This blog continues the blog series on naming and framing of violations in maternity care. Rachelle Chadwick traces the racist, sexist, and misogynistic history of obstetric care and provides some hard-hitting critique of those who refuse to engage with ‘obstetric violence’ and its ‘struggle history’.
Some regard the term ‘obstetric violence’ as a new and faddish feminist term that risks criminalising obstetric healthcare and is harmful to medical professionals. However, far from being a ‘new’ phenomena, history shows that violent harm is entwined with obstetric and gynaecological medicine. Racialised gynaecological violence against enslaved women (i.e. in the form of experimental surgeries) was central to the development of gynaecological and obstetric techniques. Across a range of contexts, obstetric racism has resulted in Black mothers receiving differential access to life-saving healthcare technology and pharmacological pain-relief. This has led to increased maternal and infant deaths and pregnancy/birth-related morbidities. Obstetric misogyny has long shaped medical attitudes and perceptions of pregnancy, wombs, and birthing, with ‘the uterine influence’ often disqualifying pregnant or menstruating persons from the realm of rational selfhood and autonomous decision-making. Medical sexism more broadly has prevented practitioners from acknowledging the pain of women and other marginalised groups, and resulted in the systematic misdiagnosis and invalidation of their embodied experiences.
Activists, feminists, and medical professionals have long spoken out against these injustices, prejudices, and violations. As a result, the term ‘obstetric violence’ is not new - i.e. the first use of the concept is traced back to 1827 when Dr James Blundell referred to the problem of ‘obstetric violence’ in a lecture published in The Lancet. In his lectures, Blundell was sharply critical of the interventionist approach to obstetrics in which medical practitioners used hands, forceps, and other instruments too freely and indiscriminately (and sometimes with violent consequences) to interfere in the birthing process. In 1839, a piece published in The Botanico-Medical Recorder reports on the successful prosecution of a case of ‘obstetrical violence’ perpetrated by Dr Septimus Hunter against Mrs Justine Cozens which led to her death. In 1957, American nurse practitioner Gladys Denny Schultz wrote on torturous forms of ‘sadism in delivery rooms’ in a letter published in the Ladies Home Journal. This was followed in 1958 by an exposé in the journal titled, ‘Cruelty in maternity wards’ based on a flood of letters from readers who graphically described experiences of mistreatment and birth violence in American obstetric contexts (i.e. being strapped down, struck, and threatened). Based on 345 letters written to her by British women in which they outlined distressing and violent birth experiences (often described as akin to rape), Sheila Kitzinger wrote in 1992 about the ‘violence against women’ routinely enacted during hospital and medicalised birth. Obstetric violence is clearly an old problem and is by no means a faddish concept.
Over the last two decades the term ‘obstetric violence’ has for the first time attained global recognition (i.e. from international bodies such as the United Nations) as a specific and transnational form of verbal, physical, psychological, and institutional abuse that occurs (usually in healthcare settings) during pregnancy and birth. Since 2007, several countries in Latin and Central America have recognised obstetric violence as a legal concept (i.e. Venezuela, Argentina, Mexico, Bolivia, Panama) and punishable offense. This legal recognition has been attained on the back of strong birth justice and humanizing birth activist movements in these contexts. In some European settings, activists are currently working hard to fight for legal recognition in their countries (i.e. Spain and Portugal). Social media campaigns against ‘obstetric violence’ have proliferated across a range of diverse contexts (i.e. Russia, Croatia, France, Finland, Hungary, Brazil, Chile, the Netherlands, England, Spain) and media reports and popular articles on ‘obstetric violence’ are frequent across a range of transnational news outlets.
The surge of international recognition and the heightened sense of (legal) legitimacy carried by the term ‘obstetric violence’ has however not meant that the term has been readily accepted by all or escaped criticism, backlash, and censure. Many medical professionals (particularly obstetricians) have continued to be hostile to the term and some have refused to recognise the existence of obstetric violence as a legitimate form of harm that happens in institutional and healthcare contexts. According to Smith, medical professionals in Latin America continue to “contest the semantics of their misconduct” and stubbornly insist that the term was invented by tabloid journalists to ruin reputations, blame doctors, and criminalise normal obstetric practice. In Spain, the General Council of Official Medical Associations released a press statement in 2021 that denies the concept of obstetric violence, claiming that it “does not conform to reality”. In response, the activist organization El Parto es Nuestro called on the organization to “open their eyes to the reality that we are making visible”. Unfortunately, efforts to name reproductive and obstetric violence are repeatedly met with incredulity, defensiveness, and hostility. Rather than engaging with the evidence and the countless testimonies documenting harm across transnational settings, many practitioners and key stakeholders refuse to even recognise or acknowledge the problem.
As Rose notes, it is often the most insidious and entrenched forms of violence that are not recognised or rendered visible. Systems of power work to distort fields of vision so that many violences are not seen. Forms of privilege, entitlement, and inequality are perpetuated by what Rose describes as a kind of ‘mental blindness’ that legitimates, dismisses, and forgets suffering and refuses to acknowledge even the possibility of violence or culpability. In the case of obstetric violence, those that dismiss the term (as dangerous, as violent, as sensationalist) often forget the complex colonial and racist histories of violence entangled with the rise of gynaecology, obstetrics, and biomedicine more broadly. They also forget the long histories of struggle against birth violence and the fact that the legal recognition of the term in some contexts has only been achieved though the persistent insistence and tireless efforts of activists. Dismissing the term ‘obstetric violence’ as itself violent to healthcare workers is a kneejerk response that does not respectfully engage or acknowledge histories of struggle, testimonies of distress, and feminist activism or research. If we are to address and eradicate obstetric violence, it is vital that medical practitioners, health workers, academics, government officials, and key stakeholders engage non-defensively and openly with the concept of obstetric violence (and its struggle history), and acknowledge the harms often embedded (structurally and materially) into obstetric and medical systems. Acknowledging the possibility of violence (even in contexts of care) and “recognising it as your problem” (p. 24) is the first step towards reducing it.
Dr Rachelle Chadwick, Senior Lecturer, Department of Sociology, University of Pretoria