Shocking maternal care in the Eastern Cape

Pregnant women seeking healthcare in Eastern Cape government facilities are facing abuse and substandard care placing them at high risk of death and injury, a Human Rights Watch (HRW) report has revealed.

Released in Johannesburg on Monday, the 66-page report Stop Making Excuses: Accountability for Maternal Health Care in South Africa shares horror reports of women being physically and verbally abused, turned away from clinics without examination while in labour, ignored by nurses when they call for help, and forced to wait hours and days for care.

The women spoke of abuse at the hands of health workers including pinching, slapping and rough handling during labour.

Several women also claimed that they were ordered to make their own beds, walk and carry their newborns despite being in pain and weak, forced by cleaners to clean up after giving birth, left unattended for hours after giving birth and not given any information critical to their well-being.

Refugee women experienced specific abuse such as delayed and denied care, active discrimination and being seen last despite arriving early.

HRW warned that ill treatment drove women away from seeking care with a greater cost to the health system.

South Africa’s maternal mortality rate has more than quadrupled in the last decade, increasing from 150 to 625 deaths per 100 000 live births between 1998 and 2007 (Government data).

The United Nations estimates that 4 500 women die each year in South Africa due to preventable and treatable pregnancy- and child-related causes.

Experts have attributed the increase in deaths to increased reporting and actual deaths, especially among women living with HIV.

HRW identified the underlying problems as shortcomings in accountability and oversight mechanisms that authorities use to monitor healthcare system performance, identify failings and needs, and make timely interventions.

Maternal health care lacking

The HRW findings were based on among others interviews with 157 women who received maternal health services or accompanied other women seeking such services in Eastern Cape health facilities over the past five years. HRW also visited 16 health facilities in OR Tambo, Amatole and Nelson Mandela Municipality districts. These districts had the highest maternal mortality ratios in the province in 2008 and 2009. Ironically, the national health department has listed Amatole and OR Tambo as priority districts.

Thirty nurses, mostly working in maternity units, were interviewed, as well as emergency medical services staff, quality assurance officials, facility managers and managers in maternity units.

The report does acknowledge that some government initiatives had borne fruit – 92% of women attend antenatal care, almost 87% deliver in health facilities and South Africa is one of the few countries where maternity care is free, abortion is legal and there is a system of confidential inquiries to assess levels, causes of and contributors to maternal deaths.

However, the information is not used to ensure problems are taken care of or systemic problems not repeated with the result that very little has changed for South Africa’s women who continue to die due to the same health system shortcomings.

HRW made an urgent appeal for the health department to ensure that current accountability mechanisms were operating properly if it hoped to make any impact on maternal mortality.

“The point of the complaint system is to show that South Africa cares enough about women’s lives to fix the problems,” HRW women’s researcher Agnes Odhiambo said.

“When accountability and oversight mechanisms don’t function, South Africa is ignoring the insights of the people who know best what’s wrong with maternal health care: the maternity patients themselves.”

Patient Stories

Abeba M's story: The nurses swore at me
Babalwa L's story: My baby was born stillborn

Have you experienced bad maternal care in a clinic?

Read more health stories on Health-E News

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