Friday, 17 May 2024

Historical overview of medical misogyny

Medical misogyny is the long-standing tendency within medicine to treat women’s bodies, pain, testimony, sexuality, and reproductive lives as less credible, less autonomous, or less worthy of serious study. It is not just individual sexist behaviour by doctors; historically, it has been built into medical theories, institutions, research practices, childbirth systems, and legal regulation.

A useful thesis is:

Medical misogyny developed through the repeated medicalisation of women’s bodies as unstable, reproductive, emotional, and unreliable, while male bodies and male expertise were treated as the norm.

1. Ancient roots: the womb as explanation

One of the oldest forms of medical misogyny was the idea that women’s health was governed by the womb. The very word hysteria comes from the Greek hystera, meaning womb, and ancient and later medical traditions often explained women’s physical or emotional distress through reproductive anatomy. The Royal College of Nursing notes that the linguistic connection between gynaecology, hysteria, and the womb reflects a long history in which women’s health was treated as mysterious, dirty, or abnormal.  

This matters because it created a durable medical habit: when women reported symptoms, those symptoms could be interpreted as the product of femininity itself rather than as evidence of disease, pain, trauma, or social harm. Hysteria became one of the classic examples of this pattern: a broad diagnostic category through which women’s suffering, anger, sexuality, or nonconformity could be pathologised.  

2. Early medicine: the male body as norm

For much of Western medical history, women were often understood as biologically derivative, weaker, colder, more passive, or more governed by reproductive function. The problem was not simply that medicine lacked knowledge; it was that medical knowledge was organised through gender hierarchy. The “normal” body was implicitly male, while the female body was often treated as a reproductive variation, a problem, or a risk.

This is the deep background to modern complaints that women are still told their pain is “normal,” hormonal, emotional, or psychological. The older language has changed, but the epistemic structure often remains: men’s symptoms are more readily read as clinical evidence, while women’s symptoms are more easily read as exaggeration, anxiety, or bodily instability.

3. Childbirth and the rise of male obstetric authority

Childbirth is central to the history of medical misogyny. Birth had long been managed largely by women, midwives, kin networks, and local forms of knowledge. From the eighteenth century, however, male physicians and surgeons increasingly entered childbirth as “man-midwives.” The Royal College of Surgeons of Edinburgh describes the eighteenth century as the period in which surgeons and physicians attempted to medicalise pregnancy and childbirth, with men entering the field in growing numbers from around 1730. It also notes that women’s exclusion from medical schools gave men leverage to undermine female authority in the birthing chamber.  

This did not mean that obstetrics was simply bad: instruments, anatomy, and surgical knowledge sometimes saved lives. But it did mean that childbirth increasingly became a site where women’s embodied knowledge could be displaced by professional male expertise. The birthing woman became more easily treated as a patient-object within a hierarchy rather than as an active subject.

This is very relevant to your point about Nohr: childbirth is difficult for rights-claiming because the biomedical hierarchy is already historically structured to privilege professional knowledge over women’s lived experience.

4. Nineteenth-century gynaecology: experimentation, race, and pain

The nineteenth century is one of the clearest periods in which medical misogyny and racism intersected. Modern gynaecology developed partly through the treatment and experimentation of poor, enslaved, and otherwise powerless women. Deirdre Cooper Owens’s Medical Bondage argues that nineteenth-century American gynaecologists advanced medicine while also creating racialised and gendered myths, including the idea that Black enslaved women could withstand more pain than white women.  

This is crucial because medical misogyny was never experienced equally by all women. Black women, enslaved women, Indigenous women, poor women, disabled women, and immigrant women were often treated not merely as irrational or fragile, but as exploitable, hyper-reproductive, sexually suspect, or biologically different in ways that justified harsher treatment. Cooper Owens’s work shows how race, gender, class, and medical authority were built together in the origins of American gynaecology.  

5. Women excluded from medical authority

Medical misogyny was also institutional: women were not only misrepresented as patients; they were excluded as producers of medical knowledge. Elizabeth Blackwell’s career illustrates this. She was rejected by numerous medical colleges before being admitted to Geneva Medical College in New York in 1847, and in 1849 she became the first woman to receive an M.D. from an American medical school. The University of Bristol notes that she later became the first woman entered on the British General Medical Council’s medical register in 1859.  

This exclusion mattered because it shaped what counted as medical evidence. If women were largely absent from medical education, research leadership, professional bodies, and hospital authority, then women’s own accounts of menstruation, childbirth, menopause, pain, sexuality, and reproductive harm were easier to dismiss.

6. Early twentieth century: hospital birth and loss of autonomy

In the early twentieth century, childbirth became increasingly hospital-based in many settings. One striking example is twilight sleep, a method developed in Germany in 1906 using scopolamine and morphine. It aimed to relieve the pain of childbirth, but it also produced amnesia: women could wake with no memory of the birth. The Embryo Project notes that twilight sleep contributed to the shift from home birth to hospital birth and increased the use of obstetric anaesthesia.  

The point is not that pain relief is misogynistic. The point is that pain relief was often embedded in a paternalistic model: doctors decided, women were sedated, and birth became something done to the woman rather than with her. This is part of the longer history behind contemporary concerns about consent, coercion, episiotomy, forceps, caesarean section, and obstetric violence.

7. Eugenics and reproductive control

Medical misogyny also took the form of controlling who was allowed to reproduce. In the late nineteenth and twentieth centuries, eugenics movements labelled many people “unfit,” including disabled people, poor people, ethnic and religious minorities, and others. The National Human Genome Research Institute explains that eugenics spread from England to the United States and other countries, and that the American movement focused heavily on sterilising those labelled “feebleminded.”  

The 1927 U.S. Supreme Court case Buck v. Bell upheld the compulsory sterilisation of Carrie Buck, a young woman labelled “feebleminded” after she had been raped and institutionalised. This shows how misogyny, classism, ableism, and state power converged: reproductive capacity was treated as something the state and medical authorities could manage, restrict, or remove.  

8. Research exclusion: women left out of evidence

A more modern form of medical misogyny is the exclusion of women from clinical research. In 1977, the U.S. Food and Drug Administration recommended excluding women of childbearing potential from early-phase drug trials, even where women used contraception or were unlikely to become pregnant. The NIH Office of Research on Women’s Health states that this policy contributed to a shortage of data on how drugs affect women.  

This is a subtle but powerful form of misogyny: women were excluded “for protection,” but the result was that medicine knew less about women’s bodies, drug responses, symptoms, and risks. The male body again became the default evidence base.

9. Contemporary residues: pain, disbelief, and childbirth mistreatment

Medical misogyny is now often discussed through epistemic injustice: women are not believed as reliable knowers of their own bodies. This is visible in delayed diagnosis of endometriosis, adenomyosis, autoimmune disease, chronic pain, heart disease, and reproductive health conditions.

In the UK, the Women and Equalities Committee warned in 2024 that women with painful reproductive health conditions are often having symptoms normalised and pain dismissed, with “medical misogyny” contributing to poor awareness, lack of research, limited treatment options, and de-prioritised gynaecological care.  

In childbirth, the World Health Organization has framed disrespect and abuse during facility-based childbirth as a violation of women’s rights to respectful care and a threat to rights including life, health, bodily integrity, and freedom from discrimination.   The CDC similarly reported in 2023 that about one in five women surveyed in the United States reported mistreatment during maternity care, with higher reported rates among Black, Hispanic, and multiracial women.  

The overall pattern

Across history, medical misogyny repeatedly appears in four forms:

  1. Pathologisation — women’s normal bodily processes, pain, sexuality, anger, or distress are treated as disease or instability.
  2. Disbelief — women’s testimony is treated as emotional, exaggerated, or unreliable.
  3. Control — women’s reproductive capacity is managed by doctors, states, courts, husbands, hospitals, or public policy.
  4. Exclusion — women are excluded from medical education, research, professional authority, and evidence-making.

So, historically, medical misogyny is not simply “medicine got women wrong.” It is more structural:

Medicine often produced women as objects of knowledge while denying them authority as subjects of knowledge.

Human rights approaches imagine women as rights-holders who can speak, claim, and challenge power. But the history of medical misogyny shows why that is difficult: the clinical setting has long been organised to make women’s embodied knowledge appear less authoritative than biomedical expertise.

Tuesday, 30 April 2024

Childbirth as Anchored in International Human Rights Law


1. The core UN human rights treaties relevant to childbirth

ICESCR — right to health

The International Covenant on Economic, Social and Cultural Rights, especially Article 12, is central. It protects the right to the highest attainable standard of physical and mental health. In childbirth, this covers access to available, accessible, acceptable and good-quality maternity care: skilled staff, emergency obstetric care, referral systems, blood, medicines, safe surgery, respectful treatment, pain relief, informed consent and non-discriminatory access. CESCR General Comment No. 14 sets out the AAAQ framework, while General Comment No. 22 applies the right to sexual and reproductive health, including autonomy, informed consent, privacy, dignity and freedom from coercion.  

CEDAW — women’s equality and maternity care

The Convention on the Elimination of All Forms of Discrimination against Women is the most important equality treaty for childbirth. Article 12 requires states to eliminate discrimination in healthcare and ensure appropriate services in connection with pregnancy, confinement and the postnatal period. CEDAW General Recommendation No. 24 confirms that reproductive healthcare is a basic right and requires states to remove barriers to women’s access to healthcare.  

CEDAW is also important because childbirth mistreatment can be analysed as gender discrimination, especially where women’s pain, knowledge, consent or decision-making are dismissed because of stereotypes about maternity, obedience, female endurance or clinical authority.

ICCPR — life, bodily integrity, privacy and remedy

The International Covenant on Civil and Political Rights is relevant through several rights:

Article 6 — right to life
Preventable maternal death can engage the right to life, especially where the state fails to ensure timely emergency obstetric care, referral, staffing, blood, medication, monitoring or investigation.

Article 7 — freedom from torture or cruel, inhuman or degrading treatment
Severe coercion, humiliation, non-consensual interventions, denial of pain relief, forced procedures, or abusive treatment in reproductive healthcare may engage this protection, especially where the woman is powerless, dependent or discriminated against.

Article 17 — privacy and bodily integrity
Childbirth care involves intimate bodily exposure and medical intervention. Non-consensual vaginal examinations, episiotomy, caesarean section, forced positioning, unnecessary exposure or disclosure of confidential information may engage privacy and bodily integrity.

Article 2(3) — effective remedy
States must ensure effective remedies when rights are violated. In childbirth, this means accessible complaints, investigation, explanation, compensation where appropriate, non-repetition guarantees and systems that do not re-traumatise women.

CAT — torture and ill-treatment

The Convention against Torture may be relevant in extreme cases of coercive, abusive or degrading reproductive healthcare. The UN Special Rapporteur on torture has recognised that abuses in healthcare settings, including reproductive health settings, may amount to cruel, inhuman or degrading treatment where discrimination, lack of consent, severe suffering and powerlessness are present.  

CERD — racial discrimination in maternity care

The Convention on the Elimination of Racial Discrimination is relevant where childbirth care is shaped by racism, ethnic discrimination, language exclusion, migrant status, caste, indigeneity or racialised assumptions about pain, compliance, fertility or motherhood. It is especially important in relation to maternal mortality disparities and obstetric racism.

CRPD — disability rights in pregnancy and childbirth

The Convention on the Rights of Persons with Disabilities applies where disabled women face coercive reproductive healthcare, inaccessible facilities, lack of reasonable accommodation, communication barriers, substituted decision-making, forced sterilisation, or discriminatory assumptions about motherhood.

CRC — newborns and the mother–infant dyad

The Convention on the Rights of the Child is relevant to the newborn’s right to life, survival, development, identity, health, breastfeeding support and family life. In childbirth analysis, it must be used carefully: it should not erase the mother’s legal personhood or justify overriding her autonomy, but it is relevant to state duties around neonatal care and the mother–infant dyad.

ICRMW — migrant women

The Convention on Migrant Workers is relevant where migrant women face exclusion from maternity care, charging regimes, fear of immigration enforcement, language barriers, detention, lack of documentation or inability to complain safely.


2. The key UN guidance on maternal mortality and morbidity

Human Rights Council resolutions

The Human Rights Council has repeatedly recognised preventable maternal mortality and morbidity as a human rights issue, not merely a public-health concern. Your article already anchors this through HRC Resolution 11/8 and subsequent OHCHR reports.  

OHCHR Technical Guidance 2012

The 2012 OHCHR Technical Guidance is foundational. It frames maternal mortality and morbidity through a human rights-based approach built around:

  • accountability
  • participation
  • transparency
  • empowerment
  • non-discrimination
  • sustainability
  • international assistance
  • availability, accessibility, acceptability and quality of services

It also states that a human rights-based approach is premised on empowering women to claim their rights, which is exactly the assumption your article critiques and refines.  

OHCHR 2025 update

The 2025 OHCHR update confirms the continued relevance of the human rights-based approach to eliminating preventable maternal mortality and morbidity. It emphasises legal and policy frameworks, accountability, and the complex socioeconomic, cultural and political factors that put women’s and girls’ lives at risk.  

This is especially useful for your article because it supports your argument that accountability must be structural and preventive, not only complaint-based.


3. The key UN treaty-body case law

Alyne da Silva Pimentel Teixeira v Brazil

This is the landmark CEDAW case on maternal mortality. Alyne, an Afro-Brazilian woman, died after failures in pregnancy-related emergency care. The CEDAW Committee found violations of CEDAW, including Articles 2 and 12, and emphasised state responsibility for poor-quality maternal healthcare, discrimination and failure to regulate private healthcare providers.  

Its importance:

  • first UN treaty-body decision on preventable maternal death
  • confirms maternal mortality as a rights violation
  • links poor maternity care to discrimination
  • confirms state responsibility for private providers
  • supports duties of regulation, monitoring, remedy and non-repetition

For your article, Alyne is also useful because it shows the limits of after-the-fact accountability: the claim only succeeded after death, through family and legal advocacy.

S.F.M. v Spain

This CEDAW case concerned obstetric violence during childbirth. The author alleged violations under CEDAW Articles 2, 3, 5 and 12, including non-consensual interventions, forced positioning, instrumental extraction, episiotomy without information or consent, separation from the newborn, and reliance on stereotypes about maternity and childbirth.  

Its importance:

  • recognises obstetric violence as a CEDAW issue
  • links childbirth mistreatment to gender stereotypes
  • emphasises autonomy, consent, quality care and freedom from violence
  • shows that administrative and judicial proceedings can reproduce stereotypes

N.A.E. v Spain

The CEDAW Committee also found Spain responsible in another obstetric violence case and urged respect for women’s autonomy, complete information at every stage of childbirth, and free, prior and informed consent for invasive treatment during childbirth.  

This is especially relevant to your Montgomery / informed consent / paternalism discussion.


4. Special Procedures and obstetric violence

Special Rapporteur on Violence against Women

The 2019 report on mistreatment and violence against women in reproductive health services, with a focus on childbirth and obstetric violence, is one of the most directly relevant UN documents. It frames mistreatment in childbirth as a human rights concern and addresses non-consensual interventions, abuse, coercion, humiliation, discriminatory care and the need for accountability.  

Special Rapporteur on Torture

The Special Rapporteur on torture has recognised that abuse in healthcare settings, including reproductive healthcare, can amount to cruel, inhuman or degrading treatment in severe cases. This is relevant to forced or coerced interventions, denial of pain relief, forced sterilisation, detention in facilities, abusive treatment, and non-consensual reproductive healthcare.  


5. WHO and respectful maternity care standards

Although WHO documents are not treaties, they are highly influential in interpreting what acceptable and good-quality maternity care requires. The WHO statement on the prevention and elimination of disrespect and abuse during facility-based childbirth recognises mistreatment during childbirth as a global problem and calls for dignity, privacy, confidentiality, informed choice, continuous support, and freedom from mistreatment.

Relevant recognised forms of mistreatment include:

  • physical abuse
  • verbal abuse
  • stigma and discrimination
  • non-consented care
  • non-confidential care
  • abandonment or neglect
  • detention in facilities
  • denial of pain relief
  • lack of privacy
  • unnecessary separation of mother and infant

6. Key rights engaged in childbirth

Right to life

Engaged by preventable maternal death, stillbirth, neonatal death, delayed emergency care, failures of referral, lack of blood, lack of surgical capacity, sepsis, haemorrhage, eclampsia and unsafe systems.

Right to health

Covers timely, acceptable, respectful, good-quality maternal healthcare. Survival alone is not enough; care must also respect dignity, autonomy, privacy and non-discrimination.

Right to equality and non-discrimination

Engaged where women are mistreated because they are women, pregnant, poor, young, unmarried, Black, Indigenous, migrant, disabled, rural, HIV-positive, non-dominant language speakers, or otherwise marginalised.

Right to dignity

Not always a free-standing treaty right, but central across human rights law. Humiliation, shouting, insults, forced exposure, abandonment, coercion and degrading treatment in childbirth violate dignity.

Right to bodily integrity

Engaged by non-consensual vaginal examinations, episiotomy, caesarean section, induction, instrumental delivery, forced positioning, suturing without anaesthesia, or other invasive treatment.

Right to informed consent and refusal

A woman must be given information about material risks, benefits and reasonable alternatives. Consent must be free, prior and informed. This includes the right to refuse treatment, subject only to narrow emergency exceptions.

Right to privacy and confidentiality

Relevant to bodily exposure, intimate examinations, presence of students, disclosure of HIV status, disclosure of medical records, and lack of curtains or private space.

Freedom from torture, cruel, inhuman or degrading treatment

Engaged in severe cases of coercion, humiliation, forced procedures, abuse, detention, deliberate denial of pain relief, or reproductive violence.

Right to information

Women need accessible information about pregnancy, childbirth options, interventions, risks, referral, pain relief, complaint mechanisms and postnatal care.

Right to participation

Participation means more than policy consultation. In childbirth it includes the ability to ask questions, be heard, have a companion, receive interpretation, request escalation, refuse non-urgent interventions and participate in decisions.

Right to effective remedy

Requires accessible complaint mechanisms, investigation, explanation, apology where appropriate, compensation, rehabilitation, and guarantees of non-repetition.

Right to benefit from scientific progress

Relevant to access to evidence-based maternity care, emergency obstetric care, safe caesarean section, blood transfusion, antibiotics, anaesthesia, neonatal resuscitation and updated clinical standards.


7. State obligations in childbirth

International human rights law creates three classic duties:

Respect

The state and public providers must not interfere with women’s rights. This includes not coercing treatment, not performing non-consensual interventions, not abusing or humiliating women, and not denying privacy.

Protect

The state must regulate third parties, including private hospitals, clinics, insurance systems, professional bodies and individual providers. Alyne is important here because CEDAW confirmed state responsibility for failures in private maternal healthcare.  

Fulfil

The state must organise systems so that rights are practically real. This includes staffing, training, emergency referral, transport, medicines, blood, accessible facilities, respectful care policies, monitoring, data collection, complaints systems and remedies.