For centuries, women worldwide have experienced violence in their homes at the hands of intimate partners with no or very little legal recourse. I witnessed this firsthand.
In 1990, when I worked at a legal aid office in Santiago, Chile, a woman sought help because her husband regularly beat her. At the time, I had neither the words nor the tools to help. Chile’s first law specifically addressing domestic violence — a law that could have changed her life — would not be adopted until 1994.
Until the mid-20th century, in most countries, the law allowed violence to occur in the home with impunity and didn’t even have a name. It took almost a century of work by women’s rights activists, many of them survivors of violence, for the concept of “domestic violence” to take shape, be named, and be recognized as unacceptable. This label helped survivors of domestic violence give words to the fear, suffering, and violence they experienced in their own homes, and to finally have fuel to press for legal remedies. Although these crimes are still alarmingly common, many countries, especially in the Americas, Africa, and Europe, have passed specific laws against domestic violence to better protect survivors and those at risk of experiencing abuse.
Today, it’s time to do the same for obstetric violence.
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Obstetric violence is the physical and emotional abuse of pregnant people seeking sexual and reproductive health services and information, including maternal health care — like antenatal care, intrapartum care, post-natal care, gynecological examinations, abortion and post-abortion care, fertility treatments, and contraception. It includes abusive treatment by medical practitioners, nurses, midwives, and other hospital staff, including administrative staff and security personnel.
It is one of the most pervasive yet underrecognized forms of gender-based violence, affecting millions of women during pregnancy, childbirth, and the postpartum period. Many may not know the term, but they can recognize the reality, especially those who have endured it.
Obstetric violence is a spectrum: from blatant violations such as forced sterilization to practices so normalized they are seen as routine in healthcare systems worldwide. Women are tied to hospital beds while giving birth, verbally abused, physically assaulted, or denied pain relief offered to other patients. Doctors sometimes ignore requests for sterilization, while at the same time performing procedures such as vaginal examinations, cesarean sections, or episiotomies without informed consent. Some women are even forced to deliver in hallways or on hospital lawns after staff dismiss their reports of pain or signs of labor.
These are only a few of the many ways gender-based violence has long marked women’s reproductive lives — violence that for years had no name.
Thanks to the work of women’s rights activists, particularly from Latin America, obstetric violence has emerged as a critical human rights issue demanding urgent global attention and legal reform. In 2007, Venezuela and Mexico were among the first countries to include situations of obstetric violence in their protections against gender-based violence. Since then, a growing number of countries have legally recognized obstetric violence and have taken measures to eradicate it.
Some of the most important international human rights systems and bodies, including the Inter-American System of Human Rights, the Committee on All forms of Discrimination Against Women (CEDAW), the special rapporteur on violence against women, and the African System of Human Rights have used the concept of obstetric violence and urged countries to tackle this structural form of violence. Experts in maternal health, such as the International Confederation of Midwives, have also adopted the concept.
In 2020, the CEDAW case S.F.M. v. Spain marked a significant milestone as the Committee’s first decision explicitly addressing obstetric violence. The case concerned a woman who underwent several non-consensual medical interventions while giving birth in a hospital in Spain, including 10 vaginal examinations in less than 36 hours, an episiotomy, administration of medicine that made the woman vomit and shiver, all without her consent. The Committee concluded that the hospital’s actions and the lack of an appropriate response by the Spanish legal system inflicted considerable mental and physical harm to the woman, amounting to obstetric violence.
In recent years, the Inter-American Court of Human Rights has issued two landmark rulings on obstetric violence. The second, in 2024, established that denying access to safe and legal abortion can itself constitute obstetric violence. In that case, the Court held El Salvador responsible for forcing a woman with lupus to continue a pregnancy with an anencephalic fetus — a fatal condition in which parts of the brain and skull do not develop — despite the grave risks this posed to her health and life.
This precedent is significant, as many countries continue to severely restrict abortion even when a pregnant person’s life is in danger. The United States is one such example. Since the Supreme Court overturned Roe v. Wade, doctors across the country have reported delaying essential care for obstetric emergencies and miscarriages until patients were deemed sick enough to qualify under narrow medical exceptions to state abortion bans.
Several women have told me about doctors stubbornly refusing their requests to perform a tubal ligation procedure after the women gave birth, telling the women that they were still young and would regret not having more children later. I know of women whose requests for pain medication during labor or painful gynecological procedures were refused or delayed until it was too late to administer, causing avoidable pain and anguish.
In Guatemala, a women’s rights defender told HRW about Marta, an eleven year old girl who became pregnant after being raped by her father. Despite all the risks this pregnancy had for her life and health, she was not given information about therapeutic abortion. Despite Guatemala having a protocol that mandates girls under 14 to give birth in proper health care facilities, Marta gave birth at her house, without medical assistance and sanitary conditions. The newborn died shortly after.
I’ve heard of girls being slapped and shouted at while giving birth, and taunted by healthcare workers for having had sex, implying that these girls have only themselves to blame for their pain. I’ve heard of women who were mistreated during reproductive health emergencies unrelated to pregnancy by health workers who assumed their condition was caused by an abortion. These experiences deny women’s autonomy and dignity.
Naming a problem is the start of its solution. And for the concept to gain traction, to be shaped and reshaped until it is useful, we need evidence, beyond anecdotal information, based on the lived experiences of those who have suffered abuse, violence, and mistreatment in healthcare settings. We can’t get this evidence without proper documentation and a public commitment to collecting this data.
Since 2016, Mexico has included questions about childbirth experience in a public national survey. The last survey revealed that more than 30 percent of women had experienced mistreatment in hospital settings. Such instruments are essential for a country to understand the scope and prevalence of obstetric violence. In sub-Saharan Africa, where 70 percent of global maternal deaths occur, information about the extent of the problem is hindered by the significant gaps in public data collection.
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Lack of reliable public data is just one challenge. Yet after identifying the problem, we also need to push for prevention, protection, and justice. Concrete measures include providing comprehensive sexuality education for all children and adolescents, educating healthcare students and personnel on respectful maternal healthcare and human rights, ensuring meaningful informed consent, and adequate public investment in healthcare facilities. Accountability cannot focus only on personal responsibility. As women’s rights experts examining punitive policies in Mexico wrote, “criminal liability fails to identify the social origin that leads to obstetric violence.”
Governments need to work, along with medical personnel and associations and women’s rights activists, to shift the cultural, ethical, and legal frameworks governing health care to ensure everyone, especially women and girls from communities most at risk of experiencing obstetric violence, instead experience respect and protection for their rights in all healthcare settings, and especially when they are seeking reproductive care. Governments also need to fully decriminalize abortion to ensure that reproductive health care is never treated as a crime.
Ultimately, eliminating obstetric violence requires a fundamental change in how societies view women’s autonomy and rights. Just like domestic violence, obstetric violence stems from deeply gendered power imbalances and legal frameworks that deny the right to information, criminalize healthcare, disregard women’s autonomy, and consider women and girls’ suffering a normal and unavoidable fact of life. At the core of the effort to end obstetric violence is the need to recognize that women and girls have the right to live lives free from violence and, above all, a right to shape their own lives themselves and make their own decisions.
Macarena Sáez, Executive Director, Women’s Rights Division
Read the original article on HRW.
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