Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence

Abstract

During recent decades, a growing and preoccupying excess of medical interventions during childbirth, even in physiological and uncomplicated births, together with a concerning spread of abusive and disrespectful practices towards women during childbirth across the world, have been reported. Despite research and policy-making to address these problems, changing childbirth practices has proved to be difficult. We argue that the excessive rates of medical interventions and disrespect towards women during childbirth should be analysed as a consequence of structural violence, and that the concept of obstetric violence, as it is being used in Latin American childbirth activism and legal documents, might prove to be a useful tool for addressing structural violence in maternity care such as high intervention rates, non-consented care, disrespect and other abusive practices.

Factors that influence the provision of intrapartum and postnatal care by skilled birth attendants in low- and middle-income countries: a qualitative evidence synthesis

“…In addition, most health workers that provide maternity care are female and may have experienced several forms of disempowerment in the workplace, and are therefore not able to advocate within the health system for better treatment of the women they care for. As a result, poor health worker-mother interaction may be normalised as part of the 'culture' of the health system in some settings, and both health workers and mothers may come to accept this as the norm (Bohren 2017, Rominski 2017, Sadler 2016). The perspective of Leape and colleagues on the nature and causes of disrespectful behaviour by physicians supports this hypothesis (Leape 2012).…”

Community and health system intervention to reduce disrespect and abuse during childbirth in Tanga Region, Tanzania: A comparative before-and-after study

“…Thus, the mechanism of action is never the tool itself but the entire process by which the problem is identified and analyzed, the intervention chosen, its use negotiated and practiced, and its effects assessed and understood [33]. And this implementation process likely works in a sustained way only when it engages the organizational culture and power dynamics at the heart of disrespect and abuse [34–36]. …”

Thematic analysis of US stakeholder views on the influence of labour nurses’ care on birth outcomes

“…One of the conditions under which this occurred was nursing concern for safety, similar to our finding that nurses used their sense of risk to frame constraint of women's options. Others note that covert power differentials in healthcare can result in women actively choosing care they do not want,25 and differences in midwifery education and philosophy might not fully mitigate this potential in the context of facility-based care 26. The potential for loss of dignity and dehumanisation during labour and birth can arise whenever women feel disregarded, disrespected or discounted, whether the provider is a nurse, physician or midwife 27.…”