A useful way to frame the issue is that exclusion does not always mean that women are literally absent from the clinic or courtroom. More often, women are present but not fully heard. Their embodied knowledge, emotional accounts, and experiences of coercion, fear, humiliation, abandonment, or disrespect may be discounted because they do not fit the dominant forms of knowledge used by medicine or law.
1. Clinical power: whose knowledge counts in childbirth?
Medical anthropology has long shown that childbirth is not simply a biological event; it is also a site where knowledge, authority, gender, technology, and institutional power are organised. Brigitte Jordan’s concept of authoritative knowledge is central here. Jordan argued that, in any childbirth setting, multiple knowledge systems may coexist, but only some are treated as the knowledge on which decisions are made. In biomedical childbirth, clinical assessment, monitors, charts, guidelines, examinations, and professional judgement often become the knowledge that “counts,” while women’s embodied knowledge may be treated as secondary.
This helps explain why women may say “something is wrong,” “I need help,” or “I can feel the baby coming,” yet still be ignored until clinical evidence confirms what they already sensed. Nohr’s recent article develops this point through comparative ethnography in Tanzania and the United Kingdom, arguing that childbirth is organised less by a simple opposition between local and biomedical knowledge than by struggles over which forms of knowledge are allowed to count in clinical encounters and in the complaint mechanisms that follow birth. In that work, women’s embodied sensations, prior birth experience, kin advice, peer narratives, and biomedical information all shaped how they understood birth, but not all of these forms of knowledge could become institutionally consequential.
Foucault’s account of the medical gaze is also useful because it shows how clinical medicine can turn the patient into an object of observation and intervention. In childbirth, this objectification can be intensified: the woman is not only a patient but also the embodied site through which fetal wellbeing, institutional risk, and professional responsibility are managed. Davis-Floyd’s work on the technocratic model of birth similarly argues that biomedical childbirth can treat the female body as a machine and the clinician as manager or technician. Rhodes’s work on biomedicine as a cultural system helps here too: medicine is not a neutral space outside culture, but a system with its own values, hierarchies, rituals, and forms of authority.
Sargent and Bascope’s work on “ways of knowing” about birth adds another dimension. They show that childbirth knowledge is socially distributed: mothers, kin, midwives, doctors, technologies, and institutions all participate in defining what birth means and what should happen. The problem is not that women lack knowledge; it is that their knowledge may not carry institutional authority. Nohr’s thesis makes the same point in relation to childbirth rights-claiming: mothers often struggled to communicate knowledge of their own bodies or claim rights in biomedical settings because clinical knowledge was valued more highly than maternal embodied knowledge.
This hierarchy is not only epistemic; it is also relational. Bourdieu’s concepts of symbolic power, habitus, and institutional field help explain how clinical authority becomes embodied in professional language, uniforms, ward routines, titles, and documentation. Nimmon and Stenfors-Hayes apply this kind of analysis to medical encounters, showing how doctor-patient relationships remain asymmetrical even in supposedly patient-centred care. The patient depends on the clinician for access to diagnosis, treatment, pain relief, referral, and legitimacy. In childbirth, that dependency is sharpened by urgency and by the mother’s concern for the infant.
The literature on disrespect, abuse, and mistreatment in childbirth makes this exclusion concrete. Bowser and Hill identified categories such as physical abuse, non-consented care, non-confidential care, non-dignified care, discrimination, abandonment, and detention. Bohren and colleagues later developed a global typology of mistreatment in childbirth and explicitly linked neglect, abuse, and disrespect to potential human rights violations. Freedman and colleagues further argued that disrespect and abuse must be understood through the quality and accountability failures of health systems, not merely through isolated interpersonal misconduct.
Strong’s work on Tanzania shows how abusive or coercive practices may be rationalised as “fierce care” within settings marked by scarcity, understaffing, professional pressure, and bureaucratic demands. Nohr’s thesis draws on Strong and von Hollen to show how health workers may themselves be constrained by hierarchy while also exercising power over poorer, less educated, or socially marginalised mothers. Dána-Ain Davis’s concept of obstetric racism adds that credibility and care are also racialised: Black women’s reproductive experiences may be dismissed, stereotyped, or managed through racialised assumptions, even where they are educated, articulate, and medically knowledgeable.
Thus, clinical exclusion can occur through several overlapping mechanisms: women’s bodily knowledge is treated as less reliable than clinical knowledge; pain and fear are normalised; assertiveness may be read as non-compliance; women may fear retaliation or neglect; and race, class, age, disability, language, migration status, or poverty may shape whether a woman is believed.
2. Legal power: why courts and complaint mechanisms can also exclude women
Courts appear, at first glance, to offer the opposite of the clinic: distance, neutrality, procedure, evidence, and remedy. Yet socio-legal and feminist legal scholarship has long shown that law is not a neutral container into which women simply pour their experiences. Law has its own language, categories, evidentiary rules, thresholds, professional actors, and credibility tests.
Carol Smart’s feminist legal theory is important here because she argues that law is not merely a tool that can be used for or against women; law itself produces gendered forms of truth. Law often presents itself as rational, neutral, objective, and disembodied, while women’s accounts may be treated as emotional, subjective, excessive, or insufficiently credible. Conley and O’Barr’s work on law, language, and power similarly shows that legal power operates through language: the way a person speaks, narrates, answers questions, and performs credibility can affect whether their account is believed.
This matters profoundly for childbirth litigation and complaint processes. A woman’s experience of coercion, fear, abandonment, humiliation, or pain may not fit easily into the legal categories of negligence, causation, damage, consent, or breach of duty. The question becomes not simply “Was she harmed?” but “Can her harm be translated into legally recognisable form?”
Felstiner, Abel, and Sarat’s classic account of naming, blaming, and claiming helps explain why many harms never become legal disputes. People must first recognise an experience as injurious, then attribute responsibility, then transform it into a claim. Each stage is unstable and socially shaped. Ewick and Silbey similarly show that people’s relationship to law is shaped by everyday consciousness, social position, expectation, fear, and perceived usefulness; many people do not claim because law feels distant, risky, ineffective, or inappropriate.
Merry’s work on women’s human rights and legal consciousness is especially relevant. She shows that women do not simply “use rights” once rights exist; they must come to understand themselves as rights-bearing subjects in social worlds that may punish or shame them for claiming. Gender, class, kinship, institutional culture, and fear of consequences all affect whether legal mobilisation is possible. Merry and Stern’s work on legal translation is also useful because it shows that women’s experiences often have to be transformed into legal forms before they can be heard.
Nohr’s ethnography provides a childbirth-specific example of this translation burden. In the United Kingdom, some mothers who complained after traumatic births felt compelled to write in a “matter of fact,” clinical, or scientific register so that their complaint would be taken seriously. Their trauma had to be depersonalised and reformulated in the language of institutional review. Nohr argues that this replicated the same authoritative knowledge hierarchy that had operated during childbirth itself: women’s embodied accounts were again treated as subjective, emotional, or individual, while records, professional accounts, and biomedical language carried more weight.
Reader, Gillespie, and Roberts show that patient complaints can provide valuable evidence about healthcare quality and safety, particularly harms that standard metrics may miss, such as disrespect, poor communication, or dignity violations. Yet Nohr’s work shows that complaints may still be institutionally discounted because they are framed as personal, emotional, or anecdotal rather than as evidence of systemic failure.
Fricker’s concept of epistemic injustice helps name the harm. Testimonial injustice occurs when a speaker’s credibility is unfairly diminished; hermeneutical injustice occurs when available interpretive frameworks do not adequately capture a person’s experience. In childbirth, women may suffer both. They may not be believed when they say what happened, and the legal or medical system may lack adequate categories for harms such as coercive consent, abandonment, disrespect, racialised dismissal, or being made to feel that one’s pain did not matter.
Courts can therefore reproduce exclusion in several ways. They may privilege expert testimony over women’s accounts; require documentary records that are controlled by the institution being challenged; focus on physical injury while marginalising dignity, fear, or coercion; demand a rational and consistent claimant while ignoring trauma and postpartum exhaustion; and individualise blame even where the harm is structural. Alicia Ely Yamin warns that human rights approaches to maternal health should not be reduced to identifying one perpetrator and one remedy; the deeper task is to transform health systems and address structural failures.
Baumgärtel captures the appeal and limits of human rights litigation: courts promise that an injured person can challenge state power before an independent arbiter, yet the process itself is shaped by vulnerability, representation, evidence, and institutional access. Feminist judgment projects, such as Hunter, McGlynn, and Rackley’s Feminist Judgments, show that legal doctrine can be reasoned differently when judges take women’s lived experiences, social context, and structural inequality seriously.
3. The shared structure: clinics and courts both discipline women’s voices
The clinic and the courtroom appear very different, but they share a central feature: both decide what kind of knowledge counts.
In the clinic, what counts may be the fetal monitor, the cervical examination, the protocol, the clinician’s interpretation, or the medical record. In court, what counts may be the file, the expert report, the chronology, the consent form, the legal category, or the evidentiary threshold. In both spaces, women’s embodied knowledge may be treated as insufficient unless it is translated into the institution’s preferred language.
This is why Nohr’s argument is so important for childbirth rights. Her thesis argues that many women were not empowered by accountability mechanisms after childbirth but re-traumatised, because the biomedical knowledge/power hierarchy was replicated within complaint and justice mechanisms. Her later article sharpens this into an epistemic claim: maternal knowledge is often silenced not only at the bedside but also in the institutional “afterlives” of birth.
The exclusion is therefore not simply a matter of individual doctors being dismissive or individual judges being biased. It is structural. Clinical systems and legal systems both require women to speak in institutionally legible ways. Women who are in pain, frightened, poor, racialised, young, disabled, migrant, linguistically marginalised, grieving, or caring for a newborn may find those forms of speech especially difficult to perform.
Both clinical contexts and courts can exclude women through power dynamics that determine whose knowledge is credible, whose suffering is recognisable, and whose account becomes actionable. In biomedical childbirth, professional expertise, technologies, protocols, and records often operate as authoritative knowledge, while women’s embodied knowledge may be dismissed as emotional, unreliable, or non-clinical. This hierarchy is especially acute in childbirth because women are physically exposed, time-pressured, dependent on staff, and often acting in relation to the perceived safety of the infant. In courts and complaint mechanisms, a parallel hierarchy may reappear: women’s accounts must be translated into legal categories, documentary evidence, expert reports, and rationalised narratives before they can be heard. As feminist legal theorists and socio-legal scholars have shown, law does not merely receive women’s experiences; it reshapes them through its own language, procedures, and credibility tests. The result is that women may be excluded twice: first in the clinical encounter, when their embodied knowledge fails to count, and again in legal or accountability processes, when their accounts of fear, coercion, abandonment, disrespect, or trauma fail to fit institutional forms of proof.
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