Obstetric Consciousness as an Ethical Category for the Prevention of Obstetric Violence

A Conceptual Framework from Bioethics and Human Rights

Research Lines

Social obstetrics and perinatal public health; obstetric violence and human rights; bioethics applied to childbirth; informed consent and autonomy in obstetrics; institutional prevention of violence in reproductive healthcare.

Abstract

Obstetric violence constitutes a specific form of institutional and gender-based violence recognized within the Argentine legal framework. However, its persistence reveals the need for structural transformations that go beyond legal classification. This article proposes the category of obstetric consciousness as a conceptual tool aimed at the cultural and institutional prevention of obstetric violence. Drawing on relational bioethics, the anthropology of childbirth, and a human rights approach, it is argued that obstetric consciousness expands clinical rationality by integrating professional reflexivity, recognition of power asymmetries, and the centrality of subjective experience as a constitutive dimension of quality of care. It concludes that its implementation requires institutional mechanisms for training, ethical supervision, and evaluation centered on users’ experiences.

Keywords: obstetric violence; human rights; bioethics; respectful childbirth; informed consent; public health.

Abstract

Obstetric violence has been recognized in Argentina as a specific form of gender-based and institutional violence within healthcare settings. However, its persistence reveals the need for structural transformations that go beyond legal recognition. This article proposes the concept of obstetric consciousness as a preventive ethical category aimed at addressing the cultural and institutional roots of obstetric violence. Drawing on relational bioethics, anthropology of childbirth, and a human right s framework, obstetric consciousness is conceptualized as an expanded clinical rationality that integrates professional reflexivity, recognition of power asymmetries, and the centrality of subjective birth experience as a core indicator of quality of care. Its implementation requires institutional commitment to human rights education, ethical supervision, and patient-centered evaluation strategies.

Keywords: obstetric violence; human rights; bioethics; respectful childbirth; informed consent; public health.

1. Introduction

In Argentina, obstetric violence is recognized as a specific form of violence against women under Law 26.485 (2009), while Law 25.929 (2004) establishes fundamental rights during the childbirth process. However, the existence of a robust legal framework has not eradicated practices that violate the autonomy, dignity, and psychological integrity of pregnant and birthing persons.
Various studies have shown that obstetric violence cannot be understood solely as an individual deviation, but rather as a structural phenomenon linked to the medicalization of childbirth and to hierarchical dynamics within the healthcare system (Vacaflor, 2016).
This article proposes the category of obstetric consciousness as a conceptual tool aimed at intervening at this structural level.

2. Medicalization and Power Asymmetry

The technocratic model of childbirth care, centered on risk management, produced significant clinical advances, but also consolidated epistemic asymmetries between professionals and patients.
The hegemony of biomedical knowledge relegated the subjective experience of childbirth to a secondary plane, favoring the normalization of routine interventions and non-consented practices.
Inter-American case law has pointed out that the lack of enhanced due diligence in obstetric contexts may constitute a violation of human rights (Gonçalves, 2025). This confirms that the issue is not merely technical, but ethical and structural.

3. Relational Bioethics and Meaningful Consent

Classical principlism (Beauchamp & Childress, 2019) provides a necessary but insufficient basis for addressing the complexity of childbirth.
From the perspective of relational bioethics, autonomy is understood as situated and shaped by institutional conditions. Within this framework, informed consent must be a continuous, comprehensible, and coercion-free process.
Reducing consent to an administrative formality constitutes one of the most frequent expressions of obstetric violence (Pickles, 2025).

4. Human Rights and the Argentine Legal Framework

Childbirth is embedded in fundamental rights recognized by:
Argentine National Constitution
CEDAW
Convention of Belém do Pará

At the domestic level:
Law 25.929 (2004): rights during the childbirth process
Law 26.485 (2009): classification of obstetric violence
Decree 2035/2015: regulation of Law 25.929

These instruments impose positive obligations of institutional prevention.

5. Obstetric Consciousness: Definition and Dimensions

Obstetric consciousness is defined as: an ethical, reflexive, and institutional competence that integrates scientific evidence, recognition of power asymmetries, and the centrality of the subjective experience of childbirth, aimed at preventing institutional violence and guaranteeing human rights in clinical practice.

Dimensions:
Permanent professional reflexivity.
Explicit recognition of structural asymmetries.
Centrality of experience as an indicator of quality.
Consent as a continuous dialogical process.
Proportionate and justified clinical decisions.

6. Institutional Implications

The operationalization of this category requires:
mandatory training in human rights;
critical review of routine protocols;
audits centered on users’ experiences;
interdisciplinary ethical supervision.
The effective prevention of obstetric violence requires sustained cultural transformation.

Declaration of Institutional Ethical Commitment

This work is grounded in a clinical practice guided by unconditional respect for human rights in the context of childbirth. From the Obstetrics Department of the San Isidro Municipal Maternal and Children’s Hospital, a model is promoted based on meaningful consent, critical review of naturalized practices, and ongoing training in obstetric violence and gender perspective.
The category of obstetric consciousness constitutes a conceptual tool aimed at strengthening this institutional transformation.

References

• Beauchamp, T. L., & Childress, J. F. (2019). Principles of biomedical ethics (8th ed.). Oxford University Press.
• Congreso de la Nación Argentina. (2004). Ley 25.929. Derechos de padres e hijos durante el proceso de nacimiento.
• Congreso de la Nación Argentina. (2009). Ley 26.485. Protección integral para prevenir, sancionar y erradicar la violencia contra las mujeres.
• Decreto 2035/2015. Reglamentación de la Ley 25.929.
• Gonçalves, J. S. (2025). Obstetric violence as a violation of the due diligence standard in the Inter-American Human Rights System. Boletín Mexicano de Derecho Comparado, 58(172).
• Pickles, C. (2025). Emerging human rights standards on obstetric violence and abuse during childbirth. International Journal of Gynecology & Obstetrics, 170(1), 508–514.
• Vacaflor, C. H. (2016). Obstetric violence: A new framework for identifying and preventing disrespect and abuse in childbirth. Reproductive Health Matters, 24(48), 18–26.