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Giving birth in a toilet: New report criticises Georgia’s psychiatric facilities  

20 May 2020
Ivane Bokeria Referral Hospital, one of the institutions studied by the Public Defender . Photo via Ivane Bokeria Referral Hospital Facebook page.

A special report from Georgia’s Public Defender states that psychiatric facilities across the country fail women patients through a litany of mispractices including, but not limited to, prescribing outdated or improper medication, a lack of testing, and providing inadequate security from sexual violence.

The Public Defender’s Office studied 12 psychiatric in-patient healthcare institutions, three boarding houses for adults with disabilities, and six community-based organisations.

The report, published on 11 May, found that women patients were left without adequate medical treatment, were often given outdated and dangerous medical medicines, and were left vulnerable to sexual violence. 

It also documented a startling lack of basic supplies, with women being forced to ration sanitary pads, while at other facilities patients did not have personal undergarments, instead, there were communal undergarments that were distributed after being laundered. 

Reproductive Health

The report states that failures at addressing the reproductive health needs of women with mental health problems at the inspected institutions existed at multiple levels, from policymaking by the government down to the practices (or lack thereof) by the institutions.  

The oversights begin from the moment a woman enters an institution, as her ‘sexual and reproductive health status’ is not assessed prior to the prescription of medication, as concern is only given to the management of mental rather than reproductive health. Worse still, in case ‘abnormalities’ are revealed during her stay at the institution ‘laboratory testing is not performed’.  

Even though patients are examined by gynaecologists, the report found that consultations of the gynaecologists employed at psychiatric hospitals largely carries a formal character and is limited to an interview and superficial examination. 

In one of the cases cited by the report, medical personnel only learned about the pregnancy of a patient after the woman had given unassisted birth ‘in the toilet of the facility’. 

Gynaecologists failed to detect the woman's pregnancy even in the last trimester, despite having previously examined her. According to the report, the patient was taking psychotropic medications ‘throughout the entire pregnancy’, which ‘posed a high risk to the fetus’. 

The report also found that many of the medicines given to patients were outdated, posed a risk to the patient’s health and would chemically ‘sterilize’ the patient.   

There is scarce information about patient pregnancies, as institutions do not record such data.

Sexual violence

The report found that women at staying at mental health institutions were also regularly subject to sexual violence, especially in mixed-gender institutions.  It cites one case where a woman patient feared that the men staying in her unit would sexually assault her, her complaints were ignored. 

The problem of sexual violence is ‘even more acute’ at boarding houses for people with disabilities staying at boarding houses, as ‘often one group of beneficiaries tries to oppress and influence the other’. In one instance, a beneficiary even reported being ‘married’ to another against her will. 

Other issues raised by the report include toilets in mixed-gender facilities that do not have locks, despite patient protests over a ‘high likelihood of someone entering an occupied toilet’. 

Lack of supplies

According to the report, many women in psychiatric institutions lack access to supplies necessary for basic hygiene, such as sanitary pads or toothbrushes. At multi-profile hospitals, that include psychiatric departments, department heads were found to have struggled in convincing superiors of the necessity of purchasing such supplies for their patients. 

‘This is particularly problematic for female patients who do not have the support of family and relatives or when they do not arrive on time at the facility and are unable to provide the necessary supplies to the patient’,  the report states.  ‘In this case, it is up to the doctors to purchase hygiene items. It is also a common practice to cut/divide hygienic pads in the absence of such pads.’

The report found also that patients lack personal clothing and that at some inpatient psychiatric facilities, clothing, including undergarments, are selected for patients from common general supplies in the facility that are reused by different patients. 

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