Molly Baker, Associate Member, Immigration and Human Rights Law Review
- Introduction
A staggering sixty-five percent of women in Ghana report that they have been victims of obstetric violence.[1] Obstetric violence is characterized as abusive medical treatment toward people at any stage of pregnancy or those seeking sexual and reproductive health services.[2] This article examines how pervasive obstetric violence in Ghana violates the human right to “the enjoyment of the highest attainable standard of physical and mental health,” as enumerated by Article 12 of the United Nations’ International Covenant on Economic, Social and Cultural Rights (ICESCR). Part II explores how obstetric violence persists in Ghana and how obstetric violence violates basic human rights. Part III discusses initiatives undertaken by non-governmental organizations (NGOs) to eradicate obstetric violence. Finally, this article recommends that the Ghanaian government take action to enact legislation that protects women and girls seeking gynecological and obstetric healthcare by requiring higher standards of care in healthcare settings.
- Background
Obstetric violence is abusive medical treatment by medical practitioners, nurses, midwives, and other hospital staff toward people at any stage of pregnancy or those seeking sexual and reproductive health services and information.[3] Obstetric violence violates the human right “of everyone to the enjoyment of the highest attainable standard of physical and mental health,” as protected by the International Covenant on Economic, Social and Cultural Rights (ICESCR).[4] Obstetric violence also violates the Declaration on the Elimination of Violence Against Women, which enumerates the right to be free from violence.[5] This section seeks to explain obstetric violence, discuss the factors contributing to its continuing prevalence, and highlight the grave human rights violations inherent in obstetric violence.
- Obstetric Violence in Ghana
Obstetric violence can occur before, during, or after pregnancy, during gynecological exams, abortion care, fertility treatments, and contraception care.[6] One woman describes a harrowing birth experience in which she was forced to give birth on a concrete floor because she could not walk and her pleas for help from medical staff were ignored. After the birth, she endured verbal and physical abuse from nurses.[7] These medical settings should be places of comfort and safety for patients, but instead, providers prey upon the vulnerability of women and girls who think they are receiving care from trusted professionals.[8] One study states that many women in Ghana experience brutal acts of physical violence, abandonment, verbal abuse, lack of privacy, unconsented care, and procedures done without proper anesthesia.[9] Other prevalent examples of obstetric violence include physical restraint, stigma, discrimination, and denying women decision-making authority over decisions such as treatment and sterilization.[10]
Several factors contribute to the continued prevalence of obstetric violence.[11] Social and cultural norms stigmatize young women’s sexuality, further normalizing violence against women and girls.[12] Stigma surrounding contraceptive use, teenage pregnancy, and the general sexuality of young women causes women and girls to stay silent about experiences of obstetric violence or avoid seeking out sexual and reproductive healthcare at all.[13] Single mothers, teenagers, and HIV-positive women are at a higher risk of being mistreated by medical personnel during gynecological and obstetric care.[14] Discriminatory laws and policies that criminalize abortion or require third-party involvement before women can access reproductive health services have also been used to justify verbal abuse and discrimination against women seeking those services.[15] Other factors facilitating the continuance of obstetric violence include the power imbalances between healthcare professionals and patients, normalization of abusive healthcare practices, insufficiently resourced healthcare facilities, lack of accountability, and oversight mechanisms.[16]
Structural inequalities in Ghana’s medical system also contribute to obstetric violence.[17] The medical personnel hierarchy in Ghana is highly patriarchal, with doctors being primarily male and midwives being primarily female.[18] Midwives in Ghana report being insulted, demeaned, and undermined by doctors in front of patients.[19] They are also often blamed for negative outcomes during birth.[20] Studies on midwifery in Ghana showed that, in some instances, doctors’ disrespect toward midwives caused a transfer of aggression onto the women and girls being treated by midwives.[21] These trends highlight the important fact that stereotypical gender norms among employees within the healthcare system can lead to negative impacts on patient care.[22]
Obstetric violence is part of the broader issue of gender-based violence because it diminishes women’s autonomy and ability to make decisions about their bodies and healthcare.[23] Obstetric violence is both a form of gender-based violence and a human rights violation.[24] Obstetric violence must be taken seriously, not only because it constitutes unethical medical care, but because it can ultimately lead to death.[25] Ultimately, obstetric violence violates the human rights of women and girls in Ghana.
- Human Rights Violations
Article 12 of the ICESCR protects “the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.”[26] Obstetric violence in Ghana violates the human right to the highest attainable standard of health because it diminishes the quality of care women receive and impacts healthcare accessibility, as many women are scared to seek healthcare from medical professionals.[27] The societal standard for women’s sexual and reproductive healthcare in Ghana is so low that it allows abuse in many forms to continue to run rampant in various healthcare settings.[28] This low standard of care is evidenced by the inadequate amount of properly trained and qualified healthcare professionals and the normalization of behavior amounting to obstetric violence in healthcare settings.[29] Moreover, Article 12 necessitates the creation of “conditions which would assure to all medical service and medical attention.”[30] As a result of obstetric violence, many women and girls in Ghana do not trust the healthcare system and providers.[31] Therefore, women are less likely to give birth in health facilities in the future, which increases their risk of death from avoidable complications during pregnancy, childbirth, and in the post-partum period.[32] Avoidance of healthcare services can also lead to an increased risk of sexually transmitted infections.[33]
Obstetric violence also violates the right to be free from violence, which is protected by the Declaration on the Elimination of Violence Against Women.[34] Such violence against women encompasses “physical, sexual, and psychological violence occurring within the general community,” including in healthcare settings.[35] By allowing the continuation of these practices and attitudes that place women in grave danger, Ghana violates women and girls the right to be free from violence. Although studies show that a majority of women in Ghana report experiencing obstetric violence, it is important to recognize that many instances of obstetric violence are never reported due to fear and the stigma surrounding women’s health issues.[36] Obstetric violence in Ghana is described as a silent epidemic because its prevalence is underreported and generally under-researched.[37]
III. Discussion
Considering both healthcare practices and widespread gender-based stereotypes fuel obstetric violence in Ghana, reform must target all areas.[38] Many civil society organizations operating in Ghana target educational and community-based programming.[39] In addition to the work of these organizations, the Ghanaian government must enact legislation to eradicate obstetric violence by increasing the standards of safe healthcare for women and girls, which includes better training for medical personnel and adequately staffed and resourced healthcare facilities.
- Current Efforts to Reduce Obstetric Violence
Some NGOs operating in Ghana emphasize the importance of challenging the myths surrounding violence against women through community advocacy.[40] Understanding that gender inequality in society has a significant impact on how healthcare professionals perceive and treat women, interventions focusing on community attitudes and stereotypes are an important component of structural change.[41] The World Health Organization (WHO) operating in Ghana works with civil society organizations to address gender-based inequalities in health services by providing tools and training that can be implemented in local communities.[42] Additionally, in early 2025, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), and the Canadian government expanded a reproductive health initiative geared toward empowering Ghanaian adolescent girls.[43] The initiative aims to empower over 400,000 adolescent girls in Ghana by enhancing their access to quality sexual and reproductive health education, services, and advocacy opportunities.[44] The initiative plans to increase adolescent girls’ informed decision-making, engage boys and men in promoting positive masculinity, and enhance the capacity of caregivers, traditional and religious leaders, and other community programs targeted at adolescent girls.[45] This initiative remains a positive example of how NGOs can target their work toward entire communities, not just the women and girls impacted by obstetric violence.[46] Although civil society can make great strides, the Ghanaian government ultimately has the power to enact laws targeting the eradication of obstetric violence.
- Proposed Governmental Action
Importantly, the state bears the primary duty regarding the provision of health care, as Ghana is a party to the African Charter on Human and Peoples’ Rights in the Context of Private Provision of Social Services.[47] Therefore, Ghana is obligated to protect women and girls seeking all types of health care, including reproductive and sexual.[48] States must ensure adequate training and adherence to standards for all healthcare professionals.[49] To meet their obligations to provide health care and protect human rights, the Ghanaian government must make a greater effort to prioritize the health, safety, and well-being of women and girls seeking reproductive and sexual health care. The government should aim its efforts at sparking radical systemic changes within the overall healthcare infrastructure in Ghana. Most basically, the government should provide training for all healthcare personnel regarding medical ethics and patients’ human rights, especially the right to respectful and dignified care.[50] Health facilities that provide reproductive and sexual health services should also be designed to enable privacy and confidentiality, further increasing feelings of safety and dignity.[51] Within these facilities, the government must also ensure adequate resources, including clean water, electricity, and pain management education.[52] Ultimately, many of these proposed changes require an increase in funding for reproductive health services. If allocated and used properly, more funding would allow improvements in training, facilities, and resources for patients.
Although governments should prioritize obstetric violence prevention entirely, they should also provide accessible remedies for victims and survivors of obstetric violence.[53] Appropriate remedies may include restitution, compensation, acknowledgement of the violation of the victims’ rights, a guarantee that it will not happen again, and stricter enforcement of related laws on medical ethics.[54] An oversight body solely responsible for working with victims and assisting them in achieving redress would allow patients to voice their experiences to a neutral body separate from the healthcare facility.[55] Initiatives promoting sexual and reproductive health education and empowering women’s bodily autonomy as well as concrete governmental action to improve the standard of care provided in healthcare facilities are imperative in reducing the prevalence of obstetric violence and protecting the human rights of women and girls in Ghana.
- Conclusion
The high prevalence of obstetric violence in Ghana continues to violate the human rights of women and girls by negatively impacting health outcomes, perpetuating violence, and deterring women from seeking sexual and reproductive healthcare. Obstetric violence in Ghana is deeply rooted in gender-based stereotypes and negative attitudes towards women’s health. Ultimately, obstetric violence leads to abusive experiences in healthcare facilities and causes women to give birth without healthcare professionals, greatly increasing the prevalence of avoidable birth complications, which can result in death. With these grave consequences in mind, the Ghanaian government must immediately take action to protect the health and livelihood of women and girls.
[1] Abena Asefuaba Yalley, Layers of inequality: gender, medicalization, and obstetric violence in Ghana, Int. J. Equity Health 23, 243 (2024).
[2] Addressing ‘Obstetric Violence’ in Africa, Hum. Rts. Watch (Nov. 13, 2024, 2:35 PM), https://www.hrw.org/news/2024/11/13/addressing-obstetric-violence-africa# [https://perma.cc/X8QY-RQF6].
[3] Id.
[4] International Covenant on Economic, Social, and Cultural Rights, art. 12, Dec. 16, 1966, 993 U.N.T.S. 3 [hereinafter the ICESCR].
[5] G.A. Res. 48/104 (Dec. 20, 1993).
[6] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[7] Prudence Mutiso, Obstetric Violence in Sub-Saharan Africa: The Struggle for Dignified Maternal Care, New Sec. Beat (Dec. 4, 2024), https://www.newsecuritybeat.org/2024/12/obstetric-violence-in-sub-saharan-africa-the-struggle-for-dignified-maternal-care/ [https://perma.cc/T6GE-UQFM].
[8] Id.
[9] Yalley, supra note 1 at 2.
[10] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[11] Id.
[12] Id.
[13] Id.
[14] Yalley, supra note 1 at 2.
[15] Id.
[16] Id.
[17] Yalley, supra note 1.
[18] Id.
[19] Id.
[20] Id.
[21] Id.
[22] Id.
[23] Rangita de Silva de Alwis, Obstetric Violence and Forced Sterilization: Conceptualizing Gender-Based Institutional Violence, 9 U. Pa. J. L. & Pub. Aff. 95, 96 (2024).
[24] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[25] Id.
[26] ICESCR, supra note 4.
[27] Id.
[28] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[29] Id.
[30] ICESCR, supra note 4.
[31] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[32] Id.
[33] Id.
[34] G.A. Res. 48/104, supra note 5.
[35] Id.
[36] Mutiso, supra note 7.
[37] Id.
[38] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[39] Yalley, supra note 1.
[40] Dorcas Coker-Appiah, A Guide to Developing a Community Response to Violence Against Women in Ghana, Gender Studs. & Hum. Rts. Documentation Ctr. (Feb. 11, 2023), https://gendercentreghana.org/site/a-guide-to-developing-a-community-response-to-violence-against-women-in-ghana/ [https://perma.cc/5GSW-JCLT].
[41] Yalley, supra note 1.
[42] WHO Supports Civil Society Organizations to Address Gender-Based Health Inequities through Monitoring of Inequalities, World Health Org. (Oct. 18, 2024), https://www.afro.who.int/news/who-supports-civil-society-organizations-address-gender-based-health-inequities-through [https://perma.cc/SG6F-3QLT].
[43] UNFPA, UNICEF, and Canada Expand Reproductive Health Initiative to Empower Ghanaian Adolescent Girls, UNFPA (Mar. 24, 2025), https://ghana.unfpa.org/en/news/unfpa-unicef-and-canada-expand-reproductive-health-initiative-empower-ghanaian-adolescent [https://perma.cc/8KNF-N9BA].
[44] Id.
[45] Id.
[46] Id.
[47] Organization of African Unity (OAU), African Charter on Human and Peoples’ Rights (Banjul Charter), CAB/LEG/67/3 rev. 5, 21 I.L.M. 58 (1982).
[48] Addressing ‘Obstetric Violence’ in Africa, supra note 2.
[49] Id.
[50] Id.
[51] Id.
[52] Id.
[53] Id.
[54] Id.
[55] Id.
