients, ensuring privacy, confidentiality and safety within obstetrics and gynaecology departments, and providing a treatment environment that respects women’s rights to healthcare without humiliation or abuse.
Meanwhile, Nevine Ebeid, executive director of the New Woman Foundation, explains that the issue of obstetric violence is linked to wider problems relating to medical practices and women’s rights during pregnancy and childbirth, since Egypt is among the countries with high rates of caesarean deliveries, which raises questions about the extent to which women obtain sufficient information to make informed decisions about the type of delivery, and the extent to which health institutions adhere to the principle of informed consent before carrying out various medical interventions.
She stresses that the problem of informed consent is not limited to surgical operations, but extends to a number of medical procedures related to reproductive health, where decisions affecting women’s bodies and health may be taken without providing them with full information or genuinely involving them in the decision.
She tells Zawia3: “Some practices related to childbirth reflect a culture that belittles the pain and suffering women go through during labour, which may lead to disregarding patients’ complaints or downplaying their psychological and physical needs during this sensitive stage.”
She also links the pressures on some public hospitals to the decline in the quality of care provided to women during childbirth, explaining that overcrowding in health institutions and the shortage of some specialised staff may contribute to the emergence of practices that lack the sensitivity needed for dealing with patients and respecting their rights.
She stresses that the literature issued by international organisations concerned with health addresses multiple forms of violations to which women may be subjected during childbirth, among them verbal insults, coercion, unjustified medical interventions, ignoring the need to obtain informed consent, or breaching the standards of safe care.
The foundation’s director calls for the adoption of a clear national framework for dealing with obstetric violence, including binding protocols for safe practices during pregnancy and childbirth, and the integration of these standards into the system of professional and medical accountability, so as to guarantee the protection of women’s rights and improve the quality of the health services provided to them.
In this context, rights and feminist organisations and human rights defenders stressed, in a statement, that the testimonies of obstetric violence and of the violations to which women may be subjected during pregnancy, childbirth and the related healthcare have contributed to opening a long-awaited societal debate on a hushed-up issue that affects women’s safety, dignity and basic rights, and have encouraged large numbers of women to share their personal experiences and disclose suffering that for years remained imprisoned by fear, silence and stigma.
The statement considered that confronting obstetric violence begins with recognising its existence and listening to the testimonies of the women harmed by it, not with silencing the voices that shed light on it, adding that individual and collective testimonies are an important source for understanding the structural problems that may affect the quality of healthcare and respect for patients’ rights.
The organisations stressed in their statement that the right to express opinions, the right to report potential violations, and the right to participate in public debate on health policies and practices are fundamental rights guaranteed by constitutional principles and international human rights standards, affirming that protecting women’s dignity during pregnancy and childbirth is an inherent part of the right to health, the right to physical and psychological safety, and the right to humane treatment free from violence, humiliation and discrimination.
The statement called for providing a safe environment that allows women and male and female health sector workers to express their concerns and experiences without fear of retaliation or intimidation, opening a serious societal and professional debate on the forms of obstetric violence and the mechanisms for preventing and confronting it, and promoting the principles of healthcare based on respect for human dignity, informed consent, privacy and non-discrimination, calling on the relevant authorities to deal with this issue from a rights-based and reformist perspective that puts women’s safety and rights first.
Practices of Obstetric Violence
In the same context, Dr Ayman Sabae, researcher on the right to health and health policy at the Egyptian Initiative for Personal Rights, stresses that the term “obstetric violence” is still not widely used among health service providers, and that it lacks an official, agreed definition, as it covers a wide spectrum of practices to which women may be subjected during pregnancy and childbirth, among them verbal insults, disregard for patients’ complaints or symptoms and the failure to involve them in decisions relating to their healthcare, along with some unnecessary medical interventions, such as performing unjustified caesarean deliveries.
Egypt is among the highest countries in the world for caesarean deliveries (about 52% in 2014–2018, reaching 60% in urban areas and 94% in some Cairo hospitals), compared with the rate recommended by the World Health Organization (10–15%), which is attributed to financial incentives, time pressure and lack of training.
The researcher links obstetric violence to the culture of “paternalistic medicine” prevailing in some medical practices, where the service provider acts as the sole decision-maker, while the patient is excluded from actual participation in decisions relating to her body and treatment, noting that this tendency may be exacerbated in obstetrics and gynaecology as a result of social and cultural perceptions that downplay the importance of women’s complaints or their ability to make decisions about their health.
He tells Zawia3: “Setting clear definitions and specific professional standards by the competent authorities is an essential step to protect patients’ rights and clarify the obligations of health service providers. Informed consent should also not be linked only to formal procedures, but to sufficient information that enables patients to make informed decisions about the care provided to them, including the options related to pain relief during childbirth.”
He sees a need to develop medical education and training programmes in a way that strengthens respect for patients’ rights and dignity and ensures women’s genuine participation in decisions related to their reproductive health, stressing that trainees’ participation in the educational process does not give them the right to examine patients or deal with them without consent, or to expose them to pain or embarrassment.
The Doctors Syndicate had affirmed its full commitment to protecting the dignity of patients and respecting their rights, as an essential part of the principles of practising the medical profession and of the doctors’ oath.
It explained, in a statement, that it is following up, in coordination with the Alexandria Doctors Syndicate, on what has been raised regarding El Shatby Hospital, along with the investigations being conducted by the Faculty of Medicine at Alexandria University to verify the circulating incidents, stressing that any violation of patients’ rights or of professional duties exposes the perpetrator to disciplinary and legal accountability.
It also called on workers in the medical sector, patients and their families to report any abuses, pledging to deal seriously with all complaints and to investigate them urgently, in a way that guarantees the protection of patients’ rights and the preservation of the ethics of the profession.
Meanwhile, Alexandria University stressed that it is dealing seriously with the circulating allegations regarding practices inside the obstetrics and gynaecology department of El Shatby University Hospital, emphasising that the dignity and safety of patients and the ethics of the profession are principles that admit no leniency.
It explained, in a statement, that what has been raised is currently subject to examination and investigation by the competent bodies at the Faculty of Medicine, pledging to take decisive measures if any abuses are proven, and calling for complaints and documented testimonies to be submitted through official channels to ensure that they are verified and that those submitting them are protected.
It called for no prejudgements to be issued before the investigations are concluded, in order to preserve the rights of patients and of workers in the medical sector, noting that El Shatby Hospital provides its services to tens of thousands of patients annually, claiming its commitment to transparency and accountability, and to taking legal action against those spreading what it described as rumours if the circulating allegations are proven untrue.
Between the demands of rights defenders and feminists for an investigation into the reported violations, and the official bodies’ insistence on awaiting the results of the examination and investigation, the testimonies of women and female doctors remain a real test of the health system’s ability to confront the accusations raised with transparency, and to guarantee women’s right to safe healthcare that preserves their dignity and their physical and psychological safety.
While the official investigations into the El Shatby Hospital violations continue, opening a wider debate on the reality of the healthcare provided to women during pregnancy and childbirth in Egypt, respect for the dignity of patients, the guarantee of informed consent, and the oversight and accountability mechanisms within obstetrics and gynaecology departments.
