A 2019 research paper titled "Assessing informed consent practices during normal vaginal delivery and immediate postpartum care in tertiary-level hospitals of Bangladesh," (hereinafter, the research paper) divulged the absence of informed consent in normal vaginal delivery (hereafter referred to as NVD) and post-partum care in the tertiary level hospitals of Bangladesh. New data provided by Save the Children reveals that Bangladesh has seen a surge in medically unnecessary C-Sections by 51 % between 2016 and 2018. Bangladesh witnessed an estimated 860,000 uncalled-for operations in 2018, whereas 300,000 women desperately in need of it are unable to afford or access it. Subsequently, a writ petition was filed in the High Court Division seeking a countrywide ban on medically unnecessary C-sections at the hospitals. The research paper affirms that lack of information about the adverse aftereffects of C-Section and inaccuracies surrounding NVD, makes many pregnant women opt for unnecessary C-Sections. The situation is diabolical in low-income health settings. The vacuum of informed consent in the existing maternity care of Bangladesh impedes women to make the educated choice.
Respectful Maternity Care Charter (hereafter referred to as RMC), a Charter of universal human rights due to every childbearing woman in every health system around the world, recognises informed consent as one of the basic rights of pregnant women. Informed consent encompasses the voluntary agreement of the patient to undergo an intervention upon disclosure of the patient's information regarding the proposed intervention, its repercussions, and alternatives. Any examination, intervention, or treatment, especially in the case of pregnant women unaccompanied by informed consent is considered assault. Pregnant women have the right to base their maternity care decisions based on accurate, contemporary, and comprehensive information. In 2014, World Health Organization issued a statement affirming, "Every woman has a right to the highest attainable standard of health, which includes the right to respectful, dignified healthcare throughout pregnancy and childbirth."
The Code of Professional Conduct of the Bangladesh Medical and Dental Council infers informed consent in case of invasive procedures for new medications or surgeries, artificial insemination, prenatal diagnostic procedure for fetal disease detection, and clinical trial participation. The code unfortunately remains silent on informed consent practices in childbirth. The admission form signed by childbearing women prior to delivery does not propound any of the repercussions of the procedure. It merely provides the information of the patient and a written consent to proceed with the procedure. This points out the infringement of the universal right of childbearing women. Appraisal on healthcare facilities worldwide unearths experiences of women facing disrespect or abuse, in the form of non-consensual services during delivery, post-partum care, surgery, and other invasive procedures. Regrettably, there is no data concerning the same in the context of Bangladesh.
The universal rights of childbearing women endorsed by RMC Charter ratified by Bangladesh, need to be incorporated in the existing Code of Professional Conduct of Bangladesh Medical and Dental Council. The inclusion of informed consent practices is the first step to make childbearing women feel heard, respected, and empowered in order to make their own choices. There needs to be transparency and accountability in maternity care. Physicians should lay out the reverberations of NVD and C-Section. The right to informed consent in childbirth enables a woman to weigh the full spectrum of perils and benefits associated with the respective procedure and make a decision free from biases pursuant to her values and perspectives. Failure of a physician to obtain informed consent from a patient should be considered tantamount to medical negligence.
The writer is a student of law, University of Chittagong.