South Africa: Substandard maternal health care due to abuse in the health system

August 12, 2011

According to a new Human Rights Watch report, a lack of oversight and accountability for recurrent problems in the health system and abuses committed by health personnel contributes to South Africa’s substandard maternity care.

South Africa’s maternal mortality ratio has more than quadrupled over the past decade, making accountability structures to improve oversight and correct health system deficiencies all the more critical, Human Rights Watch said. The 66-page report, “‘Stop Making Excuses’: Accountability for Maternal Health Care in South Africa,” documents maternity care failures that include abuse of maternity patients by health workers and substandard care in Eastern Cape Province, putting women and their newborns at high risk of death or injury. It examines shortcomings in the tools used by health authorities to identify and correct health system failures that contribute to poor maternal health.

Examples of abuses

Human Rights Watch interviewed women who had experienced physical and verbal abuse at the hands of public health workers, including pinching, slapping, and rough handling during labor. They described treatment delays; nurses who ignored calls for help; and facilities that denied referral letters for pregnancy or childbirth-related problems, left women unattended for long periods after delivery, discharged women inappropriately and sent them home without pain medication or antibiotics, sometimes after Cesarean births, and refused them admission, sometimes without examining them, when they were in labor. Women also described widespread verbal abuse. They said that when they sought care for pregnancy, nurses taunted them about enjoying sex or berated them for getting pregnant knowing they were HIV positive, or told them they did not deserve care because they were migrants. Others said nurses ridiculed women when they said they were having labor pains or pleaded for assistance. Some said hospital staff shouted at them for “messing up” when they bled on the floor and ordered them to clean up the blood.

Some women, especially migrants with language barriers, said health workers made little attempt to communicate with them and pressured them to undergo Cesarean sections without informed consent. Others said hospital workers demanded bribes or gifts. Many said that inadequate communication by ambulance dispatchers meant that they could not reach a health facility to give birth. Some families of women or newborns who died, or women who had stillbirths, said they got little or no information about what caused the deaths.

According to Human Rights Watch, mistreatment of maternity patients not only causes unnecessary suffering but also contributes to poor maternal health outcomes. Ill-treatment drives women away from seeking care. Abuses can lead to delay in diagnosis and treatment, and in turn to increased morbidity and mortality that is more costly to the health system.

More information

Download report (PDF)