How Gentle Must Violence Against Women Be in Order to Not Be Violent? Rethinking the Word “Violence” in Obstetric Settings

Abstract

With the growing concern of human rights in health, the word “violence” is being used to describe apparent disrespectful treatment received by women by either health care practitioners or health care systems. As the definition of violence in health care settings broadens, questions arise over the impact of the term in describing objective reality. Specifically, does use of the term “violence” inadvertently disempower the women that it is meant to empower? This article explores the changing use of the term “violence” and specifically draws on evidence in a South African labor ward, where phenomena such as silence and limited social support have cultural underpinnings that contradict labels of structural or obstetric violence. As global research on obstetric violence in disadvantaged communities grows, choice of terminology will become more important in filtering results into medical policy and practice.

Obstetric Violence: An Intersectional Refraction through Abolition Feminism

“…Bohren et al (2020) responded to this critique, stating that the intentionality that the term obstetric violence implies makes it difficult to engage with healthcare workers and policymakers. Two recent examples of the controversy surrounding the term, one from the Global North and one from the Global South, center around the question of intentionality tied in with the defensiveness of obstetricians (Lappeman and Swartz 2021;Ravaldi et al 2018).…”

Re‐centering Relationships: Obstetric Violence, Health Care Rationalities, and Pandemic Childbirth in Canada

“…Drawing on their own research context of South Africa, Lappeman and Swartz (2021), for instance, argue that many perinatal health care providers work under conditions of incredible constraint and are themselves survivors of ongoing systemic violence. Given these circumstances, Lappeman and Swartz (2021) question whether naming and shaming these care providers as perpetrators of violence should be a necessary step toward improved perinatal care. This perspective is countered by those who argue that leaving violence unnamed means it will likely go unaddressed, and that the term "violence" entails a call to positive action (Lévesque and Ferron-Parayre 2021;Salter et al 2021).…”

“…This was the case even in contexts where the actual risk of community or in‐hospital transmission of COVID‐19 was negligible, for instance in regions where there was little or no presence of the virus in the community, and where COVID‐19 caseloads remained consistently low until the arrival of the Omicron variant in January 2022—long after these interviews were collected 1 . In this way, some participants experienced what has been termed “gentle” (Lappeman and Swartz 2021) or “unintentional” (Shapiro 2018) obstetric violence as a direct consequence of health system responses to the COVID‐19 pandemic.…”

“…Existing literature on obstetric violence is thus far largely silent on the harms caused by treating pregnant and birthing people and their newborns as potential disease vectors who must be isolated from others as a means of disease prevention. Considerable literature from low‐ and middle‐income countries does, however, highlight a connection between obstetric violence, inadequate care, and strained, under‐resourced health care systems operating beyond capacity (e.g., Castro and Savage 2019; Chadwick 2017; Lappeman and Swartz 2021). Beyond demonstrating that holistic, person‐centered care is extremely difficult to provide under conditions of intense strain, this work raises powerful questions about how to approach and address the harms caused by health care providers who do not intend harm and who work hard to provide good biomedical perinatal care in difficult circumstances.…”

“…Beyond demonstrating that holistic, person‐centered care is extremely difficult to provide under conditions of intense strain, this work raises powerful questions about how to approach and address the harms caused by health care providers who do not intend harm and who work hard to provide good biomedical perinatal care in difficult circumstances. Drawing on their own research context of South Africa, Lappeman and Swartz (2021), for instance, argue that many perinatal health care providers work under conditions of incredible constraint and are themselves survivors of ongoing systemic violence. Given these circumstances, Lappeman and Swartz (2021) question whether naming and shaming these care providers as perpetrators of violence should be a necessary step toward improved perinatal care.…”