Over the last century, pregnancy and childbirth have become increasingly medicalised in most parts of the world. The process of childbirth is often conceived of and treated as a medical event, requiring control, risk management and constant monitoring of the woman’s body. In many countries, childbirth still includes a variety of routine medical interventions, such as labour-inducing drugs, the lithotomic position, epidurals, manoeuvres, episiotomies and an excess of surgical deliveries. These interventions are also used in women with low-risk pregnancies, despite WHO recommendations and the findings of evidence-based medicine on the topic.
Sometimes women can be coerced into accepting medical interventions or these interventions are performed without their consent. In some cases, this coercion can be psychological or not explicit, i.e., related to the authoritativeness of biomedical knowledge and power issues in the doctor-patient relationship. It represents at times a subtle form of limiting a woman’s fundamental right to participate actively in the process of pregnancy and childbirth and to decide in a free and conscious manner in consideration of the woman’s own body.
In Latin America, over the past decade, the term “obstetric violence” (OV) has become part of the legal framework. The concept refers to acts in the context of labour and birth categorised as physically or psychologically violent due to unjustified use of medical interventions, dehumanizing treatment and pathologisation of natural processes. At the national level, specific laws against obstetric violence – a type of gender-based violence and violation of human rights – exist in Venezuela (2007) and Argentina (2009); at the state level laws exist in Mexico (2007-2017) and in Brazil (2017).
In Europe, the issue is raised by human rights organisations and social movements fighting for more humane and respectful births.
In Spain, Italy and France, Observatories on OV were implemented, but no country has passed legislation on the matter yet. The concept is far from receiving sufficient critical examination within biomedical practice and public policy, and it is not seen by decision makers as a potential tool for rethinking and improving birth care policies and practices.
However, in Europe as in other countries, it is widely recognised thatover-medicalisation and disrespect, do not benefit women and their children in terms of better outcomes; on the contrary, it deprives women of an active role in childbirth, increases the costs of health care systems and the number of legal disputes.