Within the framework of PRAGG strategic partnerships, an advocacy campaign has been launched towards higher levels of government on the topic of accompaniment during childbirth and better protection of women from violence in the FBiH, and is being implemented by the "Baby Steps" association.

The fight for dignified childbirth in BiH

“Now, when someone asks me when I’m having my second child, I’d rather slap them. I felt like they were veterinarians, and I was a cow. And so they come, press, want – don’t want,” is just one of the traumatic experiences that women in labor shared with the “Baby Steps” association for the analysis “Natality and Motherhood Between Desires and Obstacles.” The association above has been fighting for the right of women in labor to be accompanied by a trusted person during childbirth for a long time. A right that women in BiH still do not have, even though it is a key mechanism for ensuring more dignified treatment and improving the experience of women in labor, as well as for reducing obstetric violence and corruption in maternity wards.

Although the World Health Organization recommends the presence of a trusted person during childbirth due to proven benefits, such as reducing stress in mothers, fewer medical interventions, and a better course of labor, the practice in BiH remains unregulated. It depends solely on the decisions of individual hospitals.

In the BiH system, without a system, restrictions are numerous, including a complete ban on the presence of an escort, selection of persons who can be present during childbirth, and limited rights at different stages of the birth process. For example, not a single maternity hospital in the FBiH allows a person to accompany the woman at her request throughout the entire duration of the birth, but only briefly at the very end, 10 to 20 minutes of a ceremonial moment, usually for the father. The question arises, why only the last period of labor? Isn't the goal to ensure continuous support for the woman during all stages of labor? Moreover, an additional restriction in many maternity hospitals is that the escort can only be the husband. What if the person at the woman's request is not the husband? And what about single mothers, widows, and direct discrimination against all women who are not in a conventional relationship?

In contrast, the presence of a companion is a completely normalized practice in the world, so in many countries the entire family and loved ones are allowed to provide support throughout the entire birth, and the WHO recommends even the simplest solutions such as installing curtains, which eliminates the excuses of our maternity hospitals about the lack of special rooms.

Institutions are silent while women suffer

The right to companionship during childbirth is not legally defined in BiH. Although the European Commission stated in its 2022 Report for BiH that the state must improve conditions in hospitals and maternity hospitals and prohibit obstetric violence, by its obligations under the Istanbul Convention, ministries of health leave this issue to hospital administrations, which is inadequate, and especially does not represent a long-term solution, because the right of women in labor to companionship must not depend on the will of individuals. This uneven approach directly threatens the right of women to equal treatment in health institutions.

Namely, according to a study by the organization "Baby Steps", out of 18 maternity hospitals to which they sent a query about the conditions under which an escort is allowed, 4 maternity hospitals do not allow escorts (Cantonal Hospital "Dr. Irfan Ljubijankić" ​​Bihać, Public Health Center Hospital "Srbija" East Sarajevo, Public Health Center Hospital Trebinje and Public Health Center Hospital Zvornik), only 6 maternity hospitals allow escorts (Public Health Center General Hospital "Prim.dr. Abdulah Nakaš", Croatian Hospital "Dr fra Mato Nikolić", University Clinical Hospital Mostar, Public Institution Hospital Travnik, University Clinical Center, University Clinical Center of Republika Srpska) where the approach is certainly not unified, but each maternity hospital allows escorts under its own specific conditions, while 8 of them did not provide a response at all (Clinical Center of the University of Sarajevo, Public Health Center Cantonal Hospital Goražde, County Hospital "Dr. fra Mihovil Sučić" Livno, Cantonal Hospital "Dr. Safet Mujić", Mostar, Cantonal Hospital Zenica, Public Health Center Hospital "Sveti Vračevi" Bijeljina, Public Health Institution “St. Apostle Luke” Doboj and Public Health Institution “Health Center Brčko”).

Attempts to regulate this issue and standardize the approach in BiH are sporadic and have not yielded concrete results to this date.

“Recommendations and guidelines have been developed at entity levels that could improve the practice and protection of the rights of women in childbirth. However, the process of implementing such changes takes a very long time, and the lack of clear accountability mechanisms further hinders progress. The health system still does not show enough initiative to proactively improve the rights of women in childbirth, even in basic issues such as the right to be accompanied during childbirth. This, unfortunately, points to a serious systemic problem in which basic human rights, patient rights, and women's rights are not sufficiently recognized,” Amila Tatarević, president of the Baby Steps association, told the Odgovorno portal.

The Baby Steps Association has been working on this issue for many years and previously launched Initiatives towards the Ministries of Health and collected petitions. A positive step forward occurred when the Federal Ministry of Health of the Federation of BiH published the “Guide for Intrapartum Care in the Federation of BiH” in April 2024, which includes recommendations for accompanying childbirth, but it did not move beyond that. Initiatives were also launched in the Federal Parliament when MP Marijana Hrvić-Šikuljak, in 2023, submitted an initiative to accompany childbirth, including natural childbirth and cesarean section, in all maternity hospitals in the Federation of BiH. Hrvić–Šikuljak stated in the initiative that “obstetric violence (physical and psychological abuse during pregnancy, childbirth and after childbirth) is still present in maternity wards in the FBiH, which is a violation of basic human rights and the rights of patients and can lead to health complications, postpartum depression, psychological disorders, and in the worst case, the death of the mother and/or baby due to neglect”. The initiative has received support, but to date, nothing concrete has been done to solve the problem, and there have still been no changes in legislation.

Obstetric violence – an invisible reality

The right to an escort is not only a matter of support for the mother in labor but also a mechanism for protection against obstetric violence. The presence of a trusted person reduces the likelihood of abuse and provides an additional level of security for women who are often in a vulnerable position.

While the health system ignores the right to an escort, numerous women testify to traumatic experiences during childbirth, where exposure is seen not only to physical exertion but also to abuse of power by medical staff. According to research by Baby Steps, women in BiH anonymously reported:

“They shouted at me not to scream and that ‘I’m not the first to give birth’.”

“The doctor told me I couldn’t get an epidural because ‘I didn’t pay’.”

“They performed the Kristeller maneuver without my consent, I couldn’t breathe.”

“They refused to give me information about the medical procedure they were doing to me.”

These statements confirm that women in labor often suffer unnecessary pain, lack of information, and disrespect for basic human rights.

If escorting is standard in most European countries, why are women in BiH still denied this right?

Healthcare facilities and relevant institutions must recognize that the issue of escorting is not just about the organization of hospital work but also about women’s basic human rights. If escorting is standard in most European countries, why are women in BiH still denied this right?

The Baby Steps Association has initiated activities to improve the rights and conditions of women in labor in Bosnia and Herzegovina by enabling the accompaniment of a person at the request of the woman during the entire labor as a basic mechanism of support and protection, but with a slightly different approach.

“After years of attempts to regulate the right to accompaniment of women in labor through the health system and the persistent refusal of the authorities to find a solution that would allow every woman to choose a person who would support her throughout the labor, we decided to approach this problem differently. Accompanying women during labor is not a matter of the medical profession, nor of health status and/or capacity – it is a matter of the fundamental rights of women in labor, a matter of birth rate, prevention of obstetric violence, the fight against corruption in maternity wards and, ultimately, fulfilling BiH’s obligations in the European integration process, which require improving conditions in maternity wards,” explained Amila Tatarević, the new approach to the Association’s struggle.

They expect that the planned activities will result in the adoption and implementation of regulations regulating the issue of escorts at the cantonal and federal levels and ultimately reduce obstetric violence and corruption in maternity wards through systemic support for the right to escort.

"We will ask the Government of the Federation of BiH and the Parliament of the Federation of BiH to introduce the right to escort as mandatory and guaranteed for all mothers in all hospitals in the Federation. This change does not require additional investments - everything that is needed already exists. Physical privacy can be protected with simple screens, by existing guidelines, and the only thing missing is the will of the health system. If it has been absent so far, then we will insist that institutions adopt regulations that will ensure that the rights of mothers in labor are respected," Amila added to the Odgovorno portal.