Women in Montenegro are facing obstetric violence, with nearly 70 percent of participants in a survey conducted by the research agency Defacto reporting such experiences.

Conversely, health institution representatives who spoke to Vijesti claimed they had not received any reports of this type of violence. It was only mentioned by officials from the Ministry of Health, led by Vojislav Šimun, who stated that two cases were reported to them via the non-governmental sector, which prompted internal procedures to be initiated.

The Defacto agency carried out a survey on obstetric violence for the NGO SPES from November 6 to December 12, 2024, involving a sample of 384 individuals. Among the respondents, 365 were women with experiences in childbirth and pregnancy, 2 had experienced pregnancy without childbirth, and 13 had no prior involvement in either. Additionally, four men participated in the survey.

Rudeness, Physical and Verbal Abuse

Respondents shared harrowing comments: “I remember my birth as one of the ugliest experiences of my life,” “The doctor said that even if I died, I would still give birth naturally,” and “I felt everything was forced upon me; I wasn’t consulted about anything, and when my birth went poorly, I was blamed,” voiced some participants.

The survey revealed that nearly 70 percent of women (66.3 percent) reported experiencing obstetric violence. A similar number indicated their needs and requests were dismissed. Correspondingly, many reported encountering humiliation, rude, and inappropriate language from healthcare professionals. They also noted experiencing at least one instance of rough treatment or procedure during medical examinations…

“After a miscarriage at 18 weeks, I underwent a curettage without anesthesia because the gynecologist on duty refused to call for an anesthesiologist,” shared one respondent.

Another recounted, “The midwife told me: ‘Shut up, you didn’t protest when your husband jumped on you.’ At another point, while stitching, the doctor remarked: ‘We’ll give you this back for screaming; see how it hurts when you don’t listen to us.’”

“The doctor and midwives pressed down on my abdomen to force the baby out. Consequently, my baby ended up with a broken collarbone and a hematoma on the head,” shared one. “During labor, without warning, the midwife cut my perineum with scissors, causing me unimaginable pain and a trauma I will remember forever,” another commented, recalling having to summon the midwife when her baby’s head emerged since there was no staff present. “The doctor remarked that formula-fed babies are less intelligent than those who are breastfed, while my baby was receiving formula at that moment,” recounted another respondent.

Interview participants also highlighted instances of physical and verbal abuse, along with violations of their personal space and dignity.

The findings indicated that 64.9 percent of respondents felt their needs and requests were overlooked, while 62.7 percent reported experiencing humiliation, rude, and improper remarks from medical personnel. Furthermore, 59.1 percent mentioned enduring rough handling or treatment at least once during medical assessments, as stated in Defacto’s research.

Many respondents expressed being subjected to forced gynecological examinations to ensure their doctor continued their pregnancy, “The water was forcibly broken, and pressure was applied to my stomach until the baby emerged, resulting in a vaginal tear up to the cervix,” recounted another. “I underwent episiotomies and examinations by at least 10 different people without any inquiries or consent,” another stated. “Male gynecological examinations were often rough and painful, devoid of explanations for their necessity,” recounted others, who consistently noted the gentleness of their female counterparts.

More than half (54.8 percent) of respondents rated the communication with medical staff during pregnancy, childbirth, and postpartum care as poor.

“There was complete disregard, a lack of empathy and comments such as ‘You’re not in pain’ and ‘What can I do; just be patient,'” one respondent reflected. “Once the induction started, there were remarks like ‘Now you’re going to hear it,'” and “I was insulted by a midwife for opting for an epidural,” recounted another. “The doctor said: ‘I’ll take care of you while you’re still fresh,'” commented another, while the remarks of “I’ll give birth to a 1,500-gram baby” surfaced from another doctor.

Overall, participants rated prenatal care higher than childbirth care, with 42.2 percent saying the support received during pregnancy was good compared to 37.6 percent who rated the support during childbirth similarly.

“Baby Friendly”—A Mere Illusion

Only 35.4 percent felt adequately supported postpartum by healthcare staff, while 64.3 percent disagreed.

“The baby-friendly initiative doesn’t allow mothers proper recovery post-childbirth, especially after cesarean sections,” some respondents expressed. “The intention of the ‘baby-friendly’ initiative is commendable, but it’s poorly executed,” another stated. “I believe the program, as it currently stands, is counterproductive,” others concurred, highlighting minimal help from nursing staff who only appeared during scheduled visits.

Moreover, participants accentuated that their postpartum experiences were frequently more traumatic than the births themselves.

The study authors noted that respondents who had given birth in the past two to five years were more likely to report experiences of obstetric violence than other cohorts.

“Participants who gave birth within the past year reported such experiences in 29.2 percent of cases, while those giving birth in the last two to five years reported it in 41.3 percent of instances.”

“Conversely, respondents who delivered in the last five to ten years reported this in 16.7 percent of cases, and those with earlier childbirth experiences accounted for 12.9 percent,” the authors noted.

The study also mentions that those who had given birth within the last year frequently expressed uncertainty about whether they had encountered obstetric violence, with 42.9 percent unsure.

The Center for Investigative Reporting in Montenegro (CIN CG) surveyed obstetric violence in a questionnaire distributed in 2022, gathering responses from 709 women who experienced natural childbirth in Montenegro within the previous five years. A significant proportion reported enduring at least one harmful practice typically undertaken without the mother’s consent, constituting a form of obstetric violence, which many countries legally prohibit.

Encouraging Patients to Lodge Complaints

Hospitals and health centers who responded to inquiries from “Vijesti” claimed they had not been alerted to any incidents of obstetric violence. They did, however, urge women and their families to report such occurrences. These findings were collected from the Hospital in Barane, the Hospital “Danilo I” situated in Cetinje, and the Kotor Health Center and Clinical Hospital.

The Ministry of Health reported no instances of obstetric violence either.

“We received a report from the non-governmental sector regarding two cases, prompting internal follow-up measures. However, we lack the personal information of those victims who reached out through the NGO, which limits our ability to investigate further,” they mentioned.

Similar to health institutions, the health department is encouraging women who have suffered verbal or other forms of abuse in maternity wards to contact the patient rights ombudsman or corresponding department.

The pertinent body within the Ministry of Health is the Directorate for Quality Control of Health Care and Human Resources Development.

“Maternity hospitals are places where life begins; they must reflect spaces where women feel safe, respected, and dignified, without the slightest chance of inappropriate treatment by healthcare staff,” emphasized the ministry led by Vojislav Šimun.

Few complaints of a technical nature were recorded at the gynecology department last year.

According to the Clinical Center of Montenegro (KC), there were no reports of obstetric violence made last year.

The institution advised patients or their partners to report suspected obstetric violence to the director of KCCG or the Patient Rights Ombudsman, or during hospitalization, to the clinic’s director or head nurse.

Furthermore, patients are able to anonymously fill out satisfaction surveys regarding medical services or submit their complaints through designated boxes during their stay.

Notably, from a total of 2,713 anonymously surveyed patients in the Clinic for Gynecology and Obstetrics, 2,656 (or 98 percent) expressed satisfaction with their care, and only two percent reported dissatisfaction.

“Most of the dissatisfaction expressed by patients during hospitalization was not linked to the quality of healthcare services but stemmed mainly from technical complaints, many of which were deemed unjustified or subjective,” they concluded. “We’re proud to note that not a single case of obstetric violence has been reported in our institution, which also leads all Montenegrin maternity wards in annual deliveries, averaging around 3,300,” they added.

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