Obstetric violence is a very common and, so far, mostly invisible dimension of how girls and women are discriminated against and their autonomy and dignity undermined by individuals or systems. Obstetric violence, which takes place in health facilities providing reproductive and especially maternal health care, is a form of gender-based discrimination. It can take a wide range of forms such as health providers beating and hitting pregnant or birthing women, verbal and psychological abuse, the use of unnecessary medical interventions, delaying care, withholding pain relief, detaining women, and unnecessarily separating women and their newborns.

Obstetric violence includes severe abandonment and neglect, forms of abuse that this report examines especially closely in the case of Sierra Leone where devastating results include avoidable maternal and newborn deaths, injuries, and suffering. When a provider delays clinical support to a women giving birth in extreme duress because she has no money, it sends a clear message; she is powerless and unimportant.

This report, based on more than 130 interviews with patients, healthcare providers, government officials, and public health and policy experts in Sierra Leone, in 2024 and 2025, seeks to provide insights into obstetric violence in Sierra Leone by examining how women, especially indigent women, are at higher risk of obstetric violence if they cannot make informal cash payments to staff in government facilities for services, drugs, and other commodities, even if in an obstetric emergency.

Report by the Human Rights Watch