Citation

Vullikanti M, Yamin AE. Am. J. Obstet. Gynecol. 2024; ePub(ePub): ePub.

Copyright

(Copyright © 2024, Elsevier Publishing)

DOI

10.1016/j.ajog.2024.07.012

PMID

39004331

Abstract

By recasting obstetric violence (OV) as simply individual clinicians' condemnable behavior, Chervanek et al. dismiss abundant evidence showing harmful impacts of structural racism and gendered stereotypes on gestating people. OV, an analytical tool to understand the impacts of pathologizing pregnancy and childbirth, builds on foundations of feminism and structural violence, originally termed by Norwegian sociologist Johan Galtung. The overuse of medical interventions during pregnancy and the physical and emotional abuses that pregnant people experience are fundamentally "structural because they are embedded in the political and19 economic organization of our social world [and] violent because they cause injury to people". These arguments are not new. AIDS risk assessments initially focused on the individual-level, omitting contributing social factors, including poverty, gender inequality, and racism.2 Similarly, framing OV as perpetuated by a few clinicians decenters structural violence within obstetrics and the medical field.


Chervanek et al. argue that the term OV may vilify the clinician; however, their rhetoric of a few bad actors better facilitates criminalization/litigation of specific clinicians, which we vehemently oppose.3 Rather, systemic changes addressing structural oppressions are obligatory to transform normative practices while protecting clinicians.3


OV in the U.S. reflects broader structural racism, which is intersectional in its different effects across genders and social classes. Obstetric racism was coined as a subcategory of OV that better characterizes experiences of Black women seeking obstetrical care.4 Chervanek et al. acknowledge violent birthing experiences yet undermine their characterizations as violent despite testimonial evidence. This reflects medicine's normative understanding of birth trauma as physical, which privileges fetal outcomes. We echo calls that emotional/psychological harms to...

Language: en