Legal Threats to Autonomy, Choice, and Informed Consent in Labor and Childbirth

Though labor and childbirth are among the most common ways women engage with health care systems, legal protections are notably weak, with women facing coercion, restrictions on their decision-making, and even being forced to undergo medical procedures without consent.

New research from the Center for Reproductive Rights finds that maternal health is the only field in medicine and law in which informed consent can be overridden, and patients can be forced to submit to compulsory treatment against their will.

Recognizing a surprising lack of research-based information on the laws regulating autonomy and consent in maternal health care, this research analyzes international human rights standards and the laws and regulations across twelve countries: Bangladesh, Brazil, Colombia, India, Kenya, Malawi, Mexico, Pakistan, Romania, Spain, Uganda, and the United States. These countries were chosen because they represent a diversity of geographies, populations, health care systems, and different levels of recognition and protection for maternal health and human rights.

The study identifies key legal gaps, challenges, and good practices within national frameworks, as well as cross-cutting legal issues that directly impact autonomy, choice, and informed consent in labor and childbirth. Based on this comparative analysis, the report outlines specific recommendations to address the legal and structural conditions that place pregnant and birthing people at risk.

Key Concepts

At the Center for Reproductive Rights, we believe that every pregnant person has the right to safe, respectful, and quality maternal health care, free from coercion, discrimination, and violence, and grounded in the principles of bodily autonomy and informed consent.

• Bodily autonomy affirms that individuals are active decision-makers rather than passive recipients of care. It includes the right to control one’s body and health without coercion or interference.
• Freedom of choice refers to the ability to decide what care to receive, as well as when, where, how, and from whom. This includes the right to shape one’s health care experience based on personal preferences.
• Informed consent requires voluntary agreement to any medical intervention, based on adequate information about the risks, benefits, and available alternatives. Patients also have the right to refuse care or treatment.

Forms of Mistreatment and Abuse during Labor and Childbirth

Despite legal and ethical recognition of autonomy and consent, mistreatment during childbirth remains widespread. Maternal mortality and morbidity remain urgent global health challenges, and despite ongoing efforts, progress has either stagnated or, in some cases, reversed, with about 800 women dying per day due to maternal health complications (WHO).

In the studied countries, at least 15% of women experienced mistreatment during childbirth, with some countries in the study (Pakistan, India, and Romania) documenting as high as 95-100%. These include non-consensual care, forced medical procedures, denial or neglect of care, sexual violence, and the use of disrespectful or abusive language.

These harmful practices are rooted in systemic and cultural factors, including gender stereotypes that assume pregnant people are incapable of making responsible health care decisions. Structural power imbalances between health care providers and patients further reinforce these dynamics, particularly in institutional models that prioritize control, efficiency, or risk avoidance over individualized, respectful care.

Legal Factors That Limit or Undermine Autonomy, Informed Consent, and Choice

1. Overly Broad Emergency Exceptions to Informed Consent. In many countries, informed consent is required by law, with exceptions allowed in cases of emergency or medical necessity. However, the definition of what constitutes an “emergency” is often vague or overly broad, which leaves excessive discretion for health professionals to override the patient’s consent. This disproportionately impacts patients in labor, where perceived risk—whether to the birthing person or the fetus—is equated with an actual emergency, even in the absence of immediate life-threatening danger.

2. Legal Frameworks That Allow Refusals to Be Overridden in Favor of Fetal Protection. Some jurisdictions (e.g. Uganda) legally prioritize fetal wellbeing over the autonomy of the pregnant person, permitting non-consensual interventions when care refusal is perceived to endanger the fetus. Courts (Brazil, Spain, U.S.) have dismissed claims of mistreatment during childbirth by framing imposed procedures as necessary to protect fetal life. However, such decisions are rarely based on clear, imminent threats to fetal life. Rather, they reflect disagreements about acceptable levels of risk, often shaped by medical paternalism and evolving standards, rather than objective urgency.

3. Legal Conditions on Birth Choices Based on Risk or Health Status. Several countries recognize the right to choose how and where to give birth but often limit this right to “low-risk” pregnancies or favorable health conditions (Mexico, Colombia). This creates a false dichotomy between autonomy and safety, implying that those facing complications forfeit their right to make decisions about their care.

4. Legal Authorization to Withhold Information during Labor and Delivery. Some legal systems (Kenya, Uganda, Brazil) permit health care providers to withhold information when it is believed that disclosure could cause harm to the patient, known as therapeutic privilege. While framed as protective, these policies often result in denying patients critical information needed to make informed decisions. Withholding information can erode trust, undermine consent, and deprive people of agency in their care.

5. Limited Remedies and Lack of System-Wide Change. Although most countries studied provide some form of remedy for rights violations in maternal health care, these mechanisms often focus on individual liability rather than structural reform. Efforts to ensure accountability must be accompanied by systemic reforms that promote cultural change, institutional capacity-building, and patient-centered care at all levels.

Recommendations

Based on the legal analysis and identification of structural barriers to autonomy, this report proposes seven key recommendations:

1. Anchor legal frameworks in a human rights-based approaches to maternal health.

2. Legally recognize that pregnancy and labor do not constitute an exception to fundamental rights including the right to informed consent and refusal, the right to make decisions that may contradict medical advice, and the right to choose the mode, location, and circumstances of birth.

3. Clearly define emergency exceptions to informed consent, noting labor pain, emotional distress, or disagreement with providers should not be interpreted as incapacity to decide.

4. Protect the right to refuse treatment, even when such refusals are believed to pose a risk to the fetus. There is not a risk-free childbirth experience, and the best way to protect newborns is to support the dignity and autonomy of the childbearing person.

5. Prohibit coercive practices and the withholding of information in maternal care.

6. Avoid punitive approaches that focus on criminalization of providers, with efforts to address mistreatment prioritizing system-level reform that enable dignified care.

7. Implement mandatory training and data collection on rights and dignity in pregnancy, childbirth and the postpartum period.