Nancy Martínez was 17 when she went into labour. Though her age meant she was considered a high-risk pregnancy, she was left alone for several hours without monitoring or pain medication.

Nurses told Martínez to be quiet and put up with the pain, while doctors mocked her mother, Nancy Ceron Diaz, denying her information about her daughter’s condition.

“My daughter was screaming, but it was only when her face turned green that she was transferred to the maternity hospital,” says Diaz, 41.

Martínez’s baby boy, who suffered asphyxia as a result of being trapped unaided in the cervix for hours, was left with permanent brain damage. Now 30 months old, he cannot sit unaided or eat solid food, and will need full-time care for the rest of his life.

They just let my wife die. I feel so guilty for not having money to take her to a private hospital Fidel Leon, 56

Martínez’s case, which dates back to January 2017, is among a growing number reported to Mexican human rights officials in an effort to hold hospitals to account for the violent treatment afforded mainly poor and indigenous women and girls when they give birth.

Martínez is from Tlapa, the biggest town in the rural La Montaña region of Guerrero – one of Mexico’s poorest states, with high rates of teenage pregnancy, infant and maternal mortality and gender-based violence. There were five maternal deaths in La Montaña during the first three months of 2019, compared with nine in the entire preceding year.

Obstetric violence is a legal term coined in Latin America to describe cruel, degrading and negligent treatment during pregnancy, childbirth and the postpartum period. Such treatment, which happens in both private and public hospitals, leads to unnecessary pain and suffering, humiliation, ill-health, sterility and even death.

The prevalence of obstetric violence is unknown in Mexico – the same applies globally – but, according to the World Health Organization, teenagers, impoverished women, those living in rural areas, and women of colour are more likely to experience abusive treatment.

At 17, Nancy Martínez, was considered a high-risk pregnancy. She was left alone for hours without monitoring or medication. Photograph: Cesar Rodriguez

In Mexico, the problem is historically rooted in racist health policies that systematically turned normal pregnancies into high-risk ones, according to medical historian Elizabeth O’Brien.

“As long as they got the baby out and baptised so it could become part of God’s kingdom, the woman’s life and her capacity to give birth in the future didn’t matter,” O’Brien says.

This pattern of medical care is ongoing. In 2013, images of an indigenous woman, Irma López, giving birth in an Oaxaca hospital courtyard after being turned away by staff sparked outrage. Meanwhile, almost 50% of babies are delivered by caesarean in Latin America – a surgery that increases the risk of life-threatening complications for women – compared with an optimal rate of 10-15%, according to the World Health Organization.

The general and maternity hospitals in Tlapa have officially endorsed zero-tolerance policies against discrimination, yet some women from communities without running water are denigrated for being unclean and refused attention until they bathe. Others are reprimanded for screaming in pain during labour, according to midwife Elizabeth Melgar, the clinical coordinator at the state school of midwifery. “Obstetric violence keeps happening, especially to indigenous women who don’t speak Spanish,” says Melgar

Often there is discrimination, inhumane and unethical treatment Neil Aria Vitinio

Consuela Moreno, 32, went to hospital with a piercing headache, nausea and cold sweats, barely able to stand.

Tests revealed that she was pregnant and Moreno, already the mother of two children, told the duty doctor something was very wrong. Her symptoms were dismissed as typical pregnancy complaints.

After seven hours in the emergency room, Moreno begged her husband to take her home. “I’d rather die at home than here.”

Her husband says Moreno was mocked by the doctor, who insisted she was fine – until a colleague discovered her blood pressure was dangerously high.

She was transferred to the maternity hospital and rushed to surgery with an ectopic pregnancy. It is unclear what happened in theatre, but doctors told the family that while Moreno wouldn’t be able to have more children, she would recover.

But Moreno never regained consciousness. She died a couple of days later, in December 2018, leaving the family devastated and questioning the care she received.

“No one took her temperature or blood pressure for seven hours, they just let my wife die,” says Fidel Leon, 56. “I feel so guilty for not having money to take her to a private hospital. I feel so guilty for being poor.”

Fidel Leon at his home in Tlapa, Guerrero. Photograph: Cesar Rodriguez

Neil Aria Vitinio, a lawyer from the Tlachinollan human rights centre in Tlapa, is representing several victims including Martínez and Moreno. “In each case we see a lack of timely and adequate medical attention, no knowledge of emergency guidelines, no notes, and, often there is discrimination, inhumane and unethical treatment,” she says.

“This keeps happening – despite 10 years of recommendations to improve hospital infrastructure, staffing numbers and training – because there’s no political will.”

The state human rights commission concluded Martínez was subjected to obstetric violence, and made a series of recommendations. The guidance, which has yet to be accepted, included financial compensation and staff training.

The failure to stamp out obstetric violence left teenager Griselda Romero unable to have more children. In June 2017, Romero, who asked for her name to be changed, was turned away from hospital on several occasions after midwives concluded her labour was not far enough advanced.

Back home, her mother made a tea from epazote, or wormseed – a nutrient-rich herb commonly used in Mexican cooking. But the pain became unbearable, so they returned to hospital where midwives berated Romero’s mother about the tea, claiming it had quickened the labour and caused complications.

The baby girl was born healthy, but then a midwife accidentally pulled out Romero’s uterus along with the placenta. Panicked, the team of midwives and nurses tried to reinsert the uterus three times. Romero was not offered pain relief at any stage during childbirth; nobody called her gynaecologist.

“She had my uterus in her hands, I saw it, it was so painful,” says Romero. “One midwife was crying, another one shouted at me to be quiet.”

Romero was eventually transferred to the maternal hospital for emergency surgery, where doctors performed a hysterectomy. “This wasn’t my fault, it wasn’t my mother’s fault,” says Romero, now 19, who recently testified at the national human rights commission, which is adjudicating her case.

“Nobody has said sorry. I’ll never have another child. I want them to apologise and recognise the damage they did.”

The general and maternity hospitals did not respond to repeated requests for comment.