By Noemi Magnani
The Ockenden Report, published on 24 June 2026 following the largest maternity inquiry in NHS history, reveals something significant about what it means to be heard–or not heard–in healthcare. The current maternity crisis is not only a clinical crisis. It is also an epistemic one.
The problem identified by the report is not merely one of clinical error. Ockenden repeatedly returns to themes such as women and other birthing people not being believed, concerns being dismissed, families being excluded from decision-making, communication failures, lack of agency, power imbalances, and particular disadvantages faced by women from minority ethnic backgrounds and deprived communities.
This immediately prompts the question: why are women’s reports about their own bodies systematically discounted in maternity care? Why are families’ concerns about their own babies similarly not listened to?
The recurring failure to listen to women, birthing people and their families in maternity and neonatal care is not merely a communication failure but an epistemic wrong: a wrong that concerns someone in their capacity as a knower. Such wrongs occur when people are denied appropriate recognition as sources of knowledge, understanding, or insight. In the language of philosopher Miranda Fricker, they constitute a form of epistemic injustice.
Consider this case: a pregnant woman reports reduced foetal movements. If clinicians dismiss her concern because they are busy, that may be a practical failure. But if her report is systematically given less credibility than it deserves, she is wronged as a knower. In this case, the injury is not only that she (and her baby) may receive worse care. It is also that her contribution to understanding what is happening is ignored, dismissed, or insufficiently investigated. So, in addition to being practically wronged (“I wasn’t helped”), the woman is wronged in her autonomy (“I wasn’t involved in decisions about my care”), as well as in her epistemic authority (“I wasn’t treated as someone who knew something important”).
The repeated instruction to “listen to women” found in maternity reviews is often interpreted as a demand for greater compassion. It should also be understood as a demand for epistemic recognition.
The Ockenden Report gives multiple examples of women reporting not only reduced foetal movements, but also pain, labour progression, feeding concerns, deterioration, and their intuition that something was wrong. These women (and their families) were repeatedly ignored or reassured inappropriately, leading to avoidable harms. This happened despite the fact that pregnant and birthing people possess forms of first-person and experiential knowledge that clinicians cannot access independently and can only learn through attending to their patients’ testimony. When such testimony is discounted, an important source of knowledge is lost.
One striking feature of the Report is that it repeatedly points out that these problems were known, yet persisted for years. Staff raised concerns, families raised concerns, external reviews raised concerns – yet the system failed to learn. This pattern suggests something larger than individual prejudice or individual clinicians failing to listen. The epistemic failure exemplified by Nottingham University Hospitals NHS Trust is therefore institutional rather than merely interpersonal, involving governance structures that filtered out knowledge, hierarchies that distorted the flow of information, and an organisational culture that suppresses dissent. And Nottingham may not be an aberration, but an example of a wider issue. In fact, Ockenden herself repeatedly notes that many of the same themes have appeared in previous maternity reviews.
Women possess a distinctive form of experiential knowledge of pregnancy, labour and their own bodies, knowledge that healthcare professionals cannot acquire except through engagement with women’s own testimony. When healthcare systems systematically fail to recognise that knowledge, women are not merely excluded from decision-making; they are deprived of recognition as contributors to knowledge itself.
If this diagnosis is correct, improving maternity care requires more than additional training, revised protocols, or better bedside manner. It requires healthcare institutions to recognise women and birthing people as indispensable contributors to knowledge about pregnancy, labour, birth, and neonatal care. Listening is not simply a matter of respect. It is a matter of recognising women and birthing people as knowers. And until maternity services take that epistemic responsibility seriously, many of the failures identified by Ockenden are likely to persist.
Author: Noemi Magnani
Affiliations: Assistant Professor at the University of Warwick, Department of Philosophy; Maternity and Neonatal Voices Partnership (MNVP) Neonatal Lead at North Middlesex University Hospital
Competing interests: None declared