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📌 This report provides detailed quantitative data on respectful, disrespectful, and discriminatory care in gynaecology and obstetrics, including their impacts on mental health and trust in the system.
It is directly useful to maternity teams, midwives, doctors, service management, community organisations, and user committees to objectify problems and prioritise corrective actions. It particularly sheds light on work with racialised women, linguistic and gender minorities, who are often more exposed to dehumanising care.
Source: 📒 Gynaecological and obstetric care in Quebec: experiences and violence encountered
✍️Sylvie Lévesque (scientific direction), Arianne Jean Thorn, Léa Séguin, Isabelle Boucoiran, Natacha Godbout, Marie‑Ève Blanchard, Sarah Landry; Université du Québec à Montréal (UQAM), Department of Sexology, with community and institutional partners.
📜🔗LINK to the source
Number of pages: 47
Field actors can rely on this report to objectify, with supporting figures, the situations of disrespectful and discriminatory care experienced by the women in their neighbourhoods, thus informing local diagnostics and advocacy with health institutions. They can use it to co-facilitate workshops with women, young people, and LGBTQI+ individuals on health rights, consent, and recourse, adapting the language and examples to the local context. Associations, social centres, community houses, and mediation teams can use it as a basis to design easy-to-read tools, visual aids, or audio clips that make the results accessible to audiences who are not comfortable with written text. Finally, this document can guide dialogue spaces between residents, local healthcare providers (doctors, midwives, nurses), and institutions, to co-construct concrete commitments to combat violence and discrimination in gynaecology and obstetrics.
1. Analytical summary
Context, audiences, and issues
The PAROLES project responds to a rise in reports of dehumanising gynaecological and obstetric care, both in Quebec and internationally, from an inclusive perspective of all individuals who may receive this care, beyond just cisgender women. It is based on a mixed design, of which this first quantitative component presents an online survey (July 2023 – January 2024) involving 1,490 individuals who have received gynaecological-obstetric care in Quebec in the last 7 years (1,599 recent experiences). The convenience sample is predominantly composed of cisgender, white, French-speaking women with a high level of education, which limits representativeness but allows for a detailed analysis of social gradients and marginalisations. The report documents access to care (type of professional, waiting times, payment methods), experiences of shared decision-making, consent, respectful care, mistreatment, discrimination, impacts on health, and trust in the system. It questions an officially universal system based on rights (LSSSS, LGSSSS, 12 user rights) but where daily practices do not always guarantee respect for dignity, autonomy, and equity. The central issue is to quantify and qualify humanising care versus disrespectful care, in order to support organisational and professional transformations.
Operational contributions for stakeholders
The document provides quantitative indicators on participation in decision-making, refusals of care, reactions from caregivers, forms of mistreatment (verbal, physical, violations of rights) and perceived discrimination, with analyses by type of professional, ethno-racial minorities, linguistic minorities, and gender. It shows, for example, that about half of the individuals feel compelled to accept the proposed care, that a third have already refused a procedure, sometimes facing guilt or pressure, and that many disrespectful behaviours are reported (infantilisation, neglect, physical violence, absence of explicit consent). The report identifies more humanising care profiles, particularly among midwives, and increased risk areas for racialised individuals and linguistic minorities, thus providing entry points to target training, service organisation, and community partnerships. It also provides data on psychological impacts (post-event symptoms, significant recourse to mental health services, alteration of sexual life), as well as on complaints, barriers to filing them, and trust in the system, which can be mobilised to strengthen user recourse and participation mechanisms. Finally, future research directions guide stakeholders towards more robust systems (representative cohorts, longitudinal studies, systemic analyses) to monitor and evaluate transformations.
2. Key points of the document
A large but convenience sample (pp. 13–14, 56–59)
The study is based on 1,490 people, 1,599 recent care experiences, recruited via social media, partner organisations, and the media, with an online questionnaire structured into four sections (recent and significant care). The sample, which is not representative, is predominantly composed of cisgender, heterosexual, white, French-speaking women with university degrees, which necessitates cautious interpretation but provides rich material on variations based on race, language, gender, and migration status.
Access to care and type of professional (pp. 16–19, 52, 58–59)
Care is predominantly provided by obstetricians-gynaecologists (40.3%) and family doctors (30.6%), followed by midwives (12.7%) and nurses (approximately 12%). About 24% of individuals are unable to consult the desired type of professional, mainly due to a shortage of professionals and waiting times, and 9% have to pay out of pocket despite theoretical coverage by the RAMQ. Demographic density is not associated with the ability to find the desired type of professional, suggesting that access constraints are transversal across territories.
Shared decision-making, consent, and refusal of care (pp. 20–23)
A majority of people feel encouraged to participate in decisions and respected in their choices (around 75–81%), but only 65% report having received clear information about the advantages and disadvantages of the options, limiting fully informed consent. One third of the sample reports having refused tests, treatments, or procedures during their last care experience; among these individuals, nearly 30% had to argue their case and 24% felt guilty, with some describing repeated pressures or actions taken against their will. At the same time, more than half of the participants say they felt obliged to accept the proposed interventions, and nearly 70% were unable to ask all their questions for fear of being judged as 'difficult' or because the staff seemed rushed.
High prevalence of disrespectful and discriminatory care, with a gradient of marginalisation (pp. 24–36, 29–31, 32–34)
Nearly half of individuals report experiences of neglect or abandonment, infantilisation or ignorance of their needs, moralistic judgments about their sexuality, inappropriate comments or threats, and about a quarter report physical violence or unnecessary painful procedures. Racialised individuals and linguistic minorities are significantly more likely to report all forms of disrespectful care and violations of rights, including non-consensual sterilisation, forced treatments, and non-consensual disclosures of personal information. About one in five reports discrimination related to age, weight, sexual orientation/gender identity, or mental health issues, often in the form of intrusive questions or being treated as 'less intelligent'.
Impacts on mental health, sexuality, recourse and trust (pp. 37–39, 41, 43–45)
Nearly half of respondents consulted for their mental health in the past year, with nearly a third for reasons related to their care experience, and a significant subgroup reports psychological symptoms for at least a month (nightmares, flashbacks, avoidance, guilt). A quarter indicate a deterioration in their sex life and difficulties in daily tasks (anxiety, sadness, sleep disorders) after care; however, only 14.9% consider filing a complaint, and less than half of this subgroup follow through, hindered by the desire to 'move on', the perceived complexity of the processes, and the feeling that 'it would be pointless'. Despite high satisfaction regarding the professionalism and competence of the healthcare provider seen, only about 61% of individuals report having trust in the Quebec healthcare system following their last care experience.
3. Action points for local stakeholders
Institutionalise shared decision-making and informed consent (pp. 20–23, 52–53)
Establish mandatory shared decision-making protocols in maternity wards and clinics inspired by the MADM and MOR scales, systematically including the presentation of options, their benefits and risks, as well as the explicit possibility to refuse. Use these tools as supports for face-to-face discussions and as audit grids for records to verify that information has been provided, understood, and documented, particularly for invasive procedures (sterilisation, caesarean section, obstetric procedures).
Identify and reduce mistreatment and disrespectful care on a daily basis (pp. 24–31, 52–53, 60–61)
Train teams to identify common abusive behaviours (infantilisation, neglect, moralistic judgments, acts without consent, disrespect for privacy) described in the MIST index, and to relate them to their own practices. Establish multidisciplinary case review sessions on situations of conflict, refusal of care, or potential complaints, to analyse the systemic mechanisms (organisation, workload, service culture) that promote dehumanisation.
Build targeted responses for marginalised groups (pp. 29–36, 35–36, 64)
Co-construct specific pathways with community organisations (immigrant women, racialised individuals, LGBTQI+, people with disabilities) that integrate interpretation, cultural mediation, peer support, and preferential matching when deemed important by the individual (gender, origin, language). Systematically incorporate measurable objectives for reducing disrespectful and discriminatory care disparities between groups into local health plans, based on the differences clearly highlighted in the report.
Strengthen user recourse, participation, and partnership mechanisms (pp. 32–39, 45, 52, 65)
Simplify and make visible the complaint mechanisms (complaint commissioners, professional orders, civil remedies) by working with user committees and the Provincial Grouping of User Committees (12 rights) to reduce the perception of uselessness and complexity of the processes. Develop, in the spirit of the "Montreal model", patient partnership mechanisms in consultations, care instances (vigilance committees on VSS, partner patient committees) and caregiver training, so that those directly affected have an active role in improving practices.
Integrate mental and sexual health dimensions into post-care offerings (pp. 37–38, 65)
Integrate systematic assessments of psychological symptoms and their impact on sexuality after obstetric/gynaecological events, using for example short questionnaires inspired by the PC-PTSD or validated mental health tools. Offer psychological and sexological support pathways post-event, including through partnerships with community organisations, to prevent the chronicity of disorders and restore trust in services.
4. Additional references
Patients’ experiences of obstetric and gynaecological care in Québec (Health Psychology and Behavioral Medicine, 2026)
Article from the PAROLES project detailing patient-caregiver interactions, respect for rights, satisfaction, and trust in the system, with regression analyses. Accessible in open access on the journal's website and on the researcher’s site, it complements the report with more detailed analyses of the links between needs, satisfaction, and trust.https://natachagodbout.com/sites/default/files/Articles_scientifiques/2026.levesque.pdf
Philosophy and model of midwifery practice care (ICM, revised version 2025)
International guide defining a midwifery practice centred on human rights, autonomy, personalisation, and non-violence, directly applicable for structuring humanising care programmes. This document provides a normative and ethical framework for interpreting the results of the PAROLES report and adapting maternity and sexual health services.https://internationalmidwives.org/wp-content/uploads/FR_Professional-Framework-Design.pdf
The 12 rights of users (Provincial grouping of user committees, updated page)
Operational resource describing the rights of users in the Quebec network (information, services, choice of professional, consent, recourse, etc.), anchored in the Act on the Governance of the Health and Social Services System. It provides simple support for raising awareness among patients and training teams on legal obligations regarding the respect of rights -https://rpcu.qc.ca/
5. Cross-sectional analysis — Values of Health Practices
Literacy: The document offers clear definitions (access, care experience, rights, indicators of abuse), but it is aimed at an expert audience; the measurement tools themselves are technical and not directly usable as is with low literacy audiences.
Empowerment: Beneficiaries are involved as respondents and co-producers of data on their experiences, but their participation in the design of the study or in interpretation is not detailed in this section; empowerment is rather envisaged as a future objective through the Montreal model.
Participation: Co-construction mainly occurs between researchers, practice environments, and community organisations (a comprehensive list of partners), without a detailed description of formalised mechanisms for shared governance with patients.
Community health: The collective dimension is present through community anchoring (women's organisations, perinatality, sexual and gender diversity) and the analysis of the effects of marginalisation on access to and quality of care; however, concrete community interventions remain to be built beyond the production of knowledge.
Ethics: The report explicitly identifies cultural and social biases (racism, sizeism, ageism, LGBTQIphobias, stereotypes about mental health) and links them to rights violations (non-consent, forced treatments, non-consensual sterilisation), but does not develop a detailed normative ethical framework.
Human rights: The approach is clearly rights-based, referencing Quebec laws, the CRPD, and the literature on health rights; it shows that these rights are not fully respected, especially for marginalised groups.
Intersectorality: Partnerships involve universities, health institutions, professional orders, and community organisations, but links with other sectors (justice, correctional services, immigration services) are mainly considered as future research avenues (e.g. incarceration context).
Partnership: The 'Montreal model' is explicitly mentioned as a framework to strengthen patient partnership, but it has not yet been operationally integrated into the project; the report serves as a lever to negotiate this type of partnership with institutions.
Fight against discrimination: The document finely describes discrimination (weight, age, sexual orientation, race, disability, mental health, migration status) and quantifies its impacts, which fosters non-judgment and recognition of diversity; however, it proposes few concrete measures for action, referring instead to structural reforms and training.
6. Assessment of the reliability of the resource
Scientific relevance
The study is based on a questionnaire developed from internationally validated tools (MADM, MOR, MIST, PC-PTSD, etc.) and on structured statistical analyses (descriptive statistics, χ² tests, regressions) documented in the report and associated articles. The convenience sample, the risk of selection bias (over-representation of negative experiences, over-representation of cis, white, educated women), and the cross-sectional nature limit the possibilities for generalisation and causal inferences, but these limitations are clearly acknowledged and discussed.
Operational relevance
The report is very rich for action: it identifies critical points (access, consent, abuse, discrimination, psychological impacts, weakness of recourse) and distinguishes situations by type of professional, minority status, or language, which allows for targeted interventions. However, the data are poorly translated into ready-to-use tools (protocols, self-assessment grids, awareness-raising materials), which requires mediation and transposition work for direct use by field teams.
7. MCQ — 5 questions
Part 1 — Statement of the MCQ (without answers)
Question 1 (pp. 13–14)
What type of sample was used in section 1 of the PAROLES study and what is the main consequence of this on the interpretation of the results?
a) A random sample, ensuring provincial representativeness
b) A convenience sample, limiting generalisation to the entire population
c) A clinical sample, recruited solely in a hospital setting
d) A stratified sample, weighted according to the demographic structure of Quebec
Question 2 (pp. 20–23)
Which of the following statements best describes the participation of individuals in decisions regarding their care during the last reported experience?
a) Almost all received complete explanations of the benefits and risks of the options
b) A majority feel involved and respected, but a third do not receive detailed explanations of the options
c) Most do not feel involved or respected in care decisions
d) Patients cannot refuse care in the studied system
Question 3 (pp. 24–31)
Which groups are most exposed to disrespectful and discriminatory care according to the analyses presented?
a) White Francophone individuals, without disabilities
b) Racialised individuals and/or those belonging to a linguistic minority
c) Only individuals with physical disabilities
d) Only individuals over the age of 56
Question 4 (pp. 37–38)
Among the following effects, which is explicitly associated with the reported experiences of gynaecological-obstetric care?
a) A significant improvement in mental health at 12 months
b) An absence of recourse to mental health services
c) Persistent psychological symptoms and difficulties in daily life
d) An increase in marital satisfaction in all cases
Question 5 (pp. 38–39)
Which statement best describes the relationship between satisfaction with the professional and overall trust in the healthcare system?
a) High satisfaction with the professional always translates into total trust in the system
b) Despite high satisfaction with the professional, overall trust in the system remains limited for a significant portion of people
c) Trust in the system is independent of the care experience
d) Trust in the system is consistently low regardless of the professional consulted
Part 2 — Commented correction
Question 1 (pp. 13–14)
✅ Correct answer: b) A convenience sample, limiting generalisation to the entire population.
📝 Explanation: The report specifies that the sample is a convenience sample, recruited mainly through social media and community partners, and that it is not representative of the Quebec population; it explicitly highlights the need for caution in generalising the results and mentions a possible bias towards individuals who have experienced negative situations.
Question 2 (pp. 20–23)
✅ Correct answer: b) A majority feel involved and respected, but a third do not receive detailed explanations of the options.
📝 Explanation: The data indicates that approximately 75–80% of participants feel encouraged in decision-making and respected in their choices, but only 65% report that the advantages and disadvantages of the options were explained; therefore, more than a third did not receive the necessary information for fully informed consent.
Question 3 (pp. 24–31)
✅ Correct answer: b) Racialised individuals and/or those belonging to a linguistic minority.
📝 Explanation: Tables 9 and 10 show that, for all items of disrespectful care, the percentages are consistently higher among racialised individuals and linguistic minorities than among white and French-speaking individuals, with significant differences for most behaviours (violence, threats, judgments, lack of consent, non-consensual sterilisation).
Question 4 (pp. 37–38)
✅ Correct answer: c) Persistent psychological symptoms and difficulties in daily life.
📝 Explanation: The report documents nightmares, flashbacks, avoidance, and guilt lasting at least a month after care, as well as difficulties in carrying out daily tasks (anxiety, sadness, sleep disturbances) and a negative impact on sexual life for about a quarter of individuals. No systematic improvement in mental health is described.
Question 5 (pp. 38–39)
✅ Correct answer: b) Despite high satisfaction with the professional, overall trust in the system remains limited for a significant portion of individuals.
📝 Explanation: While more than 70% of participants report being satisfied with the quality of care and the professionalism of the healthcare provider, only about 61% have confidence in the healthcare system; this dissociation between micro satisfaction (relational) and macro trust (system) is also discussed in the scientific article associated with the PAROLES project.
8. Frequently Asked Questions (FAQ) – 7 questions
Who is this report aimed at and in what contexts can it be used? (p. 5–7, 8–11)
It is aimed at healthcare professionals (gynaecologists, obstetricians, midwives, family doctors, nurses), service managers, community organisations, and policymakers, as well as rights advocacy bodies. It can be used to diagnose issues of accessibility, respect for rights, discrimination, and trust, and to inform local or national action plans in sexual and reproductive health.
What are the main types of care analysed in the report? (p. 3, 13–14, 16–19)
The report covers recent gynaecological and obstetric care (consultations, follow-ups, births) and 'notable' care identified by individuals as particularly significant. It notably distinguishes experiences based on the type of professional (obstetrician-gynaecologist, family doctor, midwife, nurse, advanced practice nurse, other specialists).
How does the study define respectful care and disrespectful care? (p. 20–25, 52–53)
Respectful care is associated with participation in decision-making, comfort in asking questions, respect for preferences, time given, and transparency, measured using scales such as the MOR and the positive interactions scale. Disrespectful care includes behaviours of ignorance, infantilisation, neglect, moral judgement, physical violence, disrespect for privacy, and procedures without consent, measured from items derived from the MIST index.
Does the report allow for the identification of differences in the quality of care between types of professionals? (p. 26–28)
Yes, the analyses show that individuals followed by midwives are generally less likely to report disrespectful care than those followed by other types of professionals, across several dimensions studied. However, for certain discriminatory behaviours (intrusive questions), individuals followed by nurses or advanced practice nurses report more negative experiences, although most differences between professions remain limited.
How are discriminations taken into account in the analysis? (p. 29–34, 61–63)
The study explicitly questions perceived discriminations based on multiple grounds (weight, age, sexual orientation, gender identity, race/ethnicity, migration status, disability, mental health, appearance, etc.). It then analyses the differences in the prevalence of these discriminations between racialised and white individuals, linguistic minorities and French speakers, as well as according to the type of professional consulted.
What are the main limitations that should be noted when using this for training or advocacy? (p. 40–41)
The authors emphasise the convenience sample, the selection bias towards individuals more likely to report negative experiences, the over-representation of certain groups (cis women, white, educated, French speakers) and the cross-sectional nature that prevents inferring causal links. It is therefore recommended to use these results as strong indicators of real issues but not as precise estimates of prevalence in the general population.
What future research directions are proposed and how can they guide field actors? (p. 42–43)
The report suggests creating representative population databases, conducting longitudinal studies on the effects of care (from humanisation to violence), exploring systemic dimensions (organisation, resources, policies) and developing qualitative research with patients and caregivers, particularly in contexts of marginalisation, sexual assault or incarceration. For field actors, this suggests participating in these initiatives, promoting the collection of structured local data and supporting research-service collaborations.
9. Rewriting in Easy-to-Read Language)
Easy-to-Read Title
Gynaecological and obstetric care in Quebec: what patients experience.
Context and issues (Easy-to-Read)
People recount care that lacks respect.
This happens during examinations or during childbirth.
The study refers to women and trans or non-binary individuals.
The responses come from an online questionnaire.
The individuals received care in the last seven years.
Researchers want to know when care is good or bad.
Contributions for the field (Easy to Read)
The report provides figures on good and bad experiences.
It shows when staff listen to patients.
It also shows when patients cannot say no.
It talks about people who experience racism or discrimination.
It explains that these experiences harm mental health.
It helps services change their practices.
Key points (Easy to Read)
Access to care
Many patients see a gynaecologist or a family doctor.
One in four does not see the professional they want.
Often, there is not enough staff or the wait is too long.
Most do not pay for care, but some pay out of pocket.
Decisions and consent
Many patients feel listened to regarding decisions.
But some do not receive all the useful explanations.
A third have refused an examination or treatment.
Some feel guilty or are under pressure.
Disrespectful care
Almost one in two feels ignored or infantilised.
Some experience physical violence or very painful procedures.
Sometimes, actions take place without clearly asking for consent.
These situations are not rare.
Discrimination
Racialised people or linguistic minorities experience more mistreatment.
They experience more hurtful remarks or judgments.
They also more often experience acts without clear consent.
Their identity or language becomes a source of injustice.
Impact on health
Many consult a professional for their mental health afterwards.
Some people have nightmares or often think about the event.
Some avoid healthcare settings or feel very guilty.
One in four also has a damaged sex life.