“The doctor examined my belly and told me: ‘The baby is dead. We can’t assist you here’,” Yasmelis Casanova told me on Mothers’ Day, 10 May.
I met her at the entrance to the public Maternal and Child Hospital in Petare, a complex of slums on the eastern side of Caracas.
The 42-year-old, who was 31 weeks’ pregnant at the time, said she had spent many hours in pain, and endured a long trip on public transport to reach the hospital via several checkpoints imposed under the coronavirus lockdown.
At the hospital, Casanova was told it had no running water that day, three of its four operating theatres were closed, its haematologist had been off sick since the lockdown began on 17 March, and its blood bank was closed, making transfusions impossible.
She then sat for two hours in a plastic chair at the hospital’s entrance, where I met her, until they agreed to admit her at 8am after her pain and bleeding became unbearable.
Four hours later, a nurse approached Casanova’s daughter-in-law and “grudgingly” acknowledged that Casanova’s life was at risk. She would be transferred by ambulance to another, better-resourced facility outside Caracas.
At that second facility, Casanova’s stillborn baby was delivered and she was given a blood transfusion and a hysterectomy. But, she told me by telephone afterwards: “They said nothing about removing my ovaries and everything else. They made me sleep and only told me what had happened the day after.”
She says she was then left ‘alone’ for almost all of her 20-day hospitalisation. Visitors were banned, though her partner and her daughter-in-law were allowed in to check on her, once each, for a few minutes. “This was the hardest thing to go through,” Casanova said, who described feeling lonely and sad before and after she was rushed into a second surgery on 13 May to stop a haemorrhage. She was discharged on 30 May.
“They said nothing about removing my ovaries… and only told me what had happened the day after.”
An intern doctor at the Petare hospital, who asked to remain anonymous, described what patients and staff have endured at the facility as “awful”.
“Running water is rare. We have to use saline solution to wash our hands. Women give birth lying on dirty stretchers with no sheets. Many doctors have resigned, while others miss their shifts because they have no transport. Since the start of the lockdown I have to walk more than an hour from home to the hospital.”
When I asked the deputy minister of hospitals, Armando Marín, for more information about the conditions under which women were giving birth during the pandemic, he referred me to the director of a maternity hospital in Caracas. But, when I called this director he said he was “not authorised” to speak to the media, and then hung up.
Several pregnant women said their antenatal check-ups had been cancelled because some healthcare facilities had been reassigned to deal only with COVID-19 cases. Travel restrictions during the lockdown (which were partially relaxed on 1 June, but imposed again at the end of the month) have also added challenges.
Casanova was hypertensive, which made her pregnancy risky. When she went to an outpatients clinic, they advised her to get an ultrasound scan (which were still possible to access at private facilities, for women who can afford them). But she said: “I had no money. Then, with the quarantine and my ailments, it was too difficult to go out.”
More than a decade ago, a pioneering 2007 law in Venezuela criminalised ‘obstetric violence’. This was defined as “not assisting obstetric emergencies in a timely and efficient manner”; forcing women to give birth lying on their backs; obstructing early skin-to-skin contact between mothers and newborns; and pressuring women to induce labour or have caesareans when they are not medically necessary.
“Give birth! Every woman is to have six children! Everyone! Make the country grow!” proclaimed Venezuelan president Nicolás Maduro in March. He was speaking at an event to promote a government programme called the Humanised Childbirth Plan, which says it “guarantees a happy maternity to women of the nation.”
The intern doctor at the Petare hospital, however, said that given the lack of resources available at hospitals it’s “a fallacy to speak about humanised childbirth in Venezuela, as doctors here practice medicine with our bare hands.”
Magdymar León Torrealba, professor of women’s studies at the Central University of Venezuela, adds: “The law by itself doesn’t guarantee protection.”
While I was at the Petare hospital in Caracas in May, I saw heavily pregnant women who had walked for more than an hour to get to the facility because of transport restrictions. Some were sent back home by staff who told them to return later (which they would have to do on foot again) when their cervixes were more dilated.
Other women who gave birth during Venezuela's lockdown described verbal mistreatment, lack of pain relief and not being consulted about procedures including induced labours and episiotomies (the cutting of a woman’s vaginal opening).
Four women said they were told to lie on their backs when their contractions became stronger, despite the law guaranteeing them the right to change positions.
Yerica Lara gave birth on 7 May at another hospital in Caracas. She says her baby’s birth was induced without her permission and she only found out afterwards that the health workers had performed an episiotomy. When she tried to get up to go to the bathroom or to get a drink of water, she was also told to “stop [her] foolishness”.
“What pregnant women have to go through in Venezuela is absolutely Dantesque”
Obstetric violence “is so normalised by authorities and medical staff”, said Mercedes Muñoz, head of the NGO Venezuelan Association for an Alternative Sex Education.
“Women feel they risk being unassisted or neglected if they demand their rights, and this usually makes them keep quiet. What pregnant women have to go through in Venezuela is absolutely Dantesque.”
Jairo Fuenmayor, a member of Venezuela’s Society of Obstetrics and Gynecology, argued that Casanova’s case did not involve obstetric violence: “If a patient’s life is at risk and the doctor can’t assist her because the blood bank is not open, there’s no water, operating theatres are closed, and there is no ambulance to rush her to another hospital, this is not obstetric violence. It is structural violence.”
“For women to be treated with dignity, we first need to solve the humanitarian crisis,” added opposition lawmaker Manuela Bolívar, head of the parliament’s sub-committee on women and gender equality.
Venezuela's oil-based economy has been seriously affected by the collapse of the commodity’s price since 2015, along with government mismanagement and US sanctions. The country’s economic collapse appears to have significantly worsened maternal and infant deaths. The most recent official figures, from 2016, show increases of 66% in maternal deaths and 30% in child deaths, compared with 2015.
There is no reliable data on cases of obstetric violence in Venezuela, and only a tiny fraction end up in court. Fuenmayor said the Society of Obstetrics and Gynecology acted last year as an expert witness in seven obstetric violence court cases – of which two resulted in convictions. The status of the other cases is unclear.