JHR Blog

April 2, 2025

“Shut up and push”,[1] was the message received by Irma López Aurelio, an indigenous Mazatec woman, who gave birth on the grass outside a Health Center in Oaxaca, Mexico, due to insufficient beds.[2] She was not the first woman to give birth under such conditions of “obstetric violence”, in fact, for many women in Mexico, giving birth is filled with violence and trauma or deeply distressing experiences that are frequently normalized and hidden.[3] Three out of ten women suffer obstetric violence in Mexico, and the testimonies show a systematic pattern of mistreatment and violence[4] against women’s rights.

This phenomenon has such magnitude, that Latin American activists use the term “obstetric violence” to describe violence during pregnancy, childbirth, and postpartum.[5] This includes acts or omissions that produce a lack of access to reproductive health services or medical abuse, and cruel, inhuman, or degrading treatment.[6] Female patients may endure physical and psychological manifestations. The former encompasses invasive practices, such as unjustified cesarean sections, non-consensual or forced sterilization, unjustified administration of medications, delayed emergency medical care, or disrespect for childbirth timelines. Whereas, the latter manifests itself as discriminatory acts, the use of offensive, humiliating, or sarcastic language, lack of timely information about the reproductive process, and dehumanizing treatment.[7]

Obstetric violence is a massive cultural problem in Mexico. Despite global efforts to prevent gender-based violence (GBV), underlying cultural interpretations of women’s roles, societal expectations, and religious stereotypes still actively contribute to this phenomenon.[8] Obstetric violence is perceived as a side effect of “culture”, and has not received the same interest as other forms of violence against women (VAW).[9] This issue pushes us to see that despite the existence of a solid international and national legal and jurisprudential framework, a state may depart from international obligations and human rights standards because of its culture.[10] Obstetric violence is a clear example of how cultural relativist approaches[11] fail women, and why we cannot continue to justify Violence Against Women in the name of “culture”.

This article focuses on Mexico and explores a form of GBV relative to reproductive health, known as obstetric violence. It aims to understand how Mexico deviates from international women´s rights due to its deeply rooted cultural context. Part I provides case studies on the current obstetric violence practices in Mexico; Part II studies the laws and jurisprudence surrounding obstetric violence; and Part III addresses potential solutions for the reduction of Obstetric Violence in Mexican cultural contexts.

I. Case Study: Mexico and the Phenomenon of Obstetric Violence

As we delve into the specific case of Mexico, it becomes imperative to understand contemporary practices of obstetric violence and the influence of cultural factors in this unique context. Therefore, Part I(a) provides an overview of contemporary practices of obstetric violence in Mexico, while Part I(b) analyzes their impact.

a. Contemporary Practices of Obstetric Violence in Mexico

Mexico faces unique challenges addressing obstetric violence due to deeply ingrained cultural norms surrounding women and childbirth. Traditional gender roles, societal expectations, patriarchy,[12] misogyny,[13] gender-based violence,[14] and historical influences of discrimination against women[15] create a complex landscape where women historically have been perceived as “inferior” or “dependent” on men. These power dynamics and “unconscious biases” rationalize the unjust perpetuation of violence against women during pregnancy, labor, and delivery. Notably, they are especially present in the healthcare setting, where seventy percent of doctors are male.[16]

Disrespect and abuse during pregnancy, labor, and delivery stem from cultural norms and power imbalances between women and medical staff. [17] Women are often seen as incapable of making decisions, while doctors assume superiority. [18] Consequently, this has led to the objectification of women’s bodies and dehumanizing treatment in healthcare settings.[19] Examples include disrespectful behavior, violations of informed consent, and neglect of women’s autonomy during childbirth, such as forced sterilizations, unauthorized C-sections, and coercive procedures.[20]

In this sense, obstetric violence is a form of gender-based violence, perpetrated by healthcare providers against pregnant individuals during pregnancy, childbirth, and postpartum.[21] Inter-American Human Rights treaties prohibit this form of GBV, including the Belém do Pará Convention.[22] This form of violence is predominantly—although not exclusively—characterized by dehumanizing, disrespectful, abusive, or negligent treatment towards pregnant women. It encompasses actions such as denying treatment or comprehensive information about health status and applicable treatments, engaging in forced or coerced medical interventions, and displaying a tendency to pathologize natural reproductive processes, viewing normal aspects of pregnancy and childbirth as medical problems that need treatment, even when they don’t.[23] For example, doctors have induced labor or performed a C-section, when the pregnancy was progressing normally and there were no complications.[24]

In Mexico, millions of women face obstetric violence, with 31.4% experiencing mistreatment during pregnancy, childbirth, and postpartum[25] including psychological or physical mistreatment (20.8%), unauthorized medical treatments (20%), lack of consent for cesarean sections (8%), and imposition of contraceptive methods or sterilization (over 4%).[26] Moreover, according to the World Health Organization (WHO) between 88% and 98% of maternal deaths could have been prevented.[27] Obstetric violence manifests in various forms, like ignoring a pregnant woman’s concerns or preferences during childbirth, performing unnecessary medical interventions without the woman’s consent, refusing to provide adequate information about medical procedures or options, using abusive language or behavior, or even conducting unnecessary pelvic exams or vaginal interventions without consent.

The Committee on the Elimination of Discrimination against Women (“CEDAW Committee”) in its concluding observations on Mexico’s ninth periodic report on compliance with the Convention on the Elimination of All Forms of Discrimination against Women, expressed concern about reports of obstetric violence by medical personnel during childbirth, and reports of forced sterilization of women and girls.[28] It also addressed the limited access to reproductive health services.[29] The report recommended a series of measures to decrease maternal mortality and suggested harmonization of federal and state laws to define obstetric violence as institutional and gender-based violence.[30] However, reports continue to declare 33.4% of the 8.7 million women in Mexico who gave birth suffered some type of mistreatment by medical professionals, while 26% spoke an indigenous language or identified as indigenous.[31]

Even if Mexico is perceived as somehow “progressive” because it federally decriminalized abortion,[32] women in Mexico still face severe challenges to access healthcare due to societal and gender biases. A recent example is the case of Aurelia, a young indigenous woman from Guerrero, Mexico, who faced a traumatic experience when an obstetric emergency led to a miscarriage and infanticide accusations.[33] Despite seeking help at a health center, she was denied assistance, and the subsequent miscarriage at her aunt’s house led to her unwarranted arrest on charges of killing her newborn.[34] Afterwards, Aurelia’s trial was amplified by media coverage and was marked by discrimination and misunderstandings about pregnancy.[35] However, with the help of a culturally sensitive and gender-inclusive judicial system[36] and with support from advocacy groups and legal advocates who understand the political and cultural aspects that underlie Aurelia‘s arrest charge, she was acquitted in December 2022, after spending over two years in prison. Notably, Aurelia’s case is not a rare occurrence, Aurelia’s case reveals the impact of cultural biases and gender stereotypes, and how they can perpetuate violence against women.

b. The Impact of Cultural Factors on Obstetric Violence in Mexico

While the specific forms of obstetric violence vary, cultural factors substantially impact obstetric violence in Mexico. In fact, “[o]bstetric violence lies at the crossroads between gender violence and structural violence.”[37] Despite legal framework and policy development advancements, effective implementation of measures to prevent and address obstetric violence encounter cultural resistance from doctors, judges or even prosecutors. Deep-seated beliefs about women’s subjugation during childbirth, power dynamics in healthcare settings, and a lack of awareness contribute to challenges in combating obstetric violence effectively.

In addition, the women who already face diverse forms of marginalization —like women of color, indigenous, poor or LGBTQ persons—, are more vulnerable to forms of obstetric violence.[38] For instance, this was the case of Estela, an indigenous woman who was forced to get an implanted form of contraception after giving birth, solely due to her indigenous origins.[39] In fact, indigenous women’s bodies have historically been targeted for violence, and the medical setting is not an exception. Obstetric violence is a phenomenon where the domestic, structural, and political intertwine to perpetuate violence against women.[40]

In fact, Mexico is a deeply misogynistic culture.[41] This is because women are not fully integrated to the workforce and are still expected to be the primary caretakers of children.[42] Women in Mexico face a high volume of violence in many forms, mostly due to cultural stereotypes.[43] Social media has also powerfully impacted, sometimes unintentionally, conveying discriminatory messages or images, perpetuating harmful gender stereotypes and promoting misogyny.[44]

Gender stereotyping is a very frequent practice in Mexico that permeates throughout the judicial spheres[45]—including access to justice.[46] Accordingly, state agents’ remarks and attitudes reveal a prejudiced and preconceived outlook regarding women’s roles as mothers and the associated societal expectations of motherhood.[47] They portray women as wives, mothers and caregivers, while men as heads of the household. This generates negative consequences for women, limiting their life plans and opportunities.[48]In addition, the effect of 78% of Mexico’s population being Catholic[49] bears a large cause to the stigmas and cultural ideas of women as child bearers, caretakers, and domestic.[50] Meanwhile, independent women are seen with a suspicious eye. In addition, cultural stigmas in Mexico profoundly reject feminism.[51]

Hence, the origin of the misogynistic deeply rooted beliefs that permeate the healthcare setting, further increasing the occurrence of obstetric violence. A form of medical violence which stems from a power imbalance between pregnant women and healthcare institutions, driven by a “biomedical care model.”[52] It combines gender-based and institutional elements, using the imposition of specialized medical knowledge to undermine women’s reproductive autonomy. Coerced procedures, like unnecessary cesarean sections and sterilizations, are often performed under the guise of medical necessity, with consent obtained under questionable circumstances due to pressure from healthcare personnel.[53]

Furthermore, gender stereotypes and ideas surrounding motherhood exacerbate the mistreatment and violence that women and pregnant individuals face in the provision of reproductive services. To understand the violence of these practices, it is necessary to question the hegemonic model of care during pregnancy, childbirth, and the postpartum period—which involves a power imbalance that places women in a subordinative position and makes them inferior to doctors—and mostly—to men. In fact, childbirth led by healthcare professionals and not by birthing women is a very conducive scenario for gender-based violence.[54] The delivery room serves as an ideal setting to illustrate the patriarchal denial and appropriation of women’s bodies. In fact, a lot of social controls exist during pregnancy and childbirth. Healthcare professionals infantilize and treat pregnant women with pathologization, as though doctors “know better”, disregarding their autonomy and expertise about their own bodies.[55] For example, mothers are held responsible for difficulties in childbirth, and they are prevented from trusting their own consent or bodily sensations.[56] Women’s bodies and experiences are denied, controlled, and appropriated by the medical establishment.[57]

From a legal standpoint, gender-based stereotypes in the judiciary create frequent obstacles for victims in addressing individual obstetric violence cases in Mexico. General corruption further contributes to an environment of impunity, or freedom from punishment, harm, or loss,[58] enabling recurrence of such incidents. This communicates a message that obstetric violence can go unaddressed, perpetuating its occurrence and societal acceptance. This situation heightens feelings of insecurity among women affected by obstetric violence and fosters a sustained lack of trust in the country’s judicial system.[59]

Therefore, it becomes especially difficult to enforce judicial rules against obstetric violence when cultural challenges exist, like resistance from conservative groups, lack of information around GBV and good healthcare practices, as well as societal expectations around motherhood. For this reason, international organizations have recognized that the widespread gender-based discrimination, stereotypes, social practices, and cultural norms in Mexico constitutes “a cause and a consequence of gender-based violence against women.”[60] Therefore, by showcasing the prevalence of obstetric violence in Mexico and the impact of cultural factors due to traditional gender roles, societal expectations, and historical influences, shows how complex the obstetric violence landscape is. Understanding the contemporary practices of obstetric violence in Mexico sets the stage for a deeper exploration of how cultural factors contribute to this issue’s persistence.

II. Understanding the Laws Surrounding Obstetric Violence

To identify potential solutions that can bridge the gap between international norms and cultural realities, we must consider Mexico’s legal response to obstetric violence. Part II (a) provides an overview of the binding Interamerican Jurisprudence, while Part II(b) analyzes Mexico´s Laws Concerning Obstetric Violence.

a. Interamerican Jurisprudence

While the binding Interamerican jurisprudence emphasizes the rights of women during childbirth, informed consent, and respectful maternity care, Mexico’s cultural landscape sometimes prioritizes traditional practices over these principles.[61] This situation creates a dissonance, raising questions about the adaptability of international jurisprudence within diverse cultural contexts, especially in healthcare systems.[62]

In the context of international human rights law, obstetric violence is considered a breach of fundamental rights, including the right to life, health, freedom from discrimination in healthcare, and access to information.[63] The Inter-American Court of Human Rights (IA Court) has addressed this issue, notably in the case of Brítez Arce and others v. Argentina,[64] where it was recognized as a form of gender-based violence under Article 7 of the Belém do Pará Convention.[65] The case specifically highlights the heightened vulnerability of pregnant women to such violence.[66]

This was also analyzed in the Manuela case where the IA Court studied the situation of Manuela, a Salvadoran woman who, in 2008, faced a health decline and a complex pregnancy.[67] This led her to being detained and held in pretrial detention for the crime of homicide.[68] The legal process was tainted by gender stereotypes and led the court to find El Salvador internationally responsible for violating her rights, emphasizing that Manuela was a victim of structural discrimination, that placed her in a situation of special vulnerability.[69] This ruling set important standards for handling obstetric emergencies and confronting gender stereotypes, marking a significant advance in international human rights.[70]

Additionally, obstetric violence has a more profound impact on individuals in conditions of vulnerability. In the Advisory Opinion 29/22, the IA Court analyzed the effects of obstetric violence on incarcerated women and pregnant individuals.[71] It notes that women represent a portion between 2% and 9% of the incarcerated population[72], with most being imprisoned for non-violent crimes related to poverty, violence,[73] and cultural stereotypes around the criminalization of abortion. In Mexico, for example, over 12,400 women are incarcerated and deprived of their liberty, with more than half of them awaiting trial[74] due to criminal policies lacking a gender perspective that takes into account the differentiated needs of women.[75] The lack of gender-sensitive policies subjects incarcerated women to heightened risks of abuse and exploitation in mixed prisons, while socioeconomic disadvantages prevent them from affording bail, trapping them in a cycle of violence and poverty.[76]

This was noted in another case by the IA Court, I.V. v. Bolivia, where the Court referred to the asymmetry of power between doctors and their patients. [77] Where Mrs. I.V., a Bolivian woman, was sterilized permanently without her informed consent. And, in the exercise of power by the doctor, the IACtHR warned that it creates an atmosphere of impunity, thereby sending a message that violence against women can be tolerated and accepted.[78] In its judgment, the Court affirmed the right to access reproductive health services as a means of exercising reproductive autonomy. It emphasized that “the lack of legal safeguards to consider reproductive health can result in a serious impairment of reproductive autonomy and freedom.”[79]

Likewise, the Poblete Vilches and Cuscul Pivaral cases highlighted the Interamerican standards on the direct enforceability of the right to health. The cases detailed how, according to article 26 of the IA Court, the State must progressively implement health services that are available, accessible, acceptable, and of sufficient quality.[80] These cases underscore the binding nature of the availability of medical services and establish that States bear responsibility for the actions of both public and private health care providers.[81]

In a pivotal ruling in November 2023, the IA Court condemned Venezuela for violations of the rights of Balbina Francisca Rodríguez Pacheco, who experienced obstetric violence in a private hospital in 1998.[82] Mrs. Rodríguez Pacheco experienced severe complications during a cesarean section, leading to long-term health problems.[83] Despite her suffering, legal proceedings were dismissed, and authorities neglected to investigate.[84] Eventually, the systemic failures in ensuring justice and protection for victims of medical malpractice were addressed by the IACtHR. The IACtHR determined that, in cases where a woman alleges being a victim of obstetric violence by private actors, States have the obligation to establish “timely, appropriate, and effective reporting mechanisms that recognize such obstetric violence as a form of violence against women.”[85] Moreover, “the perpetrators of such violence, and provide the victim with effective compensation, damage repair, or other fair and effective means of compensation.”[86] Fortunately for the victims in Mexico, the jurisprudence of the IACtHR is binding for Mexico and places a significant responsibility on the State. This includes the obligation to “prevent third parties from committing acts of obstetric violence” and to “regulate and supervise all health care.”[87]

b. Mexico´s Laws Concerning Obstetric Violence

The right to health is established in Article 4 of the Mexican Constitution and the General Health Law.[88] Additionally, in Mexico, all individuals are entitled to the human rights granted by the Constitution and the international treaties signed by the Mexican State.[89] Therefore, the right to health is also recognized by Articles 25.1 of the Universal Declaration of Human Rights,[90] 12 of the International Covenant on Economic, Social, and Cultural Rights,[91] and 10 of the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social, and Cultural Rights.[92] Specifically, in the context of reproductive rights, the Mexican Constitution (Article 4, second paragraph) asserts that: “every person has the right to decide freely, responsibly, and informedly about the number and spacing of their children,”[93] emphasizing the importance of personal autonomy in family planning decisions.

In addition, the Convention on the Elimination of All Forms of Discrimination Against Women (“CEDAW”) establishes the obligation of states to eliminate discrimination against women. Article 10(h) calls for access to information contributing to family health and well-being, including family planning and counseling.[94] Furthermore, Article 12 mandates states to eliminate discrimination against women, specifically in healthcare and with special emphasis on family planning services.[95] Finally, states have an obligation to ensure that there is no discrimination in the exercise of the right to decide freely and responsibly on the number of children and the spacing between births and to have access to this right.[96]

Similarly, Article 1 of the Inter-American Convention on Preventing, Punishing, and Eradicating Violence against Women (“Belem do Para”) defines what constitutes violence against women as: “any action or conduct, based on gender, that causes death, physical, sexual, or psychological harm or suffering to women, both in the public and private spheres”.[97] And Article 9 recognizes the particular situation of vulnerability of pregnant women.[98]

In addition, the United Nations Committee on Economic, Social, and Cultural Rights, in its General Comment 14, emphasized that the right to health includes control over one’s health and body, particularly sexual and reproductive freedom. Moreover, paragraph 2(a) of Article 12 of the International Covenant on Economic, Social, and Cultural Rights should be interpreted to mean that measures should be taken to improve child and maternal health, sexual and reproductive health services, including access to family planning, pre and postnatal care, emergency obstetric services, and access to information.

Nevertheless, in the current local state context, only 7 out of 32 states in Mexico have formally recognized and defined obstetric violence with associated consequences.[99] Many people remain unaware of the problem of obstetric violence, leaving most women who experience this form of gender-based violence without the necessary resources or information to protect themselves. The Supreme Court of Mexico recognized this gap in their ruling on a constitutional amparo claim, “Amparo en Revisión 1064/2019,”[100] where a woman was granted an “Amparo” human rights claim for non-consensual sterilization during a cesarean section procedure at a hospital of the Mexican Social Security Institute (IMSS). The Court identified this as gender-based violence and an act of torture, because medical personnel acted based on gender stereotypes.[101]

Accordingly, the decision to sterilize her without her authorization diminished her decision-making capacity regarding her own body.[102] Additionally, they concluded that the complainant was a victim of institutional obstetric violence as a form of gender-based violence expressed through dehumanizing practices in the public health sphere, specifically in reproductive health, affecting women’s autonomy, freedom, and ability to decide freely about their bodies and sexuality.[103]

However, despite the Mexican laws and jurisprudence fighting against obstetric violence, the implementation of such laws within Mexican society encounters cultural challenges. Traditional gender roles, uneven power dynamics in healthcare settings, insufficient education on reproductive rights, and societal reluctance to question established practices all contribute to the normalization and continuation of this form of gender-based violence. What potential solutions could be envisioned to address these challenges?

III. Potential Solutions for Reducing Obstetric Violence in Cultural Contexts

Considering the challenges presented by cultural factors, exploring new viable solutions becomes essential to mitigate obstetric violence and its consequences. In this sense, Part III (a) presents general solutions for the cultural issue of obstetric violence; and Part III (b) approaches public policy solutions for this phenomenon.

a. General Solutions for the Cultural Issue of Obstetric Violence

In Mexico, there is a big gap between the rules on paper and what is happening regarding violence against women.[104] 66.1 percent of women have reported experiencing violence in their lifetime.[105] To fix this problem, we need to actively involve people participating in shaping, implementing, and evaluating public policies to make sure human rights, especially the rights to health, are fully respected.

Thus, education is the first urgent action which can address obstetric violence. Finding common ground between cultural values and international standards, — like the Inter-American jurisprudence–, is crucial for addressing obstetric violence in Mexico. Education and awareness campaigns for doctors, explaining what obstetric violence is in the medical sphere is essential. We must spread information to medical personnel regarding gender-based stereotypes, by educating the medical personnel on intersectionality and obstetric violence we can help challenge harmful practices. Therefore, educating and engaging healthcare professionals, communities, and policymakers can help dialogue and facilitate a more inclusive approach to combating obstetric violence and break down cultural stereotypes.

Notably, there is currently no established legal procedures to address obstetric violence. It remains a significant national problem, which is persistently overlooked by existing legislation, the healthcare system, and society at large. Exploring solutions like reforming the law, and clarifying the typification and legislation of obstetric violence, its consequences and remedy is vital. Also, participation and consultations with NGOs or civil society organizations that address Violence Against Women could help address the phenomenon of obstetric violence.

In conjunction, the State must recognize patterns of intersectional and structural discrimination to develop proactive strategies through the implementation of policies that address the underlying causes. The State holds a specific responsibility to uphold the presumption of innocence and the right to defense in cases where various intersecting forms of discrimination come together within a context of structural bias against women.

b. Public Policy Solutions for the Problem of Obstetric Violence

Moreover, to address potential human rights violations associated with obstetric violence, it is imperative to institute a comprehensive national public policy. When the Inter-American Commission (IA Comission) referred the Balbina case to the IACHR, it suggested some points for the suggested public policy that should be seriously taken into consideration.[106] First, the policy should prioritize the implementation of means of reparation for victims, encompassing both material and immaterial dimensions.[107] It ought to include provisions for economic compensation and satisfaction, recognizing the potential impact on affected individuals’ life trajectories. Secondly, the IACHR suggests that policy must ensure accessible physical and mental health care with a gendered perspective, in accordance with the Interamerican Jurisprudence, encompassing the provision of necessary medicines and services. Efforts should be directed toward effective investigations and timely punishment of justice operators involved in undue delays in criminal proceedings, safeguarding access to justice.[108] Thirdly, the IACHR indicated that the development programs for prevention and policies within the justice system and medical associations should align with established international standards.[109] The implementation of training programs on health and human rights, integrating a gendered perspective, for healthcare and judicial personnel at the national level is indispensable to uphold women’s rights.[110]

In another way, the IA Commission also suggested interesting public policy ideas in the Manuela case, that might bring some clarity in how to address the cultural phenomenon of obstetric violence:[111] It suggested that measures should be taken to decriminalize and avoid pretrial detention for the cases of obstetric emergencies or situations that are criminalized due to stereotypes surrounding abortion. [112] One way would be to implement a comprehensive training and awareness initiative targeting both judicial professionals and healthcare personnel across national medical facilities. [113] On the other hand, in the context of judicial officials, the State is encouraged to establish continuous educational programs for doctors that focus on individuals participating in legal processes involving women accused of offenses related to abortion or infanticide.[114]

According to the IACHR, these programs should emphasize the potential of discriminatory presumptions and gender stereotypes during investigations and legal proceedings.[115] Additionally, they should address how the credibility and consideration of opinions, arguments, and testimonies from women, serving as both parties and witnesses, are handled.[116] The aim would be to mitigate the impact of inflexible norms (stereotypes) that may influence judgments regarding what is deemed acceptable behavior for women.[117] In this way, the approach seeks to ensure fair and unbiased legal proceedings in cases of obstetric violence.[118] Lastly, the IACHR considered that States should design and implement specific content on sexuality and reproduction within school programs.[119] This content should be comprehensive, non-discriminatory, evidence-based, scientifically rigorous, and age-appropriate.[120] Finally, it is necessary for States to immediately take the necessary measures to ensure comprehensive medical care for women experiencing obstetric emergencies.[121]

Taking all the above-mentioned recommendations, considering that Obstetric violence is primarily perpetuated by medical staff and doctors, it is important to create educational models and comprehensive educational programs targeting obstetricians, medical staff and anesthesiologists across Mexico. These programs should effectively combine theoretical knowledge with practice methodologies to enhance the management of obstetric emergencies. The training content should be gender-sensitive, have a focus on reducing maternal mortality, and be particularly sensitive to violence against women. Therefore, a change in public policy must address the importance of education, legislative reform, and comprehensive public policies to bridge the gap between global standards and cultural traditions, to create lasting change.

IV. Conclusion

In conclusion, understanding how obstetric violence in Mexico is deeply rooted in cultural factors is essential to grasping the root of the issue. It must be recognized as a cultural phenomenon to bridge the gap between the normative framework and practice. Prioritizing concrete actions and public policies around education and awareness is vital. Campaigns should be tailored to local cultural values to combat the issue at its root. Moreover, clarity on established procedures to address obstetric violence is necessary, as there is currently little clarity on legal actions to take against this form of violence. Legislative reforms and inclusive policy implementation are needed to recognize and address obstetric violence as a form of structural discrimination.[122] It’s crucial to develop a comprehensive national public policy ensuring victim reparations, access to gender-sensitive healthcare, and ongoing training for healthcare professionals and the judicial system.[123]

Hence, the necessity of a multidimensional approach combining cultural awareness, legal reform, and the implementation of inclusive public policies to combat obstetric violence in Mexico. Concrete measures must be established to protect women’s rights and address the root causes of obstetric violence. Only through a comprehensive and collaborative approach can progress be made towards an obstetric care system that respects human rights and ensures the safety and well-being of all women during childbirth.

[1] ‘Cállese y puje’, ecos de la violencia obstétrica en México, Reporte Índigo, https://www.reporteindigo.com/reporte/callese-y-puje-ecos-de-la-violencia-obstetrica-en-mexico/.

[2] Id.

[3] Parir en oscuridad. Violencia obstétrica: Una violación a los derechos humanos de las mujeres, https://www.scjn.gob.mx/sites/default/files/igualdad-genero/2019-11/1er_LUGAR_ENSAYO_639_parir-en-oscuridad.pdf.

[4] ‘Cállese y puje’, ecos de la violencia obstétrica en México, Reporte Índigo’, supra note 1.

[5] GIRE, Obstetric Violence: A Human Rights Approach (2015), https://gire.org.mx/wp-2 content/uploads/2019/11/informeviolenciaobstetrica2015.pdf; See also GIRE, Zero Impunity, 23.

[6] Id.

[7] Id at 23.

[8] Comm. on the Elimination of Discrimination Against Women on Its Eleventh Session, U.N. CEDAW General Recommendations No. 19: Violence against women (1992) (“1. Gender-based violence is a form of discrimination that seriously inhibits women’s ability to enjoy rights and freedoms on a basis of equality with men.”).

[9] Roberto Castro and Sonia M. Frías, Obstetric Violence in Mexico: Results From a 2016 National Household Survey, sagepub.com, DOI: 10.1177/1077801219836.

[10] On the one hand, after WWII, Universalism emerged and built the IHR regime under the belief that “[a]ll human beings are born free and equal in dignity and rights” (Universal Declaration of Human Rights), just because they are human. And, on the other hand, cultural relativists have maintained that different cultures “have different definitions on what constitutes a human right.” In other words, while Universalists rely on a “one size fits all” list of obligations binding everywhere, Cultural Relativists believe that “human rights vary from culture to culture.” They argue that specific cultural differences “cannot be reconciled”, and that “different cultures have different definitions of what constitutes a human right”. See The Belgrade Circle Journal, The Politics of Human Rights (1999); Elene G. Mountis, Cultural Relativity and Universalism: Reevaluating Gender Rights in a Multicultural Context, 15 Penn State Int’ L. Rev. 113, 113-150 (1996)http://elibrary.law.psu.edu/psilr/vol15/iss1/3; Itván Lakatos, Thoughts on Universalism versus Cultural Relativism, with Special Attention to Women’s Rights, Pécs Journal of Int’l and European Law (2018).

[11] Bret L. Billet, Cultural Relativism in the Face of the West: The Plight of Women and Children 1-18 (Palgrave Macmillan eds., 2007) (“virtually every society to be ‘distinct’ from others. The chief implication arising from this is that while some human rights may be applicable to perhaps a few societies, there can never be a universal human right that is uniformly applicable to people worldwide . . . Many maintain that the introduction of such ‘universal’ concepts, which are in reality not universal at all, . . . Adherents to cultural relativism claim that the rich variety of practices among different cultures does not make the uniform application of universal human rights feasible.”).

[12] Biermann, M.C., Farias, M.G., Patriarchy and Feminist Perspectives, in Encyclopedia of Evolutionary Psychological Science 5812, 17 (Cham: Springer International Publishing eds., 2021) (Patriarchy is “A system of gender-based hierarchy in which men hold primary power. Feminist perspectives are related to the feminist movement based on the social, political, and economic equality of the sexes. . . . Patriarchy is an example of a hierarchical social system in which power is held by men based on male dominance in social, legal, religious, economic, and political organization”).

[13] The term “misogyny” is derived from the Ancient Greek word “mīsoguníā” which means hatred towards women. Misogyny has taken shape in multiple forms such as male privilege, patriarchy, gender discrimination, sexual harassment, belittling of women, violence against women, and sexual objectification. Cheris Kramarae & Dale Spender, Routledge International Encyclopedia of Women 1374–77 (2000).

[14] U.N. CEDAW General Recommendations, supra note 8.

[15] General Recommendation 19 defines discrimination against women as: “6. The Convention in article 1 defines discrimination against women. The definition of discrimination includes gender-based violence, that is, violence that is directed against a woman because she is a woman or that affects women disproportionately. It includes acts that inflict physical, mental or sexual harm or suffering, threats of such acts, coercion and other deprivations of liberty. Gender-based violence may breach specific provisions of the Convention, regardless of whether those provisions expressly mention violence.” Committee on the Elimination of Discrimination Against Women, General Recommendation 19, Violence Against Women (Eleventh session, 1992), UN Doc. A/47/38 (1992).

[16] M. E. Harrison, Female physicians in Mexico: migration and mobility in the lifecourse, 47 Soc. Sci. Med. 455 (1998).

[17] GIRE, supra note 1.

[18] Id.

[19] Id.

[20] Id.

[21] Brítez Arce y Otros v. Argentina, Merits, Reparations, and Costs, Judgment, Inter-Ame. Ct. H.R. (ser. C) 75 & 81 (Nov. 16, 2022).

[22] Id at 81.

[23] Fernández Guillén, M., Violencia Obstétrica: Una Forma de Violencia de Género en la Atención Sanitaria, Revista Española de Derecho Sanitario, 89-104 (2017).

[24] Id.

[25] ENDIREH, The National Survey on the Dynamics of Relationships in Households (INEGI. Encuesta Nacional sobre la Dinámica de las Relaciones en los Hogares) (2021).

[26] Id.

[27] World Health Organization (WHO), Maternal Mortality: Helping Women Off The Road To Death, 40 WHO Chronicle 177 (1986).; See also Office of the High Commissioner for Human Rights, Technical Guidance On Applying A Human Rights-Based Approach To The Implementation Of Policies And Programs Aimed At Reducing Preventable Maternal Mortality And Morbidity, U.N. Doc. A/HRC/21/22 (July 2, 2022).

[28] Committee on the Elimination of Discrimination Against Women, Concluding observations on the ninth periodic report of Mexico, UN Doc. CEDAW/C/MEX/CO/9, 41 (July 25 2018).

[29] Id.

[30] Id at 42.

[31] CEDAW Committee, Mexico’s 9th Periodic Report, Alternative Report on the Reproductive Rights of Mexican Girls, (July 2018); Adolescents and Women, Grupo de Información en Reproducción Elegida, AC (GIRE).

[32] Regina Tamés, Mexico’s Supreme Court Orders Federal Decriminalization of Abortion Next Steps Include Ensuring Access, Human Rights Watch (Sep. 8, 2023), https://www.hrw.org/news/2023/09/08/mexicos-supreme-court-orders-federal-decriminalization-abortion. See also Gabriella Borter, Mexico has decriminalized abortion, but politics could decide access, Reuters (Sept. 8, 2023 12:54 PM), https://www.reuters.com/world/americas/mexico-has-decriminalized-abortion-nationwide-access-remains-elusive-2023-09-08/#:~:text=The%20ruling%20set%20a%20significant,seekers%20fleeing%20more%20restrictive%20laws.

[33] Margena de la O & Amapola Periodismo, Aurelia, la indígena que pasó mil 140 días presa por una emergencia obstétrica, Pie de Página (March 14, 2023), https://piedepagina.mx/aurelia-la-indigena-que-paso-mil-140-dias-presa-por-una-emergencia-obstetrica/#:~:text=Mujeres%20y%20feminismos-,Aurelia%2C%20la%20ind%C3%ADgena%20que%20pas%C3%B3%20mil%20140,presa%20por%20una%20emergencia%20obst%C3%A9trica&text=Tras%20el%20acompa%C3%B1amiento%20pol%C3%ADtico%20y,libertad%20en%20diciembre%20de%202022.

[34] Id.

[35] See id.

[36] Id.

[37] See Mounia El Kotni, Between Cut and Consent: Indigenous Women’s Experiences of Obstetric Violence in Mexico, 40 American Indian Culture and Rsch. J. 21 (2018).

[38] Id.

[39] Id at 32.

[40] Id.

[41] Ines de la Morena, Machismo, Femicides, and Child’s Play: Gender Violence in Mexico, Harv. Int’l Rev. (May 19, 2020), https://hir.harvard.edu/gender-violence-in-mexico-machismo-femicides-and-childs-play/.

[42] Id.

[43] Id.

[44] See Kramarae & Spender, supra 13 at 1374-7 (”The term ’misogyny’ is derived from the Ancient Geek word “mīsoguníā” which means hatred towards women. Misogyny has taken shape in multiple forms such as male privilege, patriarchy, gender discrimination, sexual harassment, belittling of women, violence against women, and sexual objectification.”).

[45] See Ríos et al. v. Venezuela, Preliminary Objections, Merits, Reparations, and Costs, Judgment, Inter-Am. Ct. H.R. (ser. C) No. 194, ¶ 138 (Jan 28, 2009). See also Case Perozo et al. v. Venezuela, Preliminary Objections, Merits, Reparations and Costs, Judgment, Inter-Am. Ct. H.R. (ser. C) No. 195, ¶ 157 (Jan. 28, 2009). See also Violence against Lesbian, Gay, Bisexual, Trans, and Intersex Persons in the Americas, Advisory Opinion OAS/V/II.rev.2, Inter-Am. Ct. H.R. (ser. L) No. 36, ¶ 242 (Nov. 12, 2015) (arguing that public officials should promote a discourse that prevents discriminatory violence, fostering a climate of tolerance and respect, refraining from statements that heighten the risk for specific groups. Although an official discourse might not directly authorize or incite violence, its content can render potential victims more vulnerable to both the State and certain societal sectors).

[46] The European Court of Human Rights held in Opuz vs. Turkey that the state’s failure to protect women from domestic violence through judicial means, or in their access to justice, violates their right to equal protection of the law, even if unintentional, constituting gender-based discrimination. (Case C-33401/02, Opuz v. Turkey, 2009 E.C.R. ¶¶ 180, 191 & 200. (June 9, 2009).

[47] See González and Others (“Campo Algodonero”) v. Mexico, Preliminary Objection, Merits, Reparations, and Costs, Judgment, Inter-Am. Ct. H.R. (ser. C) No. 205, ¶ 401 (Nov. 16, 2009) (recognizing the existence of descriptive and prescriptive stereotypes when it stated that a gender stereotype is “a preconception of attributes or characteristics possessed or roles that are or should be performed by men and women respectively”).

[48] Emanuela Cardoso Onofre de Alencar, Mujeres y estereotipos de género en la jurisprudencia de la Corte Interamericana de Derechos Humanos, 9 Eunomía. Revista en Cultura de la Legalidad 26, 26-48 (2015–2016).

[49] INEGI, Información sobre diversidad, https://cuentame.inegi.org.mx/monografias/informacion/mex/poblacion/diversidad.aspx?tema=me&e=15#:~:text=78%20%25%20de%20la%20poblaci%C3%B3n%20es%20cat%C3%B3lica.

[50] Annik M. Sorhaindo et al., Qualitative evidence on abortion stigma from Mexico City and five states in Mexico, 54 Women Health 622, 622–40 (2014).

[51] Id.

[52] Biomedical Model of Health, OxfordReference.com, https://www.oxfordreference.com/display/10.1093/acref/9780191828621.001.0001/acref-9780191828621-e-5075) (“a model of health which focuses on purely biological factors and excludes psychological, environmental, and social influences. It is considered to be the leading modern way for healthcare professionals to diagnose and treat a condition in most Western countries.”)

[53] Law iniciative of Mexico City, named “Iniciativa con proyecto de decreto por el que se deroga el artículo 151 bis y se adiciona un Capítulo Tercero al Título Segundo “Delitos contra la libertad Reproductiva” del Código Penal para Distrito Federal, se adicionan diversas disposiciones a los artículos 206 bis, 206 ter, 206 quarter y 206 quinquies del Código Penal para el Distrito Federal, se adicionan los incisos f) y g) a la fracción VII del artículo 6, y se adicionan diversas disposiciones a las fracciones VI y VII de la Ley de Acceso de las Mujeres a una Vida Libre de Violencia de la Ciudad de México”, https://www.congresocdmx.gob.mx/media/documentos/cc092924ec536692fa4e70721acd13da055e08a7.pdf

[54] Meghan A. Bohren et al.,The Mistreatment of Women during Childbirth in Health Facilities Globally: A Mixed-Methods Systematic Review, 12PLoS Med. 1, 2 (2015).

[55] Adrienne Rich, Of Woman Born: Motherhood as Experience and Institution (1976); Emily Martin, The Woman in the Body: A Cultural Analysis of Reproduction (2001).

[56] Id.

[57] Id.

[58] Impunity refers to the “freedom from punishment, harm, or loss”, Encyc. Britannica, https://www.britannica.com/dictionary/impunity#:~:text=%3A%20freedom%20from%20punishment%2C%20harm%2C,in%20the%20phrase%20with%20impunity.

[59]Veronica Esparza et al., Justicia Olvidada, Violencia e impunidad en la salud reproductiva, GIRE Impunidad Cero, https://gire.org.mx/publicaciones/justicia-olvidada-violencia-e-impunidad-en-la-salud-reproductiva/.

[60] The Convention on the Elimination of All Forms of Discrimination Against Women (CEDAW), Belém do Pará Convention, Inter-American Commission on Human Rights (CIDH), Violence and Discrimination Against Women, Girls, and Adolescents: Good Practices and Challenges in Latin America and the Caribbean, OAS/Ser.L/V/II. Doc. 233, November 14, 2019, para. 182. Inter-American Commission on Human Rights (CIDH), Women facing violence and discrimination resulting from the armed conflict in Colombia, OAS/Ser.L/V/II. Doc. 67 (2006), para. 43. Inter-American Commission on Human Rights (CIDH), Report on Poverty and Human Rights in the Americas, OAS/Ser.L/V/II.164. Doc. 147 (2017), para. 187. Inter-American Court of Human Rights (Corte IDH), Case González and Others (“Campo Algodonero”) Vs. Mexico, Preliminary Objection, Merits, Reparations, and Costs, Judgment of November 16, 2009, Series C No. 205, para. 401.

[61] I.V. v. Bolivia, (Merits, Reparations, and Costs, Inter-Am. Ct. H.R (Nov. 30, 2016); Beatriz v. El Salvador, Case 13.248, Inter-Am. Comm’n H.R. Report No. 136/21 (2021); Manuela and Family v. El Salvador, Case No. 13.069, Inter-Am. Comm’n H.R., Report No. 153/18 (2018); Brisa Angulo v. Bolivia, Case No. 13.581, Inter-Am. Comm’n H.R., Report No. 327/21 (2021); Britez Arce v. Argentina, Preliminary Objections, Merits, Reparations, and Costs, Inter-Am. Ct. H.R. (Nov. 24, 2023).

[62] Id.

[63] Britez Arce and Others v. Argentina, Judgement, Inter-Am. Ct. H.R. (ser. C), No. 22, ¶ 75 (Nov. 16, 2022) (concluding that this violence violates the: (i) right to health under Article 26 of the American Convention on Human Rights (ACHR), in conjunction with Article 1.1; (ii) right to life as per Article 4.1 of the ACHR, in conjunction with Article 1.1; and (iii) right to personal integrity under Article 5.1 of the ACHR, also in conjunction with Article 1.1.).

[64] See id at ¶ 75.

[65] Inter-American Convention on the Prevention, Punishment, and Eradication of Violence Against Women, Belem do Parà Convention, June 9, 1994, Inter-Am. Ct. H.R. 33 I.L.M 1534 (“Every woman has the right to a life free of violence. Violence against women shall be understood to include physical, sexual, and psychological violence occurring in the family or domestic unit, as well as any form of violence against women within the general community. This shall include, but is not limited to, the following: a) physical, sexual, and psychological violence occurring in the family, including battering, sexual abuse of female children in the household, dowry-related violence, marital rape, female genital mutilation, and other traditional practices harmful to women; b) physical, sexual, and psychological violence occurring within the general community, including rape, sexual abuse, sexual harassment, and intimidation at work, in educational institutions, and elsewhere; c) trafficking in women; d) forced prostitution; and e) violence perpetrated or condoned by the state or its agents, regardless of where it occurs”)

[66] Id.

[67] Manuela and Others v. El Salvador, Inter-Am. Ct. H.R., Judgment of Nov. 2, 2021, Prelim. Obj., Merits, Reparations, and Costs.

[68] Id.

[69] Id at ¶¶ 146, 173, 253.

[70] Id.

[71] Advisory Opinion OC-29/22, Differentiated Approaches Regarding Certain Groups of Persons Deprived of Liberty, Inter-Am. Ct. H. R., May 30, 2022, at 48.

[72] Id.

[73] Miranda Carballo Corrales, Prison: Where Gender Gaps Increase, NEXOS (Aug. 11, 2022), https://anticorrupcion.nexos.com.mx/la-prision-donde-las-brechas-de-genero-aumentan/.

[74] Id.

[75] Id.

[76] Id.

[77] I.V. v. Bolivia, Preliminary Objections, Merits, Reparations, Costs, Judgment, Inter-Am. Ct. H.R. (Nov. 30, 2016).

[78] Id at ¶ 317.

[79] Human Rights Committee, General Comment No. 36. Article 6: Right to Life, para. 8.

[80] Poblete Vilches and Others v. Chile, Merits, Reparations, and Costs, Judgment, Inter-Am. Ct. H.R., 121-139 (March 8, 2018); Cuscul Pivaral and others vs. Guatemala, Merits, Reparations, and Costs, Judgment, Inter-Am. Ct. H.R., 106-107 (Aug. 23, 2018).

[81] See id at 119. See also Ximenes Lopes v. Brazil, Preliminary Objection, Judgment, Inter-Am. Ct. H.R. ¶ 89 (July 4, 2006).

[82] Rodríguez Pacheco v. Venezuela, Judgment, Inter-Am. Ct. H.R. (Sept. 1, 2023).

[83] Id.

[84] Id.

[85] Id at 107.

[86] Id at 112.

[87] Id at 112.

[88] Constitución Política de los Estados Unidos Mexicanos (Mex.) [Political Constitution of the United Mexican States], as amended, Diario Oficial de la Federación [DOF], Art. 4 (Feb. 5, 1917); Diario Oficial de la Federación [DOF] (Feb. 7, 1984).

[89] Constitución Política de los Estados Unidos Mexicanos [Political Constitution of the United Mexican States], as amended, Diario Oficial de la Federación [DOF], art. 1 and 133 (Feb. 5, 1917) (Mex.).

[90] Article 25.1 of the Universal Declaration of Human Rights.

[91] Article 12 of the International Covenant on Economic, Social, and Cultural Rights.

[92] Article 10 of the Additional Protocol to the American Convention on Human Rights in the Area of Economic, Social, and Cultural Rights.

[93] See Political Constitution of the United Mexican States Oct. 8, 2013, art. 4 (Mex.).

[94] Article 10(h) Convention on the Elimination of All Forms of Discrimination Against Women.

[95] Id at art. 12.

[96] Id at art. 16.

[97] Supra note 54 at art. 1.

[98] Id at art. 9.

[99] Supra note 50.

[100] First Chamber of the Supreme Court of Mexico, Amparo en Revisión 1064/2019.

[101] Id.

[102] Id.

[103] Id.

[104] How Prevalent is Gender-Based Violence?, Wilson Center, https://gbv.wilsoncenter.org/explore-gbv-data#:~:text=GBV%20in%20Mexico,signs%20of%20torture%20or%20beatings.

[105] Id.

[106] IAHR, Press release, La CIDH presenta caso sobre Venezuela ante la Corte Interamericana [The IACHR presents a case on Venezuela before the Inter-American Court] (March 31, 2021) https://www.oas.org/pt/CIDH/jsForm/?File=/es/cidh/prensa/comunicados/2021/081.asp.

[107] In the Balbina Case, the Court established that its Judgment constitutes, by itself, a form of reparation and, additionally, ordered the State, within the deadlines set in the judgment: (i) within a reasonable time, to investigate, through competent public institutions, the officials accused of irregularities and, after due process, to apply the corresponding administrative, disciplinary, or criminal sanctions to those found responsible; (ii) to pay the amounts set forth in this Judgment for rehabilitation; (iii) to publish the official summary of the Judgment prepared by the Court in the Official Gazette and in a widely circulated national media in a legible and adequate font size; (iv) to publish this Judgment on an official website of the Supreme Court of Justice of the Bolivarian Republic of Venezuela and of the Ministry of Popular Power for Health, accessible to the public and from the homepage of the website; (v) to adopt the necessary measures for the organs of the Judiciary and the Public Ministry to develop training programs in the investigation of possible cases of obstetric violence, taking into account the inter-American standards on the matter concerning due diligence and reasonable time, as well as from a gender perspective; (vi) to develop training and continuing education programs aimed at medical students and professionals, as well as all reproductive health care personnel, both in public and private health centers, on women’s maternal health rights and gender-based discrimination and stereotypes, as well as on the investigation and prevention of cases of obstetric violence, and (vii) to pay the amounts set forth in the judgment for material and immaterial damage, as well as for the reimbursement of costs and expenses.

[108] Supra note 86.

[109] Id.

[110] Id.

[111] See Manuela et al. v. El Salvador, Preliminary Objections, Merits, Reparations, and Costs, Inter-Am Ct. H.R. ¶ 282-300 (Nov. 2, 2021).

[112] Id.

[113] Id at ¶ 15.

[114] Id.

[115] Id at ¶ 293.

[116] Id.

[117] Id at ¶ 293.

[118] Id.

[119] Id at ¶ 297.