When Care Harms: Obstetric Violence as Institutional Trauma in Peru.

Childbirth in health facilities now covers the large majority of births in Peru, and the conditions of institutional care shape the experience of almost every woman who gives birth. We argue that obstetric violence should be understood as a form of institutional production of psychological trauma, which quality-of-care frameworks do not capture. Accountability for mistreatment in childbirth is weak across health systems for reasons that extend beyond the legal status of the conduct, and Peru illustrates these limits: obstetric violence is named in sectoral technical standards but has not been legislated on, and the standards that prohibit specific practices attach no sanction to non-compliance. Drawing on this analysis and on evidence linking obstetric violence to perinatal posttraumatic stress and postnatal depression, we propose that such harm be recognized as iatrogenic. We outline implications for trauma-informed care, for informed consent as a clinical process, and for the systematic monitoring of women's experiences.