Obstetric Violence as Gender-Based Violence:

what it is, how it is perceived, and how it can be addressed

This science communication article presents and contextualizes the volume Obstetric Violence as Gender Based Violence: What it is, how it is perceived, and how it can be addressed, with a specific focus on the contribution of Ester Massó Guijarro, a member of the IPOV – Respectful Care consortium.

The book enters a debate which—although relatively recent in some academic traditions—already has a robust body of research, normative frameworks, and public discussion: obstetric violence as a form of gender-based violence, with physical, psychological, and symbolic impacts, and with direct relevance to human rights and public health.

At the end, you will find an explicit invitation to download the book and to share comments, because one of the volume’s central threads is precisely the power—and the dispute—of naming, narrating, and transforming.

Where this book comes from and what it investigates

According to the Introduction (Re, Strazzeri and Fariello), the volume is the outcome of an Italian national research project (PRIN 2022) funded by the Italian Ministry of University and Research: “Giving Birth with Care. Conceptions of Maternity and Professional Ethics in Obstetrics and Gynecology for the Prevention of Obstetric Violence.” The project began in October 2023 and is scheduled to conclude in February 2026, with national coordination by Irene Strazzeri (University of Salento), team leadership at the University of Campania “Luigi Vanvitelli” by Sara Fariello, and coordination at the University of Florence by Lucia Re.

The stated aim is a sociological investigation—both theoretical and empirical—into obstetric violence understood as:

• a form of gender-based violence (physical, psychological, and symbolic),
• a serious violation of women’s human rights,
• a phenomenon that occurs in childbirth care and, more broadly, across reproductive healthcare services.

The Introduction proposes a broad definition: obstetric violence as any form of violence perpetrated by healthcare professionals in the context of childbirth and reproductive healthcare, including lack of informed consent, excessive medicalization, mistreatment, and degrading or humiliating practices. It emphasizes that obstetric violence can take the form of over-intervention, directive approaches to childbirth, and the pathologization of physiological processes, as well as clinical environments that disregard privacy, autonomy, and informed choices. A crucial nuance is highlighted: such behaviors are often subtle, normalized, and therefore difficult to recognize or even name.

Latin America as a key antecedent: the example of Venezuela (2007)

The Introduction notes that—even if scholarly literature is relatively recent—the phenomenon has been extensively studied in South America, where feminist movements have strongly shaped legal frameworks and public discourse. It cites Venezuela’s 2007 legislation, which explicitly recognizes obstetric violence and defines it (as reported in the book) as the appropriation of women’s bodies and reproductive processes by health professionals through dehumanizing treatment, abuses of medicalization or the pathologization of natural processes, resulting in loss of autonomy and the ability to decide freely about one’s body and sexuality, negatively impacting quality of life.

Within the volume, this reference plays a double role: historical (a genealogy of the concept) and political (showing that legal and social recognition does not emerge “out of nowhere,” but through struggles to name and make visible an experience).

Social processes that sustain obstetric violence in the book’s framework

The Introduction argues that obstetric violence results from interrelated social processes. Among the most relevant:

• The medicalization of society, with specific characteristics when applied to women’s bodies.
• The gradual transfer of childbirth into the domain of pathology, linked to the history of the biomedical paradigm as hegemonic.
• The progressive delegitimization of other forms of knowledge, including women’s embodied understandings and the traditional expertise of midwives, replaced from the eighteenth century onwards by the supposedly “superior” knowledge of physicians.
• Reproductive biopolitics, described as a colonization of knowledge, corporeality, and lived experiences of childbirth and motherhood.
• The fragmentation and hyper-specialization of medical expertise, which may operate “at the expense” of a holistic understanding of the patient, whose health is also shaped by emotional, psychological, and social dimensions.
• The persistence of cultural, religious, and social stereotypes that shape how childbirth is experienced and managed.

This framing is consistent with a humanistic and anthropological reading: childbirth appears as a biographical and relational event, embedded in institutions, cultural narratives, and hierarchies of knowledge.

International recognition: WHO, Council of Europe, UN, European Parliament

The volume argues that, despite growing international attention, obstetric violence remains underestimated and insufficiently recognized institutionally. The Introduction mentions several milestones:

• WHO (1985): a statement aimed at limiting practices that compromise women’s dignity during childbirth.
• WHO (2014): explicit identification of disrespectful and abusive treatment during facility-based childbirth, including physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilization), lack of confidentiality, failure to obtain fully informed consent, refusal to give pain medication, gross violations of privacy, refusal of admission to health facilities, neglect during childbirth leading to avoidable complications, and detention of women and newborns due to inability to pay.
• Council of Europe (Resolution 2306/2019): relates obstetric violence to patriarchal culture in society and medicine, and notes that difficult working conditions in healthcare can affect patient treatment.
• UN Special Rapporteur on Violence Against Women (2019): in a report on a human-rights-based approach to mistreatment and violence in reproductive healthcare, urges States to adopt comprehensive policies, systematically collect data, and provide appropriate training for healthcare personnel.
• European Parliament (2021): expresses concern about deteriorating maternal healthcare conditions, particularly in relation to the impact of COVID-19.

The Introduction also highlights the role of human rights bodies and case law:

• The CEDAW Committee has contributed to recognizing obstetric violence as a form of gender-based violence and a violation of women’s human rights, including the right to reproductive health.
• The European Court of Human Rights has repeatedly emphasized that breaches of privacy and failures to obtain informed consent constitute serious infringements of fundamental human rights.

The book’s approach: interdisciplinary, comparative, and prevention-oriented

The Introduction explains that the volume connects general sociology with sociology of medicine and sociology of law, joined by bioethics and anthropology, without neglecting international law. It includes contributions from the Italian research teams (Salento, Campania, Florence), work linked to panels convened in the framework of the project at the 16th European Sociological Association Conference (Porto, summer 2024) devoted to obstetric violence at the intersection of trust and transformation, and invited scholars working on obstetric violence from other disciplinary fields.

A methodological and political stance is also emphasized: obstetric violence is addressed as a structural issue, not merely the outcome of individual behavior, with the aim of moving beyond polarized public discourse that pits victims against healthcare providers and instead prioritizing effective strategies for prevention.

Contents of the volume, chapter by chapter

Below is the book map with the correct chapter numbering (the Introduction is not counted as a chapter):

Chapter 1. Carlo Botrugno — Obstetric Violence from the Perspective of Everyday Bioethics

The Introduction explains that Botrugno examines the epistemic debate around defining obstetric violence in light of available literature and the first protection tools that have emerged at legislative and soft-law level. He highlights factors that may have fueled bioethics’ lack of attention to obstetric violence and focuses on key elements for building an “everyday bioethics” perspective to stimulate further research and contrast obstetric violence.

Chapter 2. Ester Massó Guijarro — Decolonizing Bioethics, Feminizing Public Health: Obstetric Violence as Epistemic Injustice

This chapter is positioned within critical, intersectional, feminist, and ultimately decolonial narrative bioethics. The Introduction notes its attention to manifestations of obstetric violence in Spain and its connection to epistemic injustice through feminist phenomenology. The chapter is developed in detail below, as it is the central axis of this article.

Chapter 3. Sara Dal Monico — Gynecological and Obstetric Violence: Framing the Phenomenon under International Human Rights Law

Presented as a human-rights-law perspective in the absence of a comprehensive legally binding definition. The Introduction notes its engagement with European Court of Human Rights case law and the contribution of the CEDAW Committee, arguing for recognition of gynecological and obstetric violence as gender-based violence and suggesting that attempts to draft a definition should adopt a human-rights-based, intersectional approach focused on gender.

Chapter 4. Camila Giugliani — Obstetric Violence: A Matter of Gender, Race and Class

According to the Introduction, this chapter offers an overview mainly from a Latin American perspective—concepts, definitions, legal aspects, and statistics—supporting the claim that obstetric violence is a matter of gender, race, and class. It defines obstetric racism, discusses consequences and the debate on terms, and presents ideas for prevention and elimination.

Chapter 5. Giulia Stolfi — The Prevention of Obstetric Violence: The Humanization of Childbirth in Brazil

Analyzes measures taken in Brazil to prevent obstetric violence, including initiatives in public facilities and the implementation of a humanized childbirth model. The Introduction stresses that the paradigm shift is not limited to eliminating certain practices, but seeks structural, ethical, and cultural change, reducing obstetric violence while ensuring better childbirth experiences and respecting women’s human rights.

Chapter 6. Keiju Vihreäsalo (in the Table of Contents) / Katja Vihreäsalo (in the Introduction) — Between Objectification and Rights Narratives of Obstetric Violence and the Question of Self-determination in Finland

The materials provided contain a discrepancy: “Keiju” appears in the Table of Contents, while “Katja” appears in the Introduction. On the basis of the text supplied, it is not possible to determine which is correct; a final publication should verify the author name in the chapter PDF itself. The Introduction explains that the chapter examines the tension between objectification and self-determination in the context of a Finnish obstetric violence campaign, analyzing narratives collected in 2019 by “Me Too in Childbirth” campaigners. It integrates phenomenological perspectives on shame with Foucauldian analyses of power.

Chapter 7. Sezen Yaraş, Eylem Mercimek, Dilek Cindoğlu — Neoliberal Paternal Authoritarianism and Obstetric Violence in Turkey: Vulnerability and Resilience in Routine Episiotomies

Explores a form of obstetric violence emerging within neoliberal paternal authoritarianism in Turkey, which undermines women’s autonomy over reproductive rights and also exposes doctors to economic, legal, and reputational risks. The Introduction emphasizes hyper-medicalization, the routinization of interventions (especially episiotomies), and women’s strategies for negotiation and self-support mechanisms.

Chapter 8. Sara Fariello, Giuditta Mitidieri — Incomplete Professionalization of Midwives as a Risk Factor for Obstetric Violence. Insights from Southern Italy

Presents qualitative findings with midwives in Campania. The Introduction highlights barriers to midwifery autonomy (training gaps, lack of social recognition, subordination to gynecologists), the predominance of prescriptive and hierarchical models, partial reductions of practices such as episiotomy and the Kristeller maneuver, persistently high C-section rates, and precarious working conditions, low pay, and lack of recognition.

Chapter 9. Lucia Re, Chiara Magneschi — Midwives’ Voices on Obstetric Violence: Exploring Care Models and Professional Cultures in Tuscany

Explores concepts of motherhood, care, and professional ethics informing midwives’ work, including prenatal and postnatal phases. The Introduction stresses structural challenges (shifts, lack of resources, precarious conditions) that increase workload and may foster unprofessional or violent behavior, arguing that preventive measures require deep understanding of professional culture with midwives playing a central role.

Chapter 10. Daniela Bandelli — Homebirth in Italy: An Alternative to Medicalisation and Vulnerability to Violence in Healthcare Facilities

Based on interviews and focus groups with birthing women, homebirth midwives, doulas, and other birth professionals. The Introduction notes how hospital birth can be perceived with distrust as a setting where women and newborns are vulnerable to disrespect and invasive practices, and explores reasons why homebirth—though marginal in Italy—can be preferred, and how home-based care might integrate with public healthcare.

Chapter 11. Irene Strazzeri, Anna Maria Rizzo, Chiara Spagnolo — Obstetric Violence: Between Recognition of Rights and Trust in Transformation

Concludes by reaffirming the need to recognize obstetric violence as a distinct form of gender-based violence. The Introduction centers its analysis on the female body constructed as an object of medical and social control, describes historical processes of medicalization, and discusses the shift to hospital-based childbirth (reducing risks from homebirth complications while contributing to unnecessary interventions). It also references analyses of traditional midwives (parteiras) in Yucatán (Patrizia Quattrocchi) and addresses female genital mutilations and their impact on pregnancy and childbirth, pointing to further fields of inquiry.

On the volume Obstetric Violence as Gender Based Violence: What it is, how it is perceived, and how it can be addressed (ed. Lucia Re, Irene Strazzeri and Sara Fariello)

Ester Massó Guijarro and obstetric violence as epistemic injustice

Ester Massó Guijarro, a member of the IPOV – Respectful Care consortium through the University of Granada, authors the chapter titled Decolonizing Bioethics, Feminizing Public Health: Obstetric Violence as Epistemic Injustice. Her proposal is, in itself, an intervention: it not only describes the phenomenon but examines the conditions that make it possible to recognize it, name it, and transform it.

Stated framework: narrative bioethics, feminist, intersectional, and decolonial

In the chapter abstract provided, Ester situates her analysis within decolonial, feminist, and narrative bioethics frameworks. She draws on:

• a qualitative systematic literature review,
• phenomenological reflection,
• and an examination of legal and social responses, from Venezuela’s 2007 legislation to emerging Spanish laws, including ontological debates about naming the concept.

The conceptual heart: testimonial and hermeneutical injustice

Ester’s focus is the concept of epistemic injustice, especially the interplay between:

• testimonial injustice (Miranda Fricker): when speakers’ testimony is granted less credibility due to structural prejudice,
• hermeneutical injustice (Fricker): when shared interpretive resources are lacking, making lived experience difficult to name and recognize as a public problem.

In the text provided, Ester connects these dimensions with embodied experiences of birthing women and with the work of Sara Cohen Shabot, positioning lived, embodied experience as a site where recognition—or its denial—is at stake.

Retaining the term “obstetric violence”: a “thick” and insurgent concept

One of the chapter’s key points, as provided, is Ester’s argument for retaining the specific term “obstetric violence”. She frames it as a concept that simultaneously describes and condemns systemic harm: when we use it, we are not only describing reality, but also asserting it is avoidable and must be rejected.

She explicitly relates this to philosophical discussions of “thick moral concepts” (as opposed to “thin” ethical concepts) and proposes understanding obstetric violence as an insurrectionary or unruly concept: a notion that is not merely classificatory, but action-oriented. In the excerpts provided, this insistence is connected to the power of concepts as tools for thought and instruments for action, and to the idea that changing words can change understanding.

The uncomfortable question: why do “good people” engage in harmful practices?

Ester raises a central question regarding intentionality: if many harmful practices are not carried out with explicit intent to harm, how do they occur so widely?

In the excerpts provided, her response emphasizes the systemic and paradigmatic nature of patriarchy, which normalizes and legitimizes practices and can render them invisible. She stresses that the point is not necessarily to accuse individuals or judicialize every process, but to understand structural mechanisms.

To illuminate this, Ester draws on Hannah Arendt and the notion of the banality of evil: within broken systems, harm can occur “naturally,” without being noticed, because cooperation may be required to survive or preserve social homeostasis. The excerpt also mentions parallels with apartheid-era South Africa and references observations by Nelson Mandela about the everyday decency of racist jailers.

“We give birth to biographies”: childbirth as a human and narrative event

The excerpts include a key phrase: “we give birth to biographies.” Ester uses it to insist that childbirth is not merely a medical act or a biological event—just as the human species is not merely biological. This points to a humanistic reading of birth as an event of meaning, subjectivity, and narrative, where the power of naming and storytelling matters.

An analogy with the ecological crisis and a “full” bioethical urgency

Ester introduces an analogy described as intriguing and unsettling: a symmetry between excessive intervention in childbirth (medicalization, technological overuse) and the systemic degradation of ecosystems (the climate emergency), linked to a myth of progress and a neoliberal-capitalist logic.

In the excerpt provided, this leads to an explicit conclusion: a bioethical reflection—“in the fullest sense of the term”—is urgent and non-negotiable. The chapter also states that obstetric violence has already been recognized as a matter of global public health due to widespread prevalence and severity (citing Edward and Kibanda 2022).

Feminizing public health: a feminist, decolonial, intersectional paradigm

The closing of the excerpt argues for the urgent need to feminize public health, i.e., to establish a feminist public health model. It connects feminist political philosophy with decolonial feminism and ecofeminism and supports advocacy for an intersectional (decolonial, feminist) bioethical perspective.

The conclusion aligns with the rest of the text: while we remain in the “interregnum,” it is necessary to name obstetric violence clearly and unapologetically, politicize it, legitimize it epistemically, and confront it in practice through active resistance.

Projects and networks listed in the text (funding and research context)

In the excerpt provided, Ester explicitly lists the following frameworks:

• POyÉTICAS Project (Politics and Ethics of Public Health) (PID2023-148517NB-I00)
• ESPACyOS Thematic Research Network. Public Health Ethics (RED2022-134551-T)
• CYTED Ibero-American Laboratory of Public Health Ethics (LIBERESP:623RT0148)
• IPOV – Respectful Care (101130141) European Commission – HORIZON-MSCA-SE-2022

Why this book matters for IPOV

Without adding elements beyond what you provided, the volume offers at least three contributions aligned with IPOV’s work:

• A framework that combines human rights, public health, bioethics, and social sciences to address a phenomenon expressed in clinical practices, professional cultures, and healthcare organization.
• A comparative perspective spanning contexts highlighted in the Introduction (Latin America, Spain, Italy, Turkey, Finland) and bringing together women’s experiences and healthcare professionals’ perspectives (including midwives’ interviews and analysis of professional cultures).
• A prevention-oriented approach grounded in models of motherhood, service organization, working conditions, and professional ethics, avoiding reduction to isolated cases or polarized disputes.

Invitation: download and comment

As presented in the Introduction and argued by Ester, this book is not only about agreeing or disagreeing with a term. It is an invitation to discuss—rigorously—how a form of harm that may be normalized is defined, recognized, and transformed.

We invite you to:

• Download the volume through the official channel where it is available in your context (publisher, repository, library, or institution).
• Read, at minimum, the Introduction and Chapter 2 (Ester Massó Guijarro).
• Share comments and debate, especially on the questions Ester explicitly foregrounds:
  • What changes when obstetric violence is understood as epistemic injustice (testimonial and hermeneutical)?
  • What does it mean—conceptually and politically—to retain “obstetric violence” as an insurrectionary and “thick” moral concept?
  • How can systems be transformed where harm may occur without perpetrators necessarily seeing themselves as harmful, in the sense discussed through Arendt?