Obstetric violence as gender violence: An emancipatory approach for social work

Obstetric violence is a form of gender-based violence that has received little attention in the field of social work, both in terms of reporting it and proposing effective solutions. This article offers an updated definition of the term, proposes prevention strategies, and emphasizes the importance of a critical human rights approach with an intersectional gender perspective to address the issue. It also highlights the need for social work to adopt paradigms such as degrowth and ecofeminism to address this problem in a comprehensive, systemic way and at its roots.

Obstetric violence, according to Albizu (2022), is a form of normalized and invisible violence linked to economic and cultural interests that privatize the process of pregnancy, ignoring the suffering involved. The World Health Organization (2014) recognizes it as a public health problem and as a violation of the human rights of pregnant people, affecting their health, integrity, autonomy, and dignity. It points out that this violence is more frequent in vulnerable groups, especially adolescents, poor women, immigrants, ethnic minorities, and people with HIV, who face greater barriers to accessing respectful care during pregnancy and childbirth. There is undoubtedly no agreed definition of the term “obstetric violence,” but there is consensus that this type of violence is much more than unjustified cesarean sections. Most definitions of this term have been influenced by dominant white and Western feminist perspectives, which do not necessarily reflect the reality of women/pregnant people in other cultural and geographical contexts. Recognizing that this type of violence can be explained from a gender perspective, with an intersectional and critical approach, Garza‑Negrón (2024) proposes the following definition of “obstetric violence”: Obstetric violence is a form of institutionalized gender-based violence that affects women/pregnant people and their babies, manifesting itself in various ways and degrees of intensity during pregnancy, childbirth, postpartum, and the puerperium. It consists of outrageous treatment, which may include, but is not limited to, physical and psychological abuse. Psychologically, it includes, but is not limited to, insults, infantilization, rudeness, scolding, discrimination, humiliation, lack of empathy, and lack of information when the woman/pregnant person seeks advice or requires care. The physical aspect manifests itself in, but is not limited to, restricting her autonomy, such as the choice of positions, companions, consumption of water or (adequate) food during labor, as well as performing medical interventions, practices, and procedures without consent and without justification, without scientific basis, such as cesarean sections and episiotomies, among others that carry risks to the health of the pregnant person and her baby. These forms of violence are perpetrated by medical staff and hospital institutions, which prioritize their protocols and needs while denying the consent, autonomy, freedom, and dignity of women/pregnant persons. Obstetric violence also involves not focusing obstetric care on women/pregnant persons and their babies, but rather on the knowledge and time of obstetricians, invalidating and belittling the biological processes and timing of women/pregnant persons, their knowledge, and individual experiences, exposing them to unnecessary risks (p. 53). This definition reflects a critical approach to human rights and an intersectional gender perspective in the fight against this form of gender-based violence. It also recognizes that this is a complex phenomenon that must be analyzed and addressed from emancipatory positions.

The Latin American Center for Social Work (2018) states in its global definition of social work that it is vital for this profession to promote critical awareness and strategies for action to transform conditions of inequality and inequity, in solidarity with people in vulnerable situations. The development of critical awareness through reflection on the structural sources of oppression and/or privilege (such as gender, social class, among others), and the development of action strategies to address and to dismantle structural and personal barriers are fundamental tasks for the emancipatory practice of social work, which aims to promote the empowerment and liberation of people.

To prevent obstetric violence before, during, and after childbirth, there are two key strategies that could increase the chances that a woman or pregnant person receives dignified and respectful care, in addition to feeling supported: the inclusion of doulas and midwives in public health systems (Garza‑Negrón, 2024). Although their benefits are consistently documented, these figures have not been systematically integrated in the health systems.

Doulas are trained women who provide continuous emotional and physical (non-medical) support to pregnant people during pregnancy, childbirth, and the postpartum period. Their main role is to accompany, inform, and defend the rights and preferences of the person giving birth, helping them make informed decisions and reducing unnecessary interventions, which can constitute forms of obstetric violence. In addition, their presence improves the birth experience, shortens the duration of labor, reduces rates of postpartum depression, increases successful breastfeeding, and reduces cesarean sections and episiotomies (Dekker, 2024). Doulas are committed to their clients, not to the hospital, which reinforces their role as advocates for the rights of pregnant people. In the United States, eight states have successfully integrated doulas into their public systems through the “Doula Medicaid Project” program.

On the other hand, midwives represent a structural alternative to combat obstetric violence. They are professionals—some with academic training, others with traditional knowledge—who provide care focused on the physical, emotional, and cultural health of the pregnant person. Instead of viewing childbirth as a medical process to be controlled, midwives approach it as a natural physiological event, encouraging autonomy, connection with the body, and informed decision‑making (Association of Midwives of Puerto Rico, 2021). They offer prenatal care, labor support, and postpartum support, working together with the pregnant person and their family. However, in places like Puerto Rico, midwifery is not regulated, which prevents its formal inclusion in the health system. Despite this, midwives have proven to be essential, especially in emergency contexts such as Hurricane Maria and the COVID‑19 pandemic, where their work was crucial in the face of a shortage of obstetricians.

Both doulas and midwives offer a respectful, humane approach focused on the autonomy of pregnant people. Integrating them into the healthcare system not only improves perinatal outcomes but also contributes to eradicating obstetric violence at its roots, promoting more equitable and dignified care.

On a theoretical level, the paradigms of degrowth and ecofeminism offer fundamental frameworks to critically and transformatively address obstetric violence (Garza‑Negrón, 2024). Both approaches may allow social workers to understand this structural problem from its roots and to propose solutions that prioritize the well‑being, dignity, and rights of pregnant people, as opposed to the dominant model based on profit and medical control.

The degrowth paradigm questions the logic of unlimited economic growth, arguing that health—including pregnancy and childbirth—has been transformed into an industry that prioritizes profits over well‑being. In this model, the medicalization of childbirth responds more to economic interests than to real needs, generating invasive and unnecessary practices that constitute obstetric violence. As Taibo (2009) argues, this system turns pregnant people into mere instruments of production, ignoring their rights, desires, and autonomy. Applying the principles of degrowth to the reproductive sphere would involve transforming the current approach to one centered on care, dignity, and respect for biological processes. Solutions from this perspective include allowing pregnant people to make informed decisions about their birth, choose the location and medical team that will accompany them, receive education about their body and the gestation process, and slow down the pace imposed by the productive system, recognizing pregnancy as a vital process and not as an obstacle to work. It also proposes reviving ancestral knowledge and guaranteeing state financial support during pregnancy to reduce stress and increase enjoyment of pregnancy, thereby reducing the risk factors associated with obstetric violence.

Ecofeminism complements and expands this vision by pointing out how the oppression of women/pregnant people and environmental destruction share common roots in the capitalist, patriarchal, and heteronormative system. According to Agenjo (2013), ecofeminism links the exploitation of nature with the subordination of pregnant bodies and denounces how the dominant economy renders care work and human reproduction invisible, relegating it to the unpaid domestic sphere. From this perspective, obstetric violence is explained as a manifestation of this system that denies value to reproductive work and the bodily experiences of women/pregnant people. The medicalization of childbirth, the denial of autonomy, and the imposition of violent practices are clear examples of this logic of domination. In response, ecofeminism proposes an approach to childbirth that focuses on life, care, connection with the body and the environment, and respect for the diversity of pregnancy experiences.

Both paradigms agree that eradicating obstetric violence requires a profound change in social and economic structures. This includes reforming the health system to prioritize human dignity, depatriarchalizing medicine, valuing the knowledge of women/pregnant people, and building a culture of childbirth based on respect, autonomy, and mutual care.

Social work must play a key role in addressing obstetric violence by promoting fair, equitable solutions. This article suggests responses to guide future action from an emancipatory, political perspective. It highlights the need for social workers to confront gender‑based and institutional power dynamics, advocate for the right to health, support preventive policies, and eliminate structural barriers—especially those affecting vulnerable groups—to ensure dignified and respectful care.

References

1. Agenjo Calderón, A. (2013). Economía feminista: Los retos de la sostenibilidad de la vida. Revista Internacional de Pensamiento Político, 8, Monográfico 1. (in Spanish) https://www.u4po.es/revistas/index.php/ripp/article/view/365
2. Albizu, C. (2022, December 12). Hacia la construcción de un sistema de salud universal, eficiente y democrático. EL PUEBLO ORGANIZADO. (in Spanish) https://larevista.ciudadana.net/hacia-la-construccion-de-un-sistema-de-salud-universal-eficiente-y-democratico-2/
3. Asociación de Parteras de Puerto Rico. (2021). ¿Qué es una partera? [What is a midwife?]. (in Spanish) https://www.asociaciondeparteraspr.org/definicin-e-historia
4. Dekker, R. (2024, April 21). Evidence on: Doulas. Evidence Based Birth. https://evidencebasedbirth.com/the-evidence-for-doulas/
5. Garza‑Negrón, A. G. (2024). Violencia obstétrica: Mujeres y personas gestantes residentes de Puerto Rico... (in Spanish) Tesis, Universidad Pablo de Olavide. https://www.academia.edu/143654214/VIOLENCIA_OBST%C3%89TRICA_ATROPELLO_DE_DERECHOS_Y_EXPERIENCIAS_DE_MUJERES_Y_PERSONAS_GESTANTES_RESIDENTES_DE_PUERTO_RICO?source=swp_share
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7. Taibo, C. (2022). El decrecimiento explicado con sencillez. Los libros de la catarata. (in Spanish) https://www.solidaridadobrera.org/ateneo_nacho/libros/Carlos%20Taibo%20-%20El%20decrecimiento%20explicado%20con%20sencillez.pdf
8. The Latin American Center for Social Work. (2018). Propuesta de definición global del trabajo social. (in Spanish) https://www.ifsw.org/propuesta-de-definicion-global-del-trabajo-social/