Experiences with obstetric violence among healthcare professionals and students in Spain: A constructivist grounded theory study



      Obstetric violence appears to be a worldwide concern and is defined as a type of gender-based violence perpetrated by health professionals. This violence undermines and harms women’s autonomy. In Spain, 38.3 % of women have identified themselves as victims of this type of violence.


      To explore current information and knowledge about obstetric violence within the Spanish healthcare context, as well as to develop a theoretical model to explain the concept of obstetric violence, based on the experiences of healthcare professionals (midwives, registered nurses, gynaecologists and paediatricians) and nursing students.


      A constructivist grounded theory study was conducted at Jaume I University in Spain between May and July 2021, including concurrent data collection and interpretation through constant comparison analysis. An inductive analysis was carried out using the ATLAS.ti 9.0 software to organise and analyse the data.


      Twenty in-depth interviews were conducted, which revealed that healthcare professionals and students considered obstetric violence a violation of human rights and a serious public health issue. The interviews allowed them to describe certain characteristics and propose preventive strategies. Three main categories were identified from the data analysis: (i) characteristics of obstetric violence in the daily routine, (ii) defining the problem of obstetric violence and (iii) strategies for addressing obstetric violence. Participants identified obstetric violence as structural gender-based violence and emphasised the importance of understanding its characteristics. Our results indicate how participants’ experiences influence their process of connecting new information to prior knowledge, and they provide a connection to specific micro- and macro-level strategic plans.


      Despite the lack of consensus, this study resonates with the established principles of women and childbirth care, but also generates a new theoretical model for healthcare students and professionals to identify and manage obstetric violence based on contextual factors. The term ‘obstetric violence’ offers a distinct contribution to the growing awareness of violence against women, helps to regulate it through national policy and legislation, and involves both structural and interpersonal gender-based abuse, rather than assigning blame only to care providers.


      Obstetric violence is the most accurate term to describe disrespect and mistreatment as forms of interpersonal and structural violence that contribute to gender and social inequality, and the definition of this term contributes to the ongoing awareness of violence against women, which may help to regulate it through national policy and legislation.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Women and Birth
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Šimonović D. A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence, 2019. 〈〉.

        • Williams C.
        • Jerez C.
        • Klein K.
        • Correa M.
        • Belizán J.
        • Cormick G.
        Obstetric violence: a Latin American legal response to mistreatment during childbirth.
        BJOG: Int. J. Obstet. Gynaecol. 2018; 125: 1208-1211
      2. World Health Organization. The prevention and elimination of disrespect and abuse during facility-based childbirth, 2015. 〈〉.

        • Mesenburg M.A.
        • Victora C.G.
        • Jacob Serruya S.
        • et al.
        Disrespect and abuse of women during the process of childbirth in the 2015 Pelotas birth cohort.
        Reprod. Health. 2018; 15: 54
        • Mihret M.S.
        Obstetric violence and its associated factors among postnatal women in a Specialized Comprehensive Hospital, Amhara Region, Northwest Ethiopia.
        BMC Res. Notes. 2019; 12: 600
        • Mena-Tudela D.
        • Iglesias-Casás S.
        • González-Chordá V.M.
        • Cervera-Gasch Á.
        • Andreu-Pejó L.
        • Valero-Chilleron M.J.
        Obstetric Violence in Spain (Part I): women’s perception and interterritorial differences.
        Int. J. Environ. Res. Public Health. 2020; 17E7726
        • Castro R.
        • Frías S.M.
        Obstetric violence in Mexico: results from a 2016 national household survey.
        Violence Women. 2020; 26: 555-572
        • Santiago R.V.
        • Monreal L.A.
        • Rojas Carmona A.
        • Domínguez M.S.
        “If we’re here, it’s only because we have no money…” discrimination and violence in Mexican maternity wards.
        BMC Pregnancy Childbirth. 2018; 18: 244
        • Grilo Diniz C.S.
        • Rattner D.
        • Lucas d′Oliveira A.F.P.
        • de Aguiar J.M.
        • Niy D.Y.
        Disrespect and abuse in childbirth in Brazil: social activism, public policies and providers’ training.
        Reprod. Health Matters. 2018; 26: 19-35
      3. World Health Organization. Violence Against Women Prevalence Estimates, 2018, 2021. 〈〉.

      4. European Commission, What is gender-based violence? Gender-based violence, 2022. 〈〉 (Accessed 6 March 2022).

      5. Borges M. A violent birth: reframing coerced procedures during childbirth as obstetric violence, 2018. 〈〉.

        • Rominski S.D.
        • Lori J.
        • Nakua E.
        • Dzomeku V.
        • Moyer C.A.
        When the baby remains there for a long time, it is going to die so you have to hit her small for the baby to come out": justification of disrespectful and abusive care during childbirth among midwifery students in Ghana.
        Health Policy Plan. 2017; 32: 215-224
        • Mena-Tudela D.
        • González-Chordá V.M.
        • Soriano-Vidal F.J.
        • et al.
        Changes in health sciences students’ perception of obstetric violence after an educational intervention.
        Nurse Educ. Today. 2020; 88104364
        • Rodríguez-Mir J.
        • Martínez-Gandolfi A.
        La violencia obstétrica: una práctica invisibilizada en la atención médica en España.
        Gac. Sanit. 2021; 35: 211-212
        • Faneite J.
        • Feo A.
        • Toro Merlo J.
        [The level of obstetric violence knowledge among healthcare workers].
        Rev. De. Obstet. Y. Ginecol. De. Venez. 2012; 72: 4-12
        • Corbin J.
        • Strauss A.
        Basics of Qualitative Research: Techniques and Procedures for Developing Grounded theory, Forth Ed.
        SAGE Publications, Los Angeles2015
        • Metelski F.K.
        • Santos J.L.G.
        • dos, Cechinel-Peiter C.
        • Fabrizzio G.C.
        • Schmitt M.D.
        • Heilemann M.
        Constructivist grounded theory: characteristics and operational aspects for nursing research.
        Rev. Esc. Enferm. USP. 2021; : 55×2020051103776
        • Mueller C.W.
        Conceptualization, operationalization, and measurement.
        in: The SAGE Encyclopedia of Social Science Research Methods. SAGE Publications, London2004: 161-165
        • Glaser B.G.
        • Strauss A.L.
        The Discovery of Grounded Theory: Strategies for Qualitative Research.
        Routledge, London2017
        • Charmaz K.
        Constructing Grounded Theory: A Practical Guide through Qualitative Analysis.
        SAGE Publications, Thousand Oaks, Calif.2007
        • Charmaz K.
        Constructing Grounded Theory. 2nd ed. SAGE Publications, Los Angeles2014
        • Mills J.
        • Bonner A.
        • Francis K.
        The development of constructivist grounded theory.
        Int. J. Qual. Methods. 2006; : 5
        • Bryant A.
        • Charmaz K.
        Grounded theory research: methods and practices.
        in: The SAGE Handbook of Grounded Theory. SAGE Publications, London2007: 1-29
        • Patton M.Q.
        Qualitative Research and Evaluation Methods. third ed. SAGE Publications, California2004
        • Lincoln Y.S.
        • Guba E.G.
        Naturalistic Inquiry.
        SAGE Publications, Newbury Park2006
        • Barbosa-Jardim D.M.
        • Modena C.M.
        Obstetric violence in the daily routine of care and its characteristics.
        Rev. Lat. Am. Enferm. 2018; 26e3069
        • Mayra K.
        • Matthews Z.
        • Padmadas S.S.
        Why do some health care providers disrespect and abuse women during childbirth in India?.
        Women Birth. 2022; 35: e49-e59
        • Savage V.
        • Castro A.
        Measuring mistreatment of women during childbirth: a review of terminology and methodological approaches.
        Reprod. Health. 2017; 14: 138
        • Mortensen B.
        • Lieng M.
        • Diep L.M.
        • Lukasse M.
        • Atieh K.
        • Fosse E.
        Improving maternal and neonatal health by a midwife-led continuity model of care – an observational study in one governmental hospital in Palestine.
        EClinicalMedicine. 2019; 10: 84-91
        • Sandall J.
        • Soltani H.
        • Gates S.
        • Shennan A.
        • Devane D.
        Midwife-led continuity models versus other models of care for childbearing women.
        Cochrane Database Syst. Rev. 2016; 4CD004667
        • Homer C.S.
        Models of maternity care: evidence for midwifery continuity of care.
        Med J. Aust. 2016; 205: 370-374
        • Sadler M.
        • Santos M.J.
        • Ruiz-Berdún D.
        • et al.
        Moving beyond disrespect and abuse: addressing the structural dimensions of obstetric violence.
        Reprod. Health Matters. 2016; 24: 47-55
        • Bowser D.
        • Hill K.
        Exploring Evidence for Disrespect and Abuse in Facility-Based Childbirth. Report of a Landscape Analysis.
        Harvard School of Public Health, Boston2010
        • Altman M.R.
        • Oseguera T.
        • McLemore M.R.
        • Kantrowitz-Gordon I.
        • Franck L.S.
        • Lyndon A.
        Information and power: Women of color’s experiences interacting with health care providers in pregnancy and birth.
        Soc. Sci. Med. 2019; 238112491
        • Mysyuk Y.
        • Westendorp R.G.J.
        • Lindenberg J.
        Older persons’ definitions and explanations of elder abuse in the Netherlands.
        J. Elder. Abus. Negl. 2016; 28: 95-113
        • Jenkinson B.
        • Kruske S.
        • Kildea S.
        The experiences of women, midwives and obstetricians when women decline recommended maternity care: A feminist thematic analysis.
        Midwifery. 2017; 52: 1-10
        • Cherniak D.
        • Fisher J.
        Explaining obstetric interventionism: technical skills, common conceptualisations, or collective countertransference?.
        Women’s Stud. Int. Forum. 2008; 31: 270-277
        • Harris L.H.
        Rethinking maternal-fetal conflict: gender and equality in perinatal ethics.
        Obstet. Gynecol. 2000; 96: 786-791
        • Yeo G.S.H.
        • Lim M.L.
        Maternal and fetal best interests in day-to-day obstetrics.
        Ann. Acad. Med. Singap. 2011; 40: 43-49
        • Mena-Tudela D.
        • Iglesias-Casás S.
        • González-Chordá V.M.
        • Valero-Chillerón M.J.
        • Andreu-Pejó L.
        • Cervera-Gasch Á.
        Obstetric violence in Spain (Part III): healthcare professionals, times, and areas.
        Int. J. Environ. Res. Public Health. 2021; 18: 3359
        • Berger B.O.
        • Strobino D.M.
        • Mehrtash H.
        • et al.
        Development of measures for assessing mistreatment of women during facility-based childbirth based on labour observations.
        BMJ Glob. Health. 2021; 5e004080
        • Khalil M.
        • Carasso K.B.
        • Kabakian-Khasholian T.
        Exposing obstetric violence in the Eastern Mediterranean Region: a review of women’s narratives of disrespect and abuse in childbirth.
        Front. Glob. Women’s Health. 2022; : 3
        • Mayra K.
        • Sandall J.
        • Matthews Z.
        • Padmadas S.S.
        Breaking the silence about obstetric violence: Body mapping women’s narratives of respect, disrespect and abuse during childbirth in Bihar, India.
        BMC Pregnancy Childbirth. 2022; 22: 318
        • Miani C.
        • Namer Y.
        Women’s voices on social media: the advent of feminist epidemiology?.
        Emerg. Themes Epidemiol. 2021; 18: 7
        • Batalden P.B.
        Building knowledge for quality improvement in healthcare: an introductory glossary.
        J. Qual. Assur. 1991; 13: 8-12
        • Diniz S.G.
        • Salgado H.
        • de O.
        • Andrezzo H.F.
        • de A.
        • et al.
        Abuse and disrespect in childbirth care as a public health issue in Brazil: origins, definitions, impacts on maternal health, and proposals for its prevention.
        J. Hum. Growth Dev. 2015; 25: 377-382
        • Mena-Tudela D.
        • Iglesias-Casás S.
        • González-Chordá V.M.
        • Cervera-Gasch Á.
        • Andreu-Pejó L.
        • Valero-Chilleron M.J.
        Obstetric Violence in Spain (Part II): Interventionism and Medicalization during Birth.
        Int. J. Environ. Res. Public Health. 2020; 18E199
        • McGarry J.
        • Hinsliff-Smith K.
        • Watts K.
        • McCloskey P.
        • Evans C.
        Experiences and impact of mistreatment and obstetric violence on women during childbearing: a systematic review protocol.
        JBI Database Syst. Rev. Implement. Rep. 2017; 15: 620-627
        • Solnes-Miltenburg A.
        • van Pelt S.
        • Meguid T.
        • Sundby J.
        Disrespect and abuse in maternity care: individual consequences of structural violence.
        Reprod. Health Matters. 2018; 26: 88-106
        • Diaz-Tello F.
        Invisible wounds: obstetric violence in the United States.
        Reprod. Health Matters. 2016; 24: 56-64
        • Oliveira C.
        • de F.
        • Ribeiro A.Â.V.
        • Luquine C.D.
        • et al.
        Barriers to implementing guideline recommendations to improve childbirth care: a rapid review of evidence.
        Rev. Panam. Salud Publica. 2021; 45e7
        • Freedman L.P.
        • Kruk M.E.
        Disrespect and abuse of women in childbirth: challenging the global quality and accountability agendas.
        Lancet. 2014; 384: e42-e44
        • Bohren M.A.
        • Vogel J.P.
        • Hunter E.C.
        • et al.
        The mistreatment of women during childbirth in health facilities globally: a mixed-methods systematic review.
        PLoS Med. 2015; 12e1001847