All Those Who Labor: Enduring Obstetric Violence In Sri Lanka

Photo courtesy of Western Hospital

Today is the International Day for the Elimination of Violence against Women

In Sri Lanka, motherhood appears to be publicly venerated: the country is called The Motherland, and mothers are universally regarded as a powerful force and influence in the lives of their children.

Yet when we look beyond the happy family pictures regularly presented to us at Sinhala and Tamil New Year with prosperity and abundance equated with fertility and progeny, we become aware of the negative experiences endured by women in Sri Lanka in the process of giving birth.

For many women, their experience of childbirth is unnecessarily traumatic and difficult, both physically and emotionally, due to the shortfall in sensitivity training and empathy on the part of the doctors and nursing staff involved in the Obstetric and Gynecological sectors of the health care industry. Gestational violence is a terrifyingly real experience for many women and it is one endured in silence because it is suppressed in cultural shame.

Many women educated in Sri Lanka are brought up in relative ignorance of the workings of their own bodies due to cultural stigma and repression of female awareness surrounding sexual matters and this lack of accurate information as part of sexual education leads to unwanted pregnancy and teenage or underage pregnancy. In addition to this knowledge gap, the lack of social progressiveness and openness in matters of romantic and sexual relationships offers a poor foundation for the stable creation of families.

It is ironic and sad that the very process of becoming part of the creative energy of life and the growth of expanding a family, which we believe should be joyful, instead becomes a violent and isolating experience for women. The personal experiences of women who undergo these ordeals require empathy on the part of the reader for the myths to be challenged and deconstructed.

A graphic example is that of Kanya D’Almeida, whose harrowing story was first publicly told in an episode of Shhh! Talk About Taboos, facilitated by Shanuki De Alwis, which was screened on YouTube. She describes her ordeal.

I birthed my son in a private hospital in Colombo, in a labor room that resembled a medical supply closet. I had a clear birth plan in place, which I’d discussed with my obstetrician months in advance of my due date: a vaginal delivery without medication, pain relief or surgical intervention, following – as much as possible – the physiological cues of my own body. That meant allowing for spontaneous labor and labor progression, spontaneous breaking of my waters, mobility during labor, pushing out my baby without the need for an episiotomy (cutting of the perineum) or forceps and spontaneous delivery of the placenta.

What transpired in the hospital was the opposite of what I’d planned. My labor was induced, for reasons I am now unsure were medically necessary. I was put on a Pitocin drip, a drug that stimulates artificial uterine contractions. I was subjected to a non-consensual vaginal exam by a male doctor. And I ended up with an epidural, a catheter, a fetal monitoring machine, an episiotomy, an attempted forceps delivery and finally a vacuum extraction of my son. I missed the golden hour – he was taken away from me at birth. I did not get to deliver my placenta or see it as I’d requested. And after my doctor had stitched me up, I was left alone in the labor room shivering uncontrollably, unable to walk, and feeling like I’d just barely survived a disaster.

At no point during this ordeal did I get any emotional support from the so-called care providers around me. Besides that one nurse, whose shift ended halfway through my 24-hour labor, no one took the time to answer my questions or to heed my concerns. Not one person spoke to me with kindness or respect. At every stage, I was instructed to wait, to submit and to comply to the doctor’s orders or the hospital’s regulations. I – the laboring person – became merely a vessel, someone whose body was not only incapable of this task but was actually standing in the way of the birth. The best thing I could do was lie still, make as little noise as possible and allow a higher authority to do the job for me.

I had imagined my son’s birth to be a sacred passage from the world of my womb into the world of my arms. What it ended up being was a violent extraction. Still, four years later, my body grows cold when I remember it.

There is a language for this – for the feeling that something awful was done to you, for a lingering suspicion that you were abused or molested in some way. It’s called obstetric violence and it is considered to be the most under-reported, under-studied, misunderstood forms of gender-based violence in the world today. It is defined as verbal, emotional, physical, medical or sexual abuse at the hands of a care provider during labor and delivery. That enormous range of possibility includes things such as being subjected to medical procedures without consent, being shouted at or hit, being restrained, being denied a companion and being sexually assaulted.

In 2018 the BMC medical journal published a paper entitled When Helpers Hurt, the only study of its kind to document mothers’ and midwives’ stories of obstetric violence in government hospitals in Colombo. Throughout extensive interviews, the researchers uncovered accounts of laboring women being subjected to racial slurs, physical violence, verbal abuse and even sexual misconduct on the wards of public health institutions. The study concluded that while Sri Lanka has a robust maternal health service, including a cadre of Public Health Midwives (PHMs) who provide crucial pre- and postnatal support, the quality of care during labor and delivery needs much improvement especially when it comes to the ethics of consent, respect, autonomy and dignity in the obstetric space.

But these changes won’t come easily. Part of the reason obstetric violence is sometimes referred to as a “silent epidemic” is because pregnancy and childbirth have become so routinely medicalized that everyone involved, from doctors to laboring women, tend to pathologize the process. Women in labor are referred to as “patients”, a misnomer that pushes the act of birth from a natural, physiological event into the realm of sickness, something that requires an obstetrician to resolve, or “cure”. And because we are so unaware of our rights in medical settings, it is easy for women to be abused under the guise of “standard” or so-called mandatory practices such as repeated cervical checks, episiotomies or artificial rupturing of the membranes (ARM), all of which are invasive procedures that require consent.

As occurs in many areas of healthcare around the world, what the institutions fail to provide patients in their care, individuals operating in a more informal and community based way can supply. When going forward into this potentially heart breaking pro-creative terrain, it is best to equip ourselves not with myths and illusions but with practical realities: proactive self-support and due diligence about what services are available and a combination of private and community based care will help bring about a better outcome for birthing mothers.

Gooneratne Memorial Library – A Legacy of Love, Learning, and Literature

Our husband and father, Brendon Gooneratne, passed away in 2021. He had had a fall on June 12th and was recovering in a hospital close to home, with excellent care and medical attention. We had been upcountry for 18 months, due to the ongoing pandemic situation. Unvaccinated as yet, we felt my parents would be safest out of the population density and congestion of Colombo.

Since March 2020, our family had a wonderful experience of lockdown, with the news on the television or via the internet being the only intrusion. I had not spent so much time with the family for years, due to work commitments in Australia and in Sri Lanka.

It was fabulous: sitting on the verandah in the mornings and evenings, growing the herb garden so that the pasta sauces he loved would have fresh basil and oregano in them, sourcing home-baked bread rolls from Colombo to have with our soup, chatting about books we loved, taking out board games, watching old movies, listening to music from the 1950s, remembering past travels, discussing the crazed antics of Donald Trump, sighting Lotan sunbirds in the garden via the iridescent flash of their wings.

These days were blessed. Radiant sunrises and soft twilights and dusks. The year turning towards summer. At the start of lockdown, I was missing travelling and the adventures of traversing physical landscapes in the world. A year and a half into lockdown, I set these adventures and my desires for them aside, to a point somewhere in the future. Human beings are adaptable and resilient. That’s why we have survived so well, as a species.

My father recovered well from the surgery, and we were looking forward to him coming home to us. Unfortunately, an infection developed in his lungs late in the second week of June, and quickly spread systemically, so fast that it could not be stopped.

On Father’s Day, 2021, we saw him in life for the last time. We spoke to him, said everything we wanted to say, and held his hands.

He was a great friend to all of us and a tremendous encourager in the challenges of life. Once, at a terrible time in my own life, I felt like giving up after a series of back-to-back calamities immediately following the loss of someone I dearly loved. My Father did not tell me to get over it or count my blessings. He said, ‘It’s true that you have had a lot to contend with lately. But you know, you haven’t yet seen the range of experiences life offers us all. Life brings us a wealth of opportunities. Don’t make a decision on insufficient information. Life goes in cycles, and this period will pass and good will come. Hold on, and keep going, if you can. We will give you all our support. It’s worth it, believe me.’

As a family, we have a million memories of things we did together, with concerts and films, jungle trips and whale watching. The early morning rounds to watch animals, drinking hot tea made with condensed milk before sunrise, star gazing and the smell of kerosene lamps at night, the sunrises on the East Coast, the visiting of caves and ancient sites, the viewing of the fireworks on my birthday. The slightly clumsy parcel wrapping of our birthday gifts, and the huge cards to express his big love.

Brendon Gooneratne was interested in so many things that he was fascinating to talk to. For the last 18 months in lockdown, we had a wonderful companion to share movies music and political discussions. We enjoyed cooking him some of his favourite foods, from his student days in England. He loved Italy, and Italian cuisine, and was very sad when the kind and genial proprietor of Dolce Italia, Colombo, passed away recently.

He was a physician, a writer of several books, a renowned cricketer as a young man, and a wildlife and conservation activist. He wrote his personal memoirs in 2016, and this book, titled ‘The Good, The Bad and The Different’, details some of the interesting life experiences he had: his extensive travels, the personal lessons learned in his professional life, his enthusiasm for history, archaeology and the natural world, the lively opinions he had of the people he encountered.

Most people live a life defined by their professional vocation. Indeed, life is such that there is little time for us to actively pursue or engage in anything other than practise the profession in which we operate. But my Father was able to engage in multiple spheres of professional activity and follow and fulfil a number of interests throughout his life.

When Brendon Gooneratne passed away at the age of 83, he left behind a treasure trove of books and journals that had been his lifelong companions. His journey as a book collector began during his school days in Colombo, and he continued to nurture this passion throughout his remarkable life. His love for reading was a legacy he shared with his wife and both of his children and over the years, we, too, developed our own personal libraries.

Now, we, his widow and daughter, are embarking on an endeavour in his memory – the creation of the Gooneratne Memorial Library (GML) in Haputale, Sri Lanka. This library brings together the literary treasures of four individuals: Dr Gooneratne himself, the academic library of Professor Yasmine Gooneratne, rich with works of Commonwealth Literature, the collection of myths and legends and classic fantasy and science fiction of our late son/brother Channa Gooneratne, and the 18th-century satiric prose and extensive modern poetry collection of our daughter/sister, Dr Devika Gooneratne. Situated within the serene surroundings of our family’s hill country home, the GML is a tribute to our family’s enduring love for books.

Our family has had the privilege of living and travelling in various parts of the world, which is reflected in the GML’s special collections. These collections include materials from India, Australia, and Britain, in addition to a wealth of resources related to Sri Lanka’s history, wildlife, cricket, and athletics, all of which held a special place in Dr Brendon Gooneratne’s heart. While he was not a creative writer himself, he deeply appreciated and enjoyed the imaginative works of others, both contemporary and classic.

The GML is not merely a library but a sanctuary for reading and research. Our doors are open by appointment to all who seek knowledge, and we provide a serene and conducive environment for quiet reading and intellectual exploration. The library does not lend books but offers reading access to them free of charge to readers, students and scholars. It has been established primarily for the people of the Uva District, to complement the resources provided by the district’s schools and universities.

Located within what was once a tea plantation, the GML is surrounded by manicured lawns and a cultivated garden. Its windows reveal wonderful views of Sri Lanka’s stunning mountain landscapes. The trees surrounding the estate are home to diverse wildlife, from colourful birds to playful monkeys. The entire area is a haven for naturalists.

The Gooneratne Memorial Library is a testament to our family’s enduring love for literature and a tribute to the patriarch of our family and his remarkable life. It stands as a place of knowledge, reflection, and appreciation for the world of books, open to all who seek the joys of reading and the wonders of exploration of the world in which we live.

The Severing Of The Social Contract

This weekend, it was three weeks since the commencement of the atrocities in Gaza. In these days, which are also traditionally the buildup to some of the holiest days of the year in Jewish, Christian and Hindu faiths, we are being told about and shown some horrifying video footage of human suffering and cruelty inflicted on vulnerable people.

In Sri Lanka, we are geographically removed from the current theatre of war. But anxiety is high that this conflict, if not contained, will explode outwards to encompass the entire world. Do we watch, while schoolyard bullies duke it out? Like every viewer of a thriller action movie which contains scenes of extreme violence asks themselves, who do we identify with, in the scenes we see on the screen?

How is World War 3, which appears to have started, different from the previous two? For a start, in 2023, citizens with the aid of personalized technology have the power to document and broadcast and interview people at the frontlines without the intervention of mainstream media.

We have mobile phones, WhatsApp, Instagram, Tik Tok, and Facebook, all with video and audio capability. Until the governments shut down the internet, as they did in Gaza over the weekend, people could tell their stories and show the world outside what their situation was like, and generate insight and empathy.

To see a person in the rubble of their home, injured and bereaved, the life they had built in shards and ribbons, is a powerful contrast to the self-justifying framing narrative of perpetrators of violence against them, calling them ‘animals’ and not human beings. Every human being wants to live: to survive and if possible thrive, and flourish. We can all recognise the devastation of other human beings and the destruction of their dreams and hopes when we see it.

The problem with viewing events via digital media today is the prevalence of falsification: are we sure that what we are seeing is actually real, or is it augmented via technology, and photo shopped, in some way? Is it happening in real time, to real people? Or is it old footage from a couple of years ago, or footage taken from another context? Is reality being misrepresented to us? Not in error, but deliberately, in order to spur us into rage, or an emotional state in which we are easy to herd? Are our real emotions being cynically manipulated, by the use of triggering images and incendiary statements which are then subsequently ‘walked back’ by news commentators? Where do our feelings come from? Where do they land?

What on earth is ‘proportionate response’ to mass murder? How is it defined? How is it measured? How is it being justified?

The second major difference in this conflict is that the citizens of many countries are openly expressing their disagreement with the policies and actions of their own governments. 14 countries voted to continue the conflict, and 120 countries (Sri Lanka amongst them) against. Of the 14 countries whose leaders want to pursue genocidal aggression, although it is described by its perpetrators and apologists as ‘self defence’, huge rallies of citizens can be seen forming in their capital cities, protesting that the ordinary citizens caught in this conflict have human rights which must be recognised and protected.

 
As the countries in which these protests are forming call themselves ‘Democratic’, to shoot down these protestors, to silence or gag or otherwise interfere with their civil rights would expose them as hypocrites.

Thirdly, it is important to note that social media is a huge factor in forming public opinion. What began 15 years ago supposedly to enable the creation of community through technology, to enable communication and the dissemination of information, is now exposed as operating in opposition to those ideals through its frequent misuse.

Misinformation is deliberately put forward through mainstream media channels, and amplified intensely by social media commentary and the way it has been constructed to inflame and weaponise human reaction. It is far easier to react than to think and evaluate, and we have as a species begun some time ago to respond to this coercive manipulation: to offer ourselves up to be tracked and formed into voting blocs, via our viewing preferences, and our likes and shares.

Critical thinking is not taught in schools, colleges and universities, and as it is not possible for us to be physically present at all events in the world, we rely on the media reporters and commentators to represent the events to us, as they occur. Bias and prejudice have tainted these representations, and hardly any media platform is truly objective in its presentation of world events. Selection of content and exclusion of content and deliberate diminishing of some aspects and heightening of others, omission and distortion of facts, and conflation of unrelated events, and false/forced analogies and equivalencies have all eroded our direct relationship with the reality of the world in which we live.

We are living in a state of perpetual cognitive dissonance which is volatile, distressing and uncomfortable. We increasingly see events done in our name to which we have not given our consent, and which we feel powerless to stop. And this feeling of powerlessness leads to disengagement and passive resignation. It is dangerous, to be relegated to the status of a sightseer in the world today.

Governments who act in brazen dismissal and arrogant contempt of the wishes of the citizens who elected them and still call themselves ‘Democratic’ are clearly exploiting the theory of the Social Contract on which democratic governance is based. They seem to treat the voting citizens as a group of people to be lied to, flattered with false promises at times of election, and blatantly ignored between elections, once the numbers of votes have delivered the mandate they need to rule.

It is notable that countries who loudly call themselves ‘beacons of democracy’ and valorise people’s rights in theory are the ones who most aggressively violate people’s rights if they conflict with their own pursuit of power. It is not enough to ask leaders of countries like this to recognise the rights of their voting citizens, and to actually represent their true beliefs honestly and accurately.

It’s a contract. To ensure that democratic systems operate well, the citizens of these countries must educate themselves, using the resources available to them, and look at the difference between the actions of their leaders and the words on the slogan boards and the promotional advertisements. We must look for our information beyond the comments threads on social media.

Only then can the contract be made more functional. Effort is required. To see what is happening around us, past the spin and below the surface, to think and to act accordingly. What we think is what informs our actions. It is a form of protest. It can help to save the world.