When talking about Gynecological and Obstetric Violence (GOV) in Montenegrin society, the emphasis is more often than not placed on childbirth or obstetric violence, explaining, to an extent, why most studies, testimonies, articles and reports are only limited to those aspects of GOV, although, by definition, harmful practices that fall under GOV are not necessarily nor exclusively linked to motherhood.
This reality does not come as a surprise in a country like Montenegro, given its predominantly traditional and patriarchal society that still views women in a subjective and relational manner based on what they mean to an individual. They are often someone’s mother, sister, daughter or girlfriend. If this shows us something, it is that many Montenegrins do not fundamentally recognize and accept women as independent beings, full-fledged citizens and political, economic and social subjects. Many Montenegrins’ inability to think about women outside of their relationships with family members and the men in their lives often renders women and girls dependent on others in order to be more visible, and thus gain more social value and worth.
A few days ago, I came across a student’s word association about the concept and figure of a mother, on the blackboard of the classroom where I teach. The column of written epithets -which I presume was from a psychology class earlier that day- included motherly qualities such as caring, busy, self-sacrificing, tired, betrayed, etc. There wasn’t a single empowering attribute on that board. So then I asked myself, what am I exactly doing, as a teacher and an activist, when I see the word 'mother' tied to selfless sacrifice and self-erasure?
The social production of mothers in the Montenegrin context lives on throughout a woman's entire life, but it is significantly shaped by the GOV to which most women are exposed. By reviewing research and talking to activists, I sought answers to questions I asked myself, after I left that classroom, mostly about whether GOV is recognized as a form of violence against women, what its most common forms are, and the fate of recent related resisting initiatives in Montenegro.
Additionally, I wanted to know how activists perceived possible solutions to the issue, so I interviewed a few. But first, allow me to present a few important findings on the matter, to clarify the picture of GOV, especially for non-Montenegrins.
Alarming findings
First, it is important to mention that the rarity of relevant research conducted in recent years in Montenegro is noteworthy, and can only testify to the prevalence of GOV in the country. The first two studies covering hospital care for mothers and newborns were both conducted by UNICEF in 2011 and 2016. The conclusions of the 2016 study, based on data from three hospitals in Montenegro, highlighted the relatively poor accommodation facilities and conditions in maternity wards, as well as the fact that in most hospitals, there was no adequate preparation of individuals and delivery rooms, nor the option of active delivery with the possibility of choosing the labor and birthing position.
Furthermore, the study noted that there is a real need to monitor the appropriateness of the indication for Cesarean sections, as nearly a third of women give birth via C-sections (31% according to data from the Health Insurance Fund of Montenegro from 2019), and in some hospitals, the rate reached as high as 55%.
The study results also showed how numerous practices considered as outdated by the World Health Organization, or medically unjustified and potentially harmful, were still widespread, such as the Kristeller's maneuver (applying pressure to the mother's abdomen during delivery), frequent and automatic episiotomy and enema, the shaving of the pubic area, and the non-vertical delivery positions, among others, in addition to the fact that companions of choice during delivery are either not allowed or discouraged.
Six years later, research results by the Center for Investigative Journalism of Montenegro (CINCG) on GOV in 2022, based on a sample of 706 respondents who gave birth naturally in the last five years, showed that as many as 97% of the women surveyed experienced at least one harmful practice -some gave birth lying on their backs and about 70% of women underwent episiotomy. Around 55% of the surveyed women experienced contractions being induced or stimulated with drugs and 48% had their water broken through amniotomy (also known as Artificial Rupture of Membranes) or some other mechanical intervention.
According to CINCG, most women were not asked for their consent on invasive interventions, nor were they informed about the nature and purpose of the procedures, in clear violation of their right to informed consent.
Becoming a mother within the Montenegrin healthcare system is not a uniform or predictable process, and for most women, it is a traumatic experience that remains unshared and suppressed, overshadowed by the "new life" in whose service their exhausted and silenced bodies are deployed.
Feminist resistance
Physical subjugation, instrumentalization, objectification and other forms of GOV were made visible by women's and feminist initiatives in most areas of the countries of former Yugoslavia, starting with the 2014 campaign #PrekinimoŠutnju (#BreakTheSilence) in Croatia, the effects of which quickly spread and multiplied to become a regional action Sloboda rađanju (Freedom for Birth).
The second wave of this action was launched in 2018, after the testimony of a Croatian Member of Parliament about her own experience of curettage without anesthesia, triggering a new wave of testimonies by women on social media and the emergence of new campaigns in the region leading to the adoption of important resolutions at the European level. In 2019, the Council of Europe adopted Resolution 2306 on Obstetrical and Gynecological Violence, explicitly referring to the #BreakTheSilence campaign (section B. Explanatory Memorandum), while in 2021, Croatian Member of the European Parliament, Predrag Fred Matić, raised the issue and helped adopt the resolution on the Situation of Sexual and Reproductive Health and Rights in the EU, 2020/2215(INI).
One of the few voices in Montenegro that drew attention to the problem of GOV and its silent normalization was that of the feminist collective “Vala Ljeposava” (Let me tell you, Ljeposava), named after the leading female character of a cult Montenegrin TV series from the 1980s, who, in 2020, raised the issue on social media platforms (Facebook, Instagram, and Twitter). During that year, a large number of women shared their violent experiences with childbirth publicly, as well as experiences of verbal and physical abuse during routine check-ups and procedures.
According to the collective, women spoke loudly enough for everyone to hear, be it the men who felt "uncomfortable" or the authorities who “understand” but have no time to address the matter. Without strong media coverage and public pressure, the collective’s fierce activists argue, such issues would not have received the attention they deserved, but they believe that an important step was indeed taken when the campaign was launched, and that the problem of GOV finally began to be addressed at higher and wider levels.
Giving birth stops being a process in which women are supported during arduous reproductive labor. Instead, they become reduced to a medium between the baby's birth and obstetric staff’s to-do list…
However, the Vala Ljeposava initiative reported not feeling satisfied with the response of relevant state institutions. The group describes the authorities’ reaction to their campaign organized three years ago as just a PR crisis management situation. In other words, the steps taken at the time were purely ceremonial and the group is almost certain that the system still does not protect women any more than it did years ago, and medical staff remain unafraid of legal consequences for poor and violent treatment of patients.
The feminist collective also found that only recently has the inadequate treatment of women in gynecologists’ clinics begun to be defined as a form of violence in public discourse.
It used to be scandalous, they stress, to mention menstruation in front of a father or brother, let alone to talk about gynecological exams. Moreover, by adapting the childbirth process to the needs of obstetric staff, women have often been pushed into the background. As a result, giving birth has stopped being a process in which women are supported during arduous reproductive labor. Instead, they become reduced to a medium between the baby's birth and the obstetric staff’s to-do list.
Generations of women have been obediently enduring this ordeal, out of fear, and because they had no one to complain to nor parties they could trust. For years, women have been resorting to the Vala Ljeposava platforms to report violence during childbirth, routine episiotomy without justified medical reasons and informed consent of the patient, as well as the execution of additional "gentleman's" or "husband's" stitches.
They have also reported neglect of patients, absence of procedures to which they are entitled, in order to facilitate childbirth and make it safer, verbal abuse, and even physical violence. Other forms of violence that women have shared included constant neglect and underestimation of the intensity of gynecological symptoms, ignoring reported pain, absence of an accurate diagnosis, and the condemnation of personal choices and refusal to provide adequate therapy due to the gynecologist's personal assumptions about the patient's reproductive plans.
As for women who have not birthed children, the universal "cure" for the gynecological problems they face have, more often than not, been reduced to: "It will all be sorted out when you give birth."
Activists’ thoughts and perceptions
Ervina Dabizinović from the NGO Anima - Center for Women's and Peace Education in Kotor- shares with MedFemiNiswiya similar experiences, mentioning the neglect of women's needs, the absence of psychological support before, during and after childbirth, as well as the humiliating treatment of women by gynecologists, primarily in the form of verbal abuse.
Additionally, she expresses deep concern about the possibility of restricting and endangering the reproductive rights of women because she recognizes how often doctors use their religious feelings and beliefs, pressuring many women to give up their rights to control their own bodies and decide their fate. Of particular concern is the potential for the current socio-political environment to lead to the abolition of women's right to choose and their right to abortion, according to Ervina Dabizinović.
Maja Raičević from the NGO Women's Rights Center in Podgorica (WRC) emphasizes that GOV is not formally recognized yet, but women's experiences show that it exists, even though it is still timidly or rarely talked about. WRC had reported this phenomenon to the UN Committee on the Elimination of Discrimination against Women (CEDAW), which at the time issued a binding recommendation to the state of Montenegro to provide adequate conditions in maternity wards and ensure adequate treatment of new mothers. However, Maja says, “the recent testimonies show that these practices are still present.” She adds that the “CEDAW committee also noted that health facilities are hygienically inadequate, access to pain relief medication was not available, and mother's privacy and participation in decision-making were not respected.”
"It will all be sorted out when you give birth (!)"
Ivana Vojvodić from the NGO Juventas believes that GOV is only talked about when there is serious harm to the health, life or a risk of permanent and very serious consequences for women or children. She also draws attention to the inadequate attitudes of radiologists during breast cancer screening, entailing, in many instances, unacceptable and sexist comments.
In addition to these forms of GOV, Ivana mentions the acceleration of childbirth for logistical rather than medical reasons, such as the induction of labor or the Artificial Rupture of Membranes needlessly, and/or without the patient’s consent. Moreover, the behavior of medical personnel in the days after childbirth, especially during doctor's visits, can at times be disrespectful to the individual's physical, emotional and psychological integrity. Women also reported careless and inappropriate behavior by medical staff during the uterine revision procedure.
Women from vulnerable communities
As for LBTIQ+ individuals, they face particular challenges, as they often report that many of their experiences within the Montenegrin healthcare system are negative ones, and can even be traumatic.
Jovan Džoli Ulićević, a trans activist from Montenegro, explains that the discrimination against women from vulnerable communities usually involves racism, homophobia and transphobia, as well as classism, roughness, neglect, lack of adequate care and dedication, violation of privacy, refusal to provide comprehensive information, and verbal and emotional violence.
In general, trans individuals prefer not to conduct gynecological exams, or only visit a gynecologist when they really have to. This, if anything, is a clear proof of the discomfort and fear that trans people regularly go through. Going to a gynecologist can often be uncomfortable for women, and even more so for vulnerable women and individuals whose bodies are different from what the society expects them to be.
Trans individuals thus often fear being faced with condemnation, ridiculing, nosy and unnecessary questions or intrusive comments. Džoli also stresses that the burden is often on individuals who find themselves forced to be both patients and educators, while also fighting for their rights: "In moments when I need someone's care, it is not that like I want to lead double or triple roles [...] but at the same time, I want it to be easier for me next time, or for someone else after me."
If there is one thing all activists and experts agree on, it is that the systemic problem of GOV requires systemic solutions which, as Džoli points out, should involve strategic educational material for medical workers about GOV, its impact on patients, and the specific vulnerabilities of those who are particularly susceptible to this form of violence.
In addition, it is important to empower citizens to recognize, name and respond to GOV, and to ensure tailored programs are designed to help patients heal from the trauma caused by GOV, as healing is not the sole responsibility of the individual or survivor, nor should it remain the privilege of those who have the money to pay for it and for their health.
This is a responsibility that must be shared collectively and systemically. The burden needs to be lifted from the backs of those who have survived this “silent” yet very widespread violence.
