Activists believe a crisis is unfolding in South Africa’s hospitals and clinics as women are stripped of their dignity, coerced, neglected and abused during childbirth. It’s obstetric violence, a largely unspoken form of gender-based violence that preys on the vulnerable at their most intimate and fragile moments.
And now a group of like-minded activists has spoken out about the phenomenon, and has penned an open letter to ministers Aaron Motsoaledi, Sindisiwe Chikunga, Enoch Godongwana and Thembi Simelane (replaced last week by Mmamoloko Kubayi) to express their concerns and call for action to address the situation.
The coalition of advocates, legal experts and academics has laid out a harrowing picture of a healthcare system that is failing women — often at the very hands sworn to help them.
“We tried to fill this gap with a small-scale survey of 482 participants within our network of mothers and found that 1 in 2 women experienced some form of obstetric violence. While not nationally representative, these findings offer a troubling glimpse into the prevalence of this issue,” the coalition wrote.
The detailed experiences included verbal abuse, coercive medical procedures or neglect. Breaches of confidentiality, discrimination and emotional abuse were some of the other forms of obstetric violence — all of them human rights violations.
The trauma does not simply go away when the incident is over. It can colour all future interactions that a person has with the healthcare system.
— Coalition
“However, obstetric violence is so far below the radar of senior government officials that accurate national statistics about the extent and impact of obstetric violence are difficult to source ... Preventive measures have been sorely lacking — until now. The national department of health’s new Maternal and Perinatal Care Guidelines, an update on the version published in 2016, includes a chapter on Respectful Maternity Care (RMC). This inclusion presents a powerful opportunity to tackle obstetric violence.”
They pleaded: “Ministers, your departments are pivotal to recognising obstetric violence as a form of GBV in health policies and legislation. Additionally, the allocation of adequate funding to address service delivery gaps in reproductive healthcare and ensuring sufficient capacity is key to implementing respectful maternity care in our clinics and hospitals — especially in rural and under-resourced facilities.”
Obstetric violence was said to disproportionately target society’s most marginalised: teen mothers, undocumented migrants and women living with HIV. Recent allegations of forced sterilisations and negligence underscored its severity, demanding accountability.
“The emotional, physical and psychological impact of obstetric violence, like other forms of GBV, are long-lasting. The trauma does not simply go away when the incident is over. It can colour all future interactions that a person has with the healthcare system,” the coalition said.
They found that most women who experienced obstetric violence reported negative psychological symptoms such as anxiety, stress and depression. Others reported physical or negative health complications as a side effect of the abuse.
“At its core, obstetric violence stems from power imbalances, gender dynamics and racial/social prejudices entrenched in our healthcare system. Historical inequities, professional hierarchies and colonial legacies create the conditions for obstetric violence to take place unabated. We need a co-ordinated government response,” the coalition said.
The coalition said the introduction of new maternity care guidelines was not enough.
“Resource shortages, overworked staff and underfunding threaten to render these new guidelines aspirational rather than implementable. In rural and underserved areas, the challenges are even greater, worsening disparities in the quality of care women receive,” they said.
They called on health minister Dr Aaron Motsoaledi to prioritise the development and implementation of comprehensive, skills-based training for healthcare workers; on women, youth and persons with disabilities minister Sindisiwe Chikunga to champion the rights and protection of women and pregnant people from obstetric violence, including from coerced or forced sterilisation; on finance minister Enoch Godongwana to cost Respectful Maternity Care and make a budget available for this; and on recently appointed justice and constitutional development minister Mmamoloko Kubayi to formally recognise obstetric violence as a form of GBV.
Nonkululeko Mbuli of Embrace Movement for Mothers — the organisation leading the coalition — said they had not yet received a single response from any of the ministers approached.
“We plan to send individual letters to the ministers on the final day of the 16 Days of Activism campaign (today) and will include a time frame for their responses,” she told TimesLIVE Premium.
She said she did not anticipate any solid feedback until the new year.
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