Obstetric Violence from the Perspective of Heise’s Social–Ecological Model: A Scoping Review

Background: Obstetric violence ranges from verbal abuse to non-consensual physical interventions, violating women’s fundamental rights during childbirth. Despite its prevalence, it is often analyzed as an isolated instance of individual misconduct, neglecting the structural and cultural determinants that normalize it. Objective: To analyze the scientific literature on obstetric violence, examining its associated factors from the theoretical lens of Heise’s social–ecological model. Method: A scoping review was conducted following the methodology of Arksey and O’Malley. Scientific literature on obstetric violence published between 2015 and 2025 was identified in PubMed, SciELO, CINAHL, Scopus, ScienceDirect, MEDLINE, and Taylor & Francis. A Braun and Clarke deductive thematic analysis was applied to categorize the findings into the four levels of the Heise model: ontogenetic, microsystem, exosystem, and macrosystem. Results: A total of 48 articles from 23 countries was included, predominantly from Africa 13 (27%) and South America 12 (25%), with Ethiopia 6 (13%) and Brazil 5 (10%) standing out. The studies revealed 38 factors associated with obstetric violence, distributed across the ontogenetic level (18), microsystem level (8), exosystem level (10), and macrosystem level (2), demonstrating the multifactorial and intersectional nature of the issue, where institutional failures undermine maternal autonomy. Conclusions: Obstetric violence goes beyond poor individual care, emerging as a systemic and structural phenomenon. Using Heise’s model the factors were organized into dimensions, highlighting problems such as service overload and resource constraints that create environments associated with greater exposure to abuse among the most vulnerable women. Therefore, strategies are needed to address structural failures, anticipate violence, and ensure a respectful and safe childbirth experience.