Global Human Rights Defence

Obstetric Violence: A Women's Human Rights Violation
Pregnant with embryo image (Undate)
Photo Source: Skitter Photo on Stocksnap

Author: Camilla Souza

Department: Women’s Rights Team


From midwives to sophisticated caesarean techniques, childbirth has gone from being part of human nature and essentially female to becoming a procedure whose decision-making is exclusively the health professional’s responsibility. With this, the woman is no longer the protagonist but the object of interventional and medical      procedures.

The advance in science concerning obstetric techniques has undoubtedly, when used appropriately,      contributed to the reduction of risks for both the parturient woman and the newborn. On the other hand, the same procedures can increase maternal-foetal mortality when applied indiscriminately without proven efficacy. Thus, a scenario of violation of rights arises in maternity wards, legitimised by medical knowledge, which leads to the pathologization of childbirth.

The fact is that these interventionist conducts and procedures, routinely adopted without concrete need, are often not perceived by the main subject involved: the woman. And for this reason, obstetric violence becomes an invisible reality.

Woman Giving Birth to a Baby Through Caesarean Section (November 18, 2019)  Photo Source: Jonathan Borba on Pexels    


The process of hospitalisation of childbirth was essential to improve medical knowledge in this area and to reduce maternal and neonatal mortality rates. However, as far as one can recognise the benefits of the institutionalisation of childbirth, one must also admit that this change has led to the establishment of the medicalization of the female body (Nagahama; Santiago, 2005). For Pontes et. al (2014), this process does not reach its primary objective of reducing risks since it creates  other negative impacts on      women’s experience during childbirth, such as verbal violence, imprudence, negligence, humiliation, threats, loneliness, fear, and unnecessary interventions.

For Dip (2013), obstetric violence is characterised by all acts or conduct that are carried out without the explicit and informed consent of the woman, causing death, physical, psychological, or sexual harm to her or the unborn child, to injure her right to choose and the right to physical and mental integrity.

Thus, obstetric violence is multifaceted and can be expressed through the woman’s body (physical), her mental health (psychological), or her intimacy and modesty (sexual), in addition to conduct that hinder access to her rights.

The report Violencia Obstetrica: un Enfoque de Derechos Humanos[1] (2015), published by the Grupo de Información en Reproducción Elegida, points out two modalities of obstetric violence: physical and psychological. Physical violence expresses itself through invasive practices and the indiscriminate use of medication, as well as the disrespect for the time and possibilities of biological childbirth. Psychological violence, on the other hand, includes harsh and inhumane treatment, discrimination, and humiliation when care or attention is requested during an obstetric procedure.

It should be noted that addressing obstetric violence from a human rights perspective implies attributing responsibilities, since international legislation on human rights establishes a broad list of rights, as well as various obligations that must be fulfilled by the different state authorities  (GIRE, 2015).

  1. The Right to Health

The first and broadest human right violated in situations that constitute obstetric violence is the right to health. The (W, which was adopted by the International Conference held in New York on 19 June 1946, defines that “health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity” (WHO, 1946, p. 1).

The Committee on Economic, Social, and Cultural Rights (CESCR), established to monitor the implementation of the ICESCR, has stipulated four basic elements of the right to health: availability, accessibility, acceptability, and quality. Availability is understood as the duty of States to provide a sufficient quantity of public health facilities, goods, and services, as well as programs; Accessibility is about ensuring that health facilities, goods, and services are accessible to all, without discrimination of any kind; Acceptability is about ensuring that all health facilities, goods, and services are respectful of the culture of individuals, peoples, communities, and minorities, as well as being sensitive to gender and life-cycle requirements; finally, Quality refers to the provision of culturally, scientifically and medically acceptable health facilities, goods, and services of good quality (CESCR, 2000).

To understand obstetric violence as a violation of the right to health, it is necessary to consider these four basic elements stipulated by the CESCR. The focus on availability and accessibility is necessary to make visible the precariousness of care and the reduced investment in maternity wards. Closing our eyes to women’s right to integral health care generates one of the most serious public health problems: the pilgrimage for beds. According to Rodrigues et al. (2015), the search for places in maternity wards constitutes obstetric violence because it is closely related to the reproductive process of women and the nullification of their rights. To this is added the risk that this pilgrimage creates for women and their newborns since the search for vacancies begins with the labour and makes it impossible for many women      to be attended to with due urgency.

It should also be noted that any and all violations of women’s and newborn’s rights also constitute a violation of the right to health in its broadest sense, as obstetric violence is related to the appropriation of women’s bodies and reproductive processes, including physical, psychological and verbal abuse, as well as the adoption of unnecessary and harmful procedures in obstetric care (Tesser et al., 2014).

  1. The Right to Information and Decision-making

In the context of antepartum, childbirth, and immediate postpartum care, the observance of these rights is related to women’s access to objective, truthful and unbiased information about their options without the presence of bias on the part of health professionals. Informed consent is not limited to formal (written) acceptance of the procedure to be performed on the patient but also encompasses her understanding of the information being conveyed to her. Thus, service providers have a responsibility to provide clear and thorough information, adopting language and methods that are understandable to the patient (UNESCO, 2005).

However, in practice, most procedures are adopted without the prior consent of the patient, who is not only unaware of the procedures to which she is being subjected      but also of the potential harm. Consequently, any possibility of alternative decision-making at a time of vulnerability, in which the woman should be the protagonist, is denied. All this reflects medical paternalism, which advocates that the woman in labour does not know and should not be in charge of her birth. Many women are unaware of their rights to childbirth care, and because of this, they are reluctant to take control of their physical and mental wellbeing and surrender their bodies to the choices of the health professional (Belli, 2013).

An example of conduct and procedures which constitute a violation of women’s rights to information and decision-making is the adoption of the routine lithotomy position with or without stirrups during childbirth. This position, which consists of leaving the woman in a horizontal position (lying down with her legs elevated by supports) has been considered since 1996, according to      guidelines published      by the WHO[2], as a harmful or ineffective practice, and that should be eliminated. According to Andrade et al. (2016), the lithotomy position can cause compression of the great vessels and prolongation of labour and the second stage of labour, with negative repercussions on perinatal outcomes. In this way, apart from impairing the dynamics of labour and being uncomfortable for the parturient, it impairs the oxygenation of the newborn (Rede Parto do Principio – Mulheres em Rede pela Maternidade Ativa, 2012).

Bowel cleansing and pubic shaving are routine obstetric procedures that also violate the decision-making rights of women in labour. Health professionals presume that shaving of pubic hair reduces infection and facilitates suturing. However, the WHO stresses that there is no evidence to support this claim and recommends that the decision regarding depilation rests with the woman and not with the health care provider (Agar, 2010).

The same is true of scheduled caesarean sections for medical convenience. Many women undergo caesarean sections without any indication of risk to their health or the health of the baby in a vaginal delivery. It is a matter of the practitioner’s desire to fit the surgical procedure into the best time slot in his or her schedule. Thus, working on weekends and public holidays can be avoided. Thus, apart from being an offence against the right to information and the right to make decisions, terminations scheduled for medical convenience are a violation of the patient’s integrity since they can be considered a physical injury Rede Parto do Principio – Mulheres em Rede pela Maternidade Ativa, 2012).

  1. Right to Privacy and Intimacy

When it comes to reproductive health, the Grupo de Información en Reproducción Elegida (GIRE, 2015) states that this right refers to the right of individuals to decide on their reproduction, especially women, based on clear, objective, and truthful information. In this way, the right to privacy and intimacy is violated in health centres when the loss of autonomy of the parturient is configured, who is no longer able to make decisions, subject to undue exposure of her body, mainly her genital organs (Belli, 2013).

The most frequent violation of this right is the subjection of women to unnecessary and painful procedures in advance, subjecting them to risks and complications, solely for didactic purposes. Examples include repeated vaginal touching, routine episiotomy, and the use of forceps.

The violation of this right also includes the prohibition of the presence of a companion during obstetric care, contrary to WHO recommendations (2019). In Brazil, for example, this right is provided for in a specific law (Law 11.108/2005) that safeguards the right of users to have someone of their own free choice, regardless of sex, by their side throughout labour, delivery, and the immediate postpartum period. According to Aguiar (2010), the presence of a companion promotes a safe and welcoming environment for the patient and has been associated with a decrease in surgical interventions, a higher degree of satisfaction among postpartum women about the birth experience, and, mainly, a reduction in institutional violence.

  1. Right to personal integrity, not to be subjected to torture or cruel, inhuman, or degrading treatment or punishment

The violation of the right to personal integrity occurs through bodily injury, torture, ill-treatment, and interventions to verify and accelerate childbirth. One of the behaviours frequently adopted in maternity wards, and which constitutes a violation of this right, is       routine episiotomy. Contraindicated as a routine procedure in 1985 by the WHO, episiotomy has been routinely performed since the middle of the 20th century under the justification that it facilitates birth and safeguards the woman’s genital integrity. However, since 1980, there has been scientific evidence in favour of eliminating routine episiotomy. Today, it is only recommended when there is sufficient indication of maternal-foetal distress or to achieve progress in situations where the perineum is responsible for inadequate progress (Diniz & Chacham, 2006).

In many countries, episiotomy is accompanied by ‘husband stitches’, a further tightening of the vulva supposedly to restore the woman to her virginal condition. This tighter stitch has the sole purpose of making the woman fit to provide male pleasure. Therefore, the routine adoption of episiotomy has been understood as a form of genital mutilation, as well as an expression of gender-based violence perpetrated by health professionals (Amorin & Katz, 2008; Diniz & Chacham, 2006; Diniz, 2001).

The Kristeller manoeuvre, for example, is another behaviour that constitutes obstetric violence of a physical and psychological nature. This procedure has been developed without scientific evidence and is performed by pressing the woman’s belly with the hands or forearm to accelerate the delivery of the baby (Rede Parto do Principio – Mulheres em Rede pela Maternidade Ativa, 2012). This behaviour generates serious consequences such as trauma to the abdominal viscera, the thorax, and dislocation of the placenta. Despite this, Kristeller’s manoeuvre is still invisible, it is often performed without the woman’s consent and information, and it is not usually recorded in the woman’s medical records due to lack of awareness or even to avoid possible legal sanctions (El Parto es Nuestro, 2014).


Venezuela (2007) was the first country to treat this type of violence as a matter of law, demonstrating a certain degree of maturity of their legislative, executive, and judiciary powers, in fulfilling their obligation as a State. After that, Argentina (2009), Panama (2013), Mexico (2014), Suriname (2014) have passed laws criminalising obstetric violence.

According to GIRE (2015), the criminalisation of obstetric violence is an easy way to try to solve the problem but does not bring about real change. The occurrence of this type of violence is closely related to a context full of issues that go beyond the mission of criminal law. For the author, converting harmful attitudes and routines into crimes       which are part of the dynamics of the faculties that train and educate health professionals may end up adding new problems instead of protecting women. It is inappropriate to resort to criminal law when the State has other, less damaging instruments that can address the problem in a more effective way. The solution to the problem is not in filling the penal codes with new offences, but in solving the problem by considering its root causes, starting with public policies in the health area, reinforcing the protection of human rights in obstetric care (GIRE, 2015).

On 11 July 2019, the Special Rapporteur on violence against women, its causes and consequences, Dubravka Šimonović, presented to the United Nations General Assembly a report which for the first time refers to what women experience in reproductive health services as violence that offends human rights and the Declaration on the Elimination of Violence against Women. The report “A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence[3]” reaffirms respect for women’s human rights, which include their right to be treated with dignity and respect in health centres      and hospitals and obstetric care without being subjected to discrimination or violence, sexism or any other form of psychological violence, inhuman or degrading treatment, torture or coercion. In addition to stating that:

“States should address the current problem of mistreatment and violence against women in reproductive services and childbirth from a human rights perspective and use it to conduct an independent investigation into women’s allegations of mistreatment and gender-based violence in health-care facilities, which should include structural and systematic causes, including stereotypes on the role of women role in society, and should publish the results and recommendations, which should be used to revise laws, policies and national action plans on reproductive health.” (United Nations General Assembly, 2019, p.21)


Obstetric violence is a violation of human rights, and violates  several rights outlined in international conventions and treaties. Unfortunately, its constant occurrence in maternity hospitals around the world constitutes disrespect for the right to life, to live free of violence, to autonomy, and the personal integrity of women during the assistance labour, delivery, and immediate postpartum. Discussing this issue is important, mainly because the number of victims may be even higher than what the researchers are showing      for the simple fact that many women do not recognise themselves as victims      because they are unaware of their rights at the time of hospital care.

This is because many women do not recognise some behaviours and procedures as violations of their rights, and if they do, they are afraid to report them because they see themselves as vulnerable to the health professional. In the different forms of violence discussed in this article, it is possible to identify that discrimination against the condition of women contributes to the maintenance of this situation so that often the violence is not recognised by those who practice it, nor by those who suffer it.

Given this, all subjects involved in this process must be aware of the need to rethink the paradigm of interventionist childbirth care. The experiences women go through during pregnancy and childbirth represent unique moments in their lives and, as such, should be seen as natural, biological, and human. In this way, seeing the woman as a subject in the professional-patient relationship is to respect and understand her individuality, valuing the attention to her needs and well-being. It is to give her the tools to claim and protect her rights. Because obstetric violence is a routine, it is more than necessary to discuss this issue and provide the women themselves with mechanisms to be aware of it, denounce it, stop it, and change this reality.


AGUIAR. (2010). Violência institucional em maternidades públicas: hostilidade ao invés de acolhimento como uma questão de gênero (PhD Thesis). Retrieved on 10 March, from     : <>

AMORIN & KATZ (2008). O papel da episiotomia na obstetrícia moderna. Feminina, 26(1), 47,54. Retrieved on 10 March, from     : <>

BELLI (2013). La violencia obstétrica: otra forma de violación a los derechos humanos. Revista red Bioética, 2(8), 25-34. Retrieved on 09 March, from     : <>

CESCR. Comité de Derechos Económicos, Sociales y Culturales. (2000). Cuestiones Sustantivas Que Se Plantean En La Aplicación Del Pacto Internacional De Derechos Económicos, Sociales Y Culturales “Observación general No 14 – El derecho al disfrute del más alto nivel posible de salud”. Retrieved on 10 March, from     : <>

DINIZ & CHACHAM (2006). O “corte por cima” e o “corte por baixo”: o abuso de cesáreas e episiotomias em São Paulo. Questães de Saúde Reprodutiva: Sexualidade e reprodução: ações e serviços de saúde, Rio de Janeiro, 1(1), 80-9 Retrieved on 12 March, from     : <>

DINIZ, Carmen (2001). Entre a técnica e os direitos humanos: possibilidades e limites da humanização da assistência ao parto (PhD Thesis). Retrieved on 12 March, from     : <>

DIP (2013). Na hora de fazer não gritou. Retrieved on 12 March, from     : <>.

El Parto es Nuestro. (2012). Informe de la campa a StopKristeller: cuestión de gravedad. Retrieved on 08 March, from     : <>

GIRE. Grupo de Información en Reproducción Elegida. (2015). Violencia obstétrica: un enfoque de derechos humanos. Retrieved on 08 March, from     :

NAGAHAMA; SANTIAGO (2005). A institucionalização médica do parto no Brasil. Ciência & Saúde Coletiva, Rio de Janeiro, v. 10, n. 3, p.651-657, jul./set. 2005. Retrieved on 10 March, from     :


PONTES et al. (2014) Parto nosso de cada dia: um olhar sobre as transformações e perspectivas da assistência. Revista Ciência da Saúde Nova Esperança, João Pessoa, v. 12, n. 1, p.69-78, jun. 2014. Retrieved on 12 March, from     : <>.

Rede Parto do Princípio – Mulheres em Rede pela Maternidade Ativa. (2012). Dossiê da Violência Obstétrica: “Parirás com dor”. Retrieved on 08 March, from     : <>

RODRIGUES et al. (2015). A peregrinação no período reprodutivo: uma violência no campo obstétrico. Esc Anna Nery, 19(4), 614-620. Retrieved on 10 March, from     : <>

TESSER et al. (2014). Violência obstétrica e prevenção quaternária: o que é e o que fazer. Revista Brasileira de Medicina de Família e Comunidade, 10(35), 1-12. Retrieved on 10 March, from:  <>

  1. [1] Violencia Obstetrica: Un enfoque de Derechos Humanos:
  2. [2] Care in normal birth: a practical guide:
  3. [3] Report: A human rights-based approach to mistreatment and violence against women in reproductive health services with a focus on childbirth and obstetric violence



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Coordinator - Tibet Team

Mandakini graduated with honours from the Geneva Academy of International Humanitarian Law and Human Rights. Her team analyses the human rights violations faced by Tibetans through a legal lens.

Kenza Mena
Team Coordinator -China

Kenza Mena has expertise in international criminal law since she is currently pursuing a last-year Master’s degree in International Criminal Justice at Paris II Panthéon-Assas and obtained with honors cum laude an LLM in International and Transnational Criminal Law from the University of Amsterdam. She also holds a Bachelor’s degree in French and Anglo-American law. 

Since September 2021, she has been the coordinator of Team China at GHRD, a country where violations of human rights, even international crimes, are frequently perpetrated by representatives of the State. Within Team China, awareness is also raised on discrimination that Chinese women and minorities in the country and, more generally, Chinese people around the world are facing.

Kenza believes that the primary key step to tackle atrocities perpetrated around the world is advocacy and promotion of human rights.

Aimilina Sarafi
Pakistan Coordinator

Aimilina Sarafi holds a Bachelor’s degree cum laude in International Relations and Organisations from Leiden University and is currently pursuing a Double Legal Master’s degree (LLM) in Public International Law and International Criminal Law at the University of Amsterdam.
She is an active advocate for the human rights of all peoples in her community and is passionate about creating a better world for future generations. Aimilina is the coordinator for the GHRD team of Pakistan, in which human rights violations of minority communities in Pakistan are investigated and legally evaluated based on international human rights legal standards.
Her team is working on raising awareness on the plight of minority communities such as women, children, religious and ethnic minorities within Pakistan.

Lukas Mitidieri
Coordinator & Head Researcher- Bangladesh

Lucas Mitidieri is currently pursuing his bachelor’s degree in International Relations at the Federal University of Rio de Janeiro (UFRJ). As the GHRD Bangladesh Team Coordinator, he advocates for human rights and monitors violations across all minorities and marginalized groups in Bangladesh. Lucas believes that the fight for International Human Rights is the key to a world with better social justice and greater equality.

Nicole Hutchinson
Editorial Team Lead

Nicole has an MSc in International Development Studies with a focus on migration. She is passionate about promoting human rights and fighting poverty through advocacy and empowering human choice. Nicole believes that even the simplest social justice efforts, when properly nurtured, can bring about radical and positive change worldwide.

Gabriela Johannen
Coordinator & Head Researcher – India

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Gabriela is the coordinator and head researcher for GHRD India, a country, she has had a personal connection with since childhood. Her primary focus is to raise awareness for the severe human rights violations against minorities and marginalized groups that continue to occur on a daily basis in India. By emphasizing the happenings and educating the general public, she hopes to create a better world for future generations.

João Victor
Coordinator & Head Researcher – International Justice

João Victor is a young Brazilian lawyer who leads our team of International Justice and Human Rights. He holds a Bachelor’s degree in Law from the Federal University of Rio de Janeiro, Brazil and possesses over 5 years of experience in dealing with Human Rights and International Law issues both in Brazil and internationally, including the protection of refugees’ rights and the strengthening of accountability measures against torture crimes.

João has an extensive research engagement with subjects related to International Justice in general, and more specifically with the study of the jurisprudence of Human Rights Courts regarding the rise of populist and anti-terrorist measures taken by national governments. He is also interested in the different impacts that new technologies may provoke on the maintenance of Human Rights online, and how enforcing the due diligence rules among private technology companies might secure these rights against gross Human Rights violations.

Célinne Bodinger
Environment and Human Rights Coordinator

As the Environment and Human Rights Coordinator, Célinne is passionate about the health of our planet and every life on it.

Angela Roncetti
Team Coordinator and Head Researcher- South America

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Lina Borchardt
Team Head (Promotions)

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She has been working for Global Human Rights Defence in the Netherlands since 2020. Her focus now is concentrated on the Human Rights and Minorities Film Festival and the cooperation of GHRD with students across the country.

Pedro Ivo Oliveira
Team Coordinator and Researcher

Pedro holds an extensive background in Human Rights, especially in Global Health, LGBTQ+ issues, and HIV and AIDS. He is currently finishing his Bachelor’s Degree in International Relations and Affairs at the Pontifical Catholic University of Minas Gerais, Brazil. Moreover, he successfully attended the Bilingual Summer School in Human Rights Education promoted by the Federal University of Minas Gerais and the Association of Universities of the Montevideo Group. Besides, Pedro Ivo has a diversified professional background, collecting experiences in many NGOs and projects.

With outstanding leadership abilities, in 2021, Pedro Ivo was the Secretary-General of the 22nd edition of the biggest UN Model in Latin America: the MINIONU. Fluent in Portuguese, English, and Spanish, Pedro Ivo is the Team Coordinator and Head Researcher of the Team Africa at Global Human Rights Defence. Hence, his focus is to empower his team from many parts of the world about the Human Rights Situation in the African continent, meanwhile having a humanized approach.

Alessandro Cosmo
GHRD Youth Ambassador
(European Union)

Alessandro Cosmo obtained his B.A. with Honors from Leiden University College where he studied International Law with a minor in Social and Business Entrepreneurship. He is currently pursuing an LL.M. in Public International Law at Utrecht University with a specialization in Conflict and Security. 
As GHRD’s E.U. Youth Ambassador, Alessandro’s two main focuses are to broaden the Defence’s reach within E.U. institutions and political parties, as well as mediate relations between human rights organizations abroad seeking European funding. 
Alessandro believes that human rights advocacy requires grass-roots initiatives where victims’ voices are amplified and not paraphrased or spoken for. He will therefore act on this agenda when representing Global Human Rights Defence domestically and abroad

Veronica Delgado
Team Coordinator and Researcher- Japan, Sri Lanka & Tibet

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Coordinator & Head Researcher (Nepal & Indonesia)

Wiktoria Walczyk has joined GHRD in June 2020 as a legal intern. She is currently coordinator and head researcher of Team Nepal and Indonesia. She has an extensive legal knowledge concerning international human rights and is passionate about children’s and minorities’ rights. Wiktoria has obtained her LL.B. in International & European Law and she specialised in Public International Law & Human Rights at The Hague University of Applied Sciences in the Netherlands. Moreover, she is pursuing her LL.M. in International & European Law and focusing on Modern Human Rights Law specialisation at the University of Wroclaw in Poland. In order to gain an essential legal experience, Wiktoria has also joined Credit Suisse’s 2021 General Counsel Graduate First Program where she is conducting her legal training and discovering the banking world. She would like to make a significant impact when it comes to the protection of fundamental human rights around the world, especially with regard to child labour. 

Fairuz Sewbaks
Coordinator and Head Researcher

Fairuz Sewbaks holds extensive legal knowledge regarding international human rights, with a specific focus on human rights dealings taking place in continental Africa. She holds a bachelor’s degree from The Hague University in public international law and international human rights and successfully followed advanced human rights courses at the Centre for Human Rights, University of Pretoria. She furthermore participated in the Istanbul Summer School where she was educated about the role of epidemics and pandemics in light of human rights.


Fairuz is the coordinator and head researcher for GHRD Africa. Her primary focus is to establish and coordinate long-term research projects regarding the differentiating human rights dealings of vulnerable and marginalized groups in continental Africa, as well as conducting individual research projects.

Priya Lachmansingh
Coordinator and Head Researcher, Political Advisor
(Asia & America)

Priya Lachmansingh is currently pursuing her bachelor’s degree in International &amp; European
Law at the Hague University of Applied Science.
As GHRD’s Asia &amp; America human rights coordinator and GHRD Political Advisor, Priya’s
prominent focus is to highlight human rights violations targeted against minority and
marginalized groups in Asia and America and to broaden GHRD reach within Dutch political
parties and as well seek domestic funding.

Jasmann Chatwal
Team Coordinator & Head Coordinator: North America

Jasmann is a political science student at Leiden University who joined GHRD in May 2021 as an intern in team Pakistan. Now, she is the team coordinator for North America and is responsible for coordinating the documentation of human rights violations in USA, Canada, and America.