Experts, Rights Groups Warn of Crisis of Obstetric Violence

The UNFPA released a report detailing how women were suffering widespread mistreatment during childbirth across Eastern Europe and Central Asia. Credit: UNFPA

By Ed Holt
BRATISLAVA, Mar 30 2026 (IPS)

Government and medical professionals must implement systematic changes to deal with a “crisis” of obstetric violence (OV) across Eastern Europe and Central Asia (EECA), experts and rights campaigners have said.

The call comes as the United Nations Population Fund (UNFPA) released a report on March 12 detailing how women were suffering widescale mistreatment during childbirth across the region.

“This report is a wake-up call. All stakeholders must make sure that women’s rights are respected and protected in all facilities in the health system and beyond,” Tamar Khomasuridze, UNFPA Sexual and Reproductive Health Adviser for Eastern Europe and Central Asia, told Inter Press Service (IPS).

The report, Respectful Maternity Care: Women’s Experiences and Outlooks in Eastern Europe and Central Asia, highlighted what the UNFPA said was a “pervasive yet often hidden OV crisis that violates women’s fundamental human rights and dignity”.

The survey, which was based on online responses from over 2,600 women who gave birth recently and conducted across 16 countries and territories in the region, found that 67 percent of respondents reported at least one form of mistreatment, including non-consensual medical procedures, verbal and physical abuse, and significant breaches of privacy.

Nearly half (48.1 percent) of women underwent obstetric procedures – such as episiotomies, Caesarean sections, or the administration of oxytocin – without their informed consent.

Meanwhile, about 24 percent of surveyed women reported experiencing verbal abuse, including yelling and humiliation, and 1 in 10 endured physical or sexual abuse during labour or gynaecological examinations. For example, 12 percent of the surveyed women reported being physically restrained during labour, such as being tied to the bed or subjected to aggressive physical contact under the pretext of facilitating delivery. Just over 10 percent experienced different forms of sexual abuse, ranging from inappropriate touching to more severe forms of assault (disrespectful manipulation of the genitals).

The survey also revealed a massive lack of awareness of OV among women in the region – almost 54 percent of surveyed women said women were unfamiliar with the term “obstetric violence”. And of those that knew they were victims of OV, very few reported such incidents – only two percent of those mistreated officially reported their experience, often due to a lack of trust in accountability mechanisms or fear of retaliation.

Previous research into the extent of OV in the region is limited and experts say it is difficult to gauge whether the situation in the region has changed in recent years.

But campaigners say the report underlines that it remains a serious problem.

“Obstetric violence has always existed, but for a long time it remained invisible, normalised, and embedded within what was perceived as ‘standard medical practice’. The major shift over the past decade is not necessarily in the prevalence of the phenomenon but rather in its increased visibility at the public, legal, and institutional levels, including its inclusion on the global agenda of human rights and public health,” Alina Andronache, a gender public policy expert at the Partnership for Development Center (CPD) in Moldova, who helped author the UNFPA report, told IPS.

“The report outlines a mixed picture: recognition and visibility of the phenomenon are increasing, yet the prevalence of experiences of abuse, coercion, and lack of consent remains alarmingly high,” she added.

Rights activists say that the phenomenon is closely linked to the wider issue of prevalent attitudes to women in the region.

“The report clearly shows that obstetric violence is not merely an issue of inadequate medical practices but is deeply embedded in broader social and cultural structures—particularly gender discrimination, power imbalances between the patient and medical staff, rigid institutional hierarchies, and norms that socialise women to accept authority without questioning it, including in highly intimate and vulnerable contexts such as childbirth,” said Andronache.

She highlighted the report’s finding that 58.4 percent of respondents believe that a mother must accept any intervention for the benefit of the child, even if it may harm her, while 19.6 percent consider that doctors may take a decision without a woman’s consent to protect the child.

“These perceptions reflect a profound internalisation of the idea that women’s bodily autonomy can be suspended during childbirth in favour of a medical authority perceived as unquestionable. This internalisation has two major consequences: it legitimises abusive or coercive practices, which are no longer perceived as violations of rights but as ‘necessary’ or ‘medically justified’ interventions, and it  directly contributes to underreporting and to the difficulty of recognising obstetric violence as such. If women are socialised to believe that they do not have the right to refuse, to ask questions, or to negotiate interventions, then their experiences are not necessarily identified as abuse but rather as a ‘normal’ part of childbirth,” she explained.

The report includes a call to action that outlines critical steps to address systemic problems with OV in the EECA states. These include legislation to protect women against OV; human rights-centred training for all healthcare personnel to shift clinical attitudes and ensure dignity is maintained at the point of service, as well as implementing monitoring and other measures to ensure accountability; and strengthening education and wider awareness of OV.

The UNFPA says its call to action has been endorsed by all countries in the survey and other stakeholders and will become part of action plans on OV at the national level.

But it is unclear how easy it will be to effect meaningful change, especially in a region where some countries have very conservative social cultures and wider problems with women’s rights.

The report showed that among respondents from Central Asian countries, such as Kazakhstan, Kyrgyzstan and Uzbekistan, around two thirds of women were unaware of OV. The report says this is due, in part, to traditional norms surrounding women’s roles and childbirth, which may make women less open to discussions about obstetric abuse.

Khomasuridze admitted that there were “of course sensitivities in different countries” in the region but was confident that with the help of various stakeholders, including civil society organisations, women’s rights groups and patient groups, changes would be implemented.

Andronache said that in countries where strongly conservative political policies and societal attitudes are prevalent, it was crucial that “the message be adapted to the context”.

“In more conservative societies, the approach should not be perceived as confrontational or ideological but rather framed as an issue of safety, dignity, and quality of care for both mother and child. Emphasising health, respect, and communication may be more readily accepted than a discourse focused exclusively on rights,” she said.

She added that it was essential that women be made aware of OV during their engagement with healthcare professionals – prenatal courses should be accessible and include, alongside medical information, clear explanations about women’s rights, informed consent, and what respectful care entails. ‘Meanwhile, information must reach those who need it most, she said — particularly in rural areas and in communities with more limited access to education.

“This requires simple messages, delivered in accessible languages and through channels that women already trust, including healthcare providers, community leaders, or other women sharing their experiences,” Andronache said.

“Awareness is built not only through the dissemination of information, but also through the creation of a space in which women feel able to ask questions, understand what is happening to them, and recognise when their rights are not being respected,” she added.

However, even in places where there is more awareness, serious problems with OV remain.

The study found that awareness of OV is higher in Eastern European countries, in part because advocacy initiatives regarding women’s rights during childbirth have contributed to increased visibility of the issue. Yet OV is widespread in some of these states.

In the survey the highest dissatisfaction rates with their childbirth experience were recorded among respondents from the Western Balkans (Albania, Serbia and Kosovo).

In 2022, a study by lawyers in Serbia found that women in the country are regularly subjected to various forms of violence at maternity clinics and hospitals, including not just verbal abuse and humiliation at the hands of staff, but violent physical examinations and invasive procedures without consent.

In January 2024, Marica Mihajlovic, a Roma woman, claimed that during labour her doctor jumped on her stomach, slapped her and racially abused her. Her baby died soon after birth.

A 2023 report on OV in Moldova included testimony from scores of OV victims, some of whom were left with serious physical and mental health issues afterwards.

As well as having to deal with the physical and mental damage of their experiences, victims of OV in the region also often face significant barriers to any redress for their suffering.

“Women who are aware of obstetric violence and would like to take action encounter, in reality, a form of distance—not only physical, but also emotional and institutional. In theory, reporting mechanisms should be ‘within reach’: easy to understand, accessible, and safe. In practice, in many countries this distance is far too great,” explained Andronache.

She said many women who want to report OV struggle with difficult and bureaucratic systems for doing so. Many are also put off by feelings that reporting what happened to them will not change anything or, worse, “that they would be placed in a position of having to prove their suffering, of being questioned, or even invalidated”.

“In the absence of clear and credible accountability mechanisms, reporting is not perceived as a solution, but as a long, uncertain, and emotionally draining process,” Andronache said.

Some also find that after a difficult or traumatic experience, they simply do not have the emotional resources to engage in a formal process. “They seek calm, recovery, and the ability to care for their child. The question ‘is it worth going through this?’ becomes very real,” said Andronache.

While the report identifies the scale of the OV crisis in the region and changes needed to reverse, or at least lessen it, fundamental improvement is not expected to come overnight, regardless of how enthusiastically governments embrace the UNFPA’s recommendations.

“Some changes can be implemented relatively quickly—for example, establishing clear and accessible reporting mechanisms, informing women, introducing more transparent procedures, or providing basic training for medical staff. These depend largely on political will and organisational capacity and can be achieved within a relatively short timeframe.

“However, the more difficult aspect is the transformation of mindsets—both within the medical system and in society at large. A deeper transformation to a system in which women feel safe to speak out and which responds with accountability and respect is a long-term process that may take a decade or more. At its core, this is a cultural shift, not merely a regulatory one,” said Andronache.

Khomasuridze agreed.

“We and our partners have a long way to go. Progress depends on action at the national level and we are very well positioned in [EECA] countries to accelerate progress, working with government, professional societies, civil societies, women’s groups, and patients’ groups to make sure that this transformative agenda is implemented,” she said.

IPS UN Bureau Report