The Concepts of Medical Misogyny, Obstetric Violence and DA in Childbirth

 

The concepts of medical misogyny, obstetric violence and disrespect and abuse (DA) in Childbirth overlap, but they are not the same concept. This article takes the concepts in turn. 

Medical misogyny is the widest concept. It refers to gendered bias in medicine: women’s pain, symptoms, reproductive experiences, and embodied knowledge are dismissed, normalised, under-researched, or treated as less credible than biomedical or professional authority.

It is not limited to childbirth. It can appear in endometriosis, menstruation, menopause, chronic pain, autoimmune disease, heart disease, contraception, gynaecological procedures, and maternity care. The UK Women and Equalities Committee, for example, described women’s reproductive symptoms being normalised and pain dismissed, linking this to “medical misogyny” and racism in healthcare.  

So medical misogyny is a structural diagnosis of medicine itself: it asks why women are so often not believed, not prioritised, or not treated as authoritative knowers of their own bodies.

2. Disrespect and abuse in childbirth

Disrespect and abuse in childbirth is narrower. It focuses on how women and birthing people are treated during facility-based childbirth.

This language is often used in global health and human rights literature. It includes things like verbal abuse, humiliation, physical abuse, non-consented procedures, lack of privacy, denial of pain relief, neglect, abandonment, discrimination, and detention in facilities. WHO frames disrespectful and abusive treatment during childbirth as a violation of the right to respectful care and as a threat to rights such as life, health, bodily integrity, and freedom from discrimination.  

Bohren et al.’s influential typology uses the broader term mistreatment and classifies mistreatment during childbirth into domains including physical abuse, sexual abuse, verbal abuse, stigma and discrimination, failure to meet professional standards, poor rapport between women and providers, and health-system constraints.  

So this concept is often operational and measurable. It helps researchers, policymakers, and health systems identify what went wrong and design respectful maternity care interventions.

3. Obstetric violence

Obstetric violence is more politically and legally charged. It does not merely say “care was disrespectful” or “quality was poor.” It names the harm as a form of violence, often linked to gender inequality, reproductive control, medicalisation, and loss of autonomy.

The term is especially associated with Latin American feminist and legal movements. The Organization of American States’ materials define obstetric violence around the appropriation of women’s bodies and reproductive processes by health personnel, expressed through dehumanising treatment and abusive medicalisation/pathologisation, leading to loss of autonomy and decision-making capacity.  

That means obstetric violence is not just about bad manners or individual cruelty. It is about how birth can become an institutional process in which the woman’s body is controlled, accelerated, cut, restrained, ignored, or over-medicalised without meaningful consent.

There is debate about how broad the concept should be. Some scholars argue that “obstetric violence” is powerful because it names harms that had been normalised; others warn that if it becomes too broad, it can become difficult to operationalise in law or policy.  

Harm in Childbirth 

Dr Katrine Nohr does not simply offer another label for the harm. She is asking why the human rights-based approach can fail in practice.

Her point is that childbirth is a very difficult place to act as an empowered rights-holder. During labour, the woman is physically vulnerable, dependent on clinicians, concerned for the baby, and embedded in a biomedical setting where doctors, midwives, risk protocols, fetal monitoring, medical records, and professional judgement carry more authority than her own embodied knowledge.

Dr Katrine Nohr’s thesis found that many mothers used a pragmatic rather than explicitly rights-based approach during childbirth, partly because of the mother–infant relationship and the immediate need to secure care. After childbirth, even when women did try to use complaints, legal claims, or accountability mechanisms, many felt re-traumatised rather than empowered because the same biomedical knowledge/power hierarchy was reproduced.  

Dr Katrine Nohr shows that women’s complaints could be dismissed as “subjective” or “emotional,” while professional or biomedical knowledge was treated as more authoritative. She describes the “authoritative knowledge” hierarchy as operating not only during childbirth but also afterwards in accountability mechanisms, with healthcare providers’ knowledge positioned above mothers’ accounts.  

In court or formal hearings, the problem can become even sharper: the mother may have to prove injury, fault, causation, and credibility while being cross-examined, often after trauma, bereavement, or infant injury. Nohr reports that mothers who went through complaints procedures or court could feel re-traumatised and give up rather than gain empowerment or justice.  

How they fit together

A non-consented vaginal examination, forced intervention, or ignored request for help could be described in all four ways, but each term highlights something different.

It is medical misogyny if the woman’s pain or testimony is dismissed because women are treated as unreliable or overreacting. It is disrespect and abuse if the conduct violates standards of dignified, respectful maternity care. It is obstetric violence if the focus is on gendered domination, coercion, medicalisation, and loss of reproductive autonomy. And it illustrates Nohr’s argument if the woman cannot effectively assert her rights during birth, and later finds that complaints or courts privilege biomedical authority over her lived account.

Dr Katrine Nohr shows that childbirth and court/accountability processes can both reproduce a hierarchy in which biomedical knowledge is treated as objective and authoritative, while women’s embodied knowledge is treated as subjective, emotional, or legally weak. The result is that a human rights approach premised on empowerment and rights-claiming may underestimate how deeply power shapes both the original clinical encounter and the later search for justice.

Historical overview: the human rights-based approach to maternal mortality up to 2026

Historical overview: the human rights-based approach to maternal mortality up to 2026

The human rights-based approach to maternal mortality developed through a gradual doctrinal shift: maternal death moved from being treated as a tragic health outcome, to a preventable development failure, and finally to a matter of legal obligation, discrimination, dignity, accountability, and remedy. By 2026, UN doctrine no longer treats maternal mortality as a narrow clinical problem. It treats preventable maternal mortality and morbidity as evidence of deeper failures in health systems, gender equality, sexual and reproductive health and rights, social protection, data systems, and accountability.

1. Pre-doctrinal foundations: women’s health as equality and non-discrimination

The legal foundation existed before maternal mortality was explicitly named as a human rights issue. The right to health under the ICESCR and CEDAW’s guarantee of non-discriminatory access to health care provided the doctrinal basis on which later maternal mortality work would build. CEDAW General Recommendation No. 24, adopted in 1999, was especially important because it clarified that states must eliminate discrimination against women in health care “throughout the life cycle,” particularly in family planning, pregnancy, confinement, and the post-natal period.  

At this stage, however, maternal mortality was not yet fully articulated as a distinct human rights problem. The dominant framing was still reproductive health, women’s health, access to services, and non-discrimination, rather than a dedicated doctrine of preventable maternal mortality and morbidity as a human rights violation.

2. The global health precursor: Safe Motherhood and the idea of preventability

The Safe Motherhood Initiative, launched in Nairobi in 1987 by major international health and development actors, was the major precursor. It did not yet formulate maternal mortality primarily as a human rights issue, but it helped establish a crucial premise: maternal death was not natural, inevitable, or merely private tragedy. It was preventable and required public action. Nohr’s thesis describes this as the moment when maternal mortality was cemented as “not ‘natural,’ but instead represented avoidable loss of life,” creating an ethical obligation for governments and the international community.  

The 1994 International Conference on Population and Development in Cairo then placed reproductive health and rights, women’s empowerment, and gender equality at the centre of population and development policy. UNFPA describes the ICPD Programme of Action as remarkable precisely because it recognized reproductive health and rights, women’s empowerment, and gender equality as cornerstones of population and development programmes.   The Beijing Platform for Action in 1995 further consolidated the view that women’s health, autonomy, and equality were central to human development and human rights.

3. The MDG period: measurement, skilled attendance, and technocratic limits

The Millennium Development Goals gave maternal mortality unprecedented visibility. MDG 5 called for improving maternal health, including reducing the maternal mortality ratio and increasing skilled attendance at birth. This helped push maternal mortality to the top of the international development agenda, but it also narrowed attention to measurable indicators, especially maternal mortality ratios and skilled birth attendance. Nohr’s thesis notes that MDG 5’s emphasis on measurable targets helped elevate maternal mortality globally, but also produced a technocratic focus that often ignored empowerment, dignity, and human rights violations in childbirth.  

This period is therefore best understood as transitional. Maternal mortality had become a major development priority, but the dominant frame remained aggregate reduction, not yet rights-based accountability. The problem was often framed as insufficient skilled birth attendance, weak referral systems, lack of emergency obstetric care, and poverty, rather than as a failure of states to respect, protect, and fulfil women’s rights.

4. The decisive UN doctrinal turn: Human Rights Council resolution 11/8 in 2009

The decisive doctrinal shift occurred in 2009, when the Human Rights Council adopted resolution 11/8 on Preventable maternal mortality and morbidity and human rights. This was the first major UN Human Rights Council resolution to frame preventable maternal mortality and morbidity explicitly as a human rights issue. The resolution linked maternal death and injury to rights to life, dignity, education, information, scientific progress, freedom from discrimination, and the highest attainable standard of physical and mental health, including sexual and reproductive health.  

This was a major conceptual move. The Council did not simply say that maternal health was important. It stated that preventable maternal mortality and morbidity implicated already-existing human rights obligations. In other words, maternal death was no longer just a failure of medicine or development policy; it could indicate a failure of law, governance, and equality.

5. The 2010 OHCHR report: maternal mortality as state responsibility

The 2010 OHCHR report, prepared pursuant to resolution 11/8, systematized the new doctrine. It identified the human rights dimensions of preventable maternal mortality and morbidity within the existing international legal framework and emphasized that maternal mortality could result from state action or omission. The report identified core principles of a human rights-based approach: accountability, participation, transparency, empowerment, sustainability, international assistance, and non-discrimination.  

Nohr’s thesis captures the importance of this moment: the report stated that states are obligated under international human rights law to respect, protect, and fulfil human rights in relation to pregnancy and childbirth, and that preventable maternal death implicates rights to health, equality, non-discrimination, information, education, and the benefits of scientific progress.  

The significance of the 2010 report was that it converted maternal mortality into a question of state obligations. It asked not only whether women died, but whether states had put in place non-discriminatory, accessible, affordable, acceptable, and good-quality systems of maternal health care, including emergency obstetric care and accountability mechanisms.

6. 2011: good practices and the Alyne decision

In 2011, OHCHR produced a report compiling good and effective practices in adopting a human rights-based approach to eliminating preventable maternal mortality and morbidity. This helped move the doctrine from legal recognition to implementation, asking what rights-based maternal health policy should look like in practice.  

The same year, the CEDAW Committee decided Alyne da Silva Pimentel Teixeira v. Brazil, a landmark case in which a preventable maternal death was treated as a violation of CEDAW. The Committee found that Alyne’s death was linked to failures to provide appropriate medical treatment and timely emergency obstetric care, and it recognized discrimination based not only on sex but also on African descent and socio-economic status.  

Alyne was doctrinally important because it clarified that states may be responsible for preventable maternal deaths even when care is delivered through private or outsourced health facilities. It also confirmed that maternal mortality is often intersectional: poor, racialized, rural, adolescent, disabled, migrant, Indigenous, or otherwise marginalized women face heightened risks because discrimination is built into the conditions under which they seek care.

7. 2012: the OHCHR Technical Guidance and the mature HRBA model

The 2012 OHCHR Technical Guidance on the application of a human rights-based approach to the implementation of policies and programmes to reduce preventable maternal mortality and morbidity is the central doctrinal document. It translated the 2009–2011 recognition into a policy framework. The guidance described women as rights-holders, states and health systems as duty-bearers, and maternal health policy as something that must be designed, implemented, monitored, and evaluated according to human rights standards.  

The Technical Guidance made accountability central. It required attention to monitoring, review, complaint mechanisms, maternal death reviews, remedies, participation, transparency, and non-discrimination. It also emphasized empowerment: women should be enabled to claim rights, not merely survive childbirth. Nohr’s thesis highlights this as a key policy premise of the human rights-based approach: the approach is not simply about avoiding maternal death or morbidity, but about empowering women to claim their rights.  

Doctrinally, this was the point at which the UN approach became fully recognizable as a human rights-based approach. It was no longer only about increasing facility births or skilled attendance. It was about availability, accessibility, acceptability, quality, dignity, informed consent, equality, participation, and accountability.

8. Respectful maternity care and the expansion from mortality to mistreatment

Around the same period, the respectful maternity care movement translated rights language into the childbirth setting. Bowser and Hill’s 2010 work on disrespect and abuse identified categories such as physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment, and detention in facilities. Nohr’s thesis presents this as a turning point in naming human rights violations in childbirth, not only maternal death.  

The White Ribbon Alliance’s 2011 Respectful Maternity Care Charter then anchored childbirth-specific rights in international human rights law, including freedom from harm and ill-treatment, informed consent, privacy, dignity, equality, freedom from discrimination, autonomy, and the right to health. Nohr’s thesis notes that this shifted attention beyond survival alone toward the wellbeing of the mother and infant during childbirth.  

WHO’s 2014 statement on disrespect and abuse during facility-based childbirth further consolidated this expansion. WHO stated that disrespectful and abusive treatment during childbirth violates women’s rights to respectful care and can threaten rights to life, health, bodily integrity, and freedom from discrimination.  

This was a crucial broadening: the human rights-based approach to maternal mortality became inseparable from the right to respectful, dignified, non-coercive, non-discriminatory childbirth care.

9. The SDG era: from MDG 5 to SDG 3.1 and SDG 3.7

In 2015, the Sustainable Development Goals replaced the MDGs. SDG target 3.1 calls for reducing the global maternal mortality ratio to less than 70 per 100,000 live births by 2030, while SDG target 3.7 addresses universal access to sexual and reproductive health-care services, including family planning, information, education, and integration of reproductive health into national strategies.  

The SDG era retained measurement but embedded maternal mortality within a wider rights-based and equality-oriented agenda. The Global Strategy for Women’s, Children’s and Adolescents’ Health 2016–2030 similarly aims to end preventable maternal, newborn, child, and adolescent deaths, while promoting wellbeing, accountability, and enabling environments under the “Survive, Thrive, Transform” framework.  

10. 2016–2020: consolidation through sexual and reproductive health rights

CESCR General Comment No. 22, adopted in 2016, strengthened the legal basis for the approach by clarifying that sexual and reproductive health is an integral part of the right to health under Article 12 of the ICESCR.   Together with General Comment No. 14 on the right to health, this provided a more developed legal structure for analysing maternal health services through availability, accessibility, acceptability, and quality.  

OHCHR then continued to monitor implementation through follow-up reports in 2014, 2016, 2018, 2019, 2020, and 2023. These reports examined how the 2012 Technical Guidance was being applied, including in humanitarian settings, and documented good practices and persistent challenges.  

During this period, the doctrine became more explicitly structural. It was not enough to provide emergency obstetric care in principle. States needed to address poverty, racism, disability discrimination, adolescent pregnancy, rural exclusion, harmful gender norms, unsafe abortion, user fees, weak referral systems, poor data, disrespectful care, and lack of remedies.

11. 2020–2023: COVID-19, backlash, and renewed Human Rights Council action

The post-2020 period exposed how fragile maternal health systems were during emergencies. COVID-19, conflict, austerity, debt, underfunding, misinformation, and anti-gender backlash all affected access to sexual and reproductive health services. The Human Rights Council’s 2023 resolution 54/16 urged states to eliminate preventable maternal mortality and morbidity, respect, protect, and fulfil sexual and reproductive health and reproductive rights, guarantee universal access to sexual and reproductive health services, and ensure availability, accessibility, acceptability, and quality of health information and services. It also requested OHCHR to prepare an updated technical guidance report for the Council’s sixtieth session.  

This marked a renewed doctrinal moment. The Council recognized that the 2012 guidance remained foundational but needed updating in light of new evidence, global crises, regression in sexual and reproductive health and rights, and persistent inequalities.

12. 2025–2026: updated doctrine and the move toward systemic, preventive accountability

The 2025 OHCHR update, A/HRC/60/43, is the latest major doctrinal statement as of 2026. It says the 2012 guidance marked an important stride in understanding preventable maternal mortality and morbidity not only as a public health concern, but also as a human rights violation. It also states that current rates of maternal mortality should not be seen as inevitable, but as reflecting failures by states to ensure the full realization of women’s human rights, especially the sexual and reproductive health and rights of marginalized populations.  

The 2025 update is significant for four reasons. First, it strengthens the structural analysis: maternal mortality is linked to poverty, limited education, health emergencies, debt, austerity, unemployment, malnutrition, conflict, environmental degradation, discriminatory norms, and restrictions on women’s autonomy.   Second, it gives greater attention to intersectionality, including racial discrimination, disability, migration, HIV status, caste, poverty, rural residence, and adolescent pregnancy.   Third, it stresses transparent, disaggregated, human rights-based data systems, maternal death surveillance, privacy safeguards, and independent audits.   Fourth, it moves accountability beyond blame: litigation is important, but not sufficient; health workers should not bear the burden of institutional failures, and accountability should aim at systemic change.  

The global data gave this renewed doctrine urgency. WHO reported in 2025 that about 260,000 women died during or following pregnancy and childbirth in 2023, that a maternal death occurred almost every two minutes, and that the global maternal mortality ratio fell by about 40% between 2000 and 2023, although progress remains uneven and over 90% of deaths occurred in low- and lower-middle-income countries.  

In October 2025, the Human Rights Council adopted resolution 60/18 on preventable maternal mortality and morbidity and human rights without a vote. The Council requested OHCHR to facilitate inclusive consultations on implementation of the 2025 update and to compile best practices for a later report to the Council.   As of May 2026, this 2025 update and resolution 60/18 represent the most recent major UN doctrinal consolidation of the human rights-based approach to maternal mortality.

State of the doctrine by 2026

By 2026, the human rights-based approach to maternal mortality can be summarized in six propositions.

First, preventable maternal mortality and morbidity are not inevitable. They are evidence of remediable failures in law, policy, health systems, equality, and accountability.  

Second, states have duties to respect, protect, and fulfil rights related to maternal health, including the rights to life, health, equality, non-discrimination, dignity, information, privacy, bodily autonomy, scientific progress, participation, and remedy.  

Third, maternal health services must be available, accessible, acceptable, and of good quality, and must include the full continuum of sexual and reproductive health care, emergency obstetric care, referral systems, contraception, antenatal care, skilled care, postnatal care, and respectful childbirth care.  

Fourth, the approach is structural and intersectional. It requires action on poverty, racism, disability discrimination, rural exclusion, adolescent pregnancy, migration status, harmful gender norms, unsafe abortion, user fees, weak public health systems, poor data, and lack of accountability.  

Fifth, accountability must be preventive as well as remedial. Complaints, courts, litigation, public inquiries, and human rights monitoring remain necessary, but the 2025 update emphasizes systemic change, independent oversight, transparent data, community accountability, professional regulation, and institutional accountability.  

Sixth, the doctrine now reaches beyond survival to dignity and respectful care. Maternal mortality doctrine and respectful maternity care doctrine have converged: a rights-based maternal health system must not only keep women alive, but ensure that care is non-discriminatory, informed, respectful, confidential, non-coercive, and responsive to women’s needs.  

Nohr’s recent work identifies an important tension in this doctrine. UN bodies have transformed preventable maternal mortality, morbidity, and mistreatment in childbirth from clinical misfortune into matters of legal obligation, but rights-based accountability still often assumes that an informed and empowered woman can identify violations and activate complaint or redress mechanisms. Her ethnographic work argues that childbirth is embodied, time-pressured, institutionally dependent, and relational, so women’s agency may be constrained, redirected, or made unsafe to exercise in legally recognizable ways.   This critique does not weaken the human rights-based approach; it strengthens it by showing why states must build preventive, structural, and institutionally supported accountability before, during, and after childbirth, rather than relying mainly on individual women to complain after harm has occurred.  

Chapter-ready synthesis

The human rights-based approach to maternal mortality emerged from the convergence of global maternal health, reproductive rights, women’s equality, and right-to-health doctrine. The Safe Motherhood Initiative first established maternal death as preventable rather than natural. The MDGs made maternal mortality measurable and politically visible, but their technocratic focus on indicators and skilled attendance did not adequately address dignity, discrimination, or accountability. The decisive UN doctrinal shift began with Human Rights Council resolution 11/8 in 2009, followed by the 2010 OHCHR report, the 2011 good practices report, the CEDAW Committee’s decision in Alyne v. Brazil, and the 2012 OHCHR Technical Guidance. Together, these instruments reframed preventable maternal mortality and morbidity as failures of state obligation, equality, non-discrimination, health-system governance, and access to remedy. From 2014 onward, WHO and respectful maternity care initiatives expanded the frame to include mistreatment, coercion, abandonment, non-consented care, and loss of dignity in childbirth. In the SDG era, and especially in the 2025 OHCHR update, the doctrine became more structural, intersectional, and preventive. By 2026, the central proposition of UN doctrine is that maternal survival is a matter of justice, not only health care, and that eliminating preventable maternal mortality requires systemic human rights-based reform of law, policy, health systems, data, participation, accountability, and social determinants.

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