Cape Town - The need for effective regulation and policy around obstetric violence (OV) has been called for, as reports of mistreatment and violence against women in reproductive health services is said to be increasingly swept under the carpet.
According to a report submitted by the Commission for Gender Equality, a number of human rights violations that women experience during childbirth, such as health care professionals slapping women in the face and legs during childbirth go unreported.
Expert adviser to the Centre for Applied Legal Studies, Dr Jess Rucell said in an article that due to health systems having been under strain since the pandemic, reports have shown that womenʼs maternal health, in particular, have been neglected. She added that there has been evidence that constraints to maternal health services around the world have resulted in increased maternal death and in the context of the pandemic, as with domestic violence, it has been argued that OV has also increased.
Nicole Daniels, who is a sociologist specialising in qualitative research methods and gender studies, said that OV is prevalent and pervasive in the South African health system and it is a globally recognised problem, with a growing body of research, policies, advocacy and actions emerging to address this problem.
“There are multiple reasons put forward to explain the many forms of violence evident in birthing facilities. These range from interpersonal issues related to the healthcare provider interactions, to larger structural issues, including institutional obstetric practices themselves.
“It is the normalisation and deep-rootedness of abusive behaviours and neglectful practices that has entrenched this form of violence within healthcare systems. Other contributing factors are: our patriarchal society, unequal gender relations, power differentials in medicine, the prevalence of societal violence, the status of midwives in a hierarchical system and limitations in their training, the spatial layout of facilities and lack of leadership in responding to injustice and abuse,” said Daniels.
Veronica Mitchell, a facilitator at the University of Cape Town’s obstetrics and gynaecology department added that OV can have a negative effect on the soon to-be-mother because childbirth is not only a physical occurrence, but a deeply emotional, spiritual event, the harms and injuries a woman can sustain include psychological and emotional damage to her psyche, her self-esteem, and can harm the developing relationship between mother and child and partner/ family.
“Research has shown that women can recall in minute detail the circumstances of their birth. Where that imprint is tainted by obstetric violence as a mostly invisible and normalised form of violence it can be difficult for women to identify the harms that linger in her psyche and cause grief. In addition the physical damages sustained might be long-term (like obstetric fistulas, damage to the uterus, etc) and affect the ability to have more children or ability to conceive (where there has been forced sterilisation). Birthers' pleas for help are often ignored, including cries for pain relief. This can be because of few medical personnel or general lack of resources. While other times the neglect is purposeful,” said Mitchell.
She added that the current system is largely authoritarian and does not offer a smooth and reliable reporting system. The pervasive, structural aspect of OV remains hidden or unacknowledged.
"Government needs to support and address the diminished quality of care in state hospitals, workshops on communication skills for midwives and obstetricians needs to take place and legal avenues for redress are needed to acknowledge past injustices in birthing facilities,” said Mitchell.
The South African Society of Obstetricians and Gynaecologists (SASOG) spokesperson Heidi Kruger said it condemns all forms of OV and invites government to work together on programmes to improve the quality of maternal care
“SASOG commits itself to promoting the respectful care of women and calls on its members to heed its mission to promote excellence and equity in women’s health at all times. SASOG further invites government to work together on programmes to improve the quality of maternal care, including respectful obstetric care,” said Kruger.