A dramatic illustration of just how bad it can be for laboring women in some countries came last week when the Lancet, a leading medical journal, released a report documenting cruel treatment women experience during childbirth in Asia and Africa. The authors, who observed 2,016 women in labor and conducted 2,672 surveys, found that 14 percent of the labors they observed involved women being physically abused, including being slapped and punched. Almost 40 percent of the women who were giving birth while being observed were mocked, shouted at or verbally abused in another way. And a disturbingly large number of serious medical procedures conducted during the observations were also performed without the women’s consent: 13 percent of the Caesarean deliveries and 75 percent of the episiotomies, controversial surgical cuts to the vaginal opening which have long-term ramifications for women’s physical and emotional health.

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This cruel treatment isn’t just due to the fast-paced nature of childbirth. As the authors of the study published in the Lancet explain, “According to qualitative research, midwives and doctors described women as ‘uncooperative’ during this period and some justified using physical and verbal abuse as ‘punishment’ for non-cooperation and to ensure ‘good outcomes’ for the baby.”

“For the baby” is the key phrase there; for many providers, the only important patient is the baby, not the mother giving birth. That is why, in the Lancet study, pain relief for the mother appears to be an afterthought for health-care providers; more than half of the women surveyed were never offered relief during one of the most excruciating experiences in human existence, and almost 30 percent of the women who requested pain relief did not receive it.

Callous treatment during labor and childbirth isn’t just an issue for women in the developing world; women in the United States are also often victims of the medical establishment during childbirth. The problems with childbirth in the United States are myriad and include unnecessarily high Caesarean rates, packed labor and delivery wards thanks to ward closures around the country, and a lack of information about interventions before they are performed or administered. Surveys conducted in 2013 in the United States and Britain shed light on the issue with shocking clarity: Six in 10 women in the United States didn’t consent to episiotomies before they were performed, and “12 percent of women feel they did not consent to birth interventions, rising to an alarming 24 percent in the case of instrumental deliveries.”

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And sometimes, the physical and emotional scars new mothers carry with them after being mistreated in childbirth are the least of it. Poor treatment of expectant and laboring mothers can also literally mean the difference between life and death, especially for black women, who are, as ProPublica’s Nina Martin and NPR’s Renee Montagne put it in a 2017 story, “243 percent more likely to die from pregnancy- or childbirth-related causes” than white women are. They continued, “In a national study of five medical complications that are common causes of maternal death and injury, black women were two to three times more likely to die than white women who had the same condition.”

Something is clearly broken both in the developing world and in the United States. No woman should ever be transported back in time and reduced to a mere vessel for the baby they are about to deliver. It doesn’t have to be this way. But the first step toward improving maternal outcomes is recognizing this crisis for what it is — and that we could be stronger by coming together to fight it.