{"id":4801,"date":"2026-08-06T03:32:40","date_gmt":"2026-08-06T02:32:40","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-ethics\/?p=4801"},"modified":"2026-08-06T03:32:40","modified_gmt":"2026-08-06T02:32:40","slug":"listening-to-women-epistemic-injustice-and-the-ockenden-report","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/08\/06\/listening-to-women-epistemic-injustice-and-the-ockenden-report\/","title":{"rendered":"Listening to women: Epistemic injustice and the Ockenden Report"},"content":{"rendered":"<p>By <span data-contrast=\"auto\">Noemi Magnani<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The <\/span><a href=\"https:\/\/www.ockendenmaternityreview.org.uk\/wp-content\/uploads\/2026\/06\/ockenden-report-review-of-maternity-services-nottingham-university-hospitals-nhs-trust-web-accessible.pdf\"><span data-contrast=\"none\">Ockenden Report<\/span><\/a><span data-contrast=\"auto\">, published on 24 June 2026 following the largest maternity inquiry in NHS history, reveals something significant about what it means to be heard\u2013or not heard\u2013in healthcare. The current maternity crisis is not only a clinical crisis. It is also an epistemic one.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">This immediately prompts the question: why are women\u2019s reports about their own bodies systematically discounted in maternity care? Why are families\u2019 concerns about their own babies similarly not listened to?<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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 (\u201cI wasn\u2019t helped\u201d), the woman is wronged in her autonomy (\u201cI wasn\u2019t involved in decisions about my care\u201d), as well as in her epistemic authority (\u201cI wasn\u2019t treated as someone who knew something important\u201d).<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">The repeated instruction to \u201clisten to women\u201d found in maternity reviews is often interpreted as a demand for greater compassion. It should also be understood as a demand for epistemic recognition.\u00a0<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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 <\/span><a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/24740808\/\"><span data-contrast=\"none\">possess forms of first-person and experiential knowledge that clinicians cannot access independently<\/span><\/a><span data-contrast=\"auto\"> and can only learn through attending to their patients\u2019 testimony. When such testimony is discounted, an important source of knowledge is lost.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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 \u2013 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.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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\u2019s 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.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><span data-contrast=\"auto\">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.<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><b><span data-contrast=\"auto\">Author:<\/span><\/b><span data-contrast=\"auto\">\u202fNoemi Magnani<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Affiliations:<\/span><\/b><span data-contrast=\"auto\">\u202fAssistant Professor at the University of Warwick, Department of Philosophy; Maternity and Neonatal Voices Partnership (MNVP) Neonatal Lead at North Middlesex University Hospital<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><\/p>\n<p><b><span data-contrast=\"auto\">Competing interests<\/span><\/b><span data-contrast=\"auto\">: None declared<\/span><span data-ccp-props=\"{}\">\u00a0<\/span><!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>By Noemi Magnani\u00a0 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\u2013or not heard\u2013in healthcare. The current maternity crisis is not only a clinical crisis. It is also an epistemic one.\u00a0 The problem identified by the report is [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/08\/06\/listening-to-women-epistemic-injustice-and-the-ockenden-report\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":522,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[8130,8079],"tags":[],"class_list":["post-4801","post","type-post","status-publish","format-standard","hentry","category-ethics","category-pregnancy"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v28.3 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Listening to women: Epistemic injustice and the Ockenden Report - Journal of Medical Ethics blog<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-ethics\/2026\/08\/06\/listening-to-women-epistemic-injustice-and-the-ockenden-report\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Listening to women: Epistemic injustice and the Ockenden Report - Journal of Medical Ethics blog\" \/>\n<meta property=\"og:description\" content=\"By Noemi Magnani\u00a0 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\u2013or not heard\u2013in healthcare. 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