‘Too little’ done to combat obstetric and gynaecological violence against women

In a sea of purple banners, one of the colours employed by suffragettes to represent loyalty and dignity, tens of thousands of protesters took to the streets of Paris to condemn violence against women on Saturday. 

Among those demanding more government action was Sonia Bisch, founder of Stop Violences Obstétricales et Gynécologiques (StopVOG), a feminist organisation combatting obstetric and gynaecological violence. Their presence in the march comes at a critical time. 

Since September, a total of seven women have lodged official rape claims against well-known Parisian gynaecologist Émile Daraï, who left his position as head of the Tenon Hospital endometriosis centre on October 8. On top of the claims, Stop VOG has received an avalanche of testimonies from various women on their social media accounts.

But while a legal investigation is under way, little has been done to curb obstetric and gynaecological violence in France. 

Unlawful

“Rape doesn’t only take place in a dark metro by a stranger holding a knife,” Bisch tells FRANCE 24. “It takes place within families, couples, and in gynaecological practices or maternity wards by doctors themselves … Unfortunately, medicine isn’t exempt from the things that happen in society.” 

Obstetric and gynaecological violence occurs when a health professional engages in behaviour or practices that are not medically justified or consented to by the patient. “It can take place during an abortion, an IVF procedure, a pregnancy or childbirth – and it can be physical, psychological or verbal,” Bisch explains. 

For Aurore, 32, it happened during her first-ever visit to the gynaecologist. She was 16 years old at the time and was told to get a check-up by her GP after she reported having itchy, irritated skin. Already feeling nervous about being examined under such intimate circumstances, she was met with hastiness. “The gynaecologist was visibly very annoyed that I hadn’t seen someone earlier. When he walked into the room, he said ‘Hello’ and immediately told me to get undressed,” she said. 

“I took off my trousers, sat on the examination table and started crying,” she explained, remembering how scared and stressed she felt at the time. “He started and I squeezed my knees together, I didn’t want to go on. He examined me with a swab to get a sample and carried out a vaginal examination with his fingers. All the while I was crying, shaking my head, saying no. I didn’t understand what was happening. I wasn’t prepared.” 

The doctor continued despite Aurore’s repeated attempts to stop the consultation. Years later, when she asked for her file, she found that he had also carried out a vaginal ultrasound. “I was so shocked at the time, I didn’t even notice what was happening,” she said. It turned out that Aurore had a simple yeast infection and only understood years later that she could have picked up medication at a pharmacy. But more importantly, she understood that she had been violated. 

According to the 2002 Kouchner law, medical practitioners must ask patients for their consent before carrying out any medical procedure. If they fail to do so and perform an act of sexual penetration “by violence, constraint, threat or surprise”, this is considered rape in France, according to article 222-23 of the penal code. 

A systemic issue

Cases of obstetric and gynaecological violence first made French headlines in 2014, when women used the hashtag #PayeTonUtérus to speak out about sexual harassment or abuse they faced during check-ups or procedures, in the wake of the #MeToo movement.  

Three years later, former secretary for equality Marlène Schiappa ordered a report on these types of mistreatments which was published in June 2018. The report found that violence committed by obstetricians and gynaecologists in France was systemic and not limited to a few isolated cases.

Some forms were found to be more common than others, like performing episiotomies (surgical incision of the perineum) without patient consent, getting vaginal stitches without anaesthesia and using fundal pressure (applying pressure on the uterus) to speed up the birthing process, a practice that has been strongly discouraged by the French National Health Authority (HAS) since 2007. 

The report also uncovered a general disregard for women’s pain and a lack of communication for procedures – something that Sandrine*, 40, experienced first-hand before the birth of her second child. When her due date was approaching and she still had no contractions, she began seeing her new gynaecologist on a regular basis to monitor the baby. 

During one of these visits, Sandrine was subjected to a painful vaginal examination, without warning. “It hurt me a lot,” she said, remembering a previous midwife in Paris who would always ask before performing the procedure. The gynaecologist then continued her examination and did something Sandrine says “didn’t feel good at all”. 

“She moved her fingers around, trying to stretch things out but wasn’t telling me what she was up to … I truly couldn’t handle the pain and felt like something was different. I told her to stop whatever she was doing and she immediately did,” she said. Sandrine found out that, without her consent or any communication, the gynaecologist had tried membrane stripping to induce labour since her baby was overdue. 

“I think the biggest problem is not asking women for their approval and not mentally preparing them for the pain they’re going to feel,” Sandrine said, echoing Bisch’s contention that, in 2021, women in France shouldn’t be leaving doctors’ practices or maternity wards feeling “tortured or violated”.  

Too little, too late

Since the release of the 2018 report, the French government and other medical authorities have done little to battle obstetric and gynaecological violence. To make matters worse, the Ordre des Médecins (French Medical Association) – the body in charge of drafting the code of medical ethics and processing complaints – was criticised in 2019 by the Court of Auditors for its disastrous handling of patient complaints. 

“Three and a half years later, nothing has happened. It’s too little. There’s a charter and that’s it,” said Bisch, referring to a good practice charter published by the French National College of Gynaecologists and Obstetricians (FNCGM) in response to the allegations against Daraï. 

When asked by FRANCE 24 if the institution plans on doing more, its president Dr. Isabelle Héron said the charter was “only one part of the answer”. The report aims to remind doctors of how to carry out a gynaecological examination, putting “the notion of consent at the centre of the consultation”, and will be pasted in waiting rooms so that patients “know this charter was published”, said Héron.

“But above all,” she said, the best solution was “to teach our young”. 

For Bisch, it is not enough. “If violence could be stopped by pasting pieces of papers on walls, there would be no need for (feminist associations) to campaign against femicide. All we would have to do is paste a paper on the walls of abusive husbands telling them not to kill their ex-spouses,” she said. 

“We need control of medical practices … We need medical professionals, students, police and lawyers to be trained in this matter, so they can understand the consequences of this violence,” Bisch concluded. “Speaking out is not enough. We need people to listen. When you don’t listen to victims, it’s as if they weren’t speaking at all.” 

*Name was changed to guarantee anonymity