Obstetric violence: the CEDAW Committee’s response

PART THREE

Women experience obstetric violence and abuse during childbirth in healthcare facilities around the world, including medical procedures without consent and neglect. This post explores how the United Nations (UN) has recognised this phenomenon as a human rights issue through the work of the CEDAW Committee, a group of experts that monitors the implementation of the CEDAW Convention, the women’s international bill of rights.

The CEDAW Committee became the first human rights body to hold a State accountable for a maternal death in 2011, and to use the concept of ‘obstetric violence’ in a decision in 2020. As it is not a court, it can respond faster to urgent issues affecting women, holding States politically accountable when it considers that the facts of a case violate the victim’s rights.

The decisions of the CEDAW Committee on maternal health show how the concept of obstetric violence and the understanding of the obligations of the State have developed over time. This is why it is useful to examine these decisions, as they have contributed to the growing recognition of obstetric violence as a human rights violation.

Evolution of decisions on maternal health 

Alyne da Silva Pimentel Teixeira v Brazil (2011) was the first time a State was considered accountable for a victim’s death, which occurred after inappropriate treatment of obstetric complications in an outsourced private healthcare institution and a public institution. Although the victim’s experience would be today considered an example of obstetric violence, the Committee did not use this concept as it was not fully developed in academia or international organisations at that time.

In this case, the Committee found that the State did not ensure appropriate healthcare to the victim regarding her pregnancy, discriminated against her on several bases, did not prevent her death from obstetric complications (considered a maternal death), and did not guarantee judicial action and protection to her family after her death.  

Some years later, in SFM v Spain (2020), the Committee used the concept of obstetric violence for the first time, albeit cautiously, in the case of a woman who experienced several unnecessary medical procedures during childbirth. It employed the concept by referring to the report of the Special Rapporteur on Violence against Women, its Causes and Consequences, presented the previous year, yet without affirming that the State had committed obstetric violence against the victim. 

The Committee found that there was a violation of the victim’s rights in this case, as the State did not take appropriate measures to prohibit discrimination against women and to eliminate gender stereotypes, did not provide access to appropriate maternal healthcare services without discrimination, did not respect the victim’s rights during childbirth, and did not guarantee effective legal action and judicial protection to her after the events.

Two years later, in NAE v Spain (2022), the Committee went a step further by asserting that the facts of the case constituted obstetric violence and specifically mentioning the events that were examples of it (“The Committee considers that the facts of the present case constitute obstetric violence — in particular…” (para. 15.7)). It also concluded that the facts of the case violated the same rights identified in SFM v Spain.

In the following case, MDCP v Spain (2023), the Committee added more elements to the understanding of the phenomenon. It explicitly recognised that events should be considered together when determining that obstetric violence had occurred and when assessing their effects on the victim. It stated that “…the cumulative facts of the case, in particular… all of which had physical and psychological consequences for the victim, constitute obstetric violence” (para. 7.12).

Although in this case the Committee identified the violated rights differently, the duties that the State did not comply with were similar to the ones identified in the previous two decisions: take appropriate measures to eliminate discrimination against women and gender stereotypes, provide access to appropriate maternal healthcare services without discrimination, respect the victim’s rights during childbirth, and guarantee effective judicial protection after the events.

The latest decision on obstetric violence, CSF v Argentina (2025), differs from earlier cases in that it was the first time the Committee decided on events that occurred in a private healthcare institution providing private services. It also gave its own definition of obstetric violence, describing it as “…violence suffered by women that is inflicted by reproductive healthcare providers during pregnancy, childbirth and the postpartum period” (para. 7.3).

This was also the first time the Committee explicitly identified the obligations infringed by the State and connected them to the victim’s rights. Thus, it concluded that the lack of an appropriate judicial mechanism to implement the provisions of existing legislation on obstetric violence, the inadequate investigation of the events by State authorities, the lack of oversight of private healthcare institutions, and the lack of measures to prevent obstetric violence resulted in the violation of the author’s rights (para. 7.10). This decision confirms that the State’s responsibility goes beyond the provision of healthcare.

What do these decisions tell us?

Overall, these decisions do two things: they help us define obstetric violence and clarify the scope of State obligations on women’s health. Thus, obstetric violence can be defined as a form of gender-based violence, inflicted by healthcare providers on women during pregnancy, childbirth or the postpartum period in any healthcare institution, that results in physical and psychological harm to them and constitutes a violation of their human rights.

The decisions also show that State obligations go beyond the general duty to respect, protect and fulfil women’s rights to healthcare and include the obligation to prevent and respond to violations of women’s rights. This means that, although the State may not be directly responsible when obstetric violence is committed by private healthcare providers, its responsibility can arise for not preventing or responding to it.

Why do these decisions matter?

Together, these decisions indicate that women’s rights must be guaranteed and respected at every stage of pregnancy, childbirth and the postpartum period. They also demonstrate that obstetric violence is, essentially, a violation of women’s rights. As a consequence, State responsibility is not limited to the most serious cases but extends to any situation of obstetric violence where those rights are violated. Finally, these decisions reinforce that the State cannot avoid responsibility by arguing that private institutions provided healthcare, as it remains responsible for preventing and responding to violations of women’s rights in that context.

Emerging Human Rights Standards on Obstetric Violence

This three-part series introduces IPOV’s roundtable process on emerging human rights standards on obstetric violence. Across the three articles, Camilla Pickles, Romina Gallardo and Veronica Garcia de Cortazar examine how international and regional human rights bodies are progressively recognising obstetric violence as a violation of fundamental rights, clarifying State obligations, and contributing to the development of the future IPOV Charter on Human Rights in Childbirth.