Human Rights and mental health: Special protection for motherhood and childhood

This doctoral thesis is grounded in the recognition that the enjoyment of the highest attainable standard of health constitutes an essential human right, and that mental health is an inseparable component of overall health. It also arises from the struggle against discrimination and violence against women within the provision of care for their reproductive processes, and it is supported by scientific evidence that identifies comprehensive maternal and child health care as a public health priority. The central hypotheses are that certain practices in the field of perinatal health negatively affect the mental health of women and their infants, potentially contravening human rights protection standards; and that the safeguarding of maternal and child health—essential for adequate development—remains insufficient.

To this end, a plural methodology has been adopted, from the perspective of critical ethnography, including an extensive literature review conducted through major search engines, medical and social sciences databases, clinical practice guidelines, documentation from international organizations and Official Gazettes. The literature examined covers topics such as mental health, perinatal mental health, motherhood, early childhood development, bioethics, and national and international health regulations. In addition, practical cases derived from daily psychiatric practice at the Puerta de Hierro University Hospital (Community of Madrid) have been considered, and three cases have been analyzed that gave rise to the CEDAW Committee’s decisions against Spain concerning obstetric violence.

The findings conclude that, within the Spanish healthcare system, a minimal standard is promoted, one that prioritizes the survival of women and their infants without emphasizing the importance of positive experiences as the foundation for health and well-being. Numerous medical practices continue to be applied that are either contrary to, or unsupported by, scientific evidence, and that may negatively affect maternal mental health. Moreover, the mental health of infants remains neglected, despite the significant impact of perinatal events, maternal stress, and perinatal psychopathology on their development. The lack of comprehensive maternal mental health care constitutes a breach of the fundamental right to health for women undergoing reproductive and maternal processes, while also undermining the well-being, health, and development of their infants.

CEDAW’s findings against Spain also highlight violations of women’s rights to autonomy, dignity, and access to health information during reproductive processes. Furthermore, the analysis of current Spanish legislation reveals a persistent lack of political attention to the social determinants of health among women who become mothers. All these factors appear to significantly harm maternal mental health, with potential long-term negative repercussions on their children.

In conclusion, deficiencies in the implementation of a human rights–based approach to maternal and child healthcare within the Spanish National Health System are evident, with harmful consequences for overall health and a particularly detrimental effect on mental health. Consequently, a significant reform of current practices is necessary to ensure more effective implementation of these rights.