For many, pregnancy is known to be an honoured, celebrated and hopeful time in a woman and family’s life. For example, African traditions, such as isicwayo/ingacayi have for centuries been practiced to engage communities to sanctify and protect women during this vulnerable life-changing time. However, such reverence and protection is not being translated into reproductive healthcare services.
Obstetric violence also includes the denial of or neglectful healthcare services to pregnant women. A special March 2022 issue of the British Medical Journal, focusing on “understanding the mistreatment of women during childbirth to improve quality of care”, can be found here.
Gender-based violence (GBV) is receiving considerable attention during the Covid-19 global pandemic. President Cyril Ramaphosa, himself drew links between the pressures of the lockdowns and domestic violence and as early as July 2020 declared that South Africa faces a second ‘shadow’ pandemic of GBV.
Obstetric violence, however, which is a normalized form of hospital-based gender-based violence during childbirth, remains below the radar of public scrutiny and national prevention efforts. For instance, it was omitted from the 2018 Presidential GBV and Femicide (GBVF) Summit declaration, and the National Strategic Plan on GBVF that followed it.
Physical abuses by health professionals include assault, for example, slapping women in the face and legs during childbirth. Women have also reported being dragged on the floor to a laboring bed, and being locked in a bathroom, abandoned during childbirth.
Other physical abuse described in my, and others’ research is routine episiotomies, and the application of pressure to the abdomen during childbirth, which go against evidence-based clinical practice and guidelines.
An overview of obstetric violence is outlined in a report submitted by the Commission for Gender Equality to the UN Special Rapporteur on Violence Against Women in May 2019.
These, often preventable and discriminatory, acts can result in trauma and post-partum depression. Women affected by obstetric violence may also suffer physical harm. These can include chronic pain, the loss of sexual pleasure, fertility, and even disability and death to the mother, fetus or newborn.
Contrary to how this problem is often portrayed in the media, nationwide evidence of violations of sexual and reproductive health rights makes it clear — this is not the result of a few health professionals’ malice or managers’ neglect. Rather obstetric violence is a systemic problem resulting from gender discrimination and inequality.
Our constitution, and in particular the bill of rights, aims to offer protections and solutions for the inequalities women live with disproportionately. The current global pandemic has brought a monolithic focus to health and healthcare systems. This has also brought to the surface the disproportionate burdens women face when accessing healthcare. Within this context, it is essential that health professionals and we as rights-based institutions emphasize the rights women have, how, and where they are being violated.