Maternity Services in England: What is Being Overlooked?

Recent news has drawn attention to the worrying state of maternity services in England. Last week, a report by Birthrights highlighted the widespread use of coercive practices in maternity services in the UK. Earlier, the interim report of the Independent Investigation into Maternity and Neonatal Services in England revealed that many women experience racism and discrimination within maternity care. Additionally, the CQC Maternity Survey 2025 found that 18% of women felt their concerns were not taken seriously when raised during childbirth.

Although there is growing agreement that these situations and others that involve violence and abuse against women during childbirth constitute obstetric violence, especially after landmark decisions of the CEDAW Committee and the Inter-American Court of Human Rights, these reports and survey findings point to a broader issue that remains overlooked: the failure to recognise the structural dimension of obstetric violence when analysing and responding to these events.

The structural dimension of obstetric violence refers to the oppression women experience in the childbirth context, and unlike the interpersonal dimension, which has received greater attention in scholarship, is not readily visible from outside.

As I argue in more detail elsewhere, identifying the structural dimension of obstetric violence and the forms it may take is essential for understanding how obstetric violence operates and designing more effective responses to it. In fact, although the interpersonal dimension is generally analysed when discussing possible solutions to the problem, the structural dimension of the different instances of obstetric violence must also be recognised and addressed as it operates not only alongside the former but also independently.

This is relevant because if the structural dimension is not addressed, obstetric violence is perpetuated. For example, if we only address the specific behaviour, such as racist comments, by sanctioning perpetrators, but fail to tackle the underlying stereotypes and discrimination, the problem is likely to persist as these operate both in healthcare settings and across society.

The structural oppression of women in childbirth takes three main forms, all of which are reflected in the experiences of women included in the reports and survey. The first one is masculine domination or the subordination of women to men within society. This can be seen in the use of gender stereotypes highlighted in one report: women being called “princesses” for being considered unable to cope with pain.

The second form is professional domination, which refers to the power that health professionals exert over patients. This is evident in cases described in the other report where women were pressured into accepting certain medical procedures, such as having an induction or a caesarean section.

The third form is structural violence, which results from the action of social structures, such as norms and institutional rules, that constrain and harm women. This is reflected in situations identified in the survey where women received inadequate care, for instance, being left alone when feeling worried during the later stages of labour.

Effectively addressing obstetric violence requires recognising both its interpersonal and structural dimensions in specific instances and understanding how these dimensions interact. The two reports and the survey on the state of maternity services in England underscore the urgency of doing so. However, without recognition of the structural dimension, efforts to address obstetric violence will remain partial and hence insufficient.

Verónica García de Cortázar, Visiting Researcher at Durham Law School. She holds a PhD from UCL Laws and is the author of “The Structural Oppression of Women in the Context of Childbirth”.