Understanding obstetric violence and why it is a concern

Understanding obstetric violence and why it is a concern (Photo: iStock) Dignity and respect ought to be the cornerstone of delivering medical services to all. Unfortunately, we are not short of upsetting stories of the labour wards in most Kenyan public hospitals. 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, Obstetric violence may be used to refer to behaviours that harm someone pregnant or giving birth or have recently given birth and is a form of reproductive violence which could also fall under the ambit of gender-based violence. 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 recognizes 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 characterized by involuntary leakage of urine, faeces, or both. This debilitating condition leads to chronic medical complications, psychological distress, social ostracization, and exacerbated poverty levels. Despite constitutional guarantees and international commitments to uphold women's rights, instances of obstetric violence persist, undermining maternal health outcomes and perpetuating gender inequality. 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 health care. The recognition of this right 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. Despite judicial interventions, challenges persist in combating obstetric violence effectively. 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. However, 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. Additionally, empowering women through education and advocacy can facilitate informed decision-making and foster a culture of respect for reproductive rights. Beverly Mumbo-Otieno 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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