Obstetric Violence and Women's Rights: A Look at Episiotomy in Puerto Rico

Abstract

Recently, obstetric violence has been recognized as a gender violence problem that
involves a violation of women's rights (ONU, 2019). In this paper, we argue that the routine use
of episiotomy -- a surgical procedure that consists of an incision in the perineal muscle -- is a kind
of obstetric violence that is practiced in Puerto Rico. Scientific evidence shows that routine use of
episiotomy provides no benefit to a birthing woman or a baby, and that, on the contrary, it puts
birthing women at increased risk of adverse health outcomes. Organizations such as the WHO,
ACOG, and the UN recommend the use of the episiotomy only if it is medically indicated. Despite
the scientific evidence and recommendations, episiotomy is routinely performed as part of the
obstetric management of birth in the United States. Although we have no official Government
statistics, studies suggest that episiotomy is a routine obstetric practice in Puerto Rico. Usually,
there is no informed consent obtained before performing this surgical procedure, in which case,according to the UN, it can be considered “an act of torture and inhuman and degrading treatment”
(2019, p. 11).