Recognised but Not Regulated: The Paradox of Obstetric Violence in Chile

In June 2024, Chile reached a milestone that activists and scholars had pursued for over a decade: the formal recognition of gynaeco-obstetric violence in national law. The Comprehensive Law on Gender-Based Violence (Law No. 21.675) incorporated obstetric violence into the legal framework as a form of gender-based violence. For the organisations that had spent years documenting abuses and pressing for reform, the achievement was real.

Yet it came with a contradiction. Chile now recognises obstetric violence as violence against women, but it still has no coherent regulatory framework governing pregnancy, childbirth, postpartum, abortion services, or reproductive healthcare more broadly. The phenomenon is named in law, while the mechanisms needed to prevent, monitor, and remedy it remain largely absent. This tension reveals a paradox of recognition without regulation.

The route to that recognition followed a familiar Latin American pattern. In the early 2000s, Chilean advocacy, centred on “humanised childbirth”, introduced a framework for reducing unnecessary medical intervention and improving women’s experience of maternity care. Over time, activists and researchers came to see that this language missed the structural core of the problem. The concept of obstetric violence offered a sharper lens: rather than treating harmful practices as isolated failures of care, it exposed how institutional routines, professional hierarchies, and gender inequality generate systematic harm. The Chilean Observatory of Obstetric Violence (OVO Chile), founded in 2014, was central to this shift, drawing on research, advocacy, and women’s testimonies to reframe childbirth as a site where rights and autonomy are at stake, and to connect childbirth activism with the broader feminist struggle against gender-based violence.

The most ambitious attempt to turn this understanding into law was the Adriana Law (Bulletin 12148-11), introduced in 2018 after the widely publicised case of Adriana Palacios, who suffered grave violations during the care that led to the stillbirth of her daughter, Trinidad. The bill proposed a comprehensive, preventive, rights-based framework spanning pregnancy, labour, birth, postpartum, abortion, and gynaecological care. Crucially, it was not primarily punitive. It sought to establish standards of care, accountability mechanisms, and institutional safeguards designed to prevent abuse before it occurred, and it emerged from an unusually collaborative process involving civil society, parliamentarians, legal experts, and health professionals.

Its passage through Parliament, however, exposed how much resistance the concept still provokes. Professional associations rarely denied that mistreatment occurred but they contested the word “violence.” They argued that the term was unfair to clinicians, implied intentional harm, and risked eroding trust in medical services, proposing milder alternatives such as “disrespect”, “abuse”, or “violations of rights”. These were not merely semantic quarrels. Naming a practice as violence foregrounds its structural and gendered character; replacing that word individualises responsibility and steers attention toward technical improvements in service delivery rather than institutional reform. Ultimately, the debate was a contest over epistemic authority: who gets to define harm, assign accountability, and set the limits of acceptable care.

The most revealing feature of the Chilean case is not that the Adriana Law stalled, but how it was transformed along the way. As the bill moved through the committee, its core provisions were diluted, and the concept of obstetric violence was narrowed. Practices once classified as obstetric violence were rebranded as mere “violations of rights”, including unjustified denial or abuse of medication; harmful or unnecessary routine practices during normal childbirth; and barriers to accessing contraception or voluntary surgical sterilisation. Yet no explanation was given for what distinguished these practices from obstetric violence. Accountability mechanisms were also weakened. For instance, the original bill included an existing complaint procedure regulated under the Patients’ Rights and Duties Law, but this mechanism was replaced with a direct claim before the Superintendency of Health. However, no corresponding modification was made to the sanctioning authority of this public agency, making the procedure entirely unenforceable in practice. Meanwhile, the 2024 Comprehensive Law on Gender-Based Violence formally recognised gynaeco-obstetric violence and added a criminal aggravating circumstance for such cases. The result is a fragmented legal landscape in which obstetric violence exists as a recognised category, while many of the instruments meant to give it effect remain stalled, diluted, or incomplete. This disconnect is even more apparent in the courts, which have treated gynaeco-obstetric violence as an autonomous category of harm since at least 2019.

In practice, this leaves a recognised wrong without a settled procedure to prevent, report, or sanction it. Thus, women are left to invoke a form of violence that the law acknowledges but does not yet operationalise, while clinicians work without clear standards against which their conduct can be measured. Recognition, in short, has outpaced regulation.

The lesson reaches beyond Chile. Legal recognition matters: it validates women’s experiences, opens new avenues for advocacy, and affirms that mistreatment in reproductive care is not an unfortunate by-product of healthcare. But recognition alone is not enough. Without clear standards of care, effective complaint mechanisms, institutional oversight, and enforceable accountability, recognition risks remaining symbolic, and the legislative process itself can become the very place where the meaning of obstetric violence is renegotiated, narrowed, or depoliticised. Chile shows that the path from recognition to implementation is neither automatic nor linear. The task for policymakers is not only to acknowledge obstetric violence as gender-based violence, but to build the regulatory architecture capable of preventing it. Only then does legal recognition become meaningful protection for those navigating pregnancy, childbirth, and reproductive healthcare.

Carla Bravo Quintana, Lawyer, Universidad de Chile; Master Gender Law, Universidad de Jaén, Spain. Legal Director, Observatory of Obstetric Violence, Chile.

Camila Díaz Pacheco, Lawyer; Pontificia Universidad Católica de Valparaíso; LL.M Law and Sustainable Development – Human Rights, Università degli Studi di Milano, Italia. Legal collaborator, Observatory of Obstetric Violence, Chile.