Understanding medical violence is the first step to stopping it
Obstetric violence represents a violation of human rights and a form of gender-based violence. Yet today, this type of abuse is still often not fully understood: partly due to widespread misinformation and partly due to the lack of consistent global data.1
According to the results of the 2019 Giving Voice to Mothers survey, 17% of American women (from a sample of over 2,700 people) reported experiencing one or more forms of mistreatment by healthcare staff. In France, 37% of women did not have their requests respected by the medical team: among them, 57% described their childbirth experience as “very bad or rather bad” physically, and 70% psychologically, according to a 2012 study. In Turkey, research published in Midwifery in 2022 reported that 76% of women experienced obstetric violence, including physical abuse, non-consensual care, undignified treatment, and discrimination. In Moldova, half of pregnant women experienced obstetric violence, according to a study by EU Neighbours. Similar findings could be reported from country to country.
As Federica di Martino (psychotherapist, activist, and founder of the social platform IVG, ho abortito e sto benissimo) explains: “Talking exclusively about obstetric violence means that only abuses committed by midwives are included in this category. We should start talking about systemic violence in healthcare settings—medical and health violence—because these behaviors also involve doctors and other healthcare professionals in hospitals, clinics, and health centers.”
What is meant by medical violence?
When we talk about medical violence—including reproductive and obstetric violence—we mean all forms of violence inflicted on women regarding sexual and reproductive health. This includes pregnancy, abortion, contraception, and all decisions that should be free but are instead constrained. Focusing on abortion (my main area of work), women are often denied the choice between medical and surgical abortion, and the differences are often not explained. In contraception, alternative methods beyond the pill are rarely proposed.
Do verbal abuses count?
Absolutely. In matters of abortion and sexual and reproductive health, change must be cultural, and culture includes language. In the case of voluntary termination of pregnancy (IVG), many people lack necessary information because they have never experienced an unwanted pregnancy. They turn to public services seeking not only a welcoming space (which is often not provided) but also answers to their questions. I recall a young woman I accompanied to a clinic for an abortion, and the midwife commented: “Her abortion is a disgrace to our work.” In other cases, they have said: “Why didn’t you keep your legs closed?” or “Who gave you the gift: your husband or your lover?” Healthcare personnel take liberties with women’s bodies, sexuality, and reproductive choices, which is violent and fuels feelings of guilt. Mistreatment goes beyond botched procedures or denied practices—words have weight. Many women seeking an abortion are treated as second-class patients punished for a “fault,” and humiliation becomes part of that punishment. Lack of postpartum support is also a form of violence: for example, in the Netherlands, a doula supports women for the first months after childbirth to help them through a period of extreme fatigue and psychological pressure.
Is medical violence recognized or punished?
Medical violence has only recently entered public discussion. Regarding abortion, Europe has adopted measures that could, in my opinion, also be implemented in Italy. In France, for example, a law punishes websites that spread false information about abortion and contraception with fines and site closures. In Spain, measures prohibit anti-abortion pickets in front of clinics and hospitals. France has also enshrined the right to voluntary abortion in its Constitution, and Spain intends to follow suit.
A fundamental step that all societies should take. In fact, restricting the right to abortion—as was done in the United States with the overturning of Roe v. Wade—does not reduce the number of abortions, but rather increases the number of unsafe procedures.
U.S. data show that the total number of abortions did not decrease: the risk is that abortions occur unsafely or become a class issue, as only wealthier women can afford to travel to states where abortion is permitted. In Italy, this also occurs on a smaller scale in regions where high levels of conscientious objection force women to travel, which is not feasible for everyone. Restricting abortion rights only increases unsafe abortions. Italian history teaches this: before Law 194 was passed, women who relied on so-called mammane (who performed clandestine abortions) faced violent procedures with risks of hemorrhage and death.
Intersectionality: does ethnicity, disability, or socio-economic status affect access to abortion?
Unfortunately, yes. Being a pregnant woman is one thing; being a Black pregnant woman is another. The same applies to wealth, age, or legal status: discussing intersectionality in sexual and reproductive health is essential to understand the complexity of the issue, as marginalized women face multiple layers of discrimination. We cannot consider one factor without looking at the others.
Have you encountered healthcare staff witnessing medical violence?
Many times, I have dealt with non-objecting healthcare professionals overwhelmed with work because other doctors or staff were conscientious objectors. This distress affects not only women but also part of the medical staff, who struggle with policies that hinder abortion rights and the ability to provide dignified care. It is essential that healthcare professionals speak up in this debate, because change must be collective.
- The data, surveys, and studies presented below are taken from the book You Will Give Birth in Pain: Understanding and Combating Obstetric Violence by Costanza Giannelli, published by Villaggio Maori Edizioni. ↩︎
Credit photo: Maristella Rana