Portugal Has Deleted 'Obstetric Violence' From Its Own Law, and With It the Fines for Routine Episiotomies

Portugal's first law to put the words violência obstétrica (obstetric violence) into the statute book was published on 31 March 2025. On Monday, 24 August 2026, the same parliament published the law that takes them back out.

Lei n.º 57/2026, printed in Diário da República n.º 163 and in force from Tuesday, rewrites almost every operative article of Lei n.º 33/2025. The phrase "obstetric violence" does not survive anywhere in the amended text. In its place sits a longer, cooler formula: práticas inadequadas, desrespeitosas ou não consentidas, meaning inadequate, disrespectful or non-consented practices.

That is not the only thing that changed. The old law's enforcement article threatened hospitals with funding penalties and cash sanctions for routine episiotomies, and threatened the individual professional with a disciplinary inquiry. Both are gone. What replaces them is a clinical audit that the authorities may order, and a national council with a duty to publish each hospital's episiotomy and caesarean rates by name.

The trade is a real one, and it deserves to be stated plainly rather than scored: Portugal has swapped a penalty regime that was never applied for a transparency regime that has a deadline.

What the words used to say

Article 2 of Lei 33/2025 was headed "Obstetric violence" and defined it in a single sentence. Obstetric violence was "the physical and verbal action exercised by health professionals over the body and over procedures in the reproductive area of women or other pregnant people, expressed in dehumanised treatment, in abuse of medicalisation or in the pathologisation of natural processes."

It was a definition written from the patient's side. It named an actor (health professionals), a wrong (dehumanised treatment, over-medicalisation) and a category of harm. It was also, from the professional bodies' point of view, an accusation embedded in primary legislation.

The new Article 2 runs to five limbs and defines conduct rather than a category of person. Inadequate, disrespectful or non-consented practices are now any acts, omissions, or clinical or organisational procedures during pregnancy, birth or the postpartum period that are:

• performed without reasoned and necessary clinical indication, without proven benefit to the health of the woman or newborn, disproportionately to the actual circumstances, or contrary to the best available scientific evidence and the applicable technical guidance;
• in disrespect of the woman's dignity, autonomy, privacy or physical and emotional integrity, including unjustified limits on her participation in decisions about her own care;
• performed without adequate information or without free and informed consent, except in clinical emergencies where consent is impossible;
• capable of compromising the woman's autonomy, wellbeing, dignity, physical and emotional integrity, or her perception of the care she is receiving;
• practised exclusively for institutional or professional convenience.

A second paragraph, which the old law did not have, protects the clinician: none of this prevents clinical interventions that are necessary and proportionate, carried out in line with good clinical practice and available evidence, to protect the life or health of the woman or the newborn.

Read as law rather than as politics, the new definition is broader, not narrower. "Performed exclusively for institutional or professional convenience" is a sharper test than "abuse of medicalisation," and it is one a complaint can actually be pinned to. The word that has gone was the word that made the law famous; the wording that replaced it is more usable.

The article that lost its teeth

The change that matters most is Article 8, and it is not a change of vocabulary.

In Lei 33/2025, Article 8 was headed Erradicação da episiotomia de rotina, the eradication of routine episiotomy. It provided that routine episiotomies, and other repeated practices not justified under the record-keeping duty, would be met with two things, "without prejudice to any civil and criminal liability arising from them":

• penalties in funding and financial sanctions applied to hospitals whenever they disrespect World Health Organization recommendations and the parameters set by the Direção-Geral da Saúde (Directorate-General for Health); and
• a disciplinary inquiry into the health professionals involved.

In Lei 57/2026, Article 8 is headed "Elimination of inadequate, disrespectful or non-consented practices" and says something quite different. Obstetric procedures must always follow adequate clinical criteria, the DGS guidance and the best scientific evidence, and depend on informed consent under the law. And: "Whenever there are indications of repeated non-compliance with the clinical or legal norms in force, the carrying out of a clinical audit may be determined."

The funding penalty is gone. The financial sanction is gone. The mandatory disciplinary inquiry is gone. In their place is a discretionary audit, expressed with the Portuguese legislative pode: it may be ordered.

Two honest qualifications. First, there is no public evidence that any hospital was ever docked a cent under the old Article 8, because the law that contained it never fully took effect: Lei 33/2025 came into force the day after publication but, under its own Article 14, only produced effects with the entry into force of the following State Budget. Second, an unenforced sanction on paper is worth less than a mechanism that runs. Whether the swap was a retreat or a repair depends entirely on whether the new mechanism runs.

The new mechanism: publish the numbers, hospital by hospital

Lei 33/2025 created a Comissão Multidisciplinar para os Direitos na Gravidez e no Parto (Multidisciplinary Commission for Rights in Pregnancy and Childbirth) with three duties: run information campaigns, run awareness campaigns, and write an annual report.

Lei 57/2026 abolishes it and creates the Conselho Nacional pela Proteção da Gravidez e dos Cuidados Perinatais (National Council for the Protection of Pregnancy and Perinatal Care) with eight. The two that matter are these.

The Council must define a minimum set of national indicators for monitoring compliance with rights in pregnancy, birth and the postpartum period, which must include: compliance with and prior discussion of the birth plan; registration of informed consent for clinically relevant interventions; rates of episiotomy, caesarean section, instrumental delivery and other obstetric interventions; compliance with DGS norms; satisfaction with the care experience; complaints, adverse events and audits carried out; access to birth preparation and postpartum follow-up; and staff training in communication, informed consent, ethics, human rights and patient safety.

And it must publish those indicators annually, "in aggregate form and by institution", subject to data protection law.

That is the substitute for the fine. A woman choosing between two hospitals within reach of her home will, if this works, be able to look up each one's episiotomy rate and caesarean rate before she books. Portugal already knows that its scheduled caesareans quadrupled in a single year while births rose 3.6 percent, a national aggregate that tells nobody which units are driving it. Per-institution publication is the number that would.

The Council also gains two powers the Commission did not have: it may put concrete and immediate recommendations to services, to the Direção Executiva do SNS and to the Health Ministry, and it must review the reports of the Inspeção-Geral das Atividades em Saúde (Inspectorate-General for Health Activities), monitoring their outcomes where they identify disrespect for the rights the law protects.

Who sits on it, and who lost a seat

Both bodies have nine members. The balance is not the same.

Two shifts follow from that table. Users go from four seats of nine to five of nine, which on the face of the statute is a majority of the elected component. And the two professional orders, which lobbied hard against the 2025 wording, arrive with two seats they did not previously hold, while the health ministry's own appointees fall from four to one.

The third shift is the quietest. The ministry responsible for gender equality is written out of the law entirely. It loses its role in proposing the president, its share of responsibility for the annual report under Article 9, and its obligation under Article 12 to resource the body. The Council now sits at the Health Ministry alone. A framework that began life as a gender-violence instrument has been reclassified as a clinical-quality instrument, and the machinery has been rearranged to match.

What is new for the woman in the bed

Set against the losses, the amending law adds four things that did not exist before.

A right to mental-health follow-up. New Article 2.º-A: women who report negative experiences in pregnancy, birth or the postpartum period must receive support and counselling in maternal health structures, with referral where necessary to mental health services within the SNS. That is a right of access, not a campaign.

A satisfaction questionnaire with a fixed content. New Article 9.º-A obliges establishments providing this care to make available, voluntarily, confidentially and accessibly, a questionnaire covering the information given, respect for autonomy and privacy, the perception of safety, informed consent, compliance with the birth plan, communication with professionals, postpartum support and the identification of negative experiences. Results are aggregated into the annual report, and the DGS writes the model after hearing the Council.

A record you can read. Article 7 already required every medical and nursing act during birth to be recorded with its clinical justification. Three new paragraphs say the record must also include the information given to the woman, the consent obtained or refused, and the clinical justification in urgent situations; that after the birth, at a clinically appropriate moment, the woman has the right to a clear and comprehensible explanation of the procedures carried out and why; and that access to the recorded information is her right, which the institution must guarantee.

Posters that name the complaint channel. Article 18.º-A of Lei n.º 15/2014, the patients' rights law, was already amended in 2025 to require posters in every establishment providing birth care. It now requires them "in accessible formats and clear language" and requires them to identify the bodies to which these practices must be reported. If you are in a Portuguese maternity unit and cannot find that poster, its absence is itself a breach.

What This Means for You

If you are pregnant in Portugal now. The amended regime is in force from today, 25 August 2026, with no budget condition attached. In practical terms three things are usable immediately: you may ask for and receive an explanation of every procedure performed, you have a right of access to the record of those procedures, and if the experience was a bad one you may ask your maternal health service for mental-health referral rather than being told to take it up with the hospital's complaints office.

If you are a foreign resident. Nothing here turns on nationality. Lei n.º 15/2014 attaches these rights to the utente, the service user, and our guide to having a baby in Portugal sets out how the SNS pathway works from the first prenatal appointment. The one language point worth knowing: the birth plan is the plano de nascimento, and both the old and new laws hang a large part of their machinery on whether it was discussed in advance and whether departures from it were recorded and justified.

If you are watching the enforcement question. Article 5 gives the Government 90 days from entry into force to regulate the law, which puts the deadline at roughly 23 November 2026. Lei 33/2025 set a 60-day regulation deadline in March 2025 and the body it created was never stood up. The test of whether this amendment was a repair or a retreat is narrow and dated: whether the Council is constituted, whether parliament elects its five user representatives by absolute majority, and whether the first annual report carries an episiotomy rate against each hospital's name.

The wider file

The law lands in a maternity system that has spent 2026 under visible strain. São Francisco Xavier curbed its obstetric emergency through August, steering expectant mothers to other Lisbon wards. Births in ambulances doubled last year, and one arrived on the A9 after the nearest maternity unit closed. Against that, births ticked up in mid-2026, with immigrant mothers holding the line.

A statute about dignity in the delivery room cannot fix a rota. But the indicator list in the new Article 10 is the first time Portuguese law has required anyone to publish, unit by unit, what actually happens inside those rooms. Whether that turns out to be worth more than a fine nobody ever levied is a question the November regulation deadline will start to answer.