Erika Schmidt, M.A. is a lecturer, activist, and member and colleague of EMMA Hub – the Women’s Association for Birth Rights in Hungary since 2012. Her academic background is in theoretical linguistics. Erika worked as assistant lecturer at Pázmány Péter Catholic University. The (home) births of her three kids led her to birth activism.
Since 2014, she has been directing the “Birthing Justice” project of the Association, which focuses on childbearing women living in extreme poverty, mainly Romani women in Hungary. In 2015, she launched the “Transparency in Maternity Care” project of the Association, which deals with public data issues in the Hungarian maternity care. In 2016, she became the programme manager of the Association. Erika also tutors interns and takes part in the coordination of the “Respectful Maternity Care!” grassroots movement in Hungary.
Q: Tell us about your background.
A: I was working in a small organisation, about to change name, rebranding, if possible use new name in luminary session EMMA, I am a mother of three who got involved in topic through birth experience, worked as volunteer responsible for international relations in 2012, after my smallest kid went to kindergarten I got more and more involved, in different activities, now responsible for academic relations I have an academic back ground in linguistics, partly related, for experience I also though in the university in Hungary, in 2014 I became director of the birthing justice association, which looks at woman in extreme poverty, I also came responsible for internship programme, space for 1 intern year in association, we launched smaller project, transparent maternity care, which deals with the public in Hungary.
Q: Having worked for many years in the area of maternal health, what do you see as the major issues currently facing women and threatening a safe motherhood experience?
A: Instead of listing problems, I will underline some hidden approaches which I feel are important, one is inequality, and another the forgotten motherhood.
Birth is a human rights issue and feminist one, it is a woman’s fundamental right to decide when and how to have a child, both are equally important, and they should be at the forefront. By inequality I mean, in one corner of the world two out of three woman undergo a C-section without reliable medical information. We spend large money on healthcare in this part of the world, while in other part they lack the proper facilities. If we go to Europe within Europe, we do have legal and financial frameworks to implement these good practices all over the continent, [but] we see in east, central or south Europe that most women do not have access to a women’s centre, which offers maternity care. There are those treated with high medical interventionist care, without consent, on the other hand in these regions, in economically distressed regions those living in extreme poverty only have restricted access to proper maternity care… there is a large gulf in quality between the capital city and small village in Hungary. I am convinced we have all the resources, financial, human resources to ensure woman’s safety, [but] we misuse them, disproportionately. The states don’t have enough trust in each other, they do not listen to woman and within do not have the strength and power to represent their own interest, we have forgotten the importance of birth – the way our babies arrive in this world, how they experience their first journey will stay with them for their lifetime. There is an independent free service in Hungary, their mission statement is “peace on earth starts with gentle birth”.
Q: One of SMW’s goals is to address the gaps in care and inequalities with regard to maternal rights/care. I believe your work focuses on childbearing women living in extreme poverty, mainly Roma women. What are the specific issues these women face, and what specific projects have you been involved
A: Yes we have a specific project, we usually refer to it as a project for Roma woman, if it were up to me I would say it’s a project for women living in extreme poverty, most of which happen to be Roma living in Hungary. Every woman needs the same care when entering maternal care, they need attention, they need personalised care, real support [that is] easy to follow, respect and dignity of their human rights.
The Hungarian system is not able to grant these to most woman, due to systematic problems and so the woman feel vulnerable, but if some belong to a disadvantaged group, it makes them even more vulnerable and they experience a more criminal impact of these systematic shortcomings. So on one hand the problems are the same… on the other hand it is much harsher for Roma woman who have other problems. Roma woman in Hungary are discriminated on the account of them being woman, being a Roma, living in difficult circumstances, financially. If we talk of challenges, of Roma woman maternity care, the first is that we have to recognise these problems are connected to poverty rather than ethnicity, while the other is that we must take a very complex approach and see woman’s physical economic and social circumstances as a whole.
I would start with family planning, families are usually uninformed, most don’t have any knowledge, but also those in upper class Hungary don’t either. This responsibility lies disproportionately on woman and a lack of family planning affects those living in extreme poverty due to financial reasons. They are unable to afford [more children]. They have little knowledge of cheaper contraception, and information must be distributed… we can see on the surface, in the case of mothers living in extreme poverty and isolation, that there is a much higher rate of low birth weight and premature births, they participate in maternity care at a lower proportion. It is quite usual that we blame these woman for this, but the main obstacle is, a physical obstacle to maternity care, poor public transport, they have no money, can’t afford to travel, have five other children, who they cannot leave with someone. Roma woman claim they don’t get the most appropriate support from health professionals but rather from confidential persons, mother, mother in law, sister, friend etc. etc., they discourage them to go to healthcare professional, even if they get there, they experience a lack of communication, they feel left out and humiliated as they aren’t educated, don’t understand technical terms, also essential (for healthcare professionals) to respect the cultural background of woman, especially those from Roma community. It is not common in Hungary but we still have several Roma groups. They often encounter negative statements and discrimination during maternity care, one woman said she can’t do right… if she has another child, it’s a bad decision, if they have a termination, it’s a bad decision, they just can’t do right. The pregnancy part, when it comes to giving birth, most Roma woman go to hospital, as it’s much safer to give birth, rather than home birth, which is not common amongst them. I think regarding birth care, they experience the same as the rest of the woman in Hungary, sometimes neglectful care, which is a plus for Roma woman… there is a good chance they will be taken to a separate ward because they are Roma.
Post-partum period is a much more peaceful period for them, they support each other (the family). The never go for professional post-partum care. Regarding the association input, they started working with Roma woman in 2014, organised workshops to raise awareness and to discuss problems they will encounter and give guidance. It was an immense success, and in 2015 they conducted in-depth reviews with Roma woman about their experiences, and they started a support service for Roma woman, which encouraged them to take part in professional healthcare with trained professionals, we trained two Roma woman living in their own community, to provide support in local areas, after training they will know how to explain how the system works, other terms or jargon, how to explain terms to women, sometimes they will go to hospital with the pregnant woman. It’s a very successful service, woman like it very much. They prefer to hear from someone who they trust and have a personal relationship with.
Q: Another of your interests is transparency in maternity care – can you tell me about your work on this issue?
A: The main problem for the mothers is partially speaking there is no birth data available, birth outcomes of different hospitals isn’t available, nation’s statistics not available. It’s very difficult for woman to gain information, and to choose the proper place to give birth, for me as an activist and mother who is interested in birth data, the problem in Hungary is that there is not a certain level of quality of care; the quality of maternal care varies a lot, from one health professional to another even if they work in the same hospital it’s a kind of lottery. If you have no knowledge, you may get a gentle natural child birth or be made to get a C-section after an hour of labour, it’s a big problem for woman, they would like to know what they can expect when they enter the hospital. We have a national data collection system but not available for the public, only for the healthcare professionals, so we try to interview woman to get their experiences and build a database, but it is difficult to get through to these woman, we contacted a European network of researchers, called the corporation of science and technology, they have a four-year project called Building Intraparty Research through Health, which is an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth. We joined this network, and also joined another project Babies Born Better… they had a survey which was conducted in 20 countries available in 13 languages; we translated it to Hungarian and collected data for them. The main aim of this was to find out about woman’s views an experience relaying to maternity care, so we can see it’s difficult to compare national results and to identify areas of best practice in maternity care, at present we are analysing the data and preparing to launch the second round of the extended version. We had great support on this project one of our supporters was a Hungarian NGO, which is a watchdog organisation and the other was a company from the not-for-profit sector; the three of us collaborated in collect analysing and presenting data, we had many ideas as to how we could collect data in the country.
Q: Birth trauma is an issue you have been active on – what are the implications of birth trauma?
A: Childbirth represents an time of intense vulnerability in a woman’s life, first-hand accounts and activists research prove that current maternity heath care is harmful presents long and short term harm, psychological and physical to woman, it is difficult to understand how process seems normal from a healthcare professional’s point of view and at the same time, seen as deeply traumatising for the woman. Behind the stories that woman tell us many forms of human rights violations are uncovered. It is seen as a hidden form of sexual violence against woman and its roots are deeply in the hierarchy of healthcare institutions and in society as well, one of the strongest social and cultural problems.
I think in developing countries, we usually don’t talk about it, and it usually brings a lot of tension, as what happens in maternity care, can be experienced as traumatic experiences and can be experienced as something violence. Birth trauma can cause a lot of physical and psychological problem including depression, PTSD can affect a woman’s ability to look after their baby, and can make them not want to have another. The association provides personalised support, for traumatic birth experiences and we have launched a unique project, which is a hotline available by phone and an email that woman can contact with questions problems and experiences. The calls are answered by trained volunteers, we also have workshops which cover child birth and traumatic birth experiences, these are not really, mommy/baby clubs, it’s a safe place which provides a safe atmosphere, where their stories are acknowledges and respected. I got involved, by listening to other stories, and while I had not not gone through any trauma with my births I had a desire to share with women that childbirth is not always a traumatic experience
Q: Our theme for Safe Motherhood Week this year is: Motherhood is our power to shape the future. It is everyone’s responsibility to make it safe. What are your thoughts on this statement?
A: A woman is safe only if she feels safe, as we experience the mothers feel safe, if they are actively involved in their maternity care if they are the person who controls their care in the end and if they have personal support and if there motherhood competence is accepted, in our region is as a first step it should be acknowledged and understood that pregnancy birth and post birth should be controlled by the mother and it is essential to support mothers during this period, in the EMMA association, we believe that good care begins with the woman, and if a woman gets support it helps the woman baby and finally society as well, and in reverse if we cause harm to the mother, we cause harm to the baby as well.
In this region mothers and babies are treated as separate but they should be treated as a whole, and any decisions made for the good of the mother should also be made for the good of the baby. We all need to stand together on the same side, mothers, partners, healthcare professions, activists, other stakeholders in maternity care our common aim is to have healthy mothers baby’s and family, that can step into life after birth, but he goes much further than having a mother and her new-born alive at the end of the birthing process, and the end of every birth, a new mother a new baby, new father and new family are born, in physical emotional and social sense as well, we are complex human beings. More and more healthcare professionals in Hungary feel that this change needs to happen, the changes can bring benefits for them as well not just women. If I could ask of something, have a desire, I would ask for more trust for ourselves and much more open discussion, more sharing of experiences and stories, and to communicate trust for each other, I really do believe that we have everything to improve the healthcare, we just need to use it smartly.
Q: Is there anything else you think is relevant in relation to your work and our campaign?
A: I feel that change should be forced on several of us at the one time, by healthcare professionals by political decision makers and most importantly by society but for the association we have been focusing on woman and we have been working on improving births in Hungary, in 2016 there was a breakthrough, some women who organised health workshops, decided to go out and organise a public event and a campaign on social media about their experiences and this movement became somehow the birth of a new grass roots birth movement in Hungary. In March 2016 we collected hundreds of stories form the public, through social media and professional decision makers and we had a very successful event in March around woman’s fundamental birth rights, which was attended by almost 1,000 woman and their families, it was a huge success. Our main aim is not just to mobilise woman, but to raise awareness about birth rights and the present state of healthcare in Hungary and to give a voice to the women who experienced this, to say this is what is happening this is what is going on. We are calling for the unification of the level of care throughout the whole country, by introducing additional evidence based guidelines.