Restorative Justice as a Transformative Strategy Against Obstetric Violence

July 2025

Authors

• Dr. Laura Abojer
  Head of the Obstetrics Department
• Dr. Guillermo Javier De Cicco
  Specialist in Gynecology and High-Risk Obstetrics
• Lic. Ivana C. Iriarte
  Certified Breastfeeding Consultant and Doula
  Bachelor’s Degree in Communication

Institution
Maternal and Child Hospital of San Isidro
Buenos Aires, Argentina

Restorative Justice as a Transformative Strategy Against Obstetric Violence: A Proposal from a Training-Based Perspective

Abstract

Obstetric violence is a specific form of gender-based violence that occurs within both public and private healthcare systems and violates the rights of women and their newborns. Restorative justice, conceived as a formative rather than punitive process, can become a transformative tool to repair harm and prevent further violations. This essay presents a critical analysis of restorative justice in cases of obstetric violence, highlighting the importance of time, safe spaces, and health team training to ensure ethical and meaningful processes of reparation.

Introduction

Although we recognize that defining something is, to some extent, limiting it, obstetric violence (OV) has been described as any action or omission by health professionals that causes physical or psychological harm to women during pregnancy, childbirth, or the postpartum period (WHO, 2015). In Argentina, obstetric violence is addressed under Law No. 25.929 on Humanized Childbirth and Law No. 26.485 on Comprehensive Protection to Prevent, Punish, and Eradicate Violence Against Women. Law 25.929 establishes the rights of pregnant people during pregnancy, childbirth, and postpartum, promoting respectful birth and avoiding invasive practices. Law 26.485, in turn, defines obstetric violence as a form of violence against women and seeks to prevent, punish, and eradicate such practices. While there is no universal consensus on its definition, there is agreement that obstetric violence includes any practice that disregards respectful childbirth. This phenomenon—ignored for decades—reflects gender hierarchies, excessive medicalization, and a lack of humanized care. In this context, restorative justice emerges as an alternative to merely punitive responses, allowing space for acknowledgment, reparation, and collective reflection. Nevertheless, conceptual, ethical, and institutional challenges must be addressed to implement effective restorative processes in obstetric care.

Restorative Justice: Beyond Mediation

Restorative justice has historically developed as a response to criminal offenses, but its adaptation to obstetric violence requires a redefinition of its objectives. As Castrillo (2021) points out, applying restorative justice in healthcare involves acknowledging the structural inequalities that shape the relationship between professionals and users, not merely repairing individual harm. It is crucial to move away from a vision of mediation as a simple encounter between victim and perpetrator. Reparation can begin, for instance, through the woman’s testimony—oral, written, or audiovisual—which serves as a reflective tool for the healthcare team, always ensuring her consent and avoiding re-traumatization (Castrillo, 2021). The emerging global debate on the role of childbirth in the context of human rights is both urgent and necessary. We must never underestimate the power of human-centered care in health. Compassion and evidence-based medicine are interwoven with human rights, shaping patient-centered decision-making. When conflicts arise in medical care, storytelling can reconnect disparate parties with their shared humanity. Narratives are a key element of restorative justice processes and may be beneficial in the human rights dimension of childbirth.

Time as an Essential Dimension of the Restorative Process

In cases of obstetric violence, time is a central element. As Carme Valls (2019) emphasizes, many women need years to recognize, process, and express the harm experienced during traumatic childbirth. Therefore, any restorative process must take into account that the narration of the experience and institutional listening do not always happen immediately after the event, but may arise long afterward. Health institutions must be prepared to support these processes even when the professionals directly involved are no longer part of the team (Valls, 2019; WHO, 2015).

Safe Spaces: Beyond the Clinical Setting

Creating safe spaces for restorative dialogue is another key element. The setting in which a restorative meeting takes place can either facilitate or hinder symbolic reparation. It is not always appropriate for the conversation to occur in the hospital where the violence took place. Primary care centers with interdisciplinary perinatal mental health teams or community institutions that offer a more welcoming environment may be more conducive to fostering an ethical and compassionate restorative process (Argentine Ministry of Health, 2019). Likewise, as Castrillo and Valls suggest, these spaces should be designed from the perspective of those who experienced the violence, not solely from an institutional standpoint.

Training and Reflection: Prerequisites for Meaningful Reparation

There can be no restorative justice without critical training for health teams. As the WHO (2015) warns, the lack of training in sexual and reproductive rights and gender perspectives contributes to the perpetuation of violent practices. Restorative justice must be integrated into educational processes that critically examine care models and enable professionals to reflect on their own practices. Without this component, any attempt at reparation risks becoming an empty gesture, incapable of promoting sustained cultural change (Valls, 2019; WHO, 2015).

Proposal for Validating the Restorative Process

To ensure that restorative justice is genuine and not merely symbolic, we propose incorporating a mechanism for external validation of the reparation process, which would verify both the implementation of agreed actions and the reparative effect perceived by the person who suffered obstetric violence. This mechanism could include:

• Appointing an external follow-up figure, such as a member of the hospital ethics committee, a representative from a human rights organization, or an independent professional trained in gender perspective.
• Documenting in writing the actions agreed upon with the woman, describing how they respond to her specific proposal (e.g., conducting an art workshop, developing educational materials, organizing a reflection event, etc.).
• Recording the actual implementation of these actions and gathering, through a dialogue or interview, the individual’s perception of the reparative impact.
• Issuing a brief report documenting the process and the woman’s satisfaction or dissatisfaction with the reparation, always safeguarding her confidentiality and respecting her right to revoke consent at any stage.
  This procedure aims to ensure that reparation does not remain merely an intention, but becomes a concrete path toward dignity and symbolic restitution of the harm suffered.

Conclusion

Applying restorative justice to obstetric violence offers a unique opportunity to reframe perinatal care, rebuild trust, and transform institutional practices. However, to be effective, it must move away from punitive or purely formal approaches and be grounded in consensual, reflective, and gender-aware processes. Acknowledging the importance of time, ensuring safe spaces, strengthening the training of health teams, and validating the restorative process are essential conditions for reparation to be real and not symbolic. Advancing toward genuine restorative justice ultimately means recognizing that obstetric violence is a structural issue requiring collective and transformative responses.

References

• Castrillo, B. (2021). Obstetric violence: genealogy, concept, and struggles for recognition. Derechos en Acción Journal, 7(7), 1-25.
• World Health Organization (WHO). (2015). Prevention and elimination of disrespect and abuse during childbirth in health facilities.
• Argentine Ministry of Health. (2019). Protocol for addressing obstetric violence in the public health system.
• Valls, C. (2019). Invisible Women for Medicine. Capitán Swing.
• Lokugamage, A.U., Pathberiya, S.D. (2017). Human rights in childbirth, narratives and restorative justice: a review. Reproductive Health, 14(1):17. doi: 10.1186/s12978-016-0264-3.