ABSTRACT:
The ethical principle for healthcare providers is "Primum Non Nocere,” which translates to "first, do no harm." Nonetheless, the evidence of obstetric mistreatment, including abusive and disrespectful care during childbirth, is well documented all over the world. Previous studies have mostly focused on quantifying its prevalence, rather than on how women make sense of such experiences. Internalized acceptance of disrespect is a manifestation of gender-based subordination that undermines accountability, demand for quality care, and creates inequality within health systems. This study examines the justification of obstetric mistreatment among postpartum women in a high-burden setting in India. It also explores how such justification depends on the exposure of women to mistreatment and their socio-economic status. A cross-sectional survey was conducted among postpartum women who had given birth in an institutional setting within the 2 years preceding the survey. A sample of 419 women was collected using a pre-tested questionnaire between August and November 2025 from two districts of Jharkhand, India. Obstetric mistreatment was measured using domains adapted from Bohren et al’s framework^1, while justification of mistreatment was assessed through five scenario-based items capturing acceptance of interpersonal abuse under conditions of non-compliance, social disadvantage, provider workload, or medical necessity. Preliminary findings indicate that approximately one out of five women experienced interpersonal abuse. Over one-third of women (36.9%) justified mistreatment in at least one scenario, with nearly one-quarter exhibiting moderate to high levels of internalized acceptance. Descriptive patterns suggest higher levels of justification among women reporting mistreatment and among those with lower education and socioeconomic status. Open-ended responses point to patriarchal norms, frequent violence in domestic spaces, and limited awareness of patient rights as key factors shaping this normalization. The findings underscore the need for transformative approaches that go beyond institutional reform and challenge social norms to strengthen women’s agency within health systems.