Obstetric violence

Inforgraphics_ Obstetric Violence FINAL (2)


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Throughout the course of her pregnancy the woman is in need of good quality health care and dignified support to help her through the intense experience of childbearing.  While this statement sounds logical and straightforward, evidence shows that there are many instances when women are not only denied access to good quality medical care but are also treated inhumanely by the service providers.

Obstetric violence is a specific type of violation of women’s rights, including the rights to equality, freedom from discrimination, information, integrity, health, and reproductive autonomy. It occurs both in public and private medical practice during health care related to pregnancy, childbirth, and post-partum and is a multi-factorial context of institutional and gender violence.[1]


Obstetric violence occurs at an intersection between Institutional violence and violence against women during pregnancy, childbirth and the post-partum period and it occurs both in public and private medical practice.

For too many women pregnancy is a period associated with suffering, humiliations, ill-health and even death.
Obstetric violence can be manifested through: the denial of treatment, the disregard of a woman’s needs and pain, verbal humiliations, invasive practices, physical violence, unnecessary use of medication, forced medical intervention detention in facilities for failure to pay, dehumanizing or rude treatment and discrimination or humiliation based on race, ethnic or economic background, age, HIV status, gender non-conformity, among others.

Unfortunately, obstetric violence is an often overlooked type of Violence Against Women. Lack of information about the issue complicates the design of public policies to prevent and eradicate it. However, emerging evidence worldwide shows that women in childbirth are being subjected to varied degrees of ill-treatment – from subtle disrespect to their autonomy, to outright abuse – verbal insults, physical violence, discriminations, abandonment, forced medical intervention or detention in facilities for failure to pay.

Ill-treatment and abuse drives women away from formal health care systems in fear of being subjected to these types of violence and may sometimes be a more powerful deterrent than geographical or financial obstacles.

The ill-treatment and human rights abuse of women in labour does not only manifest itself in the denial of services, but also that women are often coerced to accept certain medical procedures that they would have preferred to avoid otherwise.  A new statement from the World Health Organization (WHO) underscores the importance of focusing on the needs of the patient, on a case by case basis, and discourages the practice of aiming for “target rates”.[2]

According to WHO, caesarean section rates higher than 10% are not associated with reductions in maternal and newborn mortality rates. Rather the contrary, it is stressed how caesarean sections can cause significant complications, disability or death, particularly in settings that lack the facilities to conduct safe surgeries or treat potential complications.[3]

Other patterns of obstetric violence identified have been the abuse of medicalization and pathologizing natural processes of birth. Indigenous women and women living in rural areas are particularly vulnerable to this type of obstetric violence.[4]

The extreme consequences of this denial of access to good quality medical care and inhumane treatment are severe psychological distress, trauma and in some cases death due to neglect. These terrible consequences stem from the denial of sexual and reproductive health services and rights, and are a form of institutional violence condoned, endorsed and/or perpetuated by the State.

Key figures by countries:


In Mexico, between 2009 and 2012 the National Human Rights Commission received 122 complaints related to obstetric violence. Due to these complaints, the government has recently added “obstetric violence” to the “General Law of Women’s Right to a Life Free from Violence.”[5] An ethnic Mazatec woman was denied medical attention by the health care personnel and was forced to give birth on a lawn in front of the health center in Oaxaca. It appears that this is not a unique case and that more births happen in the immediate surroundings of the health care facilities in Oaxaca due to ffailure to attend indigenous women in labour.[6]



The notorious case of a woman being beaten by the nursing staff and forced to give birth on the concrete floor at the Bungoma District Hospital in Kenya, making national headlines in 2013 is a stark example of the lack of dignity and respect in the maternity care sector.  The case was documented by chance by another patient, witnessing the inhumane treatment of the woman in labour and captured it on her cell phone.[7]

Dominican Republic:

In the Dominican Republic, adolescent women are targets of obstetric violence in health services. A study carried out in two maternity hospitals of the city of Santo Domingo, where health professionals across the country are trained, indicating that 78% of adolescents surveyed (between 15 and 18 years) were subject of ironic, disqualifying comments, and jokes about their behavior.[8]

El Salvador:

Obstetric violence as an expression of discrimination against women, is also experienced on grounds of ethnic origin; such is the case of indigenous women from El Salvador.[9]

South Africa:

Abuse in maternity facilities is common in South Africa. South African women describe verbal abuse, including being ridiculed while pleading for assistance or pain relief, and being berated for “messing up” when they bled on the floor during labor. Many are later forced to clean up their own blood. According to a report from Health Partners International it has become so normal that some nurses don’t understand why it is a problem to slap or shout at women in labor.[10]


A case in Brazil illustrates how women’s human rights are disregarded in the name of the unborn child. A mother who previously had two Caesarean deliveries was preparing to give birth to the third child vaginally – Vaginal Birth After Caesarean (VBAC). Despite living in a country with one of the highest caesarean rates in the world (82% for those with private insurance and 50% for those without), she felt the earlier Caesarean sections were unnecessary. Despite there being no question of reduced mental capacity, doctors had obtained a court order allowing them to perform a caesarean. Instead of delivering her baby on her terms, the woman was taken from her home, forcibly anaesthetized and operated without consent.

Around the world:

These are only a handful of examples from the millions of cases of obstetric violence happening worldwide. As previously mentioned, a lack of information about the issue  and fear of talking about it from the women who experienced complicates the prevention and eradication of this type of violence.

Every woman needs and has the right to access skilled and high quality health care during childbirth. The State is responsible for institutional violence when women are denied access to health care, treated inhumanely, forced into unnecessary medical procedures or when a fetus is prioritized over a woman’s personhood.

[1] GIRE, Obstetric Violence, (In spanish) https://www.gire.org.mx/nuestros-temas/violencia-obstetrica

[2] WHO, News release : Caesarean sections should only be performed when medically necessaryhttp://www.who.int/mediacentre/news/releases/2015/caesarean-sections/en/

[3] Idem

[4] Patterns of Violence Against Women in Latin America and the Caribbean, http://www.cladem.org/pdf/Informe-Relatoria-de-Violencia-ing.pdf

[5] Obstetric Violence is now included in the Law of Women living free from violence, News (Spanish) http://www.semexico.org.mx/?p=768

[6]Health director suspended in Mexico, News report, http://www.dailymail.co.uk/news/article-2451618/Mexican-woman-gives-birth-clinic-LAWN-treatment-denied.html

[7] Leaders want Bungoma hospital boss arrested News report, http://www.standardmedia.co.ke/article/2000092941/leaders-want-bungoma-hospital-boss-arrested


[8] Patterns of Violence Against Women in Latin America and the Caribbean, http://www.cladem.org/pdf/Informe-Relatoria-de-Violencia-ing.pdf

[9] Idem

[10]From Rights-based Advocacy to Maternal Outcomes, http://whiteribbonalliance.org/rmc-blogs/rights-based-advocacy-maternal-health-outcomes/