Tense concepts: obstetric violence, structural injustice and moral injury

Obstetric violence has emerged as a powerful conceptual, activist and legal framework to name and struggle against abuse, coercion and mistreatment during childbirth. The term is, however, controversial. In the midst of these contestations, some have called for greater precision in definition. Against the call for a singular definition, I argue that we need to remain alert to the divergent goals that shape the way the lexicon is used and embrace complexity. I explore these ‘complexities of use’ and suggest that a closer exploration of the relations between structural and direct violence is needed in order to understand obstetric violence as a totality. The article makes two key interventions. First, using Young’s concept of ‘structural injustice’, obstetric structural injustice is theorized as a totality that includes both structural and interpersonal wrongs. This framing allows us to differentiate different types of violation and keep the overall systemic and oppressive aspects of obstetric violence in sight. Second, the relationship between structural and interpersonal violations in the sphere of birth is further clarified by recognizing that both forms of harm comprise a moral injury . Drawing on work by Gilligan (2014) and Bernstein (2005; 2020), moral injury is framed as a betrayal of trust that constrains and degrades personhood. The concept of ‘the imaginary domain’ (Cornell, 1995) is further mobilized to develop the analysis of obstetric structural injustice as a moral injury.