Decolonising informed consent: Ethics, language, and power in public-sector maternal health systems
1
Linguistics and Applied Linguistics, Nelson Mandela University, Gqeberha, South Africa
Popul. Med. 2026;8(Supplement Supplement 1):
ABSTRACT
BACKGROUND:
Informed consent is widely regarded as a cornerstone of ethical healthcare practice, grounded in respect for autonomy, dignity, and bodily integrity. In maternal healthcare, however, informed consent is not a single procedural act but a relational process unfolding within moments of vulnerability, urgency, and profound bodily and emotional exposure. In South Africa’s public-sector maternal health system, informed consent practices are shaped by intersecting histories of colonialism and apartheid, persistent structural inequality, linguistic marginalisation, and institutional power asymmetries. Despite a strong constitutional and rights-based policy framework, women continue to report consent practices that are procedural, coercive, or poorly understood.
METHODS:
This study presents a systematic narrative review examining how informed consent is conceptualised and practised in South Africa’s public-sector maternal healthcare system, with particular attention to ethics, language, and power. Peer-reviewed literature published between 2000 and 2024 was identified through structured searches of biomedical, public health, social science, and regional databases. A reflexive narrative synthesis approach was employed to integrate findings across diverse study designs, foregrounding context, lived experience, and ethical meaning.
RESULTS:
Five interrelated themes emerged: the proceduralisation of informed consent; linguistic exclusion and communication injustice; gendered and racialised power asymmetries in clinical encounters; ethical strain within resource-constrained health systems; and persistent gaps between policy commitments and clinical practice. Together, these themes illustrate how informed consent failures are structurally produced rather than incidental or individualised.
CONCLUSIONS:
By integrating decolonial theory, language justice, narrative medicine, and reproductive justice frameworks, this review reframes informed consent as a relational, context-sensitive, and justice-oriented ethical practice. Decolonising informed consent is presented as an ethical imperative central to reproductive justice, health equity, and the transformation of public-sector maternal healthcare in South Africa.
Informed consent is widely regarded as a cornerstone of ethical healthcare practice, grounded in respect for autonomy, dignity, and bodily integrity. In maternal healthcare, however, informed consent is not a single procedural act but a relational process unfolding within moments of vulnerability, urgency, and profound bodily and emotional exposure. In South Africa’s public-sector maternal health system, informed consent practices are shaped by intersecting histories of colonialism and apartheid, persistent structural inequality, linguistic marginalisation, and institutional power asymmetries. Despite a strong constitutional and rights-based policy framework, women continue to report consent practices that are procedural, coercive, or poorly understood.
METHODS:
This study presents a systematic narrative review examining how informed consent is conceptualised and practised in South Africa’s public-sector maternal healthcare system, with particular attention to ethics, language, and power. Peer-reviewed literature published between 2000 and 2024 was identified through structured searches of biomedical, public health, social science, and regional databases. A reflexive narrative synthesis approach was employed to integrate findings across diverse study designs, foregrounding context, lived experience, and ethical meaning.
RESULTS:
Five interrelated themes emerged: the proceduralisation of informed consent; linguistic exclusion and communication injustice; gendered and racialised power asymmetries in clinical encounters; ethical strain within resource-constrained health systems; and persistent gaps between policy commitments and clinical practice. Together, these themes illustrate how informed consent failures are structurally produced rather than incidental or individualised.
CONCLUSIONS:
By integrating decolonial theory, language justice, narrative medicine, and reproductive justice frameworks, this review reframes informed consent as a relational, context-sensitive, and justice-oriented ethical practice. Decolonising informed consent is presented as an ethical imperative central to reproductive justice, health equity, and the transformation of public-sector maternal healthcare in South Africa.
| eISSN: | 2654-1459 |
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