Maternal-Newborn Nursing · Violence Against Women
Social and Cultural Practices of Violence Against Women
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In 30 seconds
Not all violence against women is committed by an intimate partner. Some harm is embedded in social and cultural practices — traditions and customs that injure, control, or devalue girls and women, often carried out by families and communities rather than by strangers. In the maternal-newborn setting, the practices most likely to matter include female genital mutilation/cutting (FGM/C), child and early marriage, forced marriage, Honor-based violence Family-perpetrated violence against a person believed to have "dishonored" the family Full entry →, Dowry-related violence Abuse and harassment connected to dowry payments and demands Full entry →, and practices tied to Son preference Societal valuing of sons over daughters, leading to sex-selective and neglectful practices Full entry →, such as sex-selective abortion and neglect of girls' health. These practices occur across many countries and migrant communities — so a nurse in any maternity unit may care for someone affected.
Two attitudes frame the topic. First, Cultural humility An ongoing practice of self-reflection and respect that treats each patient as an individual Full entry →: the nurse approaches each person as an individual and does not assume that a cultural background predicts a practice. Second, a practice is not automatically acceptable because it is traditional — international bodies, including the World Health Organization, classify many of these practices as forms of violence and human rights violations. The nurse's task is respectful, competent, nonjudgmental care that protects health, safety, and autonomy while working within the law, where some practices (such as FGM/C performed on minors) are criminalized.
Why this matters
- Obstetric consequences are real. FGM/C is associated with genitourinary scarring and can affect pregnancy, labor, and birth; nurses need to know how to assess, how to communicate, and what care decisions belong to the qualified provider with the patient's informed consent.
- Pregnancy can be a window of intervention. A pregnant adolescent or a person under honor-based family control may be reachable through maternity care in ways she is not elsewhere.
- Culture and violence intersect with ethics. The nurse must balance respect for the person's values and community with health, safety, legal duties, and the person's own autonomy — a genuinely hard clinical skill.
- Avoiding harm includes avoiding stereotyping. Assuming a practice based on a patient's ethnicity is itself a form of bias and can damage trust; individual assessment is the antidote.
The college version
Core Concepts
Female genital mutilation/cutting (FGM/C)
FGM/C refers to procedures that intentionally alter or injure female genital organs for non-medical reasons. It ranges from partial removal of the clitoris to more extensive cutting and closure ("Infibulation A type of FGM/C that closes the vaginal opening with scar tissue Full entry →"), is performed on girls from infancy to adolescence, and is internationally recognized as a harmful practice. In maternity care, the person who has undergone FGM/C may have:
- scar tissue that makes pelvic exams, catheterization, or perineal assessment more difficult;
- specific labor and birth considerations that require individualized assessment by a qualified clinician;
- needs for special communication, privacy, and consent around every examination.
Management during pregnancy and birth — including whether any procedure such as deinfibulation (opening closed scar tissue) is indicated — is a clinical decision made by the attending provider with the patient's informed consent, and it varies by facility, specialty, and the individual's anatomy and wishes. The nurse's role includes sensitive inquiry (many people will not volunteer a history of FGM/C), privacy, gentle examination technique, clear explanation, and referral to providers experienced in this care. Note that in many countries, performing FGM/C on a minor is a crime, and the nurse must know local reporting requirements — while also understanding that the survivor of an old procedure needs care, not judgment.
Child and early marriage
Child marriage Marriage of a person under 18, often linked to poverty and gender inequality Full entry → — marriage of a person under age 18 — is driven by poverty, family honor, and gender inequality, and it is linked to adolescent pregnancy, school dropout, and limited decision-making power over health. In maternity care it shows up as the pregnant adolescent, often married and pregnant quickly, with little control over her own care decisions. The nurse's approach: treat the adolescent as the patient, assess her understanding and consent separately from her husband or in-laws when possible, and connect her with social services per facility resources.
Honor-based violence and dowry-related violence
Honor-based violence is violence committed by family members who believe a girl or woman has "dishonored" the family through behavior such as refusing a marriage, leaving a marriage, or a relationship the family disapproves of. It can include restriction, threats, forced marriage, and in extreme cases murder ("honor killing"). Dowry-related violence involves harassment or abuse around dowry payments, including abuse after marriage when demands are not met. Both are forms of family-perpetrated control that may escalate during pregnancy. Safety planning, private assessment, and connection to domestic-violence and legal advocacy follow the same principles as Topic 2 — with attention to the fact that the danger may come from the family, not a partner.
Son preference and sex-selective practices
In some societies, sons are valued more highly than daughters for inheritance, lineage, and economic reasons. Consequences include sex-selective abortion, female infanticide, and neglect of girls' nutrition and healthcare. In maternity care this surfaces in the ultrasound and delivery rooms: families may press for sex disclosure, react with anger to a female fetus or infant, or pressure the mother about another pregnancy. The nurse respects the family's values while protecting mother and newborn, follows facility policy on sex disclosure, and flags situations where the mother's or newborn's safety is compromised.
Nursing care with cultural humility
A practical approach for every encounter:
- Assess the individual, not the stereotype — two people from the same community can have completely different situations.
- Use professional interpreters for language; never rely on a child, spouse, or in-law to translate health information or consent.
- Explain and obtain consent for every exam; a person who has experienced genital cutting needs extra care that exams are announced, explained, and controlled by her.
- Educate and advocate within your scope: health teaching about harms (e.g., FGM/C) is appropriate; shaming or imposing values is not.
- Know the law and the policy: reporting duties and facility protocols vary; flag uncertainty for review rather than guessing.
- Refer to social work, advocacy, and specialty providers as available.
Common Confusions
| Do Not Confuse | With | Difference |
|---|---|---|
| A cultural practice = an acceptable practice | A harmful practice that happens to be traditional | Tradition does not make harm acceptable; FGM/C and child marriage are internationally recognized as violence — but the person is never to blame |
| "Everyone from that community has FGM/C / supports child marriage" | Individual variation within every community | Cultural humility means assessing the individual; assuming from ethnicity is stereotyping and damages trust |
| FGM/C management = nurse's independent decision | Provider-led, patient-consented clinical decision | Deinfibulation and birth management are clinical decisions made by the qualified provider with the patient's informed consent; the nurse facilitates, documents, and protects privacy |
| The husband/in-laws translate or consent for the patient | The patient consents for herself; professional interpreters translate | The patient is the decision-maker; relying on family for translation or consent can violate her autonomy and the law |
| Reporting laws are uniform | State- and country-specific duties | Reporting of newly performed FGM/C on minors and other abuse varies by jurisdiction — verify local law and policy |
| Respecting culture means never discussing harm | Respectful education and advocacy | Nurses can respectfully provide health education about harms (e.g., FGM/C) without shaming or imposing values |
Eli explains
The same idea, in plain words
Explain it like I’m 10
Female genital mutilation/cutting (FGM/C) is like a tradition that hurts girls' bodies and is done because families have always done it. It can cause problems during pregnancy and birth, and nurses must be extra gentle, explain everything, and let the woman make her own choices. Other traditions marry girls off too young or punish women for "shame." A nurse's job is not to judge the person — it is to care for her health, explain clearly, respect her choices, and quietly help her find safety and support.
Worked example
Amina, 19, is admitted in early labor with a history of infibulation on her clinic record. The nurse explains every step before touching: "I'm going to place the fetal monitor now — is that okay? You can tell me to stop at any time." Amina's husband and mother-in-law answer questions for her, so the nurse quietly asks Amina directly, through the interpreter, whether she would like a moment alone and whether she has questions about the birth. The attending provider then assesses Amina and discusses her options — including whether deinfibulation is appropriate — with Amina's informed consent; the decision is hers, not her family's. Later, the nurse notices the mother-in-law berating Amina because the baby is a girl. The nurse privately checks in with Amina, documents objectively, and mentions the hospital's social work support in case she wants it. No one lectures the family; Amina is treated with dignity and given control.
Key takeaways
- Harmful traditional practices include FGM/C, child/early marriage, forced marriage, honor-based violence, dowry-related violence, and son-preference practices — often family-perpetrated.
- FGM/C can affect pelvic exams, catheterization, and labor/birth; management is individualized by a qualified provider with the patient's informed consent — the nurse facilitates, explains, and protects privacy.
- Cultural humility ≠ cultural relativism: respect the person; do not assume practice from ethnicity, and do not excuse harm because it is traditional.
- International bodies classify FGM/C and child marriage as human rights violations; many countries criminalize performing FGM/C on minors — reporting duties vary, know yours.
- Adolescent pregnancy linked to child marriage carries heightened obstetric and psychosocial risks; treat the adolescent as the patient and assess her understanding separately from family when possible.
- Pregnancy can escalate family-perpetrated violence (honor-based, dowry-related) — screen privately and plan safety the same way as for IPV, with the family as the source of danger.
- Professional interpreters only — never children, spouses, or in-laws.
- No practice is proven by appearance: individualized assessment is the foundation of safe, ethical care.
Check yourself
5 review questions from the chapter. Try each one, then open the answer.
Name three social/cultural practices of violence against women relevant to maternity care.
Show answer
Any three: female genital mutilation/cutting (FGM/C), child/early marriage, forced marriage, honor-based violence, dowry-related violence, son preference/sex-selective practices.
Why is FGM/C clinically important in labor and birth, and who makes management decisions?
Show answer
Scar tissue from FGM/C can make pelvic exams, catheterization, and perineal assessment more difficult and may create specific labor/birth considerations. Management — including whether deinfibulation is indicated — is an individualized clinical decision made by the qualified provider in discussion with the patient, with her informed consent; the nurse assesses sensitively, explains procedures, and protects privacy.
What is the difference between cultural humility and cultural relativism?
Show answer
Cultural humility means respecting each patient as an individual, reflecting on one's own biases, and assessing the person's actual situation; cultural relativism would treat any tradition as beyond criticism. Humility respects the person without excusing harmful practices.
How can pregnancy escalate family-perpetrated violence, and what should the nurse do?
Show answer
Family members may intensify control when a pregnancy is seen as dishonorable, when the patient asserts autonomy (e.g., in birth decisions), or around dowry/son-preference pressures. The nurse screens privately, uses the same validate–support–refer approach as for IPV, treats the family as a potential source of danger, and connects the patient with social work and advocacy.
Why must a professional interpreter (not a spouse or in-law) be used?
Show answer
A spouse or in-law may filter information, control the conversation, or be the source of coercion; using them violates the patient's privacy and autonomy. A professional interpreter provides accurate, confidential communication.
Study tools & related lessonsKey vocabulary · Related
Key vocabulary
- FGM/C (female genital mutilation/cutting)
- Procedures that intentionally alter or injure female genital organs for non-medical reasons
- Infibulation
- A type of FGM/C that closes the vaginal opening with scar tissue
- Child marriage
- Marriage of a person under 18, often linked to poverty and gender inequality
- Honor-based violence
- Family-perpetrated violence against a person believed to have "dishonored" the family
- Dowry-related violence
- Abuse and harassment connected to dowry payments and demands
- Son preference
- Societal valuing of sons over daughters, leading to sex-selective and neglectful practices
- Cultural humility
- An ongoing practice of self-reflection and respect that treats each patient as an individual
Sources & references
This lesson was adapted from the open educational references above; their licenses and attributions are preserved. See Copyright & Licensing.
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