Obstetric and gynaecological violence in Europe: when healthcare becomes control

Trigger Warning: This article discusses obstetric and gynaecological violence, with descriptions of different forms of gender-based violence, medical abuse, and systemic violations of women’s autonomy and dignity, which may be distressing to some readers.

Disclaimer: The author of this article uses women and girls as terms to address a wide spectrum of individuals, including persons socialised as girls, identifying as girls/women, or having the experience of life as a girl/woman, as well as all identities connected to some form of girlhood/womanhood.

About

In Europe, thousands of women and girls experience forms of violence every year, and most of them without even knowing. This is the case with obstetrical and gynaecological violence, which often hides behind practices that are normalised or falsely justified as necessary for healthcare even when, in fact, they are neither medically required nor respectful of patients’ dignity. Non-consensual interventions, lack of respect, and non-evidence-based medical practices are just a few examples of this violence. These are not isolated incidents but reflections of systemic power imbalances in healthcare, where women’s autonomy over their bodies is too often disregarded.

In a context of backlash against women’s rights, in which sexual and reproductive health and rights are already under pressure, obstetric and gynaecological violence represents a further attack on the autonomy and dignity of women and girls in Europe. With Human Rights Day approaching, it is high time to bring this phenomenon to light.

Written by

Carlotta Geremia, WAVE intern (2024)

An undefined form of violence

There is currently no universally recognised definition of obstetric and gynaecological violence. This lack of clarity makes it challenging to identify and categorise the various forms of this violence takes. Without explicitly using this term, the World Health Organization (WHO) describes it as any abuse, disrespect, and mistreatment in childbirth by healthcare professionals, which undermines women’s dignity and autonomy.¹ Despite this definitional gap, a recent study requested by the European Parliament’s Committee on Women’s Rights and Gender Equality (FEMM) drawing from a broad review of legal, policy, and academic publications, as well as insights from civil society organisations, took a significant step forward.² The study pieced together a clearer –yet heterogeneous– picture of obstetric and gynaecological violence, which manifests through a variety of harmful practices perpetrated in medical settings, occurring not only during pregnancy and childbirth, but also during gynaecological consultations, abortion care, and fertility treatments. It can be perpetrated by gynaecologists, nurses, obstetricians, and other medical professionals.

The following forms of violence are among the most diverse: psychological including humiliating behaviour, inappropriate comments or ridicule (of pain) by healthcare personnel; physical including non-consensual penetration during medical examinations, forced medical procedures such as sterilisation, abortion, contraception or any intervention performed without the patient’s informed and explicit consent. Among non-medically necessary practices we can find routine caesarean sections and routine induction with oxytocin to accelerate birth.³ Another common practice is the episiotomy, which consists of a cut between the vaginal area and the anus to allow the baby to pass more easily during childbirth. Although it serves to prevent tearing and further complications, it is only needed on rare occasions. The WHO does not recommend its routine use, aimed at speeding up delivery, for its serious consequences for the birthing woman’s pelvic floor, as well as in her sex life.⁴ Linked to this, is also the so-called “husband stitch”, a term that reflects the patriarchal origins of a practice not intended for the well-being of the birthing woman, and with no documented benefit.⁵ It consists of stitching the vaginal tear post-episiotomy deliberately tighter to supposedly increase the male partner’s sexual pleasure. Among non-evidence-based practices, we can find the risky Kristeller manoeuvre, where strong pressure is applied to the top of a woman’s lower belly to facilitate the expulsion of the foetal head.⁶ A further form of violence is also refusal or delay in treatment, such as refusal to supply anaesthesia or pain-relieving drugs, to provide assistance at the termination of a pregnancy, or to allow an attendant or partner to assist during childbirth.⁷

Between structural causes and current crises

The fact that the term “violence” is not harmoniously recognised to collectively define these harmful practices is a missed opportunity to also emphasise their structural dimension.⁸ In fact, while some of these forms of violence might result from deliberate acts, many are born from institutionalised and normalised practices that dehumanise women, treating their bodies as objects to be controlled rather than subjects with rights. It is therefore important to stress that obstetric and gynaecological violence originates from the intersection of two forms of oppression: gender-based violence, targeting and disproportionately affecting women because of their gender, and institutional violence, in which power imbalances in healthcare systems prevail. Furthermore, the FEMM report emphasises that obstetric and gynaecological violence in Europe is exacerbated by the coexistence of two crises, which are also structural.⁹ The first is the medicalisation of women’s bodies, resulting from a modern medicine that has historically been highly gendered and based on patriarchal dynamics. Because of the imbalance of power and alleged asymmetry of knowledge between patients and healthcare personnel, most women are deemed incapable of making decisions about their own sexual and reproductive health and consequently excluded from participation and design thereof.¹⁰ The second crisis, with a strong capitalist component, lies in the structural deficiencies of many healthcare systems across Europe. Although varying among countries, these systems frequently struggle with chronic underfunding, staff shortages, insufficient supervision, and inadequate infrastructure.¹¹ Healthcare workers, subjected to stress and unsustainable workloads, may resort to abusive behaviour as an outlet mechanism. Additionally, medical facilities often adopt emergency approaches excessively, aiming to maximize efficiency and reduce costs. As emphasised by Alessandra Battisti (University of Roma Tre) in the case of childbirth, “the prevailing idea is that if women and their babies are alive, then everything was fine and all the interventions and manoeuvres carried out on women’s bodies by health personnel were justified by necessity”.¹² Undoubtedly, childbirth is an extremely risky activity despite the advances in the field of medicine. However, it should be remembered that maternal care is not and should not only be about mortality but also about morbidity, meaning all conditions associated with childbirth.¹³

Obstetric and gynaecological violence does not just leave physical scars but also deep psychological ones, including post-traumatic stress disorder (PTSD) and postpartum depression (PPD).¹⁴ Socially, such abuses isolate women and push many to avoid critical healthcare out of fear, or to move from practitioner to practitioner in search of recognition or assistance, as per the so-called “medical wandering”.¹⁵ This is a striking example of how institutional violence not only inflicts direct harm, but also prevents women from accessing their fundamental right to health. In addition, understanding who is most at risk requires an intersectional perspective: women who do not conform to dominant norms of “good motherhood”, either because they are too young, too old, single, unemployed, living with disabilities, part of an ethnic minority, or the LGBTQ+ community might be particularly exposed to obstetric and gynaecological violence.¹⁶ This, once again, shows how obstetric violence is not only a healthcare issue, but also a form of sociocultural oppression that perpetuates systemic inequalities.

A barely existing legal and policy framework

A further aggravation of the situation regarding obstetrical and gynaecological violence in Europe is that, to date, there is no effective legal and policy framework that can guarantee protection for those who suffer such violence. Globally, article 12 of the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) mandates measures to eliminate discrimination against women in healthcare and ensure appropriate services, yet it provides only broad definitions that fail to specifically address obstetric and gynaecological violence.¹⁷ Progress has been made in Latin America, where countries like Venezuela, Argentina, and Puerto Rico have enacted laws explicitly defining and addressing obstetric violence and, most importantly, explicitly referring to the structural causes of it.¹⁸ However, Europe remains far behind. Catalonia, in Spain, is a notable exception, having incorporated a definition of obstetric violence into its regional law on sexist violence, though it lacks criminal proceedings due to its regional status.¹⁹ Non-binding resolutions, such as Resolution No. 2306 of 2019 from the Parliamentary Assembly of the Council of Europe and the European Parliament’s Resolution of 2021 are indeed important for acknowledging the issue and calling for reforms at the member states level; however, they concretely offer no enforceable obligations.²⁰ The aforementioned FEMM Committee study, published in 2024, further exposed legislative gaps and the absence of comprehensive and comparable data, which prevents a full understanding of the European situation. In May 2022, the European Commission issued a call for evidence for the “Recommendation on harmful practices against women and girls”, but it did not explicitly include obstetric and gynaecological violence. Despite a call by an MEP to provide updates,²¹ the legislative process for this recommendation remains stalled.

The consequences of this inaction are devastating. Without legal protection, women are left in the dark and unable to properly recognise and report the violence they endure. As a consequence, political institutions reinforce a culture of silence, in which obstetric and gynaecological violence continues to be normalised. Given that the rates of obstetric and gynaecological interventions that are not medically justified nor recommended by the WHO have increased in middle- and high-income countries and given that healthcare systems in these countries have not improved over the past 30 years,²² anything less than bold feminist action at both European and national levels is complicity in the abuse and dehumanisation of women.

Breaking the silence: grassroots actions as drivers of change

Various civil society organisations have over time tried to shed light on this situation and advocate for a comprehensive definition and legal protection. One inspiring example is the Italian Obstetric Violence Observatory (OVO), an initiative born out of the powerful #Bastatacere (break the silence) campaign launched in 2016.²³ This grassroots movement, founded by activists Elena Skoko and Alessandra Battisti, began as a Facebook campaign where thousands of women shared personal stories of obstetric violence. The campaign coincided with an Italian law proposal advocating for human rights-based maternity care and the introduction of obstetric violence as a criminal offense.²⁴ While the proposal did not become law, the campaign empowered Italian women to speak out and made obstetric violence part of the public discourse. Building on this momentum, the activists established OVO and in 2017, it commissioned a groundbreaking national survey through the research institute DOXA. It revealed that 33% of women reported feeling insufficiently involved in decisions during childbirth and that 21% of respondents (representing approximately 100,000 women annually) identified their experiences as obstetric violence.²⁵ Through its efforts, the OVO brought obstetric violence into national discourse, influencing public opinion and breaking the silence surrounding the issue. It also provided vital data that continues to guide advocacy and initiatives to this day.

Another grassroots initiative with a big impact is the so-called “Roses Revolution”. On 25 November, the day for the elimination of violence against women, it consists of placing roses in front of hospitals in which women have suffered abuse that can be traced back to obstetrical and gynaecological violence. It has been a widespread movement in Europe since 2011, and has been very successful in Germany, where 25% of hospitals received roses in 2022.²⁶

For years, NGOs working on gender-based violence and sexual and reproductive rights have tirelessly advocated to bring the issue of obstetric and gynaecological violence into the political spotlight, providing recommendations to the main stakeholders and evidence-based medical practices.²⁷

One important point is to distinguish obstetric and gynaecological violence from other forms of healthcare malpractice, as it carries a structural gender dimension that must be acknowledged. Addressing it requires several key actions. First, the establishment of a universally recognised definition, the collection of comparable and accessible data, and a strong European legal and policy framework to provide real protection for those affected. Institutions must also confront the systemic deficiencies in healthcare systems: not only in public facilities, where responsibility is direct, but also in the private sector. Outdated and unscientific practices must be replaced with human rights-based approaches and modern medical standards. This requires sustained, lifelong training for healthcare professionals to improve care quality and recognise the intersecting dynamics of power at play. Finally, while much of the responsibility falls on institutions and policymakers, raising awareness about this violence is a shared duty. Public awareness is vital to dismantle stereotypes and confront societal misconceptions about sexual and reproductive health. Only through collective action can we break the silence and bring meaningful change.

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Carlotta Geremia, Winter 2024 intern of the WAVE Office. She recently graduated in European Studies with a focus on gender, and she is strongly interested in the world of EU policy making, especially on women’s rights and gender equality.

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1. World Health Organization (2015). Statement on the Prevention and Elimination of Disrespect and Abuse during Facility-Based Childbirth. ↩︎
2. Policy Department for Citizens’ Rights and Constitutional Affairs (2024). Obstetric and gynaecological violence in the EU – Prevalence, legal frameworks and educational guidelines for prevention and elimination. Study for the FEMM Committee. Brussels: Directorate-General for Internal Policies. ↩︎
3. ibid. ↩︎
4. World Health Organisation (2018). WHO recommendations Intrapartum care for a positive childbirth experience Executive summary. WHO. Available at: https://iris.who.int/bitstream/handle/10665/272447/WHO-RHR-18.12-eng.pdf. ↩︎
5. Murphy, C. (2018). The Husband Stitch Isn’t Just a Horrifying Childbirth Myth. Healthline. Available at: https://www.healthline.com/health-news/husband-stitch-is-not-just-myth. [Accessed 2 Dec. 2024]. ↩︎
6. Malvasi, A., Zaami, S., Tinelli, A., Trojano, G., Montanari Vergallo, G. and Marinelli, E. (2018). Kristeller maneuvers or fundal pressure and maternal/neonatal morbidity: obstetric and judicial literature review. The Journal of Maternal-Fetal & Neonatal Medicine, 32(15), pp.2598–2607. doi:https://doi.org/10.1080/14767058.2018.1441278. ↩︎
7. International Planned Parenthood Federation (2022). Gynaecological and Obstetric Violence – a form of gender-based violence. IPPF European Network. Available at: https://europe.ippf.org/resource/gynaecological-and-obstetric-violence-form-gender-based-violence. ↩︎
8. Sadler, M., Santos, M.J., Ruiz-Berdún, D., Rojas, G.L., Skoko, E., Gillen, P. and Clausen, J.A. (2016). Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence. Reproductive Health Matters, 24(47), pp.47–55. doi: https://doi.org/10.1016/j.rhm.2016.04.002. ↩︎
9. Policy Department for Citizens’ Rights and Constitutional Affairs (2024). Obstetric and gynaecological violence in the EU – Prevalence, legal frameworks and educational guidelines for prevention and elimination. Study for the FEMM Committee. Brussels: Directorate-General for Internal Policies. ↩︎
10. Davis-Floyd, R.E. and Carolyn Fishel Sargent (1997). Childbirth and Authoritative Knowledge – Cross-Cultural Perspectives. 1st ed. University of California Press. ↩︎
11. Policy Department for Citizens’ Rights and Constitutional Affairs (2024). Obstetric and gynaecological violence in the EU – Prevalence, legal frameworks and educational guidelines for prevention and elimination. Study for the FEMM Committee Brussels: Directorate-General for Internal Policies. ↩︎
12. Battisti, A. (2022). The need to legislate and regulate obstetric violence to ensure women a real legal protection. (Con)textos: revista d’antropologia i investigació social, (10), p.134. ↩︎
13. Bohren, M.A. et.al. (2015). The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review. PLOS Medicine, 12(6), p.e1001847. doi: https://doi.org/10.1371/journal.pmed.1001847. ↩︎
14. Çapik, A. and Durmaz, H. (2018). Fear of Childbirth, Postpartum Depression, and Birth‐Related Variables as Predictors of Posttraumatic Stress Disorder After Childbirth. Worldviews on Evidence-Based Nursing, 15(6), pp.455–463. doi: https://doi.org/10.1111/wvn.12326. ↩︎
15. Institut de Recherche & d’Action pour la Santé des Femmes. (2017). Préconisations provisoires de L’IRASF Contre les violences obstétricales et gynécologiques. Institut de Recherche & d’Action pour la Santé des Femmes. https://afar.info/biblio/public/3056.pdf ↩︎
16. Policy Department for Citizens’ Rights and Constitutional Affairs (2024). Obstetric and gynaecological violence in the EU – Prevalence, legal frameworks and educational guidelines for prevention and elimination. Study for the FEMM Committee Brussels: Directorate-General for Internal Policies. ↩︎
17. UN General Assembly (1979). Convention on the Elimination of All Forms of Discrimination Against Women. United Nations, Treaty Series, vol. 1249, http://www.un.org/womenwatch/daw/cedaw/cedaw.htm. ↩︎
18. See, for example: República Bolivariana de Venezuela (2007). Ley Orgánica sobre el derecho de las mujeres a una vida libre de violencia), Gaceta oficial de la República Bolivariana de Venezuela, n. 38.668, https://www.acnur.org/fileadmin/Documentos/BDL/2008/6604.pdf ↩︎
19. Comunidad Autónoma de Cataluña (2020). Ley 17/2020, de 22 de diciembre, de modificación de la Ley 5/2008, del derecho de las mujeres a erradicar la violencia machista. https://www.boe.es/diario_boe/txt.php?id=BOE-A-2021-464 ↩︎
20. Parliamentary Assembly of the Council of Europe (2019). Resolution 2306 on Obstetrical and gynaecological violence. https://pace.coe.int/en/files/28236/html; European Parliament (2021). Resolution on the situation of sexual and reproductive health and rights in the EU, in the frame of women’s health (2020/2215(INI)), https://eur-lex.europa.eu/legalcontent/EN/TXT/?uri=CELEX%3A52021IP0314 ↩︎
21. Fitzgerald, F. (2024). Parliamentary question | Commission recommendation on the prevention of harmful practices against women and girls | E-000040/2024 [online] European Parliament. Available at: https://www.europarl.europa.eu/doceo/document/E-9-2024-000040_EN.html [Accessed 3 Dec. 2024]. ↩︎
22. Sadler, M., Santos, M.J., Ruiz-Berdún, D., Rojas, G.L., Skoko, E., Gillen, P. and Clausen, J.A. (2016). Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence. Reproductive Health Matters, 24(47), pp.47–55. doi: https://doi.org/10.1016/j.rhm.2016.04.002. ↩︎
23. OVO Italia (2016). #Bastatacere. [online] Osservatorio sulla Violenza Ostetrica Italia (OVOItalia). Available at: https://ovoitalia.wordpress.com/bastatacere/ [Accessed 3 Dec. 2024]. ↩︎
24. Camera dei Deputati (2016). Proposta di legge d’iniziativa del deputato Zaccagnini – Norme per la tutela dei diritti della partoriente e del neonato e per la promozione del parto fisiologico. [online] Camera dei Deputati. Available at: https://documenti.camera.it/_dati/leg17/lavori/stampati/pdf/17PDL0039650.pdf. ↩︎
25. OVO Italia (2017). Indagine Doxa-OVOItalia. [online] Osservatorio sulla Violenza Ostetrica Italia (OVOItalia). Available at: https://ovoitalia.wordpress.com/indagine-doxa-ovoitalia/ [Accessed 3 Dec. 2024]. ↩︎
26. Gerechte Geburt (2020). Roses Revolution – für eine gewaltfreie Geburtshilfe. [online] Gerechte-geburt.de. Available at: https://www.gerechte-geburt.de/home/roses-revolution/ [Accessed 3 Dec. 2024]. ↩︎
27. See, for example: International Planned Parenthood Federation (2022). Gynaecological and Obstetric Violence – a form of gender-based violence. IPPF European Network. Available at: https://europe.ippf.org/resource/gynaecological-and-obstetric-violence-form-gender-based-violence. ↩︎

Disclaimer: The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or opinion/position of Women Against Violence Europe (WAVE).