The Constitutional Court of Colombia recently released its decision in the case of Sofia, a woman who struggled to access an abortion in Santa Marta and then suffered obstetric violence during the provision of the service. Two years after the historic decision that decriminalized abortion up to 24 weeks in Colombia, the Court set an important precedent with this decision regarding the quality requirements of abortion services. It also explicitly recognized that obstetric violence often occurs in cases of abortion and not only when a pregnancy is carried to term. This decision demonstrates how abortion services must be both available for those who need them and meet the elements of accessibility, acceptability, and quality of the right to health.
Obstetric Violence and the Violation of the Right to Health
The Committee on the Elimination of Discrimination against Women (CEDAW) has recognized that obstetric violence is widespread and systematic in different health systems around the world and should be understood as a form of gender-based violence. This type of violence is usually experienced during pregnancy, childbirth, postpartum, or when receiving other reproductive health services; it can manifest as mistreatment, humiliation, the denial of pain medication, nonconsensual interventions, and violations of informed consent and confidentiality, among other forms of abusive treatment. This type of violence is different from medical negligence, as it takes place in the context of gender stereotyping and discrimination. The Special Rapporteur on Violence against Women explained that this violence can be understood as a continuation of the discrimination women face in society and is rooted in inequality, power imbalances in the medical field, patriarchy, and other systems of discrimination. Because of these factors, Afro-descendant Indigenous, rural, and women of low socioeconomic status are more likely to experience abusive treatment by health professionals in reproductive health care and childbirth settings.
This is not the first time that obstetric violence has been of interest at the regional level in Latin America. On November 16, 2022, the Inter-American Court of Human Rights (IACtHR) declared Argentina responsible for violating the rights to life, integrity, and health of Cristina Brítez Arce in a case that it classified as obstetric violence. In September 2023, in the case of Rodríguez Pacheco v. Venezuela, the IACtHR reiterated the definition of obstetric violence and emphasized that States must regulate and supervise all health care provided under their jurisdiction, in both public and private settings, to prevent obstetric violence acts and violations of the right to health and personal integrity. They must also take measures to investigate, punish, and remedy such violations when they occur.
Obstetric violence can have many consequences for women’s rights — affecting their personal integrity, autonomy, private life, equality, non-discrimination, and their right to the highest standard attainable of physical and mental health. The WHO recognizes that this type of violence “constitutes a violation of trust between women and their health-care providers.” Mistrust disincentives the use of maternal health services in general, which disproportionately affects women and people who can gestate, and violates the element of accessibility required by the right to health. Moreover, obstetric violence weakens the acceptability of health services, as it impacts the conditions of medical ethics — including the principles of beneficence and nonmaleficence, informed consent, and confidentiality —and perpetuates gender discrimination. Finally, the persistence of obstetric violence in reproductive health services constitutes a violation of the element of quality, which refers to the scientific, medical, and treatment conditions in health services.
Obstetric Violence in Abortion Settings
Obstetric violence is frequent in the context of abortion services. Research has shown that abortion-related violence is connected to the persistent stigma surrounding this service, and it can be exacerbated in contexts where abortion is criminalized or restricted. According to a study by Global Doctors for Choice, obstetric violence in abortion services can manifest as disregard for the women, information sharing designed to try to change the patients’ minds, long or unwarranted hospitalizations, excessive referrals, punitive practices, violations of confidentiality, and attitudes and behaviors to make them feel guilty, among others. Additionally, in Latin American countries, such as Brazil, Ecuador, and Chile, obstetric violence in abortion services often manifests as issues with the quality of services provided and the disregard for the standard of care, including the use of surgical procedures, such as curettage, instead of less invasive procedures and abortion medications — even when they are available. These issues also include delays in care, unnecessary procedures, and disregard for symptoms like chronic pain. Finally, in countries where abortion is highly criminalized, obstetric violence in reproductive health care can escalate — manifesting as violations of confidentiality and medical professional secrecy, unnecessary reports to the police, forced retentions in the hospital, the denial of family visits, and interrogations from medical staff and police officers.
The Case of Sofia
When Sofia requested an abortion from her insurance company, they contacted her father to ask for authorization without her consent, despite the fact that she was an adult woman. Moreover, she was not fully informed about the medical procedure that would be performed, its steps, and the symptoms it would entail. She received threats and criticism from the medical staff, delays in the delivery of medications, lack of medical supervision, mistreatment in pain management, and irregularities in the techniques used by health professionals. The Court concluded Sofia suffered “physical and psychological obstetric violence,” thus recognizing that this type of violence also occurs in abortion contexts — deepening a stigma that women and people with the capacity to gestate face when accessing legal abortion. Furthermore, the Court emphasized the violations of Sofía’s confidentiality, privacy, and dignity, finding they occurred in a context of gender stereotypes dictating that it is “men who must make reproductive decisions for women.”
As a result, the Court urged competent authorities to supervise the quality of abortion services in the country and investigate Sofia’s case specifically to avoid the same issues from happening again. The Court ordered the insurance company and the clinic to provide training to their doctors and staff on the existing guidelines and parameters of quality in abortion services, as well as on maintaining strict confidentiality of patients who request abortions.
Overall, Colombia’s decision constitutes an important step to guaranteeing abortion services that are free from violence and stereotypes. Eradicating obstetric violence in abortion services is essential and must be an urgent priority to ensure that the right to health and women’s reproductive rights can be fully realized.
