Image: Mustafa Omar on Unsplash

When a woman goes into labour, she is arguably at her most vulnerable, but in many African countries, this is also the time when she is most likely to be a victim of obstetric violence and abuse in a health facility.

The term obstetric violence is a contested one among academics and health practitioners, but one of the accepted definitions is that it encompasses behaviours, actions and systemic practices or failures that result in the mistreatment, disrespect, abuse, humiliation, or neglect of women during pregnancy, childbirth and postpartum care.

At a recent webinar, hosted by the University of the Western Cape (UWC) Dullah Omar Institute, it was highlighted that there is currently no legal definition or policy framework specifically addressing obstetric violence in most African countries, including South Africa. Although there is growing global recognition, accountability remains limited.

Manifestations of Obstetric Violence in Africa

• Non-confidential care: People in labour rooms without a woman's consent, a lack of privacy in maternity wards, and allowing health information to be heard by other patients. Lack of privacy can occur because of the design of maternity wards.
• Neglect/abandonment: This occurs where there is a lack of support, ignoring requests for assistance before, during, or after delivery. This has been cited by some studies to occur intentionally, negligently or unintentionally.
• Non-dignified care: This includes exposing women’s bodies against their wishes, offensive or humiliating words, threats of withholding treatment, or undergoing a caesarean section, or a poor outcome for the mother and baby.
• Verbal abuse: Overt aggression from health workers, including using harsh, disrespectful, or degrading words towards birthing women.
• Physical abuse: May include hitting women, forcing them into specific positions, performing episiotomy and/or stitching without anaesthesia.
• Unconsented interventions: Forced sterilisation, caesarean section, episiotomies or vaginal examinations without consent.
• Denial of birth companions
• Denial of pain medication
• Denial of mobility in labour or choice of birthing position
• Denial of traditional practices
• Maternal detention

Women, particularly adolescents, migrants, the poor, rural populations, and those living with HIV, are disproportionately affected. In whatever form it manifests, obstetric violence strikes at the core of women's dignity and reproductive autonomy. 

Aisosa Jennifer Omoruyi, a Research Fellow at the Dullah Omar Institute, said: “An important aspect of women's sexual and reproductive health and rights is ensuring that they are the centre of the entire process. Whatever medical intervention is done must be with their full and informed consent.”

Omoruyi added that part of the difficulty in combating obstetric violence is that it’s been normalised by healthcare workers, communities and women themselves. She said: “Some studies show that some women are not even critical of the care received because they are not well informed about their rights or the expected standard of care, and are likely to see mistreatment as normal behaviour of health care workers.”

There have been landmark cases of litigation in various African states. These cases involved the forced sterilisation of women living with HIV, which highlighted systemic failures, lack of informed consent, and state complicity. These cases have resulted in court rulings recognising constitutional rights violations and emphasising the need for policy enforcement. Information on this litigation can be found here. 

Litigation can be an effective tool for accountability, but it faces challenges such as evidence gathering and delays. Experts agreed that there are clear human rights violations resulting from obstetric violence, including the right to health, dignity, autonomy, and freedom from cruel, inhuman, or degrading treatment, the right to privacy, information, and non-discrimination. This means that combating obstetric violence requires a multifaceted and rights-based response. Immediate actions like improving monitoring and accountability mechanisms, educating women about their rights in the context of maternal healthcare, educating health providers about women’s rights and respectful maternity care, and allowing birth companions can help reduce obstetric violence. As a start, it is essential to take the conversation forward and raise stronger awareness about combating obstetric violence as a human rights imperative.