正文翻譯

“Come on, smile! This is the most important day of your life.” The midwife was upbeat. But Agustina, a 38-year-old comedian and brand-new mother, was shaken. It was 2012; she had just undergone a Caesarean section at a hospital in Argentina. Her obstetrician, she believes, had made the surgery more likely by inserting hormones into her vagina during a check-up, without explanation.

助產(chǎn)士開朗地說：“來，笑一個！這是你人生中最重要的日子?！钡?8歲的喜劇演員兼準(zhǔn)媽媽阿古斯蒂納感到內(nèi)心動搖。2012年，她剛剛在阿根廷的一家醫(yī)院做了剖腹產(chǎn)。據(jù)她判斷，她的產(chǎn)科醫(yī)生在體檢時為了讓手術(shù)更順利未經(jīng)解釋就向她的陰道注入了荷爾蒙。

Such abuse is, perversely, a consequence of progress. Better health care reduced maternal and infant mortality. Yet it also reinforced a culture that treats doctors as infallible, patients as passive and medical intervention as the first resort, even when harmful or against a woman’s wishes. Covid-19 may make the problem worse.

說來反常，正是醫(yī)療進(jìn)步引發(fā)了這樣的虐待。更好的醫(yī)療保健降低了母嬰死亡率，然而也同時深化了這樣的文化：醫(yī)生是絕對可靠的，病人是全然被動的，即使醫(yī)療干預(yù)有危害或有違產(chǎn)婦意志，也是首要選擇。新冠肺炎可能會使這一問題更加嚴(yán)重。

In 2007 Venezuela became the first country to define “obstetric violence” in law and make it a criminal offence. There it means the “appropriation of women’s bodies and reproductive processes by health professionals”. Similar laws followed in Argentina, Bolivia and Panama. Other measures are more practical. In 2001 Uruguay gave mothers-to-be the right to have a companion during delivery. This month Puebla, a Mexican state, classified as obstetric violence filming a birth without the mother’s consent.?

2007年，委內(nèi)瑞拉成為第一個在法律中定義“產(chǎn)科暴行”并將其規(guī)定為犯罪行為的國家。其法律認(rèn)為“產(chǎn)科暴行”是指“醫(yī)務(wù)人員對產(chǎn)婦身體及生產(chǎn)過程做出的不當(dāng)行為”。阿根廷、玻利維亞和巴拿馬隨后也制定了相關(guān)法律。還有另一些更加實(shí)用的舉措。2001年，烏拉圭給予產(chǎn)婦在分娩時可有一人陪同的權(quán)利。這個月，墨西哥的普埃布拉州將未經(jīng)同意拍攝分娩過程劃定為產(chǎn)科暴行。

Venezuela’s ruined health system makes a mockery of its “humanised-birth policy”. Women often have to bring their own medical supplies, such as antiseptics, to delivery rooms. When the country’s obstetric-violence law was enacted, Rogelio Pérez-D’Gregorio, a former head of the Society of Obstetrics and Gynecology, advised obstetricians to protect themselves by making note of missing medications and other problems beyond their control.

委內(nèi)瑞拉崩潰的醫(yī)療系統(tǒng)嘲弄了其“人性化分娩政策”。產(chǎn)婦時常需要自行攜帶抗菌劑等醫(yī)療用品到產(chǎn)房。委內(nèi)瑞拉通過產(chǎn)科暴行的法律之時，婦產(chǎn)科協(xié)會的前負(fù)責(zé)人羅赫略·佩雷斯·格雷喬里奧建議產(chǎn)科醫(yī)生們記錄好缺失的藥物和無力控制的其他問題來保護(hù)自己。

Such deficits do not explain why women like Agustina, who gave birth at a well-appointed private clinic, suffer as they do. Mr Castro blames an “authoritarian medical disposition”, instilled at medical schools in male and female doctors alike. Critics say that teachers often emphasise technical prowess rather than patients’ welfare. Complaints to prosecutors in Brazil revealed that doctors-to-be were taught to perform episiotomies, surgical cuts to the perineum, to practise their skills, whether or not patients needed them.?

上述資源不足的情況無法解釋像阿古斯蒂納這樣在設(shè)施完備的私人診所分娩的產(chǎn)婦為何也有同樣遭遇?？ㄋ固亓_先生認(rèn)為這是由于醫(yī)學(xué)院向男性和女性醫(yī)生灌輸了“獨(dú)裁的醫(yī)療處置方式”。批評人士說，教師通常強(qiáng)調(diào)技術(shù)能力而非病人福祉。在巴西，檢察官收到的控告揭露了教師讓準(zhǔn)醫(yī)生們對產(chǎn)婦進(jìn)行會陰切開術(shù)來練習(xí)技法，而不考慮產(chǎn)婦是否有此需要。

While activists focus on pressure and punishment, some governments and international agencies are trying to be less confrontational, starting with the language they use to describe the problem. Last year Rio de Janeiro’s Regional Council of Medicine, which supervises doctors, declared that the term “obstetric violence” was “invented to defame” them. The Pan American Health Organisation prefers to talk of “abuse during childbirth” because “many times just mentioning [obstetric violence] closes to us the possibility of dialogue”, says Bremen De Mucio, an adviser to the group. It plans to launch a seminar on respectful maternal care by October.

活動人士致力于對醫(yī)療人員施加壓力并進(jìn)行懲處，而一些政府及國際機(jī)構(gòu)正試圖減緩醫(yī)患對抗，首先從描述問題的語言解決起。去年，里約熱內(nèi)盧負(fù)責(zé)監(jiān)管醫(yī)生的區(qū)域醫(yī)學(xué)委員會稱，“產(chǎn)科暴行”一詞的發(fā)明對醫(yī)生“造成了中傷”。泛美衛(wèi)生組織更傾向于使用“分娩虐待”一詞，因?yàn)椤昂芏鄷r候，光是引用‘產(chǎn)科暴行’的表述就關(guān)閉了雙方對話的通道?！痹摻M織的一位顧問布萊梅·德姆茨奧這樣說道。泛美衛(wèi)生組織計(jì)劃在十月前舉辦一場有關(guān)孕婦保健的研討會。

Governments are beginning to emphasise training. Brazil’s ministry of health has started a programme that stresses women’s rights in obstetrics in about 100 teaching hospitals. A similar programme in Argentina contributed to declines in infant and maternal mortality.

政府開始重視培訓(xùn)。巴西的衛(wèi)生部門啟動了一個項(xiàng)目，在100家教學(xué)醫(yī)院的產(chǎn)科強(qiáng)調(diào)孕婦權(quán)益。阿根廷的一個類似項(xiàng)目幫助降低了母嬰死亡率。

But progress is slow. When Agustina got pregnant again, in 2014, she changed obstetricians and hospitals and wrote a birth plan. It included a vaginal delivery and immediate skin-to-skin contact with her baby, who would drink breast milk, not formula. The hospital rejected all her requests. After a birth by c-section, a female doctor threatened to report Agustina to child-protection services. She left “screaming in my mind”, unable to work and struggling to bond with her baby. Her marriage ended. In 2016 she filed a lawsuit against her doctors, the hospital and the health insurers, the first case of its kind in Argentina. She is still awaiting a verdict.

但進(jìn)步是緩慢的。2014年，當(dāng)阿古斯蒂納再一次懷孕時，她換了產(chǎn)科醫(yī)生和醫(yī)院，并寫下了她的分娩計(jì)劃。其中包含陰道分娩以及與嬰兒的親密接觸，讓孩子喝母乳而不是奶粉。醫(yī)院拒絕了她的所有要求。在阿古斯蒂納做了剖腹產(chǎn)手術(shù)之后，一位女性醫(yī)生威脅稱要向兒童保護(hù)機(jī)構(gòu)投訴她。離開醫(yī)院時她的內(nèi)心大聲呼喊著，無法工作，難以與孩子建立親子關(guān)系，隨后與丈夫離了婚。2016年，她向醫(yī)生、醫(yī)院及醫(yī)療保險公司提出了訴訟，這是阿根廷的第一例此類訴訟。現(xiàn)在，她仍在等待裁決結(jié)果。