Understanding obstetric violence and why it is a global concern

An expectant woman in a maternity ward. [Samson Wire, Standard] Dignity and respect ought to be the cornerstone of delivering medical services to all. Unfortunately, several women have suffered obstetric violence (OBV) at the hands of healthcare workers instead of receiving respect and dignity during the labour and delivery process. While the term is not defined in law, OBV may be used to refer to behaviours that harm someone pregnant or giving birth or has recently given birth and is a form of reproductive violence which could also fall under the ambit of gender-based violence (GBV). To distinguish it from common assault or GBV, the mistreatment has to come from someone with a duty of care, by law, towards the mother e.g. a doctor, or health worker. It includes mistreatment, abuse, and neglect during childbirth. It violates women's reproductive rights and dignity, often resulting in physical and psychological harm. This goes against the principles set out in Article 38 of the Kenyan Constitution which recognises the rights of women's dignity, respect, and protection from all forms of violence, including physical, and emotional abuse. Such practices are exacerbated by systemic factors such as inadequate healthcare infrastructure, provider shortages, and some socio-cultural beliefs. OBV is systematically inflicted upon women and girls with a callous disregard for the consequences it may have on maternal health. Tragically, OBV can result in fatal outcomes, contributing to elevated rates of maternal and infant mortality. Survivors of OBV are also at heightened risk of developing obstetric fistula, a devastating childbirth injury characterised by involuntary leakage of urine, faeces, or both. This debilitating condition leads to chronic medical complications, psychological distress, social ostracisation, and exacerbated poverty levels. Despite constitutional guarantees and international commitments to uphold women's rights, instances of OBV persist. Statistics from the World Health Organization indicate that 2.8 million pregnant women and newborns lose their lives every year despite these deaths being preventable. In Kenya, courts have acknowledged that OBV is a violation of women's rights the highest attainable standard of healthcare, including reproductive healthcare. The recognition signals to women in the country that obstetric violence will not be tolerated, empowering them to speak out, seek justice, and demand respectful maternal care. It is also a recognition that the right to high standards of healthcare includes dignified support before, during and after childbirth. However, limited awareness, cultural norms, and resource constraints hinder efforts to address underlying systemic issues. Moreover, stigma and fear of reprisals deter women from seeking legal recourse, perpetuating a culture of impunity among healthcare providers. These challenges also present opportunities for multi-stakeholder collaboration to enact sustainable solutions. Strengthening legal frameworks, enhancing healthcare infrastructure, and promoting community awareness are crucial steps towards eradicating obstetric violence in Kenya. - The author is a Women's human rights and SRHR expert and the Senior Legal Programs Manager for Africa at Women's Link Worldwide

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Understanding obstetric violence and why it is a global concern

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