By Ezio Di Nucci

Here I defend ’obstetric violence’: not the practice, but its name – and more generally the idea that some obstetric practices deserve to be called acts of violence, contrary to what has recently been argued.  

This question is relevant beyond sexual and reproductive health: what is at stake is the very idea of assigning the term “violence” beyond traditional violent practices such as, for example, rape, homicide, assault and terrorism (we can debate whether rape is a sexual practice, but there can be no debate on whether it qualifies as violence). 

Inclusive vs exclusive use of the term “violence” 

Should we be inclusive about violence, or exclusive? Let us be conceptually clear: being inclusive about violence here means not being too strict about what kinds of practices we call violence; while being exclusive about violence is the opposite, namely being picky about what we ‘reserve’ the label violence for. Inclusion is good, right? Both in general and when it comes to the concept of violence. 

The question here is not just whether being refused epidural should count as violence; whether a paternalistic C-section qualifies; or being gaslighted, ignored, or condescended while pregnant or during delivery. Those are clear wrongs, but are these also instances of violence? What happens when we use – or misuse – the ‘violence’ label? 

One simple exclusivist solution would be to stipulate that violence must be physical: but that is not as easy as it looks, because according to what metaphysical standard is verbal abuse not physical? It’s a speech act with physical consequences, so what is exactly the difference? A slightly more difficult case, for the idea that violence must be physical, is not believing a patient, because that might have physical consequences but not be itself an act. But again, why assume violence must be physical in the first place?  Another simplistic approach is to think that exclusivists about violence believe that the practices that don’t deserve that label aren’t as bad as inclusivists make them out to be: maybe, say, your wish for a vaginal delivery not being fulfilled isn’t as bad as, I don’t know, being mugged?  

But, first of all, are you so sure about that? Isn’t giving birth more meaningful than your iPhone? And who gets to make that assessment? One obvious inclusivist move is self-ascription, namely that it is only the victim who can decide. Is that going too far? Could letting subjects of experience define the conceptual space mean there is no conceptual space left in the end? That is a particularly difficult question when that conceptual space happens to have normative urgency, like with obstetric violence.  

Even if one agreed that being assaulted was worse than being refused a vaginal delivery, that does not settle the question of obstetric violence, because maybe being refused an epidural is worse than assault – and being refused an abortion definitely is anyway, because the consequences of the assault in question must be pretty severe to begin to compare with nine months of unwanted pregnancy or a lifetime of (biological) parenthood. 

Finally, the debate between exclusivists and inclusivists about violence – even the one within obstetrics – is not settled by whether obstetric practices are more or less problematic than more traditional non-obstetric practices like assault, because it could very well be that both deserve the ‘violence’ label.  

Further considerations for naming obstetric violence  

Calling obstetric violence by its name, then, is a simple and effective way of emphasizing the harm – and stakes – in question. Three final points here: 

Could the obstetric violence label reproduce patriarchal prejudices? 

The first point is a reminder, even to inclusivists, that we should be careful not to overplay the intimacy of the obstetric domain, because that might replicate oppressive patriarchal pressures and expectations on women to mother: here the idea is not just that gestation and delivery should not be overstated in their importance or indeed supposed intimate character, but also that sexual health should not be reduced down to reproductive health, so that the obstetric domain might be particularly sensitive for sexual rather than reproductive reasons. This means that, first, we must not assume that women care more about obstetric issues than about other health concerns and, second, that even if that were true, the reason might be sexual and not reproductive. 

Beyond obstetric violence, what should we do with inclusivism? 

 Secondly, does a defense of inclusivism for the case of obstetric violence have any repercussions for more general inclusivism about violence? Are there domains where it is indeed fair to worry that the label violence is overstating the harm in question? To mention a standard example: is disputing the gender identity of a person a form of violence? And if so, what kind of violence is that? Surely disagreeing with someone is not a form of violence, but are there disagreements so fundamental as to challenge that? 

Could inclusivism mask an even bigger problem?  

 Zizek’s trichotomy of violence (subjective, objective, and systemic violence) reminds us that inclusivism might leave something important out: namely that the less graphic forms of violence (socio-economic oppression, for example), where we might genuinely be tempted to be exclusivists, are actually morally (and politically) worse than the less subtle forms of violence.

About the Author

Ezio Di Nucci is a philosophy professor at the University of Copenhagen.

Competing interests: None declared

Many thanks to Andrea Bidoli for very helpful comments on an earlier draft.