Reflecting on Challenges to the Concept of Obstetric Violence

In the third post of our collaborative series for the Obstetric Violence Blog, members of the Obstetric Violence Reading Group reflect on a clinical opinion piece, Frank A. Chervenak et al “Obstetric Violence is a Misnomer” (2024) 230(3) American Journal of Obstetrics and Gynecology S1138. The authors argue that the term “obstetric violence” is overly emotive and misleading. They propose replacing it with the phrase “mistreatment in healthcare,” which they suggest more accurately captures a range of harms that may occur during childbirth. We explore how the piece navigates language, frames ethical responsibilities, and positions obstetric mistreatment in relation to broader patterns of gender-based violence. Rather than present our own ideas for change, our reflections aim to engage critically with the claims made, and to consider their implications for ongoing debates about reproductive rights, structural harm, and professional accountability.

Reflection 1: Policing Language

In our first reflection, we consider how the authors seek to control the terms available to women when describing their childbirth experiences, and what this reveals about broader power dynamics in clinical discourse. The authors assert that “women … should be empowered” to denounce abuse, yet also claim that describing their experiences as “violent” is inappropriate. This suggests that whilst they believe women should be encouraged to speak out about their experiences, this is only through acceptable terminology. It raises questions about whose voices are authorised, and how language, shaped by power, sets boundaries around what can be said about childbirth.

The authors’ concerns with the term “violence” appear to prioritise professional defensiveness over attentiveness to the lived experiences of patients. This raises concerns about whether resistance to certain terminology might obscure rather than illuminate the harms described by those who give birth. The authors’ preoccupation with the perceived inaccuracy of the term “obstetric violence” risks diverting attention away from the substantive harms described in the literature and by victim-survivors. This shows how definitional debates shape and constrain responses to systemic violations in reproductive healthcare. The fact that one in five women described their experience using the term “violence” (as cited in the clinical opinion itself) underscores the importance of listening to how those most affected articulate their experiences. The tension between professional definitions and patient narratives demands further critical reflection, especially when patients’ linguistic choices are characterised as inappropriate.

Reflection 2: Situating Obstetric Violence Within Gender-Based Violence

A second reflection concerns the characterisation of obstetric violence as a form of gender-based violence. Indeed, one of the important reasons for Latin American activists’ adoption of the terminology of “obstetric violence” is that it situates the phenomenon within broader discussions about systemic violence against women. Nevertheless, the authors reject this framing without engaging with the supporting literature.

Violence against women includes “violence that is directed against a woman because she is a woman or that affects women disproportionately”. Obstetric violence, which is exclusively experienced by women and people assigned female at birth, may fall into either category. It is facilitated and reinforced by patriarchal systems, narratives, and assumptions. For example, healthcare professionals’ suggestions that non-compliance with their direction marks a woman as a “bad mother” draws on patriarchal narratives that associate childbirth with expectations of obedience, moral worth, and maternal fitness. There are also numerous similarities between obstetric violence and other forms of violence against women. For example, much like domestic violence, obstetric violence frequently entails attempts to control, and a breach of trust in an intimate, personally significant context. Moreover, as with many other forms of gender-based violence, many women describe feeling objectified during childbirth: like a “lump of meat”. Further, victims of obstetric violence are often disbelieved, even by loved ones.

Recognising patriarchy and the devaluation of women as connecting threads across forms of obstetric violence helps to reveal its root causes, power dynamics, and harms. Lack of engagement with this perspective leaves a gap in the discussion, especially given its grounding in feminist theory and its recognition in national legal frameworks and by international human rights bodies.

Reflection 3: Beyond Ethics

Our third reflection focuses on the limitations of using ethics as the primary framework for addressing obstetric violence. The authors argue that harmful behaviours during childbirth are better described as “mistreatment,” and best addressed through professional ethics. They argue that duties like ensuring consent can help prevent mistreatment. Thus, the authors position informed consent as a key mechanism through which patients can protect themselves from potentially non-consensual practices. They also highlight the importance of patient rights, particularly autonomy and dignity.

While these commitments are important, our discussion raised concerns about whether ethics alone can address the structural conditions in which obstetric violence occurs. Ethical frameworks are abstract and individualised, limiting accountability for systemic harms. Emphasising informed consent as the main safeguard may instead place responsibility on patients to resist violations, rather than on institutions to prevent them. Understanding obstetric violence as a structural issue that is shaped by institutional cultures, hierarchies, and gendered norms calls for approaches that extend beyond ethical obligations. Ethics is a vital part of clinical care, but it may be insufficient on its own to respond to the deeper power dynamics that sustain obstetric violence.

Conclusion

Our reflections on Chervenak et al’s clinical opinion centre on three themes: the power of language in shaping whose experiences are heard; the significance of naming obstetric violence as a form of gender-based violence; and the limitations of relying on medical ethics alone to address systemic harm. Each point underscores the importance of how violence and abuse in childbirth is conceptualised, and by whom. As debates around terminology continue, our reflections highlight the need to critically examine language and power dynamics that shape who is able to speak and be heard.

Simone Gray, Lecturer and PhD candidate at the School of Law, University of KwaZulu-Natal.

Frances Hand, DPhil in Law candidate at St Edmund Hall College, University of Oxford.

Patricia San Juan, PhD student at Andalusian Interuniversity Institute of Criminology (Malaga Section), University of Malaga.

Kerigo Odada, Reproductive justice advocate and PhD researcher, University of Pretoria.

Camilla Pickles, Associate Professor of Biolaw, Durham University.

Georgia Speechly, DPhil in Law candidate at Exeter College, University of Oxford.