Human Rights in Childbirth: One Year Later

Today marks the anniversary of the 2012 Hague Conference on Human Rights in Childbirth.  Those of us who organized that conference sought to gather consumers of maternity care, care providers, lawyers, and other disciplines into a room to discuss human rights in birth care.  The conference drew participants from 50 nations.   Discussions about the human rights concerns of birthing women around the world revealed the international need for activism around women’s rights in birth care, and the existence of organizations and motivated individuals on all continents working for improvement in this area.  After the conference, we started hearing more from these groups about their work, the issues in different birth care systems, and their need for connection to the international community as they worked to understand the problems and solutions.  And so the Hague conference became a grass-roots organization: Human Rights in Childbirth.

Why Now?

This organization is committed to ensuring that all healthcare systems and providers respect the basic decision-making authority of every birthing woman about what will happen to her body and her baby during childbirth.   The individual nature of women’s needs in childbirth demand that healthcare systems preserve the option for individualized care.  Whether healthcare systems seek to improve  maternity care, in the developed world, or implement it, in the developing world, every healthcare system can acknowledge the fundamental human rights of the birthing women it aims to serve.

The need for activism in this area stems from the fact that, in both the developed and developing world, birthing women report the routine violation of their rights to be supported in decisions around childbirth.  In the developed world medical protocol often channels women into systems of care that deny their autonomy.  The protocols themselves vary from region to region, and from practitioner to practitioner, but the assumption in institutionalized birth care is that a woman should submit to the directions of whichever provider is standing in front of her.

This assumption is especially concerning in light of the ongoing escalation of cesarean rates around the world.  Pregnant women face providers who cut the babies out of 20, 30, 50% of their clients saying, “I have decided that you are having a planned cesarean section.  If you insist on giving birth vaginally, I will tell the judge, or Child Protective Services, that you are a mother who puts her baby at risk.”  Every legal system needs to make clear that women have the right to refuse an offer of cesarean surgery.  Yet the right to refuse is complicated by the fact that many providers and hospitals simply withdraw care  from women who choose vaginal over cesarean section delivery, a denial that is not based in evidence.  With rates of cesarean section 5 or 10 times higher than they were a generation ago, all women should be concerned with the suggestion that they do not have the right to refuse a surgery that they consider unnecessary, and that can actually cause their death.

Monopoly, Suppression, and Persecution

Laws that operate to enforce a medical monopoly over childbirth violate the human rights of birthing women.  Woman’s ability to turn away from abusive hospital care depends on their ability to get birth support outside the hospital.  In legal systems most protective of a medical monopoly over childbirth, this monopoly is preserved through the heavy legal sanction of home birth midwives.  Over the last year, we have heard from midwives and doctors from a wide range of legal and healthcare systems, facing legal challenges for birth care provided outside the hospital that can fairly be said to go beyond prosecution to persecution.

The essential allegation in many of these cases is that the birth professional should have made the woman go to the hospital, including sometimes the charge that the professional should have recognized earlier a symptom requiring medicalization.  In medical malpractice, these allegations would be called “failure to intervene,” and “failure to diagnose.”  Because the deaths of babies are painful tragedies, and because bad outcomes are unavoidable in obstetric care, obstetrician-gynecologists are among themost sued specialists in medicine.  But doctors face legal challenges in civil and regulatory settings, with civil and regulatory consequences.  Due to the illegitimate status of home birth midwifery in systems of medical monopoly, allegations of negligence against midwives play out in ways, including criminal prosecution, that could foreseeably dissuade any midwife from offering services for childbirth outside the hospital.  For this essential claim that a midwife should have made a woman go to the hospital, midwives are charged with manslaughter, homicide, murder, quackery, fraud, and cannibalism (this last for the encapsulation of placentas).  They are subject to home raids (in one American state this year, with cadaver dogs searching the midwives’ gardens), house arrest, and imprisonment.  When no midwife is willing to risk such treatment in the event of a stillbirth, home birth services disappear.  Women in those systems thus face a choice between unnecessary surgery or unassisted home birth.

We at Human Rights in Childbirth believe that the use of coercion and forceagainst birthing women, including the frightening threat of Child Protective Services against women who make healthcare choices of which their providers disapprove, stems from a failure to understand and recognize that pregnant women retain the rights of all citizens.   The birthing woman is the person with the right to make the decisions that will affect herself and her baby around childbirth.  We have committed ourselves to supporting the clarification of that fact wherever necessary.

Since the Hague

Our first step has been to simply observe and gather information about global activism concerning birth care.  In September, the film Freedom for Birth reported on the Hague conference and raised awareness about legal issues in birth care in over 1000 screenings worldwide.  From Japan to California, India to Israel, Bulgaria to Uruguay, movie theaters and living rooms filled with people eager to discuss local concerns and plans for action.  Over the last year, regional conferences modeled on the Hague conference convened consumers, birth and legal professionals, and interested scholars to discuss human rights in birth care in Finland, Australia, Ecuador, Israel, and Croatia, among others.

In April, Human Rights in Childbirth held a joint conference with Midwifery Today in Eugene, Oregon, USA, for consideration of the legal treatment of homebirth midwives.  A panel of a dozen birth professionals working in the U.S. and Canada shared stories that demonstrated that the sanction of home birth professionals as a human rights issue transcends debates about licensure and regulation.  Consumers, activists, lawyers and birth professionals exchanged information and strategies that generated hope in the face of systemic injustice.  The Eugene event illuminated the value of a Human Rights in Childbirth conference as an opportunity to get people together and strengthen the connections necessary for mutual support and political action in this area.  Among midwives, as among activists, there is more that unites than divides, namely a shared appreciation for woman-centered care and a belief that all women deserve respect and support around childbirth.

On November 4, we will host another one-day conference with Midwifery Today, this time after their international conference in Belgium. This event will examine legal actions across Europe that evoke the human right to choose the circumstances of childbirth.  From the denial of home birth services in rural Sweden, to forced episiotomy in Italy, from the regulatory annihilation of home birth midwives in Western Europe, to the criminal annihilation of home birth midwives in Eastern Europe, panels will consist of mothers, midwives, and lawyers whose cases have pointed to Ternovszky v. Hungary since last year’s Hague conference.  The conference will be held at a beach resort on the North Sea, and many of the great minds in modern childbirth will be present.  We hope to see you there!

The need for respectful and individualized birth care certainly extends beyond the western world, with its plentiful infrastructure and resources.  Together with colleagues across South Asia, we are also planning a conference in India during 2015 for discussion of the role of human rights in developing birth care systems.  To that purpose, we will bring together the world’s leaders in obstetric care, midwifery, ethics, pediatric care, law and consumer groups, in a nation working to reduce maternal and fetal mortality across a vast population, in a healthcare system that lacks funding and is often understaffed. The country that has the most diverse groups, socially as well as culturally, that harbors many challenges and has many resources and a wealth of ancient and modern knowledge and wisdom, is India. On this fertile ground we propose to put our hearts and minds together.

Advancing HRiC Together

The fact that our conferences focus on legal issues in birth care has connected lawyers working in this area, and has given rise to a network of legal professionals communicating about developments in this area.  Human Rights in Childbirth is working to connect these lawyers and scholars both regionally and internationally.  National Legal Defense Networks can educate the public about legal issues and rights, share information and strategy, and collaborate for legislative action and strategic advocacy.  By connecting these networks at the international level, we can track developments in this area and further explore the fundamental human rights at stake across national borders.

The last year has therefore revealed a purpose for Human Rights in Childbirth: to connect and advance both political activism and legal advocacy relating to the rights of birthing women.  We are now ready to take the organization from its embryonic state as a grass-roots network of international volunteers to a foundation in The Hague with the ability to do meaningful work in this area.  We are therefore taking this anniversary as an opportunity to invite support for the formation and advancement of Human Rights in Childbirth.  We would like to offer the following Hague Conference materials to express our gratitude for contributions toward HRiC.

  • 20€: A pdf copy of the Hague Conference Papers
  • 50€: A printed book copy of the Hague Conference Papers
  • 75€: A pdf copy of the Hague Conference Papers and access to the video recordings of the full Hague Conference.
  • 100€: A printed book copy of the Hague Conference Papers and access to the video recordings of the full Hague Conference.
  • 500€: in addition to the above, you or your organization can demonstrate your alignment with birthing women around the world by sponsoring Human Rights in Childbirth. In honor of your contribution, we will publicly acknowledge your support in our next newsletter and through various social media shout-outs over the next year.
  • 1,000€: in addition to the above, HRiC will publicly acknowledge your contribution and distribute your marketing material at every HRiC conference through 2014.

Donations can be made via the Paypal button on the Human Rights in Childbirth website  Please contact us at info@humanrightsinchildbirth.com for more information.

The year since the Hague Conference has revealed a global demand for a rights-based approach to problems in maternity care.  Human Rights in Childbirth is prepared to facilitate the political movements and legal revolutions necessary to ensure that every pregnant woman receives the respectful healthcare support that she, personally, needs in order to bring new life into the world.  We would like to thank all those whose ongoing support and encouragement has carried our work forward over the last year.

Human Rights in Childbirth Summit: Eugene, Oregon

From the Organizers of Human Rights in Childbirth/ Midwifery Today Summit

We’d like to thank everyone who participated in April 2’s day-long summit.  It was a pivotal meeting of attendees and speakers from all walks of life and backgrounds, where game-changing ideas were presented, and relationships were forged and strengthened.

Jan Tritten began the day with a call for unity, and unity was the experience that attendees most carried away.  As midwife after midwife shared a story of how legal sanction had affected her life and her family, we saw the common threads that run through these stories.  Home birth midwives had similar experiences with the law, despite the different legal systems where they worked, whether the midwife was a CPM or a CNM, “legal” or “illegal.”  A powerful panel of mothers and birth activists described the effect that the legal climate around midwifery has on birthing women.  The day began by laying bare the problems, and it ended with solutions: a panel of committed lawyers described their work advocating for midwives and justice in maternity care.

The diversity of perspectives voiced over the day enabled all present to elevate their own perspectives.  By understanding the common threads, we could identify political problems and their solutions.  We could see the forest, instead of the trees, and walked away with the knowledge that we are not alone and the hope that, together, we can generate solutions.

A few things that came out of the summit that we think deserve clarification, especially for attendees who requested a summary that they could share with their own organizations.

First, we want to highlight the diversity of attendees and speakers.  Not everyone agreed on everything, but discussion was respectful and productive.  We’ll continue to foster those discussions.

Second, understand that the summit was a place to share stories and ideas in a neutral environment.  No one was on trial here.  Our interest in the cases before us at the conference lay in the ways that legal systems treat home birth providers, and how that treatment affects the safety and accessibility of home birth as a legitimate healthcare option.  This issue transcends the facts of any particular case, including the question of whether the midwife might have made a mistake in this case.

Why support midwives, even before the facts of a case come out?

Many voiced concerns about “supporting” midwives who may have made negligent decisions in care. This is a critical topic and something that must be clarified.  Doctors make mistakes.  Midwives make mistakes.  Decision-making in childbirth is not a clear science.  But when doctors are negligent, they are treated one way, and when homebirth midwives are negligent, they are treated another.  Our question is not, “Was she negligent?” but “How did the legal system approach the allegation of negligence?”

Midwives should not be sanctioned for professional negligence through the criminal justice system, when doctors are immune from criminal prosecution for professional negligence. 

Our analysis starts from the assumption that women have the right to choose whether to give birth inside a hospital or outside of one, and that women have the right to choose a birth provider whose approach to childbirth, for example as a physiological or a medical event, most likely mirrors their own.  A healthcare system concerned with the safety of mothers and babies does not try to force every woman into a one-size-fits-all birth care model.  But when the providers of out-of-hospital birth support are treated as outlaws, the choice for home birth goes underground and becomes less safe, less transparent, and less accountable to birthing women and the public at large.

For this reason, we are concerned with equitable legal treatment of birth care providers, and interested in the effect that the inequitable treatment of those providers has on birthing women.  Legitimate healthcare providers are held accountable for negligent acts every day—but they are held accountable for negligence through medical malpractice lawsuits and disciplinary sanctions.   That same system of accountability should apply to midwives.  So, when we hear of home raids, arrests, and homicide charges against home birth midwives, on allegations that amount to every-day medical malpractice claims (failure to diagnose, failure to intervene),  we say, “No, that particular sanction is not appropriate, period.”

Disincentivizing midwifery is not good for maternity care. 

We are interested in ensuring the survival of midwifery as a profession, not for midwives, but for women.  We support midwives because we support the rights of birthing women to make personalized decisions in birth care.  That includes their right to give birth where and with whom they choose.   The choice to give birth inside the hospital is not meaningful unless you also have the option to give birth outside of it.  The inequitable legal treatment of homebirth midwives makes home birth midwifery an extremely risky profession, and thus dissuades providers from offering these services.

Should midwives be held accountable for negligence?

Absolutely.  Quality of care is paramount in order to ensure safety for mothers and babies.  Midwives must be held accountable like any healthcare provider, through equitable and transparent systems.  These are systems that treat maternal health care providers—doctors, nurses, and midwives—the same.  They allow mothers to protect themselves and their babies and to make personal healthcare decisions with full and transparent information.

But the necessary first steps toward effective systems of accountability for out-of-hospital midwives are

  1. the legal recognition that midwives ARE legitimate healthcare providers,
  2. the recognition that there is no legal obligation to give birth inside a hospital, and home birth is a legitimate healthcare choice, and
  3. regulatory systems that legitimize the midwifery model’s treatment of the birthing woman as the bottom-line decision-maker in childbirth.

The theme that emerged throughout the day was the need for unity among those who serve and advocate for women and babies in childbirth.  Regardless of our individual beliefs, we must find our common ground if we are to see real and lasting change in the way birthing women are cared for and treated.  It’s time to lay down our weapons and recognize our mutual concerns.

Thanks to all who participated in this enlightening, inspiring, whirlwind event.  We look forward to seeing all of the fruits of our labor throughout the coming year.

Human Rights in Childbirth Conference Opening Speech by Joyce Hoek-Pula

I have to admit, I only realised this was important, for the world, a year ago.  In a workshop with Barbara Harper we were talking about the declining rate of homebirth and the rise in pain relief. And how we felt an urge to do something about it. She said at one point: do you realise that the WHOLE world is looking at you and your birth system? Because your system makes home birth a real option for women? That there is in fact no other country, even when there is a system in place, where the homebirth rate is above 3%?

I stood silent. It sank in. And I realized that indeed, Holland is absolutely unique in the way we deal with childbirth. For me, as a Dutch woman, this is the norm. Home birth is normal. Home birth is not exclusively for the hippies or the deprived. It is in our tradition not to be afraid of birth, to consider birth as a life event rather than a potentially life-threatening situation. And yes, all this is changing. Maybe our cultural identity is changing, maybe we are becoming more like ‘the rest of the world’. Maybe we are losing our dutch stubborness – the dutch word for that is : ‘eigenwijsheid,’ which literally means: your own wisdom. But hey, should we just let this happen, and implement far reaching changes, before we even reflect on the how and why all this is happening in the first place?

We have talked and will talk more about why home birth is important, as it teaches us about true physiology of birth, so I won’t go into that. What I will emphasize, is that by looking at our birthsystem, we are looking at ourselves as a nation. It isn’t in the Dutch character to think much of oneself. But we have to look from a broader perspective at what we are. And when Barbara made that comment, there was some hesitation in me to accept it: nah, it cannot be true that what is happening here is actually of importance for other countries, to Europe. To the world.

But in that moment when it sank in, it also kicked in. It ignited the spark in me to actively DO something. Something to make people reflect before the system got washed down the pipelines of agreements and protocols between care givers, insurances, politics and hospitals. Within one month we came together, with 45 women and one man. A diverse group of mothers, doula’s, midwives, and childbirth educators. This was the start of the Geboortebeweging, the Birthmovement. And please raise your hand if you have been at that meeting or other meetings of the BirthMovement. And I am proud to say (and that is maybe not very Dutch) that we helped to give this great initiative of the Bynkershoek Research Center for Reproductive Rights, hands and feet. That together we are adding the missing link to the discussions about changes in the birth system: the role and the human rights of the mother.

I am very humbled that such a big group of international speakers, people from diverse backgrounds, from so many different countries, you, have come here together to put your minds and hearts together to reflect on the Dutch birth system.

Do we Dutch now realize that we matter? See all the speakers from yesterday seated here; all of them stayed for the ‘Dutch day’. Do we realise now that we matter?

And in fact, we are facing a very challenging future, but we have everything in us, our own inner wisdom, our eigenwijsheid, to make those changes that really matter.

In the hours to come, it will be our challenge to seek out what is binding us instead of that which divides us. Let us go beyond our opinions, our convictions of what is right or wrong. Let us do something NEW. Let us be careful in too quickly formulating answers or solutions. Let us listen, and really listen, to the doubts and concerns the other has. And let the mother speak, and through the mother, the child.

To illustrate that I would like to leave you with this extract from a poem by the Indian writer Rabindranath Tagore:

They clamour and fight, they doubt and despair, they know no end to their wranglings.

Let your life come amongst them like a flame of light, my child, unflickering and pure, and delight them into silence.

Let them see your face, my child, and thus know the meaning of all things; let them love you and thus love each other.
Thank you.

Joyce Hoek-Pula is a mother, yoga teacher, doula, and founding leader of the GeboorteBeweging (Birth Movement), a group of mothers, midwives, childbirth educators, doula’s and fathers who are concerned with the changes in the birth culture and system in the Netherlands, and who want to protect and promote the human right for the mother to choose the circumstances of her delivery.

Welcome to the Human Rights in Childbirth (HRiC) Blog

This blog will be a space where people can contribute articles, stories, or commentaries regarding human rights in childbirth. The blog is a space where we can continue the conversation about the legal, ethical, and practical issues of Human Rights in Childbirth (HRiC) going forward. Please contact us if you are interested in posting a writing here.

To kick off, here is the speech delivered by conference organizer and American lawyer Hermine Hayes-Klein at the opening of the Human Rights in Childbirth Conference in The Hague, on May 31 2012.

WELCOME – May 31 2012

Welcome, Everybody! I am Hermine Hayes-Klein. I am the director of the Bynkershoek Research Center for Reproductive Rights, here in The Hague.

You have come from around the world to The Hague, the world capital of peace, justice, and law. You have come to learn, to share, and to work together to figure out the role of law and human rights in the most fundamental of human experiences: birth.

In December 2010, the European Court of Human Rights held that childbirth is a human rights issue. In the case of Ternovszky v. Hungary, the Court acknowledged that more is at stake in childbirth than the right to survival, the right to access healthcare capable of saving the life of mother or baby, critical as that right is. In Ternovszky v. Hungary, the Court of Human Rights held that women have a human right to choose, not only whether to give birth to a baby, but how they give birth to that baby.

So we’re here to figure out, what does that mean, to say that women have a human right to choose the circumstances in which they give birth? You could say that such a right breaks down into two fundamental parts. First, is the woman the chooser? Is she recognized as the person with the ultimate authority to make the decisions about how she gives birth, where she gives birth, who is present at her birth, what is done to her body and her baby? Second, does the woman have choices? To be recognized as the chooser only has meaning if there are options to choose from.

The European Court of Human Rights held both that women are the ones with legal authority to make the decisions of childbirth, and that the state cannot use the force of law to take away their options. The basic options that the court discussed in the Ternovszky case were the choice between giving birth at home or in the hospital, and also the choice to be attended during childbirth by a medical doctor or a midwife.

These simple choices, between home and hospital, between doctor and midwife, are unavailable in many jurisdictions. In others, they are available, but the state lays a heavy thumb on the scale to steer all women toward one choice: giving birth at the hospital, with a doctor. The weight of that thumb can render the choice meaningless. When state insurance will pay doctors, but not midwives, women cannot afford to hire midwives. Midwives exist in any community, and can be found if you look hard enough. But if those midwives face the threat of prison for attending birthing women, can we say that women have a real choice to give birth with a midwife?

As the European Court of Human Rights explained in the Ternovszky holding: if there is one country that provides meaningful choice for birthing women regarding the circumstances in which they birth their babies, it is The Netherlands. I discovered that myself when I moved here from the United States five years ago, pregnant with my first child. I found myself in the one western country that never came to define childbirth as a medical event that can only be managed by doctors in hospitals. The Dutch have long seen birth as a normal life event, with the potential to become a medical event. Unlike the United States, they had never wiped out midwifery. The state had supported two professions, doctors and midwives, as partners in service of the birthing population. The Dutch tradition was that healthy women birthed their babies at home, and if medical issues arose, they could go to the hospital and be treated. This system resulted in more live babies and more live mothers than the United States.

And so here, I had options. I could give birth at home with a midwife, or at home with a general practitioner. I could give birth at a birth center with a midwife. Or I could give birth in the hospital, with a midwife, or in the hospital with an obstetrician. Like all women, I wanted a healthy birth and a healthy baby. My research into the physiological processes of birth made clear that my body would have the best chance of delivering safely if I felt safe, and supported, during my birth. For me, I knew that the place where I would feel safe and secure was in my home, with a midwife who I could really trust. And so I choose for a home birth, with a midwife, reserving doctors and hospitals for emergency backup.

I got the birth I wanted. Twice.

I gave birth at home in Rotterdam, with a highly skilled, experienced, and compassionate midwife. And her two sweet-hearted young apprentices. These were the circumstances in which I chose to give birth. I am certain that the quality of care that I received, and the security that came with laboring in my own home, are the reasons that I was able to deliver without a medical emergency arising.

Does this right matter? Is the quality of a birth the frivolous concern of a privileged western woman? All I know is that, in most parts of the world, women do not really get to choose the circumstances in which they give birth. They don’t have many choices, and they aren’t really treated as the central authority in what happens during the birth. The right to be the decision-maker is not just about the right to choose who will attend your birth, or where you deliver. If birthing women have real authority over their birth processes, they can never be told that they “must” do anything. They can’t be told that they must lie down, stay still for the machine, keep quiet, or push that baby out within the next 10 minutes. But if this is the case, if birthing women have the right of informed consent and the right to refuse treatment like everybody else, then most of the world hasn’t got the memo.

Does it matter? Give women a chance to tell you the deepest truth about the circumstances in which they gave birth, and you’ll find out that it does matter. Too many times have I listened to my friends weeping as they tell me about the births of their babies. Disrespect and abuse during childbirth are not the necessary price of safety. Quite the opposite.

This birth was my choice. It was safe and it was healthy, and not only on the level of survival. It was the best start to life that I could have wished for my baby, and the best start to parenthood for myself and my husband. I was lucky to give birth in a nation capable of providing that choice. A fully supported birth should not be only for the lucky; it need not. The human right to choice in childbirth is the legal basis for ensuring that all birthing women have the ability to access healthcare services that give them what they, personally, need for a safe, healthy birth.

You are here because you, too, know that this human right matters. And you know that great work will need to be done, all around the world, to bring this right from abstraction to reality. We are going to spend the next two days systematically unpacking the elements of this right. Today’s four panels will unpack the fundamental human rights at stake in childbirth.

We will start with the case of Ternovszky v. Hungary the first human rights case to formally address these issues. Panel 1 will tell us about that case. Who was this Hungarian mother, who sued her nation for the protection of her human rights? What did the Court say exactly? What does the decision mean? In what sense is this decision now “law”? What changes resulted from the judgment, within Hungary?

Panel 2 will assess the science of decision-making in childbirth. What choices are safe, what choices are risky; what does it mean to call them so? How do the different people involved in a birth decide what to do? What issues matter to them when they weigh the options?

Panel 3 will discuss the ethics of decision-making in childbirth. What would the baby want from its birth, if it could tell us? Who has the responsibility to protect that baby’s interests, and who has the power to do so? Can a mother’s decisions during birth put her in conflict with her unborn baby, and if that happens, then what?

Panel 4 will look at the professional healthcare framework in which women give birth. What are the rights and responsibilities of doctors, midwives, nurses and doulas? How does the relationship between these professionals affect the human rights at stake in childbirth?

The second day of the conference will also unpack the science, ethics, and practical problems underlying human rights in childbirth, but it will focus on the birth system of The Netherlands. The Dutch birth system gave me two happy, healthy births. But I have learned over my five years here that the Dutch are at something of a crossroad with regard to the unique tradition of Dutch birth. Tomorrow we will convene a wide range of stakeholders in the Dutch birth system to meet face to face and talk about this system, its value, its problems, and where it will go in the 21st century. The conference is a wonderful opportunity to bring the Dutch together with so many members of the global community working in birth care. It gives the international community a chance to bear witness to the complexities that the Dutch are facing with the Dutch birth system, and also a chance for the Dutch to see the global significance of their birth model.

Look around this auditorium. You have come from all over the world. Look at our panelists. They are many of the most famous thinkers, writers, and doers in the international world of birth care. They are midwives, doctors, lawyers, ethicists, anthropologists, mothers, fathers—you know, the list goes on. We come from so many cultures, from so many disciplines, from so many different personal experiences. There will be as many opinions on the issues that we discuss, as there are people in this room. That is the promise of this event—that through exchanging these opinions, and really listening to each others’ perspectives, we will all move forward in our own thinking on the subject of human rights in childbirth.

Thank you for making the journey to be here. No matter what occurs in the discussions that we will have over the next two days, something has already happened, by the mere fact of our assembly in this room.