Authored By: Bongekile Msibi
Abstract
Childbirth should be a moment defined by dignity, care, joy, and respect. For many women, pregnancy is filled with anticipation and hope as they look forward to meeting their baby for and they imagine the joy of hearing their baby’s first cry, holding a healthy child in their arms, and returning home healthy and safe to begin the life-changing journey of motherhood. It is a moment that should be remembered with happiness, empowerment, and a sense of accomplishment.
Yet for many women, this expectation is shattered. Instead of experiencing compassion and support, they encounter humiliation, neglect, coercion, and abuse at a time when they are most vulnerable. What should be one of the most meaningful moments of a woman’s life can become a source of trauma that remains long after childbirth has ended.
These practices, increasingly recognised as obstetric violence, occur when women are subjected to abuse, discrimination, non-consensual medical interventions, or degrading treatment during pregnancy and childbirth. Although South Africa possesses a progressive constitutional framework that protects dignity, equality, bodily integrity, and access to healthcare, growing evidence suggests that many women continue to experience violations of these rights within maternity care settings.
This article argues that obstetric violence constitutes a distinct violation of constitutional rights, international human rights obligations, and reproductive justice principles. Drawing upon South African legislation, Constitutional Court jurisprudence, international human rights instruments, and comparative legal developments in jurisdictions such as Venezuela, Argentina, Mexico, and Brazil, the article examines whether South Africa’s existing legal framework adequately addresses obstetric violence. It contends that explicit legal recognition is necessary to strengthen accountability, improve access to remedies, and ensure respectful maternity care. Ultimately, the article argues that childbirth should never require women to surrender their dignity, autonomy, or humanity.
Introduction: The Hidden Violence in the Delivery Room
For many women, childbirth is imagined as one of life’s most significant moments. It is often portrayed as a celebration of life, family, and hope. Yet for countless women across South Africa and beyond, childbirth becomes something entirely different. Instead of empowerment, they encounter fear. Instead of compassion, they experience humiliation. Instead of being treated as active participants in decisions concerning their own bodies, they are treated as passive recipients of medical authority.
The stories are deeply troubling. Women describe being shouted at while in labour. Some recount being slapped, mocked, or ignored when expressing pain. Others report undergoing medical procedures without explanation or consent. Some discover only after childbirth that irreversible decisions affecting their reproductive futures were made without their knowledge. For many, the physical experience of childbirth ends, but the emotional consequences remain for years.
These experiences are increasingly recognised under the concept of obstetric violence.
The World Health Organization (WHO) has identified various forms of mistreatment during childbirth, including physical abuse, verbal abuse, discrimination, neglect, non-confidential care, and procedures performed without informed consent.[1]Such practices are not merely examples of poor healthcare delivery. They represent infringements of fundamental human rights, including the rights to dignity, equality, bodily integrity, privacy, and autonomy.[2]
The term “obstetric violence” emerged in Latin America, where activists, scholars, and lawmakers sought language capable of capturing the systemic nature of abuse experienced by women during pregnancy and childbirth. Unlike traditional medical negligence claims, which focus on isolated instances of professional misconduct, the concept of obstetric violence highlights broader patterns of power, gender inequality, and institutional practices that undermine women’s reproductive autonomy.[3]
South Africa has yet to formally recognise obstetric violence in law. This is particularly significant given the country’s constitutional commitment to human dignity and equality. The Constitution of the Republic of South Africa, 1996 guarantees the rights to dignity, equality, bodily and psychological integrity, privacy, and access to healthcare services[4].The National Health Act 61 of 2003 further protects informed consent and participation in healthcare decision-making.[5]
Despite strong constitutional and legal protections, many women in South Africa continue to experience mistreatment during childbirth. The Embrace 2025 Birthing Survey found that nearly 60% of women experienced some form of obstetric violence, including verbal abuse, neglect, discrimination, non-consensual procedures, and violations of informed consent. Perhaps most concerning was that many women did not recognise these experiences as abuse because such treatment had become normalised within maternity care settings.[6]
When harmful practices become routine and normalised, they become invisible. Women may come to believe that humiliation is simply part of childbirth. Healthcare providers may become desensitised to conduct that would be unacceptable in other medical contexts. Institutions may fail to identify systemic patterns of abuse because incidents are viewed as isolated occurrences rather than manifestations of a broader problem.
This normalisation creates a profound legal challenge. Existing remedies often address individual acts of negligence or misconduct but struggle to capture the structural and gendered dimensions of obstetric violence. Consequently, many survivors are left without effective mechanisms for accountability or redress. Sadler and colleagues argue that obstetric violence should not be understood solely as isolated incidents of disrespect or abuse by individual healthcare providers, but rather as a structural phenomenon rooted in unequal power relations, gender discrimination, and institutional practices within maternity care.[7]
This article argues that obstetric violence should be understood as more than a healthcare issue. It is a constitutional issue because it violates rights protected by the Constitution. It is a human rights issue because it infringes internationally recognised protections relating to dignity, autonomy, and equality. It is a reproductive justice issue because it reflects broader patterns of gender inequality and control over women’s reproductive lives. Most importantly, it is a legal issue that demands a legal response.
Understanding Obstetric Violence: Beyond Medical Negligence
The phrase “obstetric violence” can initially appear controversial. Critics often argue that the term is too harsh or that it unfairly characterises healthcare professionals who frequently work under difficult and under-resourced conditions. However, understanding the concept requires moving beyond the assumption that obstetric violence is simply a criticism of healthcare workers. Rather, it is an attempt to identify and address harmful practices that have historically been normalised within maternity care systems.
The WHO framework identifies several categories of mistreatment during childbirth, including physical abuse, non-consented care, non-confidential care, verbal abuse, discrimination, neglect, and detention within healthcare facilities.[8]While each category involves different forms of conduct, they share a common characteristic: they undermine women’s dignity, autonomy, and agency during one of the most vulnerable moments of their lives.
A woman who undergoes a caesarean section without receiving adequate information about risks and alternatives experiences more than a technical breach of consent procedures. Her ability to make decisions concerning her own body has been compromised. Similarly, a woman who is mocked while in labour experiences more than poor customer service; she experiences a violation of dignity that may leave lasting psychological scars.
The origins of the concept can be traced to Latin America. Scholars such as Michelle Sadler argue that obstetric violence should be understood as a structural phenomenon reflecting broader inequalities within healthcare systems. [9]The issue is not merely whether an individual healthcare professional behaved improperly but whether institutional practices systematically diminish women’s autonomy and reproductive decision-making.
Venezuela became the first country to explicitly recognise obstetric violence through its Organic Law on the Right of Women to a Life Free of Violence. The legislation defines obstetric violence as the appropriation of women’s bodies and reproductive processes by healthcare personnel through dehumanising treatment, excessive medicalisation, and the denial of informed decision-making. [10]The significance of this approach lies in its recognition that harm during childbirth can constitute a form of gender-based violence rather than merely medical malpractice.
Argentina adopted a similar rights-based approach through Law 25.929 on Humanised Birth, which recognises women’s rights to dignity, autonomy, information, and respectful treatment throughout pregnancy and childbirth[11].The legislation emphasises informed consent, participation in decision-making, respect for dignity, and access to information throughout pregnancy and childbirth. [12]By framing maternity care as a matter of rights rather than professional discretion, Argentina shifted the focus from institutional convenience to patient autonomy.
These developments reflect a broader recognition that childbirth is not simply a medical event; it is also a legal and human rights event. Decisions made during labour and delivery directly affect a woman’s bodily integrity, privacy, dignity, autonomy, and reproductive freedom. Violations occurring during childbirth can have profound and long-lasting consequences, leaving survivors with physical, psychological, and emotional scars that may persist long after the birth itself. In many instances, women do not immediately recognise that they have experienced a violation of their rights because harmful practices have become normalised within maternity care settings.[13]
The distinction between medical negligence and obstetric violence is therefore important. Medical negligence focuses on whether a healthcare provider failed to meet professional standards of care. Obstetric violence, by contrast, focuses on violations of dignity, autonomy, equality, and reproductive rights. While negligence and obstetric violence may overlap, they are not identical concepts. A woman may experience obstetric violence even where no physical injury occurs. The harm lies in the denial of agency, respect, and informed decision-making.
This distinction becomes particularly relevant within South Africa, where constitutional values place significant emphasis on dignity and autonomy. If the law recognises that individuals possess the right to make decisions concerning their own bodies, then practices that systematically undermine those decisions require scrutiny that extends beyond traditional negligence frameworks[14].
The challenge for South African law is therefore not whether women possess rights during childbirth. The Constitution clearly confirms that they do. The challenge is whether existing legal mechanisms adequately recognise and respond to violations occurring within maternity care settings[15]
Conclusion
Obstetric violence is a constitutional, human rights, and reproductive justice issue. Despite South Africa’s strong legal protections for dignity, equality, bodily integrity, and reproductive autonomy, many women continue to experience mistreatment, coercion, neglect, and non-consensual interventions during childbirth.
The South African survey findings reveal a troubling gap between legal protections and lived experiences. Nearly two-thirds of women who experienced abuse did not recognise it as abuse, while approximately one-third underwent procedures without explanation or consent. These findings demonstrate how deeply obstetric violence has become normalised and highlight ongoing failures to realise constitutional guarantees of dignity, bodily integrity, autonomy, and informed consent.
This article has argued that obstetric violence extends beyond individual acts of negligence and should be recognised as a systemic violation of women’s rights. Addressing it requires legal recognition, effective accountability mechanisms, respectful maternity care, and greater awareness of women’s rights. Ensuring dignity, respect, and autonomy during childbirth is essential to fulfilling South Africa’s constitutional and human rights commitments.
References/ Biography
Legislation
- Constitution of the Republic of South Africa, 1996.
- National Health Act 61 of 2003.
- Law No 25.929 of 2004 (Argentina) (Ley de Parto Humanizado/Humanised Birth Law).
- Organic Law on the Right of Women to a Life Free of Violence 2007 (Venezuela) (Ley Orgánica sobre el Derecho de las Mujeres a una Vida Libre de Violencia).
Cases
- Christian Lawyers Association v Minister of Health 1998 (4) SA 1113 (T).
Books, Articles and Reports
- Chadwick RJ, ‘Obstetric Violence in South Africa’ (2016) 106(5) South African Medical Journal 423–424.
- Sadler M, Santos MJDS, Ruiz-Berdún D, Rojas GL, Skoko E, Gillen P and Clausen JA, ‘Moving Beyond Disrespect and Abuse: Addressing the Structural Dimensions of Obstetric Violence’ (2016) 24(44) Reproductive Health Matters 47–55.
- Social Surveys Africa, The Extent and Nature of Obstetric Violence in South Africa 2025 Birthing Survey: Findings Report (Embrace and DG Murray Trust 2025).
- World Health Organization, The Prevention and Elimination of Disrespect and Abuse During Facility-Based Childbirth (WHO 2015).
[1]World Health Organization, The Prevention and Elimination of Disrespect and Abuse During Facility-Based Childbirth (WHO 2015).
[2] Constitution of the Republic of South Africa, 1996 ss 9, 10, 12(2), 14 and 27.
[3] Michelle Sadler and others, ‘Moving Beyond Disrespect and Abuse: Addressing the Structural Dimensions of Obstetric Violence’ (2016) 24(44) Reproductive Health Matters 47.
[4] Constitution of the Republic of South Africa, 1996 ss 9, 10, 12(2), 14 and 27.
[5] National Health Act 61 of 2003 ss 6–8.
[6] Social Surveys Africa, The Extent and Nature of Obstetric Violence in South Africa 2025 Birthing Survey: Findings Report (Embrace and DG Murray Trust 2025) 1–2, 38–40.
[7] Sadler and others (n 3) 48–52; Rachelle Joy Chadwick, ‘Obstetric Violence in South Africa’ (2016) 18(2) South African Journal of Bioethics and Law 45, 46–48.
[8] World Health Organization (n 1).
[9] Sadler M, Santos MJDS, Ruiz-Berdún D, Rojas GL, Skoko E, Gillen P and Clausen JA, ‘Moving Beyond Disrespect and Abuse: Addressing the Structural Dimensions of Obstetric Violence’ (2016) 24(44) Reproductive Health Matters 47–55
[10] Organic Law on the Right of Women to a Life Free of Violence 2007 (Venezuela) art 15(13).
[11] Law No 25.929 of 2004 (Argentina) (Ley de Parto Humanizado/Humanised Birth Law); Michelle Sadler and others, ‘Moving Beyond Disrespect and Abuse: Addressing the Structural Dimensions of Obstetric Violence’ (2016) 24(44) Reproductive Health Matters 47, 48–52.
[12] Law No 25.929 of 2004 (Argentina) (Ley de Parto Humanizado/Humanised Birth Law), arts 2–4.
[13] Social Surveys Africa, The Extent and Nature of Obstetric Violence in South Africa 2025 Birthing Survey: Findings Report (Embrace and DG Murray Trust 2025) 38–40
[14] Constitution of the Republic of South Africa, 1996, ss 10, 12(2) and 14; Christian Lawyers Association v Minister of Health 1998 (4) SA 1113 (T) 1120–1122; Rachael Chadwick, ‘Obstetric Violence in South Africa’ (2016) 18(2) South African Journal of Bioethics and Law 45, 46–48.
[15] Constitution of the Republic of South Africa, 1996, ss 9, 10, 12(2), 14 and 27; Rachael Chadwick, ‘Obstetric Violence in South Africa’ (2016) 18(2) South African Journal of Bioethics and Law 45, 46–48; Embrace, The 2025 South African Birthing Survey Report (Embrace, 2025)
