Defining Obstetric Violence in Law: Feminist Origins, Medical Shifts, and Legal Limits in Uruguay

This final post brings together the central insights from the series by examining how the concept of obstetric violence was ultimately incorporated into Uruguayan law. Building on the historical and feminist foundations traced in Parts I and II, it explores how a concept grounded in women’s lived experiences and epistemic justice was translated into a legal definition through legislative processes shaped by competing institutional and professional interests. Focusing on the socio-historical context of this incorporation, the post highlights the different discourses that informed the legal definition and the tensions that emerged as feminist understandings encountered medical and legal frameworks. It then offers a focused legal analysis of the definition adopted in Law 19.580, drawing attention to its conceptual limits, its indeterminacy, and the challenges it poses for legal accountability in practice.

From Feminist Human Rights to Medical Framing

As noted in Part Two of this blog series, Uruguay initially defined obstetric violence as “the appropriation of women’s bodies and reproductive processes by healthcare personnel, which manifests as dehumanizing treatment, overuse of medicalization, and the pathologizing of natural processes, leading to a loss of autonomy and the ability to freely decide about their bodies and sexuality, negatively impacting women's quality of life.” This legal definition did not emerge organically from domestic medical or legal debates; it was incorporated through the Inter-American human rights system, drawing directly on a Venezuelan feminist definition grounded in women’s lived experiences and an epistemic justice perspective.

Feminist discourse played a central role in shaping how obstetric violence was conceptualised in law. The author’s research examines the development of the Uruguayan legal framework through analysis of legislative texts and interviews with feminist activists, as well as legal and policy actors involved in the law-making process. Drawing on these materials, a consistent finding emerges: Feminisms operating across academia, social movements, and key sectors of the state were crucial in placing obstetric violence on the public agenda and in influencing its legal definition. This influence is visible in the Uruguayan legislative process itself, in the Venezuelan feminist definition that informed it, and in the broader Latin American construction of obstetric violence as a category of gender-based violence, which predated national legislation and was later taken up by inter-American bodies such as the MESECVI Committee of Experts.

During the parliamentary debate, significant changes were introduced to the original definition of obstetric violence, resulting in a markedly different final formulation. While the initial definition framed obstetric violence in feminist and human rights terms, emphasising the appropriation of women’s bodies, dehumanising treatment, and the pathologisation of natural reproductive processes, these elements were removed during legislative negotiations. The final legal definition instead narrowed the concept to actions or omissions affecting women’s autonomy, particularly through the overuse of invasive techniques and procedures. This shift reflects the growing predominance of medical discourse within the legislative process. Although the phenomenon continued to be recognised as a form of violence and retained references to bodily autonomy, the revised definition made conceptual concessions in response to resistance from medical communities. At the same time, the influence of a bioethical perspective became more visible, particularly through the emphasis on concepts such as informed consent, informed decision making, and patient autonomy.

Legal Indeterminacy and the Limits of Definition

The legal definition of obstetric violence in Uruguay is contained in Law 19.580, the Comprehensive Law on Gender-Based Violence Against Women. However, this definition raises a problem shared by other legal systems in Latin America: Its legal indeterminacy. The law recognises obstetric violence but does not specify the legal consequences that follow from the conduct described in the definition.

Obstetric violence encompasses both forms of gender-based violence and violations of sexual and reproductive rights, while also relating directly to professional conduct of healthcare teams in hospital settings. For this reason, even in countries that recognise obstetric violence within their comprehensive laws on violence against women, legal action in practice often relies on the framework of medical civil liability.

When the legal definition of obstetric violence was incorporated into Uruguayan law, its implications in the civil sphere were not considered. In particular, there was no analysis of how this form of violence would operate in relation to medical civil liability, nor of whether existing civil law provisions should be adapted to address it. Although Diana González noted that this tension was raised during the drafting of the gender-based violence law, obstetric violence was not treated as a central issue in the legislative process.

To add further uncertainty to the legal implications of the definition, there is no explicit framework regulating civil liability for obstetric violence. Although this gap could, in principle, be addressed through legal doctrine and jurisprudence, the issue has not been taken up by legal scholarship and, to date, there is not a single judicial ruling that adopts the expression “obstetric violence”.

Among the concepts used in the legal definition of obstetric violence, autonomy was given a central place. However, this emphasis reflects a narrow understanding of autonomy that does not fully account for the ways in which decision-making can be constrained in clinical contexts. From a relational perspective, autonomy can be compromised in a range of scenarios, depending on various factors such as power imbalances, institutional settings, and the patient's circumstances.

The Uruguayan legal definition frames obstetric violence in terms of the “abuse” of invasive techniques or procedures. This formulation risks conflating violence with excess, overlooking the fact that obstetric violence may arise from the performance of a single procedure carried out without the woman's consent. The use of the term “invasive” is similarly problematic, as many obstetric procedures necessarily involve bodily invasion but do not constitute violence if they are medically justified, properly informed, and consented to.

While the exclusions of expressions such as “appropriation of the body” or “pathologization of natural processes” from the legal definition may be justified by the difficulty of specifying the medical actions to which they refer, the omission of the notion of “treatment” is more troubling. Obstetric violence is intrinsically connected to the way in which medicine, and obstetrics in particular, treats women. By focussing narrowly on discrete acts or procedures, the definition risks overlooking the power dynamics embedded in medical relationships, which often operate in more subtle or symbolic ways and cannot always be captured through references to overtly humiliating or discriminatory conduct.

The Traps of Power

Although both Law 19.580 and its subsequent regulations formally incorporated obstetric violence, this has not translated into any significant progress in terms of concrete tools for addressing it. Legal recognition was not accompanied by a sustainable debate on how to dismantle the power dynamics embedded in healthcare systems, especially in areas related to the care of women and gender minorities.

This limitation is compounded by the lack of effective oversight by the competent health authorities, whether due to budget constraints or institutional reluctance, given that regulation often involves doctors exercising control over other doctors. At the same time, there has been limited critical reflection within healthcare institutions on the role of professionals in the perpetration of this type of obstetric violence. Taken together, these factors make it clear that legal recognition alone is an important but insufficient response, and the challenges posed by obstetric violence remain largely unaddressed.

The text published here is based on the conclusions from the author’s master’s thesis, titled “Incorporation of Obstetric Violence into Uruguay’s Legislative Agenda: Processes, Perspectives, and Discourses”, presented last year as the culmination of her master’s degree in Public Policy and Feminisms at the University of José C. Paz (UNPAZ - Buenos Aires).

Romina Gallardo Duarte, Assistant Professor, University of the Republic and co-lead of the Law and Human Rights Working Group, International Platform on Obstetric Violence.