In this first post in a series of posts by Dr Gallardo Duarte, the author charts the evolution of the term “obstetric violence” from its early 19th-century medical critiques to its redefinition by Latin American feminisms, with particular attention to Uruguay’s contributions. This opening instalment uncovers the historical roots of a concept that has become central to today’s legal and political debates on reproductive rights.
This post examines the socio-historical evolution of the concept of obstetric violence internationally, with special focus on Latin America’s Southern Cone. The analysis is structured around three key historical periods constructed by the author: a foundational stage identifying the first references to obstetric violence in English medical literature in early 19th century Europe; a second stage during the latter half of the 20th century marked by the term’s appearance in Spanish medical literature, the movement for birth de-medicalisation, and World Health Organization’s approach; and a third crucial period from the early 21st century to present, highlighting Latin American feminist contributions to the concept’s development, particularly in Uruguay.
The Foundational Stage: First References in English
Contrary to the belief that the term “obstetric violence” is relatively recent, historical evidence demonstrates otherwise. According to research, the first documented use of the term dates to the early 19th century by physician James Blundell, who employed “obstetric violence” to denounce the terrible practices to which pregnant women were subjected during that era. As Ruiz-Berdún notes, women’s bodies became material for experimenting with techniques that were often aberrant, leaving terrible physical and psychological sequelae assuming they did not die during childbirth or from puerperal fever.
According to Chadwick, multiple documented examples of the term appear throughout the century, establishing that “obstetric violence is clearly an old problem and is by no means a faddish concept”. James Blundell first used the term “obstetric violence” in 1827, in a lecture published in The Lancet, criticising the interventionist approach to obstetrics where physicians used hands, forceps and other instruments too freely. As well, a Botanico-Medical Recorder article published in 1839 reported on a successful prosecution in a case of “obstetric violence” perpetrated by a physician against a woman, resulting in her death.
Chadwick reinforces this historical perspective, stating that “far from being a ‘new’ phenomena history shows that violent harm is entwined with obstetric and gynaecological medicine”. She emphasises that racialised gynaecological violence towards enslaved women through experimental surgeries was central to the development of gynaecological and obstetric techniques, highlighting the deeply problematic historical foundations of these medical practices.
Early Spanish Usage and the World Health Organization’s Approach
The second historical stage encompasses several key developments, including the first appearances of the term “violencia obstétrica” in Spanish. While Ruiz-Berdún claimed no references existed until the late 20th century, documentary research uncovered that Dr García-Triviño, director of the provincial maternity hospital in Jaén (Spain), used the expression “violencia obstétrica” in 1956 during a seminar on the “Zarate method” for treating pelvic dystocia. García-Triviño employed the term to criticise questionable obstetric practices such as embryotomy, forceps use, and even caesarean sections, stating: “Through the ages, and incomprehensible as it may seem, unreason triumphed over reason ... The fetus that died in obstetric violence was silent. The woman who died in a caesarean was also silent.” This early critique challenges contemporary medical discourse that attempts to discredit the term when applied to abusive obstetric practices.
The 1970s and 1980s marked a turning point with growing criticism of birth medicalisation and technification. From within obstetrics itself, alternative proposals emerged with figures like Michel Odent and Frederik Leboyer questioning the techno-medicalised birth model. Concurrently, feminist voices like Adrienne Rich in Of Woman Born addressed abuses and over-medicalisation in childbirth, questioning practices that remain controversial today.
The WHO made its first contributions to the topic in the mid-1980s with the Fortaleza Declaration, establishing recommendations for birth technology while framing the issue from a rights perspective. By 2014, the WHO adopted new terminology such as “disrespect” or “mistreatment in childbirth”, though still linked to quality of maternal and neonatal care rather than gender violence.
Latin American Feminisms and Their Influence
The third historical period, from the early 21st century to the present, is characterised by the significant influence of Latin American feminist movements on the conceptualisation of obstetric violence. The feminist movements that emerged in Latin America and the Caribbean during the “second wave” (from the 1970s onwards) incorporated the term “violence” into the feminist agenda of the 1980s. They expanded beyond suffragist movements to include new demands such as reproductive rights, free choice regarding motherhood and sexuality, and addressing violence against women of all classes, races, and ages.
While early use of “obstetric violence” referred to specific harmful practices in obstetric care, the recent feminist approach introduces an epistemic shift allowing for a structural and political reading of the phenomenon, positioning it as a gender violence issue affecting women and sexual dissidents.
Moving beyond approaches that framed these problems merely as issues of healthcare quality (as promoted by the WHO), feminist scholars advanced a perspective that reinterprets the abuses experienced by women during pregnancy, childbirth, and the postpartum period as violations of their reproductive rights. This political positioning subsequently influenced legislative policy in several Latin American countries, within the framework of comprehensive Gender Violence Laws, recognising obstetric violence as a form of gender-based violence.
The Uruguayan Experience
The use of the term “obstetric violence” in Uruguay has a more recent history linked to feminism but was preceded by activist groups focused on the humanisation and de-medicalisation of childbirth. A significant milestone was the creation of the Latin American and Caribbean Network for the Humanisation of Childbirth (Relacahupan) in 2000, which began activities in Uruguay in 2002 with a workshop on the Humanisation of Childbirth and Birth, sponsored by the municipal government of Montevideo.
These groups played a foundational role in framing women’s rights during pregnancy and childbirth as part of sexual and reproductive rights, significantly impacting the legislative recognition of humanised childbirth. However, documents from this period, such as those produced by Relacahupan, did not yet employ the concept of obstetric violence.
The interaction of these movements with political actors and the insertion of some of their members into state health institutions contributed to the implementation of the first laws establishing rights in childbirth in Uruguay. A notable example is Law 17.386, approved in 2001, guaranteeing accompaniment for women during pre-labour, labour, and birth.
According to Gilda Vera, a midwife and activist related to the movement for the humanisation of childbirth in Uruguay, the bill was proposed by former socialist Senator Mónica Xavier, coinciding with the formation of Relacahupan. The implementation of this law faced resistance from medical professionals, requiring persistent advocacy efforts and political support, particularly during the first Frente Amplio government when the Health, Women and Gender Programme was established under feminist Dr Cristina Grela.
Current Perspectives
The relationship between feminism and the movement for the humanisation of childbirth has many points of contact regarding the construction of the concept of “obstetric violence”, even though this relationship is not free from tensions. The concept of “obstetric violence”, so steeped in Latin American feminisms, continues to evolve.
Jeréz observes a shift in how we understand who can be subjected to obstetric violence, highlighting the 2022 National Campaign against Gyneco-Obstetric Violence in Argentina, which explicitly included in its demands the experiences of people capable of gestation who do not identify as cisgender women. While this position has been shared by various activist groups for some years, such as the Uruguayan feminist collective Gestar Derechos, it is not without tensions both in Argentina and other countries, with Spain being a paradigmatic case where several relevant voices resist the inclusion of other gender expressions.
It is also necessary to point out that the current concept of “obstetric violence” has been shifting towards other more comprehensive concepts that we understand are preferable, such as “gyneco-obstetric violence” or “violence in sexual, reproductive and non-reproductive processes”, as they allow for an account of the multiple forms of violence that take place in sexual and reproductive healthcare spaces. While the analytical category initially dealt only with pregnancy and childbirth, it now also addresses violence in the context of gynaecological consultations, assisted reproduction processes, gestational and perinatal death, voluntary termination of pregnancy, puerperium, neonatal care, and more.
The text published here is based on a chapter from the author’s master’s thesis, titled “Incorporation of Obstetric Violence into Uruguay’s Legislative Agenda: Processes, Perspectives, and Discourses”, presented this year as the culmination of her master’s degree in Public Policy and Feminisms at the University of José C. Paz (UNPAZ - Buenos Aires).
Romina Gallardo Duarte, Assistant Professor, University of the Republic and member of the Law and Human Rights Working Group, International Platform on Obstetric Violence.
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