Written by Laura Dragnic Tohá, Paulina Macías and Guillermina Pappier
Laura Dragnic Tohá is a student of the 2024-2025 LL.M in National and Global Health Law at Georgetown University. She is originally from Chile, and is focused on social and reproductive justice within an international human rights law framework.
Paulina Macías is a student of the 2024-2025 LL.M. in National and Global Health Law at Georgetown Law. She is originally from Mexico and is focused on litigation and promotion of human rights and reproductive justice within the Inter-American and Universal Human Rights Systems.
Guillermina Pappier is a second-year fellow at the O’Neill Institute for National and Global Health Law. Originally from Argentina, her work focuses on reproductive health and international human rights law.
In recent years, research has highlighted the widespread mistreatment of women during the provision of healthcare related to prenatal care, pregnancy, childbirth, postpartum, obstetric emergencies, and abortion access. This phenomenon transcends continents and cultures, manifesting itself in a wide range of forms yet remaining a common practice across different countries.
A focus on the first 1,000 days of life -from conception to age two- underscores that this phenomenon not only violates the rights of pregnant individuals but also poses a critical threat to the health and development of newborns. Disrespectful care can cause immediate complications like obstructed labor and postpartum hemorrhage, as well as long-term effects like PTSD and barriers to breastfeeding. It also undermines healthcare trust, leading to delayed care and increased reliance on unskilled birth attendants.
Global Patterns of Mistreatment
Mistreatment during maternity care is a global issue. In Chile, 80% of women have reported experiencing some form of it, while in Colombia, almost six in ten women felt uncomfortable, offended, or humiliated by comments, questions, or maneuvers during gynecological or prenatal consultations. In Mexico, one-third of women reported mistreatment during childbirth, and nearly half underwent cesarean sections. Furthermore, a WHO-led study in Ghana, Guinea, Myanmar, and Nigeria revealed that almost half of women experienced abuse during childbirth. This issue is not confined to low- and middle-income countries. For instance, in the US, 1 in 5 women reported mistreatment while receiving maternity care, with higher rates among Black (30%), Hispanic (29%) and multiracial women (27%).
Legal Recognition and Policy Responses
This problem has gained recognition within legal and policy arenas. For example, Argentina enacted Law 25.929 on Humanized Birth. It recognized obstetric violence as a specific form of gender-based violence in its Law for the Integral Protection to Prevent, Punish, and Eradicate Violence against Women. Similarly, Chile introduced a concept of obstetric violence in its Comprehensive Law against Gender Violence, and Colombia published a Law on Dignified, Respectful, and Humanized Childbirth.
It has also resonated internationally, as courts and international human rights bodies have started to address obstetric mistreatment in landmark cases. For example, in the case of da Silva Pimentel v. Brazil, the CEDAW Committee established the state’s responsibility to ensure maternal health as a human right under the CEDAW, and underscored the obligation to address systemic inequities in access to health services, particularly for marginalized communities. While in the case of S.F.M v. Spain, the CEDAW Committee recognized obstetric violence as a form of violence that is widespread and systematic in nature, whose roots include labour conditions, resource limitations, and power dynamics in the provider-patient relationship. Furthermore, in the Britez Arce case from Argentina, the Inter-American Court of Human Rights reaffirmed that women have the right to live free from obstetric violence. Also, it emphasized that States must prevent, punish, and refrain from such practices.
Terminology and Conceptual Frameworks
How we name this phenomenon has profound implications for understanding and addressing the problem. In some contexts, it is explicitly framed as a form of violence. For example, countries like Chile and certain states in Mexico have incorporated “obstetric violence” into their legal frameworks, recognizing it as a specific manifestation of gender-based violence. Some have criticized the framing and use of the word “violence” for being usually understood as implying deliberate harm, which is not the case in many intrapartum situations. Critics of this terminology have noted that “obstetric” implies that the issue is limited to obstetricians, excluding other healthcare providers such as anesthesiologists, neonatologists, midwives, nurses, and auxiliary staff. Further, it has been stated that this term can also discourage open dialogue needed to address disrespectful care effectively.
In other regions, the focus has been on promoting “humanized childbirth” or “respectful maternity care,” as seen in Colombia and Costa Rica. For instance, the European Court of Human Rights has addressed childbirth conditions in landmark cases such as Ternovszky v. Hungary and Dubská and Krejzová v. Czech Republic, explicitly addressing the regulation of home births and midwifery assistance.
Intervention Strategies
As terminology varies, so do the strategies for addressing this phenomenon. Some countries have opted to criminalize obstetric violence by creating specific criminal offenses that hold healthcare personnel accountable. Others have chosen to incorporate aggravating factors into common criminal offenses. Some countries have developed a broader approach. As such, Argentina and Chile have incorporated obstetric violence into their laws on the eradication of violence against women. Similarly, some Mexican states (like Chiapas, Guanajuato, Durango, and Veracruz) have incorporated definitions of obstetric violence into comprehensive gender violence laws that mandate local authorities to take action across all branches of law.
However, studies suggest that criminalization is not an effective approach to prevent and eradicate obstetric violence, as the problem is structural, and individual punishment can hardly address a structural issue. Instead, they advocate for integrating gender perspectives into health education. The Special Rapporteur on the Right of Health warns that criminalization in healthcare perpetuates stigma and restricts girls’ and women’s ability to access and fully utilize sexual and reproductive healthcare services, information, and resources.
Countries like Colombia and Argentina have prioritized preventive measures by promoting good practices around respectful maternity care or humanized childbirth. These efforts emphasize dignity and respect, enforce informed consent, protect the rights of pregnant individuals and newborns, and train healthcare workers to address biases and foster empathy. Additional strategies include strengthening institutional policies, improving patient-provider communication, and creating mechanisms for accountability and redress.
Moving Forward: Unresolved Questions
However, one of the main challenges in addressing this issue is the absence of universally agreed-upon minimum standards. This raises fundamental questions about definitions and approaches: How does our definition of the problem shape treatment approaches? What different effects emerge when framing harmful practices in maternity care as a public health issue versus a criminal offense? Even the conceptualization of this phenomenon as violence brings its complexities: Should all forms of mistreatment be considered equally severe? How do we distinguish between violence specific to childbirth and broader manifestations of institutional gender-based violence? When considering potential solutions, especially from a public health perspective, new questions arise: Which legal instruments would most effectively foster collaboration with healthcare providers? Should policies emphasize medical education and professional development? We now face more uncertainties than concrete answers, reflecting this issue’s complexity and evolving nature.