Obstetric violence prevalence and risk factors: an umbrella review

Abstract

Background: Obstetric violence (OV) is a gender-based human rights violation during pregnancy, labour, and postpartum. Despite increasing recognition, the global prevalence and risk factors associated with OV remain poorly understood. We aim to estimate the prevalence of OV worldwide, examine regional disparities, and identify the associated risk factors through an umbrella review. Methods: After prospective registration (PROSPERO CRD42025631985), a comprehensive search was conducted in PubMed, Scopus, Web of Science, and Scielo for reviews published between January 2015 and March 2025. Two reviewers independently selected studies, extracted data, and assessed methodological quality using the AMSTAR 2 tool. Overlap of studies among the included reviews was quantified using the corrected covered area (CCA). The risk factor data were summarised as odds ratio (OR) with 95% confidence interval (CI). Results: Fourteen reviews, with a total of 1,116,159 participants, were included; of which 10 (71.4%) were of critically low or low quality and only one review was high quality. The CCA was very low at 1.136%. OV prevalence varied from 23.2% to 59%, depending on region and definitional criteria. Forms of OV included physical (3.1–78.4%), verbal or psychological (2.6–66%), and social (1.9–94%) mistreatment. Statistically significant risk factors included low socioeconomic status (maximum OR = 3.68; 95% CI = 1.4–9.7), obstetric complications (maximum OR = 6.41; 95% CI: 1.36–30.14), limited education (OR = 5.92; 95% CI 1.38–23.81), public healthcare births (maximum OR = 4.34; IC 95%: 1.58–11.97), instrumental delivery (OR = 2.35; 95% CI: 1.72–3.22), and inadequate provider training (OR = 1.47; 95% CI: 1.05–2.04). Conclusions: OV is a prevalent global issue. Vulnerable populations, i.e. those with lower socioeconomic status and limited education, were more often affected. The low methodological quality of the existing literature is a key weakness. There is a need for standardised definitions and improved research validity for the development of evidence-based interventions.