The UNFPA released a report detailing how women were suffering widespread mistreatment during childbirth across Eastern Europe and Central Asia. Credit: UNFPA
By Ed Holt
BRATISLAVA, Mar 30 2026 (IPS)
Government and medical professionals must implement systematic changes to deal with a “crisis” of obstetric violence (OV) across Eastern Europe and Central Asia (EECA), experts and rights campaigners have said.
The call comes as the United Nations Population Fund (UNFPA) released a report on March 12 detailing how women were suffering widescale mistreatment during childbirth across the region.
“This report is a wake-up call. All stakeholders must make sure that women’s rights are respected and protected in all facilities in the health system and beyond,” Tamar Khomasuridze, UNFPA Sexual and Reproductive Health Adviser for Eastern Europe and Central Asia, told Inter Press Service (IPS).
The report, Respectful Maternity Care: Women’s Experiences and Outlooks in Eastern Europe and Central Asia, highlighted what the UNFPA said was a “pervasive yet often hidden OV crisis that violates women’s fundamental human rights and dignity”.
The survey, which was based on online responses from over 2,600 women who gave birth recently and conducted across 16 countries and territories in the region, found that 67 percent of respondents reported at least one form of mistreatment, including non-consensual medical procedures, verbal and physical abuse, and significant breaches of privacy.
Nearly half (48.1 percent) of women underwent obstetric procedures – such as episiotomies, Caesarean sections, or the administration of oxytocin – without their informed consent.
Meanwhile, about 24 percent of surveyed women reported experiencing verbal abuse, including yelling and humiliation, and 1 in 10 endured physical or sexual abuse during labour or gynaecological examinations. For example, 12 percent of the surveyed women reported being physically restrained during labour, such as being tied to the bed or subjected to aggressive physical contact under the pretext of facilitating delivery. Just over 10 percent experienced different forms of sexual abuse, ranging from inappropriate touching to more severe forms of assault (disrespectful manipulation of the genitals).
The survey also revealed a massive lack of awareness of OV among women in the region – almost 54 percent of surveyed women said women were unfamiliar with the term “obstetric violence”. And of those that knew they were victims of OV, very few reported such incidents – only two percent of those mistreated officially reported their experience, often due to a lack of trust in accountability mechanisms or fear of retaliation.
Previous research into the extent of OV in the region is limited and experts say it is difficult to gauge whether the situation in the region has changed in recent years.
But campaigners say the report underlines that it remains a serious problem.
“Obstetric violence has always existed, but for a long time it remained invisible, normalised, and embedded within what was perceived as ‘standard medical practice’. The major shift over the past decade is not necessarily in the prevalence of the phenomenon but rather in its increased visibility at the public, legal, and institutional levels, including its inclusion on the global agenda of human rights and public health,” Alina Andronache, a gender public policy expert at the Partnership for Development Center (CPD) in Moldova, who helped author the UNFPA report, told IPS.
“The report outlines a mixed picture: recognition and visibility of the phenomenon are increasing, yet the prevalence of experiences of abuse, coercion, and lack of consent remains alarmingly high,” she added.
Rights activists say that the phenomenon is closely linked to the wider issue of prevalent attitudes to women in the region.
“The report clearly shows that obstetric violence is not merely an issue of inadequate medical practices but is deeply embedded in broader social and cultural structures—particularly gender discrimination, power imbalances between the patient and medical staff, rigid institutional hierarchies, and norms that socialise women to accept authority without questioning it, including in highly intimate and vulnerable contexts such as childbirth,” said Andronache.
She highlighted the report’s finding that 58.4 percent of respondents believe that a mother must accept any intervention for the benefit of the child, even if it may harm her, while 19.6 percent consider that doctors may take a decision without a woman’s consent to protect the child.
“These perceptions reflect a profound internalisation of the idea that women’s bodily autonomy can be suspended during childbirth in favour of a medical authority perceived as unquestionable. This internalisation has two major consequences: it legitimises abusive or coercive practices, which are no longer perceived as violations of rights but as ‘necessary’ or ‘medically justified’ interventions, and it directly contributes to underreporting and to the difficulty of recognising obstetric violence as such. If women are socialised to believe that they do not have the right to refuse, to ask questions, or to negotiate interventions, then their experiences are not necessarily identified as abuse but rather as a ‘normal’ part of childbirth,” she explained.
The report includes a call to action that outlines critical steps to address systemic problems with OV in the EECA states. These include legislation to protect women against OV; human rights-centred training for all healthcare personnel to shift clinical attitudes and ensure dignity is maintained at the point of service, as well as implementing monitoring and other measures to ensure accountability; and strengthening education and wider awareness of OV.
The UNFPA says its call to action has been endorsed by all countries in the survey and other stakeholders and will become part of action plans on OV at the national level.
But it is unclear how easy it will be to effect meaningful change, especially in a region where some countries have very conservative social cultures and wider problems with women’s rights.
The report showed that among respondents from Central Asian countries, such as Kazakhstan, Kyrgyzstan and Uzbekistan, around two thirds of women were unaware of OV. The report says this is due, in part, to traditional norms surrounding women’s roles and childbirth, which may make women less open to discussions about obstetric abuse.
Khomasuridze admitted that there were “of course sensitivities in different countries” in the region but was confident that with the help of various stakeholders, including civil society organisations, women’s rights groups and patient groups, changes would be implemented.
Andronache said that in countries where strongly conservative political policies and societal attitudes are prevalent, it was crucial that “the message be adapted to the context”.
“In more conservative societies, the approach should not be perceived as confrontational or ideological but rather framed as an issue of safety, dignity, and quality of care for both mother and child. Emphasising health, respect, and communication may be more readily accepted than a discourse focused exclusively on rights,” she said.
She added that it was essential that women be made aware of OV during their engagement with healthcare professionals – prenatal courses should be accessible and include, alongside medical information, clear explanations about women’s rights, informed consent, and what respectful care entails. ‘Meanwhile, information must reach those who need it most, she said — particularly in rural areas and in communities with more limited access to education.
“This requires simple messages, delivered in accessible languages and through channels that women already trust, including healthcare providers, community leaders, or other women sharing their experiences,” Andronache said.
“Awareness is built not only through the dissemination of information, but also through the creation of a space in which women feel able to ask questions, understand what is happening to them, and recognise when their rights are not being respected,” she added.
However, even in places where there is more awareness, serious problems with OV remain.
The study found that awareness of OV is higher in Eastern European countries, in part because advocacy initiatives regarding women’s rights during childbirth have contributed to increased visibility of the issue. Yet OV is widespread in some of these states.
In the survey the highest dissatisfaction rates with their childbirth experience were recorded among respondents from the Western Balkans (Albania, Serbia and Kosovo).
In 2022, a study by lawyers in Serbia found that women in the country are regularly subjected to various forms of violence at maternity clinics and hospitals, including not just verbal abuse and humiliation at the hands of staff, but violent physical examinations and invasive procedures without consent.
In January 2024, Marica Mihajlovic, a Roma woman, claimed that during labour her doctor jumped on her stomach, slapped her and racially abused her. Her baby died soon after birth.
A 2023 report on OV in Moldova included testimony from scores of OV victims, some of whom were left with serious physical and mental health issues afterwards.
As well as having to deal with the physical and mental damage of their experiences, victims of OV in the region also often face significant barriers to any redress for their suffering.
“Women who are aware of obstetric violence and would like to take action encounter, in reality, a form of distance—not only physical, but also emotional and institutional. In theory, reporting mechanisms should be ‘within reach’: easy to understand, accessible, and safe. In practice, in many countries this distance is far too great,” explained Andronache.
She said many women who want to report OV struggle with difficult and bureaucratic systems for doing so. Many are also put off by feelings that reporting what happened to them will not change anything or, worse, “that they would be placed in a position of having to prove their suffering, of being questioned, or even invalidated”.
“In the absence of clear and credible accountability mechanisms, reporting is not perceived as a solution, but as a long, uncertain, and emotionally draining process,” Andronache said.
Some also find that after a difficult or traumatic experience, they simply do not have the emotional resources to engage in a formal process. “They seek calm, recovery, and the ability to care for their child. The question ‘is it worth going through this?’ becomes very real,” said Andronache.
While the report identifies the scale of the OV crisis in the region and changes needed to reverse, or at least lessen it, fundamental improvement is not expected to come overnight, regardless of how enthusiastically governments embrace the UNFPA’s recommendations.
“Some changes can be implemented relatively quickly—for example, establishing clear and accessible reporting mechanisms, informing women, introducing more transparent procedures, or providing basic training for medical staff. These depend largely on political will and organisational capacity and can be achieved within a relatively short timeframe.
“However, the more difficult aspect is the transformation of mindsets—both within the medical system and in society at large. A deeper transformation to a system in which women feel safe to speak out and which responds with accountability and respect is a long-term process that may take a decade or more. At its core, this is a cultural shift, not merely a regulatory one,” said Andronache.
Khomasuridze agreed.
“We and our partners have a long way to go. Progress depends on action at the national level and we are very well positioned in [EECA] countries to accelerate progress, working with government, professional societies, civil societies, women’s groups, and patients’ groups to make sure that this transformative agenda is implemented,” she said.
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Credit: Ryan Brown/UN Women
By Inés M. Pousadela and Samuel King
MONTEVIDEO, Uruguay / BRUSSELS, Belgium, Mar 30 2026 (IPS)
On 19 March, the Commission on the Status of Women (CSW) did something unprecedented in its eight-decade history: it held a vote. The Trump administration, having spent two weeks attempting to defer, amend and ultimately block the session’s main outcome document, known as the agreed conclusions, cast the only vote against its adoption. That dissenting vote said a lot, as it came from the world’s most powerful government, backed by financial leverage, bilateral reach and a network of anti-rights states and organisations that are making inroads at many levels.
Established in 1946, the CSW brings together 45 states each year to negotiate commitments that, while not legally binding, shape domestic legislation, set international norms and signal the direction of political will. Civil society plays an important role in it: the NGO Committee on the Status of Women coordinates thousands of organisations, from large international bodies to grassroots groups, with the aim of ensuring those most affected by policy have a seat at the table. For several decades, this has been the closest thing the world has to a dedicated annual intergovernmental negotiation on women’s rights.
The assault on gender equality
The Trump administration arrived at CSW70 having withdrawn from UN Women in January and from its Executive Board in February, citing opposition to what it calls ‘gender ideology’. It submitted eight amendments targeting language on reproductive health. When these didn’t succeed, it attempted to defer or withdraw the conclusions entirely. When that too failed, it voted against adoption and tabled a separate resolution seeking to impose a restrictive definition of gender, effectively attempting to rewrite 30 years of carefully negotiated commitments. Its resolution was blocked.
At the Munich Security Conference in February, US Secretary of State Marco Rubio defined western civilisation as bound together by Christian faith, shared ancestry and cultural heritage, an ideological approach that treats women’s equality, reproductive rights and LGBTQI+ rights not as human rights but ideological impositions to be rejected. The Trump administration’s financial muscle is now the delivery mechanism for this worldview.
Defunding as a weapon
The immediate material crisis at CSW70 was the collapse of funding. The elimination of 90 per cent of USAID contracts wiped out US$60 billion in foreign aid. The USA is instead negotiating bilateral deals with 71 countries under its ‘America First’ global health strategy, extending its global gag rule not just to civil society organisations but to recipient governments. This means any institution that receives US health funding must certify that neither it nor any organisation it works with promotes or provides abortion.
Funding will now flow through faith-based groups, with ultra-conservative Christian organisations such as the Alliance Defending Freedom and Family Watch International set to benefit, having spent years building networks across Africa, Asia and Latin America. They use the language of family values, parental rights and national sovereignty to consolidate conservative influence over laws affecting women, LGBTQI+ people and young people. In many countries, they already have direct access to governments while progressive organisations are routinely excluded.
With threats intensifying, the UN is signalling retreat. A proposal under the UN80 cost-cutting initiative to merge UN Women with the UN Population Fund (UNFPA) has alarmed civil society worldwide. The stated rationale is efficiency, but there’s little overlap between the two agencies and their combined budgets make up a small part of the UN’s overall spending, suggesting savings would be modest. It’s hard to escape the conclusion that the targeting of these organisations reflects the increasing contestation of their rights-based mandates rather than any logic of organisational efficiency.
Over 500 civil society organisations signed an open letter to UN Secretary-General António Guterres warning that, when sexual and reproductive health rights are absorbed into broader mandates, they risk ‘being deprioritised, underfunded, or rendered politically invisible’. Some states have urged caution but so far none has committed to blocking the merger.
Civil society holds the line
In difficult times, over 4,600 civil society delegates attended CSW70 and made their presence count. They took the floor to name structural barriers and demand accountability: youth representatives challenged the normalisation of online violence, Pacific Island delegates described how geography compounds the denial of justice for survivors, and activists from Haiti documented the labour exploitation of migrant domestic workers. They all emphasised that when women’s rights organisations are restricted or defunded, survivors lose their primary pathway to justice.
The NGO CSW Forum hosted over 750 events alongside the official session. But not everyone could participate. US visa restrictions meant several women’s rights activists, particularly from the global south, couldn’t enter the country. This is a worsening problem that limits civil society’s ability to engage.
CIVICUS’s newly released 2026 State of Civil Society Report documents exactly what civil society has been up against: institutions built to protect women’s rights under sustained, coordinated attack, their funding cut, their mandates targeted and the human rights values they are built on reopened for revision. CSW70’s agreed conclusions offer hope, committing states to action on AI governance, discriminatory laws, digital justice, labour rights, legal aid and the formal recognition of care workers. But as the contest over them made plain, political will is running low and the anti-rights community is emboldened. Civil society left CSW70 without losing ground – and this seems to be the measure of success in the regressive times we live in.
Inés M. Pousadela is CIVICUS Head of Research and Analysis, co-director and writer for CIVICUS Lens and co-author of the State of Civil Society Report. She is also a Professor of Comparative Politics at Universidad ORT Uruguay.
Samuel King is a researcher with the Horizon Europe-funded research project ENSURED: Shaping Cooperation for a World in Transition at CIVICUS: World Alliance for Citizen Participation.
For interviews or more information, please contact research@civicus.org
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Vivian van de Perre, Deputy Special Representative for Protection and Operations in the United Nations Stabilization Mission in the Democratic Republic of the Congo (MONUSCO) and Interim Head of MONUSCO, addresses the Security Council meeting on the situation concerning the Democratic Republic of the Congo. Credit: UN Photo/Eskinder Debebe
By Oritro Karim
UNITED NATIONS, Mar 27 2026 (IPS)
In the month following the reopening of the Burundi-Democratic Republic of Congo (DRC) border, the humanitarian crisis in the DRC has deteriorated considerably, recently marked by an influx of Congolese refugees returning home, where they face overcrowded conditions and a severe shortage of essential services. This comes in the midst of escalating clashes between rebel groups AFC and M23, and forces affiliated with the Kinshasa government, with drone strikes causing widespread destruction and pushing violence closer to Burundi’s borders, where conditions are most dire.
Vivian van de Perre, Deputy Special Representative for Protection and Operations with the United Nations Organization Stabilization Mission in the Democratic Republic of Congo (MONUSCO), described the current humanitarian situation as “extremely volatile”. During a press stakeout on March 26, she highlighted that the rapid spread of the conflict from North and South Kivu into Tshopo Province and toward Burundi’s borders is a major concern, warning that it increases the risk of a broader “regional conflagration.”
Van de Perre also warned that armed militants have been increasingly relying on the use of heavy weapons and drone strikes in densely populated urban areas, which have caused great damage to civilian infrastructure as well as serious risks to civilian safety, underscoring recent violent incidents at the Kisagani Bangoka International Airport and in Goma, the largest city in North Kivu. Additionally, she warned of M23’s growing presence in Goma, where the coalition has managed to gain influence, undermine state authority, and disrupt humanitarian aid deliveries.
Furthermore, the United Nations Joint Human Rights Office in the DRC (UNJHRO) has uncovered a considerable rise in human rights violations committed by armed groups. Since December 2025, approximately 173 cases of conflict-related sexual violence have been documented, affecting at least 111 victims, the majority of whom were women and girls.
Van de Perre described these findings as “only the tip of the iceberg,” and highlighted growing rates of exploitation, particularly along artisanal mining sites, where child labour is especially pronounced. Armed groups have also been alleged to hamper monitoring, investigation, and justice mechanisms, and subject human rights defenders, journalists, and civil society actors to intimidation and arbitrary detention.
This follows a sharp escalation of hostilities between the armed groups in December 2025, which forced hundreds of thousands of Congolese to flee to Burundi, most coming from Uvira in South Kivu Province and the surrounding areas. Figures from the United Nations High Commissioner for Human Rights (UNHCR) show that after M23’s withdrawal from Uvira in January and a relative return of stability, more than 33,000 refugees began returning home since the border’s reopening on February 23, with most crossing through the Kavimira border point. Many of these returnees already received little humanitarian assistance in Burundi due to chronic underfunding.
“Conditions in many areas of return in the DRC remain fragile, with acute humanitarian needs,” said Ali Mahamat, UNHCR Head of Sub-Office in Goma, DRC, on March 24 at a press briefing at the Palais des Nations in Geneva. “Initial UNHCR assessments in Uvira and Fizi show families arriving with few belongings, in urgent need of shelter, basic household items, health care, and access to water and sanitation. Many returned to find their homes destroyed and belongings looted, leaving them in deep despair and unable to resume normal life without substantial support.”
According to the latest updates from the International Federation of the Red Cross and Red Crescent Societies (IFRC), roughly 60 percent of returnees are living in damaged shelters and over 30 percent face challenges accessing their land. Returnees face heightened risks of gender-based violence, forced recruitment into armed groups, extortion, and exploitation, with female-headed households disproportionately affected due to limited livelihood opportunities for women, which leave these communities entrenched in poverty and especially vulnerable.
Figures from UNHCR show that approximately 30 percent of returnees had been taking refuge in Burundi’s Busama displacement camp, where they faced significant levels of overcrowding and limited access to clean water, sanitation services, healthcare, and shelter. Currently, roughly 4,500 Congolese refugees remain stuck at transit points as they await being relocated to Busama. Additionally, Burundi continues to host over 109,000 Congolese refugees, with 67,000 of them in Busuma alone.
Additionally, internal displacement remains widespread in the DRC, with more than 6.4 million people currently displaced. IFRC estimates that over 5.2 million internally displaced Congolese are concentrated in North and South Kivu, as well as Ituri, 96 percent as a result of ongoing armed violence. According to van de Perre, over 26.6 million people, roughly a quarter of DRC’s population, are projected to face food insecurity this year.
Currently, UNHCR’s response plan to assist returnees, refugees, and displaced Congolese civilians is only 34 percent funded, seeking a total of USD 145 million. MONUSCO is currently on the frontlines providing protection services for nearly 3,000 civilians in Djaiba village. Through the mission, the UN has been able to support over 18,000 farmers in harvesting and transporting crops and has conducted 204 patrols. Van de Perre stressed that stronger governance and security enforcement are crucial in protecting vulnerable civilians, and disarmament and repatriation efforts must be conducted to resolve broader regional tensions.
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The Human Rights council, Geneva.
United Nations High Commissioner for Human Rights Volker Türk in an address
to the Human Rights Council.
By Volker Turk
GENEVA, Mar 27 2026 (IPS)
More than three weeks after the United States and Israel launched strikes on Iran, the conflict is spreading and intensifying in the region and beyond, with civilians bearing the brunt. Families across the region marked Eid and Nowruz under fire, in fear and uncertainty, and facing further hardship.
The situation is extremely dangerous and unpredictable, and has created chaos across the region, affecting Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, the United Arab Emirates, Jordan, and beyond.
Since the start of hostilities, Iran has launched large numbers of drones and missiles against military bases, residential areas and energy facilities across these Gulf States and Jordan. Strikes and interceptions have caused terrible harm to civilians, including dozens of deaths and injuries.
Meanwhile, ports, energy facilities, airports, water infrastructure, and diplomatic premises have suffered damage, disrupting essential services and increasing risks to all civilians.
Many of the strikes in this conflict raise serious concerns under international law, which prohibits attacks targeting civilians and their infrastructure, and attacks on military targets where harm to civilians is disproportionate.
I also need to underscore the grave ramifications of this conflict for a number of other countries in the broader region, including Iraq and Syria, as well as the Occupied Palestinian Territory.
Recent missile strikes near nuclear sites in both Israel and Iran underscore the immense danger of further escalation. States are flirting with unmitigated catastrophe.
Civilians in Lebanon are caught up in a human rights and humanitarian disaster. Government figures detail more than one thousand people killed by Israeli military strikes in the past three weeks, including 79 women, 118 children and 40 medical workers. I am deeply concerned by attacks that have hit apartment buildings, killing entire families in some cases.
Meanwhile, Iran and Hezbollah continue to launch missiles and drones into Israel, also causing loss of life, damage to civilian infrastructure, and displacement.
Inside Iran, civilians seek shelter from airstrikes across all 31 provinces of the country. According to Iranian government figures, some 1,400 civilians have been killed and more than 20,000 injured.
There is a growing pattern of strikes affecting residential areas, civilian infrastructure, and other sites that are protected under international law. Housing, hospitals, schools, cultural sites, transport networks and energy infrastructure have all been hit.
As Iranians shelter from these strikes, they also face another wave of cruel state repression, including arbitrary arrests, executions, intimidation and censorship. The internet has been shut down for more than three weeks.
This conflict is also having very serious ramifications beyond the region.
The disruption by Iran of shipping through the Strait of Hormuz is affecting global supply chains, with dire implications for some of the world’s poorest people.
Fossil fuels, medicine, food, and fertilizers are just some of the vital goods that are being held up at sea. This is disrupting global energy markets and supplies; and has the potential to create serious hunger and healthcare crises. The World Food Programme warns that almost 45 million more people could fall into acute hunger unless the conflict ends soon.
The effects are most destructive in lower-income countries, particularly across South Asia. Developing economies are in general less able to withstand price shocks.
Several States have already introduced energy-saving measures. Bangladesh, for example, has closed universities and introduced fuel rationing, while the Philippines has introduced a state of national energy emergency. The crisis could also reduce the flow of remittances from migrant workers that keep families and communities afloat.
There are ongoing attempts to mitigate the closure of the Strait by releasing oil reserves and easing sanctions. But they have not made a significant difference, and the wider consequences remain unpredictable.
Analysis by UNCTAD shows that insurance premiums and marine fuel costs are surging, increasing prices across the board and around the world.
The UN’s Economic and Social Commission for West Asia assesses that the conflict has already caused some $63 billion in economic losses across the Arab region.
Conflict can never be ordinary or standard. But this conflict has an unprecedented power to ensnare countries across borders and around the world. The complex dynamics could ignite further national, regional or global crises at any moment, with an appalling impact on civilians and people everywhere.
The only guaranteed way to prevent this is to end the conflict, and I urge all States, and particularly those with influence, to do everything in their power to achieve this.
Our deeply interconnected world requires that all countries recommit to full respect for international law, and the UN Charter.
We cannot go back to war as a tool of international relations.
When some powerful States are trying to weaken the multilateral system, we need the rest – the vast majority – to stand up for it. While the conflict continues, I call on all parties to ensure full respect for international humanitarian and human rights law.
Attacks on civilians and civilian infrastructure must end. If they are deliberate, such attacks may constitute war crimes.
I stand in solidarity with civilians across the region, who are crying out for peace.
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