International Day on the Elimination of Violence against Women: Time to stop obstetric violence

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Brussels, 25th November 2017- On this day, La Goccia Magica, CiaoLapo, the Italian Obstetric Violence Observatory and Make Mothers Matter (MMM) spotlight the need to promote respectful maternity care in full compliance with the World Health Organization (WHO) statement.[1] We urge Governments to eliminate all forms of obstetric violence, institutional[2] and against women, according to article 12 of the CEDAW Convention.[3]

Many women across the globe still experience disrespectful, abusive or neglectful treatment during pregnancy, childbirth and postpartum care. Women in vulnerable situations are particularly likely to experience disrespectful and abusive treatments. Such treatments include physical abuse, profound humiliation and verbal abuse, coercive or unconsented medical procedures (including sterilization), lack of confidentiality, failure to get fully informed consent, refusal to give pain medication, violations of privacy, refusal of admission to health facilities, neglecting women during childbirth to suffer life-threatening avoidable complications, and detention of women and their newborns in facilities after childbirth due to an inability to pay.

Although, in some countries (Venezuela, Argentina, Mexico, Chile, Brazil) laws are in place to eliminate obstetric violence, in the rest of the world the phenomenon is not even acknowledged. It is almost impossible for women to report it, as it is considered “normal”, both in medical as well as in legal contexts. The extent of the phenomenon is not known but it pertains to both developed and developing countries.

For instance, the first Italian survey[4] conducted by Doxa Institute in September 2017, commissioned by national civil society associations of mothers, found that one in three Italian women felt excluded from fundamental choices related to her childbirth. The most negative practice, suffered by 54% of Italian women, was the performance of episiotomy. For an estimated 1,6 million Italian women, it was practiced without informed consent. Of these women, 15% (400.000) perceived the practice as genital mutilation and another 13% (350.000) felt deceived by medical personnel as they did not communicate the negative consequences. The equivalent of one million women (21%) declare they suffered some form of obstetric violence during their first experience of childbirth.

Therefore, we all urge Governments to:

  1. Support research and data collection in order to measure the prevalence of obstetric violence during pregnancy, childbirth, and postpartum and investigate its impact on the health and autonomy of women;
  2. Adopt national strategies on the involvement of maternity health care users in the decision-making process, at individual and policy levels;
  3. Implement accountability and transparency policies in health care facilities allowing users to make informed decisions;
  4. Support of women’s choices on birth settings (including homebirth and midwifery-led birth centers), as part of a regular offer within maternity care;
  5. Set up channels for women to report about their childbirth experience without stigma or fear;
  6. Regulate a system of remedies and monetary compensation for human rights violations during childbirth and postpartum;
  7. Design educational programmes on the respect of human rights in childbirth for both health care providers and users, starting from schools to universities;
  8. Include women and mothers in educational programmes aiming at teaching health care providers how to treat a childbearing woman and babies with dignity and respect.

In addition, we are launching a 16 day campaign until International Human Rights Day on 10th December 2017 to end obstetric violence around the world. To participate, please use #obstetricviolence and #orangetheworld because every woman has the right to the highest attainable standard of health, including the right to dignified, respectful health care throughout pregnancy and childbirth, as well as the right to be free from violence and discrimination.[5]


Notes to Editors – Background

Obstetric violence is the “appropriation of a woman’s body and reproductive processes by health personnel, in the form of dehumanizing treatment, abusive medicalization and pathologization of natural processes, involving a woman’s loss of autonomy and of the capacity to freely make her own decisions about her body and her sexuality, which has negative consequences for a woman’s quality of life.”[6]

An episiotomy is a surgical intervention in the muscular area between the vagina and the anus made just before delivery to enlarge a vaginal opening. Although the procedure was once common practice to facilitate the expulsion of the newborn, the WHO now considers the practice outdated and unnecessary except on rare occasions. In comparison to potential spontaneous tearing that may occur during childbirth, the episiotomy is much more dangerous and invasive, carrying a high risk of infection and haemorrhage as well as a longer postpartum recovery time.

About Make Mothers Matter

Make Mothers Matter (MMM) is an international NGO created in 1947 to raise the awareness of policy makers and public opinion on the contribution of mothers to social, cultural and economic development. MMM brings together and represents a network of 45 organisations from 23 countries around the world. MMM has no political or religious affiliations, and thus transparently voices the concerns of mothers at international level with permanent representatives at the United Nations (with a General Consultative Status) and at the European Union.

About La Goccia Magica

The Magic Drop is a volunteer association of peer to peer moms who have had direct experience with breastfeeding. The purpose is to provide information and help all those moms who desire it, highlighting the importance of direct support from one mother to another to learn how to identify the needs of their child and to meet them in the best way.

About CiaoLapo

CiaoLapo Onlus is an association that deals with the protection of high-risk pregnancy, perinatal health and offers psychological support to families in the loss of a child before and after birth. Founded in 2006 by two parents who prematurely lost their child, Lapo, promotes the health of parents and families through psychological support and the creation of a network of training, composed of gynecologists, midwives, nurses, psychologists and parents.

About OVO Italia

The Italian Obstetric Violence Observatory (OVOItalia) was born as a continuation of the social media campaign #bastatacere, with the purpose of preserving and disseminating the collected testimonies, continuing to give voice to mothers and raise awareness of Italian society towards the phenomenon of obstetric violence through advocacy, research and data. OVOItalia is part of the international movement on obstetric violence InterOVO.

For more information & interviews please contact:

Olalla Michelena
Make Mothers Matter, Secretary General EU Delegation
+32 477 62 77 07



[3] Convention on the Elimination of All Forms of Discrimination against Women. 175 countries have ratified it.




First Data on Obstetric Violence in Italy





According to the first national survey conducted by Doxa Institute, and commissioned by the Obstetric Violence Observatory in Italy, La Goccia Magica and CiaoLapo, 21% of mothers with children from 0 to 14 years, declared that they have experienced obstetric violence during the birth of their first child.

While childbirth is expected to be the most exciting event in a woman’s life, 4 mothers out of 10 affirm that they have been subjected to practices that undermined their personal dignity and integrity.

Episiotomy “by deceit” (without informed consent) for 1,6 million women, a practice that the WHO considers unnecessary, except on rare occasions.

The continuation of the social media campaign #bastatacere (“break the silence”) that last year gave voice to mothers against abuse in childbirth, and in favour of the law proposal that introduces obstetric violence as a criminal offence.

One million mothers in Italy (21% of the total) have suffered various degrees of obstetric violence in their first experience of motherhood – reveals the Doxa survey. For 6% of women in the last 14 years the trauma was so harsh so to make them renounce having more children, a choice that translates roughly in 20.000 children not being born every year.

Staggering and alarming data emerged for the first time from the national opinion survey “Women and Childbirth”, on the yet unexplored phenomenon of “obstetric violence”: the appropriation of the body and reproductive processes of women by health personnel during pregnancy, childbirth and post-partum.

The survey, commissioned by the Obstetric Violence Observatory in Italy (OVOItalia, founded in 2016 by Elena Skoko and Alessandra Battisti), was conducted by Doxa – the first Italian market research company, founded in 1946. The survey was financed by national civil associations La Goccia Magica e CiaoLapo. The results of the survey were presented at the press conference in September 20th, 2017, in Rome, Palazzo delle Esposizioni, with the attendance of the member of the Parliament Adriano Zaccagnini and senator Maurizio Romani. The initiative is the extension of the social media campaign “#Bastatacere: mothers have voice” that in 2016 put for the first time under national spotlight the hidden phenomenon of abuse and disrespect in childbirth in hospital facilities, as framed by the WHO, advocating for a respectful maternity care on a national level.

The Doxa survey “Women and Childbirth” was conducted on a sample (424) representative of nearly 5 million women in Italy, aged 18-54, with at least one child 0-14 years, and it analysed – from the users’ perspective – several aspects and moments of maternity assistance during labour and birth: from the relationship with the health care providers to the type of interventions, from the communication by caregivers to informed consent, from the role of childbearing women in the process of decision making to the respect of personal dignity.

The survey revealed that for 4 women out of 10 (41%) the assistance provided at birth was in some ways violating their dignity and psychophysical integrity. The most negative experience during birth was the practice of episiotomy, suffered by over half (54%) of the interviewees. Once considered as helpful for facilitating the expulsion of the newborn, today, the World Health Organization (WHO) describes it as unnecessary, except on rare occasions. The episiotomy is a surgical intervention in the muscular area between the vagina and the anus made just before delivery to enlarge a vaginal opening. Comparing to the spontaneous tearing that may occur during childbirth, this operation requires a longer recovery time and it carries the risks of infection and haemorrhage.

From the stories that many women shared with us – explains Elena Skoko, the founder and spokesperson of the Obstetric Violence Observatory Italy (OVOItalia)we were aware of the fact that for many of them the maternity assistance at birth was a traumatic experience. For this reason, last year we launched the social media campaign #bastatacere. In order to understand the extent of the phenomenon: there were so many women who responded in such a short time frame that the campaign went viral. We decided to launch the Obstetric Violence Observatory in our country in order to define the extent of a phenomenon that is still submerged, yet those who experienced it wear the scars for the rest of their lives, renouncing even to have more children. Now, with the data, we know that the phenomenon is much wider than we though.”


In Italy, in the last 14 years, 3 women out of 10 – the equivalent of 1,6 million women (61% of the ones that received episiotomy) – declare that they did not give their informed consent to the intervention.

According to the results of the survey, the practice of episiotomy appears to be extensive inside Italian maternity wards: one woman out of 2 was subjected to it (54%). For 15% of women that underwent the procedure, about 400.000 mothers, it was perceived as a genital mutilation, while 13% of mothers, about 350.000, felt deceived by medical personnel: if at the beginning they thought episiotomy was necessary and harmless, only later they realized it had negative consequences. More episiotomies have been reported at the South and on the islands (58%), closely followed by Centre and North-East (equally 55%), and the North-West with 49%.

When asked about the overall satisfaction regarding the care they received, 67% of interviewees considered the health care provided as adequate. However 1.350.000 women (27% of the sample) declared they felt only partially assisted by medical team, more specifically – they wished they were more involved in what was happening during childbirth. This data was further confirmed by 6% of new moms that affirm they went through labour and birth all alone and without due assistance.

Briefly, one out of 3 women felt excluded from the decision-making process and from fundamental choices related to her childbirth. 


In order to leave little to interpretation, the interviewees were offered a very last question: “The definition of obstetric violence is the following: appropriation of women’s body and reproductive processes by health personnel; to force a woman to undergo unnecessary C—section; to force an unnecessary episiotomy on a woman; to force a woman to give birth lying on her back with her feet on stirrups; to expose a woman naked in front of many subjects; to separate a mother from her newborn without medical reason; not including a woman in decisions concerning her body and her birth; verbal humiliations before, during and after birth. Based on the provided information, do you think you experienced obstetric violence during your birth?” While 56% responded “Absolutely not” and 23% said “I think not”, there was 21% of the total that affirmed that they were subjected to some form, verbal or physical, of obstetric violence at their first experience of birth: 17% of them responded “Partially yes”, and 4% stated “Absolutely yes”.

“In front of this objective picture of the phenomenon – declared Alessandra Battisti, lawyer and co-founder of Obstetric Violence Observatory Italy – we expect a collaboration with doctors and the institutions in the direction of including women in decision-making processes, on personal and political level, in order to make a real change in maternity health care provision, in the direction of respect of the human dignity. As stated by the WHO and by the United Nations High Commissioner for Human Rights (UNHCHR), the abuse, the negligence and the lack of respect during childbirth can lead to the violation of basic human rights of a woman and a child, putting their lives and their security at risk. The campaign that we launched last year was addressed to women in the first place, inviting them to claim their rights and to refuse to suffer any form of mistreatment, including the violence at birth. Our intention was also to support the law proposal presented by the member of the Parliament Adriano Zaccagnini that promotes the recognition of obstetric violence as a criminal offence, since without judicial recognition it is very difficult for women to seek legal redress.”


The Doxa survey indicates that, in Italy, 32% of women gave birth by caesarean. However, not all caesareans are done for the same reason: if 15% of women stated it was an emergency C-section, there were 14% declaring they had a scheduled C-section, indicated by their health care providers. For the remaining 3% of women, the C-section was their own decision.


According to the survey, 84% of women gave birth to their first/unique child inside a public hospital. 12% have chosen a private facility that is funded by the national health care system, 3% opted for private clinics and only 1% gave birth at home or inside birth centers.

Inappropriate practices denounced through the survey were numerous. 27% of mothers said they did not receive adequate support and information on breastfeeding and 19% denounced the lack of privacy during various stages of their permanence inside the hospital. Furthermore, 12% of women complained that they were not allowed to have a person of choice with them during labour, while 13% were not given an adequate pain relief.

Finally, it is quite alarming to find out, in regard to safety and risk at birth, that 4% (about 14.000 women per year) affirmed being neglected, which resulted in suffering life-threatening, avoidable complications. The Italian National Health Institute estimates that there are 1259 cases of “near miss”[1] every year in Italy, while the maternal mortality rate is underestimated by 60%.[2]

The combination of factors drives 14% of maternity service users to declare that they would definitely choose another facility for a second pregnancy, while 72% would come back to the same hospital, nonetheless. Another 14% remain uncertain. 


For the majority of interviewees (63%), the experience at the first birth did not influence the choice of having other children or it was not the decisive factor that influenced their choice of not having other children (15%). Yet, 11% of mothers in Italy confirm that they experienced trauma in relation to the maternity health care; because of that they delayed further pregnancies for many years, a choice that may have significant unnoticed impact on the fertility at the national level. Finally, for the 6% of mothers the trauma was so strong as to make them decide to completely renounce having any more children, which translates in 20.000 of children not being born every year – a consequence on the national birth rate that has not been taken into the account.


The social media campaign “#Bastatacere: mothers have voice”, launched in April 2016, was an initiative curated by Elena Skoko and Alessandra Battisti with the purpose of drawing public and institutional attention to the phenomenon of obstetric violence, through individual stories of women shared on the dedicated Facebook page. Ten national associations of mothers coordinated the on-going initiative[3], with dissemination support of 20 more associations. In 15 days the official Facebook page reached 21.000 likes, about 700.000 daily visits, 70.000 daily interactions, and, most importantly, more then 1.100 stories of obstetric violence in the format of a banner-photo. The #bastatacere campaign was directly connected to the law proposal “Norms for the Protection of the Rights of Women and Newborns in Childbirth and Regulation for the Promotion of Physiological Birth”, deposited at the Parliament in March 2016, prior to the social media campaign, by Adriano Zaccagnini (Democratic Progressive Movement). The law proposal promotes the recognition of obstetric violence as a criminal offense. At the end of the campaign the Obstetric Violence Observatory in Italy (OVOItalia) was born, with the aim of collecting data and testimonies of violence against women and babies at different stages of labour and birth. OVOItalia’s Ethical Committee members are Alessandra Battisti, Elena Skoko, Michela Cericco, Eleonora Piras, Claudia Ravaldi, Giovanna Riso, Nadia Babani, Annalisa Melis, Luana Vignoli.


Everyone can give their contribution to the #bastatacere campaign and to the activities of OVOItalia aimed at raising awareness, providing information, producing data, and conducting researches on the issue of obstetric violence. It is possible to give a donation through the association La Goccia Magica, on the website or through their bank account IBAN IT68Z0895139130000000344705, indicating #bastatacere on the memo line.



The advocacy initiatives described above have benefited from the participation of the coordinators Elena Skoko and Alessandra Battisti in the EU-funded COST Action IS1405: BIRTH: Building Intrapartum Research Through Health – an interdisciplinary whole system approach to understanding and contextualising physiological labour and birth, supported by the COST (European Cooperation in Science and Technology) Programme as part of EU Horizon 2020. 

For information and interview requests, please, contact the press office of OVOItalia:
INC – National Institute for Communication
Francesca Riccardi, +39 335 7251741,
Barbara Cimino, +39 335 5445420,


[1] A maternal near miss (MNM) is defined as pregnant or recently delivered woman who survived a complication during pregnancy, childbirth or 42 days after termination of pregnancy.

[2] Donati S, Senatore S, Ronconi A; Regional Maternal Mortality Working Group, Acta Obstet Gynecol Scand. 2012 Apr;91(4):452-7. doi: 10.1111/j.1600-0412.2012.01352.x. Epub 2012 Feb 22.

[3] La Goccia Magica (Genzano di Roma), Nanay (Roma), Centro Alma Mater (Rieti), Forum Parto Naturale (Reggio Calabria), CiaoLapo Onlus (Prato), Rinascere al Naturale Onlus (Lecce), Comitato per la Buona Nascita (Puglia-Calabria-Umbria-Toscana), Innecesareo Onlus (Mantova), Città delle Mamme Frascati (Frascati), Cerchidarcobaleno (Padova).