Commentary

Violence Against Women

1–10
The Dangers of Minimizing © The Author(s) 2021
Article reuse guidelines:
Obstetric Violence sagepub.com/journals-permissions
DOI: 10.1177/10778012211037379
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Rachelle Chadwick1

Abstract
This commentary is a response to the article by Lappaman and Swartz, “How gentle
must violence against women be in order not to be violent?” in which the term
“obstetric violence” is critiqued. The authors argue that the term is harmful and
does violence (to health care workers and even birthers themselves) and is not helpful
to efforts to improve or reform maternity care. They suggest that we abandon the
term and use less inflammatory descriptions (i.e., such as “mistreatment”) instead.
While recognizing the inevitable risks involved in naming and writing about obstetric
violence, I argue that these risks are necessary in the interests of struggling against
unjust systems. I unpack the authors’ critique and argue that it ultimately works to
minimize experiences of obstetric violence, silence the voices of those that have
been speaking out on this issue for a very long time, and casts doubt on the legitimacy
of a concept that has only recently received global recognition (after a long and trans-
national struggle). These harms and dangers are not necessarily the direct intentions
of the authors but are embedded in wider structures of power that are often incred-
ulous, disbelieving, and dismissive in the face of testimonies and evidence of gendered
and racialized pain/violence.

Keywords
obstetric violence

If the exposure of violence is read as the origin of violence, then the violence that is
exposed is not revealed. (Ahmed, 2010, p. 170)

This commentary is a response to the article by Lappeman and Swartz (2021),

“How gentle must violence against women be in order not to be violent?” in which

1
University of Pretoria, Pretoria, South Africa
Corresponding Author:
Rachelle Chadwick, Room 19.2, Human Science Building, University of Pretoria, Private Bag X20,
Hatfield 0028, South Africa.
Email: Rachelle.chadwick@up.ac.za
2 Violence Against Women 0(0)

the term “obstetric violence” is critiqued. The authors argue that the term is harmful
and does violence (to health care workers and even birthers themselves) and is not
helpful to efforts to improve or reform maternity care. They suggest that we
abandon the term and use less inflammatory descriptions (such as “mistreatment”)
instead. While welcoming debate and critical reflection on the uses, possibilities,
and limitations of a vocabulary of violence in relation to birth and reproductive mis-
treatment, I have a number of concerns with the implications of Lappeman and
Swartz’s (2021) article. These concerns revolve around the potential harms, effects,
and dangers of their arguments. My task and responsibility (as a feminist scholar) is
to point to the harms and dangers of arguments which ultimately work to obfuscate
the problem of obstetric violence, minimize its severity/harms, and undermine the
existing feminist scholarship on the issue. At the crux of this harm are not individual
intentions but deeply toxic and persistent sociosymbolic structures that continue to triv-
ialize gendered violence, disregard the perspectives of victims1, and consolidate the
status quo.
As critical researchers, we must be prepared to reflect on the effects and implications
of our theories, conclusions, and arguments. In responding to Lappeman and
Swartz’s (2021) critique, I thus recognize the inevitable risks that come with naming
and writing about obstetric violence. However, I argue that these risks are necessary
in the interests of refusing and struggling against unjust systems. I focus on unpacking
the dangers of the authors’ critique and argue that it ultimately works to minimize expe-
riences of obstetric violence, silence the voices of those who have been speaking out on
this issue for a very long time, and casts doubt on the legitimacy of a concept that has
only recently received global recognition (after a long and transnational struggle).
Furthermore, the arguments made in the article threaten to derail the progress feminist
activists/scholars have made in fighting for transformative action in respect of the
global problem of obstetric violence. These harms and dangers are not necessarily
the direct intentions of the authors but are embedded in wider structures of power
that are often incredulous, disbelieving, and dismissive in the face of testimonies
and evidence of gendered and racialized pain/violence.

The Risks of Naming Violence

According to Murphy (2012), writing about violence is fraught terrain, often inviting
counter-accusations of violence and harm. For example, writing about perpetrators of
violence opens one to accusations of silencing victims, while articulating the harms of
misogynist violence invites censure that one is contributing to the erasure of other
systems of violent power (i.e., racism, cisnormativity, and ableism). In their critique
of the term “obstetric violence,” Lappeman and Swartz (2021) argue that work on
obstetric violence (particularly that which centers the perspectives of birthers such
as my own), is implicated in doing violence to health care workers and disempowering
women by constructing them as “victims.” There are inevitable risks involved in
naming and writing about violence, particularly violence involving such an intimate,
Chadwick 3

vulnerable, and emotionally charged event such as birthing—a form of violence that
has long been normalized despite decades of complaints and resistance from birthers,
activists, and feminists (Goer, 2010).
For example, there are risks of backlash in the inevitable efforts by those in posi-
tions of privilege and power to bolster normative structures and smother change and
accountability. There are also risks of misrecognition that are an inevitable result of
the difficulties of naming a form of violence that disrupts normative assumptions,
and for which we are still trying to forge a language. For example, our writing and
theorizing is often interpreted through the lenses of male-centered frameworks and
vocabularies (i.e., individualist assumptions that violence means only direct phys-
ical violence with a clear perpetrator and a victim). Such frames are not helpful for
thinking through the complexities of gendered and intimate modes of violence in
which the personal and the political collide in intense and powerful ways.
Lappeman and Swartz (2021) do this repeatedly in their article; as a result, concepts
such as “gentle violence”2 are misrepresented and taken out of context. Speaking
and writing about gendered forms of violence in patriarchal cultures also often
invites doubt, incredulity, and suspicion as kneejerk epistemic counter-responses
(see Code, 2009). Furthermore, in daring to openly name as violence that which
is often seen as “normal” or acceptable, we risk being seen as biased, extreme,
and overly hostile. This can become a basis for dismissing our work (i.e., it is
too “subjective” or “inflammatory”). Ironically, our insistence on defining violence
against the grain of normative truths can also result in our work being described as
itself violent. In naming a problem where society prefers not to see one, we become
problems and obstacles (see Ahmed, 2010).
Languages of violence are thus complicated, slippery, and diffuse, even for more
recognized forms of gendered violation (e.g., rape, domestic violence, and sexual
harassment). Defining violence is never a neutral act but is deeply contested and polit-
ical. While individuals might accept that acts of direct physical abuse during labor/
intrapartum care (e.g., hitting) and nonconsented obstetric and gynecological proce-
dures count as forms of abuse and violence, recognizing the existence of “obstetric vio-
lence” as a specific and transindividual mode of harm, is harder to achieve. This refusal
to recognize “obstetric violence” as a distinctive form of harm underlies and grounds
Lappeman and Swartz’s (2021) arguments. There is a deep-seated resistance to
acknowledging that normative patterns of relating, interacting and “caring” within
maternity and obstetric settings might enable and reproduce symbolic (invisible) vio-
lence that restricts, constrains, diminishes, shames, and coerces reproductive subjects
(as well as health care providers) in particular ways. There is a desire to keep violence
and care sharply separate and polarized and to insist that their possible entanglement
and coexistence is unthinkable.3 In efforts to reject the argument that “obstetric vio-
lence” exists as a distinctive phenomenon, Lappeman and Swartz (2021) argue that
the use of this term shames and violates the rights of health care workers. In so
doing, they miss the point that most feminist scholars of obstetric violence do not
regard individual health care workers as the primary source of such violence but are
working to make visible the sociosymbolic and structural relations (i.e., racism,
4 Violence Against Women 0(0)

sexism, and medical authority) that structure the rules, norms of engagement, roles,
accepted story lines, and ways of relating in specific obstetric and maternal health
care contexts. Indeed, feminist researchers (see Chadwick, 2017; Dutton & Knight,
2020) have argued that health care providers are themselves potential victims of
broader structural disrespect and obstetric violence (e.g., their work is not valued,
they are themselves often subject to bullying, and toxic work conditions).
Part of the risk of naming obstetric violence as a specific form of reproductive harm
is that specific individuals will feel targeted as “the perpetrators.” This kind of polar-
ization is indeed unhelpful and limits change/transformation in this area, but it is not
the inherent result of using “obstetric violence” as a conceptual framework. It is in
fact rather the product of a defensive and hostile epistemic machinery that reacts
with incredulity, suspicion, and obfuscation in the face of testimonies of gendered vio-
lence and that (willfully) mishears what feminist writers/scholars and activists are
saying. In actual fact, feminist scholars and writers have been careful to conceptualize
obstetric violence as a structural phenomenon rooted in hierarchical relations of power
(i.e., biomedical, racialized, gendered, and classed) and not in individual agents (see
Sadler et al., 2016). There are risks involved in naming and writing about obstetric vio-
lence, but these risks are necessary in the interests of challenging oppressive and
harmful structures that work to disrespect reproductive subjects and normalize
violent relations. In the face of incredulity, minimization, and obfuscation, we must
not revert to a less inflammatory language but continue to name, contest, and refuse
obstetric violence as a specific form of structural and sociosymbolic harm directed
at reproductive subjects (see Chadwick, forthcoming).

Minimizing the Problem

The key problem that I have with Lappeman and Swartz’s (2021) article is that it obfus-
cates and minimizes the problem of obstetric violence. Such minimization is achieved
in various ways, that is, via the use of language that creates doubt as to the “serious-
ness” of obstetric violence, the lack of effort to engage substantively with the extensive
body of feminist writing/research on the topic, and the failure to recognize and
acknowledge the testimonies of lived distress that have fueled activism in this area
for decades. Instead of engaging with the feminist work on the topic and appreciating
the context of struggle within which the term emerged, the article mobilizes incredu-
lity4 as a way of dismissing the problem. Epistemic incredulity is a stock response
to efforts to have gendered forms of violence recognized and taken seriously. As
Code (2009) notes, “ecologies of incredulity” play a central role in the perpetuation
of normative discourses that both exceptionalize and tolerate rape and sexual violence.
In such endeavors, there is often a willful effort to dismiss the voices and lived expe-
riences of victims and trivialize feminist campaigns.
I recognize similar dynamics at play in Lappeman and Swartz’s (2021) article. In the
piece, there is little concrete evidence given or efforts made to engage substantively
with feminist work; the authors’ offer one ethnographic study (their own) as evidence
that the term “obstetric violence” lacks relevance. It is worth noting that this study was
Chadwick 5

based on ethnographic observations at one setting by a researcher who was also

employed as a health care worker at the same hospital. Interviews with health care
workers and patients were also conducted but few details are given (e.g., as to
numbers interviewed or how questions of language/translation were dealt with).
Tellingly, in their article, Lappeman and Swartz (2021) argue that women did not
want labor companions and that widespread silence on the ward was not evidence of
“obstetric violence” without ever allowing women’s voices on the matter to be heard.
The only interview extracts that are included in the article are drawn from interviews
with health care providers. How did birthers themselves experience the silence and lack
of relational engagement on the ward? We do not know. Did birthers experience the
atmosphere on the ward as affirming, supportive, or distressing? We do not know.
Feminist scholars of violence deliberately foreground the perspectives of victims in
defining and naming violence. In mobilizing arguments against the use of the term
“obstetric violence,” it is telling that Lappeman and Swartz do not include or highlight
the voices or perspectives of birthing persons.
Minimization is also produced in Lappeman and Swartz’s (2021) article via the
use of certain phrases and language that cast doubt on the seriousness of the
problem of obstetric violence. While the authors do not deny outright that “obstetric
violence” exists, they nonetheless engage language which questions the veracity and
legitimacy of such forms of violation. For example, the use of words such as:
“apparent disrespectful treatment” (p. 1), the reformulation of such violence as
better described as a “misunderstanding” (p. 11) or “cultural misalignment”
(p. 11), and references to obstetric violence as “trivially true” (p. 10) all work to
suggest that the authors do not, in fact, regard obstetric violence as a serious
matter (despite later equivocations).
Of all forms of gendered violence, abuse during birth remains one of the most unrec-
ognized and invisible iterations of such violence. Efforts to minimize the problem of
obstetric violence are thus potentially dangerous and damaging. For a long time, vio-
lence and abuse during birthing and reproductive care has been “a problem with no
name” (Friedan, 1963). Despite longstanding vocalizations of distress by birthers
(Goer, 2010), a sociostructural “ediface of ignorance” (Code, 2009, p. 345) has
veiled abuse during birth as normal, as part of the suffering of childbirth, in the best
interests (of the patient/the baby), as justified by medical and professional expertise,
and as inherently well-intentioned (and therefore not “violence”). Thus, while the
term “obstetric violence” is relatively recent, reports of verbal abuse, slapping, humil-
iation, neglect, forcefully strapping birthers down, unconsented procedures, the refusal
of pain relief, and the coercive use of technologies or pharmacological interventions,
go back several decades (see Goer, 2010). For a long time, these problems were
regarded as part of the machinery of “medicalization,” examples of mistreatment, or
misguided outbreaks of nonevidence-based practices. It is only since the early 2000s
(due to Latin American activists) that the term “violence” has been used systematically
to describe the harms endemic to institutional forms of birthing across transnational
settings, including in Africa, Asia, Latin and Central America, Europe, and North
America (Perrotte et al., 2020).
6 Violence Against Women 0(0)

The struggle to gain societal, legal, state, and institutional recognition of abuse
during labor/birth as a form of violence and a human rights abuse (see Šimonović ,
2019) has been incredibly difficult and remains an ongoing and unfinished project.
For decades, feminists, public health scholars, and birth activists worked with the
vocabularies of “mistreatment,” “medicalization,” “childbirth abuse,” “nonevidence-
based practice,” and “disrespectful care,” and attempted to change problematic
health care practices by favoring a less antagonistic language that called for the
“humanization of birth” (see Williams et al., 2018). While these efforts did lead to
some shifts and improvements in maternal health care practices (particularly in
highly resourced settings), birthers nonetheless continued to report distressing and
traumatic birth experiences across a wide range of transnational contexts. It is these
persistent cries of distress that have necessitated the shift to the more provocative ter-
minology of “obstetric violence” and the demand for justice in the sphere of birth and
reproductive health care (Oparah & Bonaparte, 2016).
In arguing for the return of less antagonistic terms such as “mistreatment,”
Lappeman and Swartz (2021) fail to acknowledge this contextual history and the
recent power and success of obstetric violence as critical terminology. As noted by
Sesia (2020), the use of the term obstetric violence has resulted in increasing global
recognition of the problem. The term has resonated both with birthing persons’ lived
experiences and resulted in the recognition of birth violence by international organiza-
tions such as the World Health Organization (WHO) in 2014 and the United Nations
(UN) in 2019. The legal framework within which the term is embedded in the Latin
American context has also given legitimacy to the terminology. Unacceptable birth
violations are thus not so easily dismissed or minimized anymore (Sesia, 2020).
There is thus little doubt that the use of this terminology has resulted in the global rec-
ognition of birth violence as a transnational problem in health care and obstetric set-
tings. In 2014, the WHO published a consensus statement pointing to such forms of
mistreatment during intrapartum care as a human rights violation. While they do not
use the term “obstetric violence,” the WHO clearly point to the provision of “respectful
care” during labor/birth as a basic human right. In 2019, Dubravka Šimonović , the UN
special rapporteur on violence against women, explicitly used the language of “obstet-
ric violence” in their report on the global mistreatment of birthers during pregnancy,
labor, and birthing.
We cannot understand the lexicon of obstetric violence without grasping the con-
textual roots of the concept in these historical struggles. As presented by Lappeman
and Swartz (2021), the concept of obstetric violence is disconnected from its femi-
nist and activist roots and stripped of the nuanced objectives of the scholars/activists
that employ it. A key objective of feminist work on gendered and sexual violence
has been to show that such violence is not merely “interpersonal” but structural, sys-
tematic, and rooted in social relations of (patriarchal, racist, medical, and colonial)
power. The enemy is not individual persons but unjust structures, repressive hierar-
chies, and unequal relations of power. The concept of obstetric violence is rooted in
this tradition of feminist work and grounded in critical languages of violence that
critique normalizing, hidden, and often societally accepted forms of violence
Chadwick 7

(e.g., in relation to marital rape, domestic violence, and sexual harassment) and that
problematize tendencies for some forms of violence (e.g., stranger rape) to be
framed/understood as more “serious” or violent than others (e.g., date rape or
marital rape).
Problematically, the authors’ failure to engage in any substantive way with feminist
literature and research on obstetric violence also minimizes the lived experiences of
distress and violence that have been articulated by birthing persons in a wide range
of contexts over many decades (e.g., Castro & Erviti, 2003; Chadwick, 2018;
Chadwick et al., 2014; Cindoglu & Sayan-Cengiz, 2010; El Nemer et al., 2006;
Kitzinger, 2006; Morales et al., 2018; Mozingo et al., 2002; Perera et al., 2018;
Shabot, 2016; Thomson & Downe, 2008). Many birthers have explicitly used the lan-
guage of rape, assault, and violence to describe their experiences of distress during
birthing (see Kitzinger, 2006; Mozingo et al., 2002). From its inception, the language
of “obstetric violence” has thus resonated with many birthers’ lived experiences. As a
result, we have seen the rise of new social movements and social media campaigns
across a range of settings (e.g., Russia, Croatia, France, Finland, Hungary, Brazil,
Chile, England) in which birthing persons are demanding that reproductive injustices
and birth violence be recognized and addressed (see also Šimonović , 2019). The con-
ceptual language of “obstetric violence” is thus in many senses rooted in the lived dis-
tress of birthing persons, and it is these experiences of distress that propel, ground, and
necessitate the continued use of the term.

Concluding Remarks
It is vital that we engage in dialog, debate, and critical reflection about the possibil-
ities, implications, and limitations of the vocabulary of obstetric violence. In efforts
to refine, question, and rethink; however, we must always remain cognizant of the
broader sociopolitical and epistemic contexts within which the term has emerged
and its long-struggle history. By claiming a language of violence and naming unac-
ceptable treatment during birth as such, feminist activists and scholars aim to make
visible long-normalized, socially accepted, and often hidden modes of violation
during reproductive events such as labor/birthing. In calling attention to obstetric vio-
lence as a specific and unaccepted form of reproductive harm, most feminist scholars
emphasize its structural, symbolic, and intersectional aspects, and do not simplisti-
cally target individual health care practitioners as the source of the problem. The lan-
guage of obstetric violence is not meant to be comforting to health care practitioners
but aims to generate discomfort in the hope of triggering critical and transformative
reflections about normalized practices. A transformative shift in obstetric and gyne-
cological care requires the rethinking and rejection of protocols, procedures, rules,
hierarchies, and relational norms that disrespect, dismiss, and exploit the vulnerabil-
ities of reproductive and birthing subjects. A shift toward dialog, respectful and
affirming care, and collaboration would empower not only birthing persons but
also health care providers. Challenging unacceptable practices and norms is neces-
sary in the interests of accountability, change, and justice. As feminist scholars of
8 Violence Against Women 0(0)

gendered violence, we must recognize and refuse the mobilization of incredulity as a

means of minimizing and dismissing the problem of obstetric violence.

Declaration of Conflicting Interests

The author declared no potential conflicts of interest with respect to the research, authorship,
and/or publication of this article.

Funding
The author received no financial support for the research, authorship, and/or publication of this
article.

ORCID iD
Rachelle Chadwick https://orcid.org/0000-0002-7526-8592

Notes
1. While Lappeman and Swartz (2021) conceptualize “victims” within an individualist frame-
work as persons with no agency, my work is rooted in a feminist approach that critiques
simplistic, perjorative, and binary understandings of victims (e.g., see Gilson, 2016). To
be clear, I do not understand victimhood as a stable attribute that connotes passivity, weak-
ness, or an inherent lack of agency.
2. In my book, Bodies That Birth, Bourdieu’s notion of “gentle violence” is drawn on briefly
and is never foregrounded or developed as a central concept. I simply use the idea to draw
attention to the relationship that exists between explicit and easily recognizable forms of
violence and abuse (e.g., verbal abuse, hitting, direct coercion, bullying) and transindividual
relations of power that inscribe and normalize inequality and silencing in obstetric care con-
texts (e.g., patients being assumed as having no expertise despite their embodied experi-
ence) and which create enabling environments for abusive interactions. I do not use or
understand the concept “gentle violence” in an individualist framework or regard it as vio-
lence perpetrated by, or originating in, an individual person.
3. See the book by Mulla (2014), The Violence of Care for a more complex rethinking of the
relations between violence and care.
4. My use of this term is inspired by the work of Lorraine Code (2009).

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Author Biography
Rachelle Chadwick is Senior Lecturer in Sociology at the University of Pretoria.