Less Than Half of States Ban Pelvic Exams Without Consent
Three states recently passed laws banning nonconsensual pelvic exams, marking a victory for reproductive justice advocates.
Nonconsensual pelvic exams occur when doctors and medical students, typically at teaching hospitals, examine an unconscious or sedated patient’s cervix without informed consent. These exams are unacceptable given that many Black women and queer people are survivors of gender violence, said Céshia Elmore, lead community organizer at New Voices for Reproductive Justice.
A nonconsensual pelvic exam “is a pipeline to sexual assault,” Elmore said. “I did not give consent for you to basically be inside of my body, but you’re a medical professional, and I’m supposed to just trust you?”
While states have passed laws banning nonconsensual pelvic exams in the last several years, the practice was not always seen as problematic by medical professionals: A 2003 study found that medical students who had completed an OB-GYN clerkship thought that obtaining consent before conducting a pelvic exam was less important compared to medical students who had not yet completed a clerkship. This research inspired a 2003 California law that requires informed consent before a medical provider performs a pelvic exam.
Nonconsensual pelvic exams don’t just happen during gynecological care. In 2020, the New York Times reported that a nurse was violated by a nonconsensual pelvic exam while unconscious after a stomach surgery. It’s also widely practiced: A 2005 survey found that a majority of junior and senior medical students at the University of Oklahoma reported performing pelvic exams on women who could not consent. Seventy-five percent of these students reported that they did not believe they received informed consent before performing these exams.
Connections to obstetric violence
According to a 2019 study, 1 in 6 women experienced mistreatment during childbirth, also known as obstetric violence, including threats, scoldings, requests for help being ignored, and loss of autonomy. The study also found that women of color with low socio-economic status reported obstetric violence more than white women. Black women have a higher likelihood of declining procedures during childbirth and subsequently facing discrimination by medical providers because of these assertions of reproductive autonomy. Black birthing people and their babies are more likely to be drug tested after delivery, often without consent, compared to other racial groups.
Reproductive justice advocates say obstetric violence and nonconsensual pelvic exams are similar violations of a person’s bodily autonomy.
“If I do not think of you as a total human with certain inalienable rights and the agency to command their own body, especially during the birthing process and that is base belief to my practice of medicine, nursery, midwifery, or any kind of perinatal care, then of course I will put my hands on you without checking for your consent,” said Kelly Davis, the executive director of New Voices for Reproductive Justice.
Obstetric violence and nonconsensual pelvic exams stem from the same root causes, Davis said: the racist origins of gynecology, and the structure of the health-care system.
“The majority of maternity care, for those who are poor, disabled, and marginalized, is provided by student learners,” Davis said. “So you have a system in which the folks with the most complex medical needs, which are caused by the chronic stressors of racism, are often receiving care through teaching hospitals and student learners who do not have the expertise and the experience to deal with complex health needs.”
Davis said the medical student’s incentive to experiment, and lingering racist stereotypes about Black people’s ability to feel pain, create the perfect circumstances for nonconsensual pelvic exams.
“The student learner wants to learn, they want to experiment—that’s how they learn and perfect their techniques,” Davis said. “When you have beliefs that are contrary to viewing Black women and gender expansive folks as agentic beings, that allows you to conduct an unnecessary pelvic exam.”
“Every Black person could have a doula and a midwife and we would still have the Black maternal health crisis because we have maternal homicides and gender-based violence,” Davis added.
Informed consent is critical
For Davis, informed consent and relationship building are integral to quality care and respecting a person’s reproductive autonomy. She said some health-care needs that result in poor birth outcomes require a conversation and building a relationship between a health-care provider and the pregnant person.
“If you do not take the time to focus on consent and partnership building and seeing every person as a human with specific strengths and a unique life context, that allows you to drug test [birthing] people without their consent,” Davis said.
Davis and Elmore also said that currently, some hospitals’ consent practices are not fully transparent and informed.
“Even [medical providers] who think that they’re doing it right will give a patient a piece of paper to sign with medical jargon and not explain the test, the utility of the test, and why it’s integral to their care.” Davis said.
Elmore added that hospitals’ requests for consent can often be masked.
“[Patients] signing some general form is like ‘cover your ass’ for hospitals,” Elmore said. “They say, ‘Well you consented to that procedure, and this procedure is part of that,’ which is a complete violation of a patient’s trust and bodily integrity.”
Davis said policy alone will not create the world we deserve, because even though policy can be a form of harm reduction for Black women and queer folks, “liberation cannot be legislated.”
“White supremacy is so dynamic and insidious,” Davis said. “You see that today with abortion rights. Roe v. Wade gave some legal protection but even with it being the law of the land, so many people did not have access to abortion. There were still medically unnecessary tests, waiting periods, and violence against abortion seekers and providers. Legislation alone does not protect people’s humanity. We organize around the world we deserve; not just our survival and the absence of abuse, but the presence of love, joy, and pleasure.”