Imagine going to a hospital while in labor, only to be told you are lying and then to be sent outside in the street, or being pinched, slapped and rough-handled by medical staff while in labor - in South Africa these awful incidents, and many others are an everyday reality, according to a new report issued by Human Rights Watch.

The 66-page report, titled "'Stop Making Excuses': Accountability for Maternal Health Care in South Africa," revealed that while maternal mortality rates throughout Africa are falling, in South Africa they rose from 150 deaths per 100,000 births in 1998 to 625 in 2007.

The authors wrote that South Africa's goal of reducing its high maternal death rate by 75% between 1998 and 2015 will not occur if the current lack of oversight and accountability for recurrent problems in the health system and abuses carried out by medical staff are allowed to continue.

The report lists some shocking failures in maternity care that include abuse of pregnant mothers by health staff and very low standards of care in Eastern Cape Province, where women and their babies have a high risk of injury and death.

Several areas of the country experience similar problems to Eastern Cape Province, including negative attitudes by staff, inefficient management and financial administration, no accountability for system failures, and poor quality care. Agnes Odhiambo, Africa women's rights researcher at Human Rights Watch, said:

"The government admits that it has a big problem on its hands and wants to do better. But for all South Africa's good intentions, policies and strategies on paper won't save women's lives without strong accountability systems to make sure policies are carried out."

According to the United Nations, approximately 4,500 women die annually in South Africa due to treatable and preventable pregnancy and childbirth related causes. South Africa should and can reverse this trend, the authors wrote.

The report is the result of extensive field research carried out between August 2010 and April 2011 with pregnant women, their families, health experts, human rights experts, health workers, caregivers, public officials, and various international agencies.

The report gives a typical example - an HIV-positive woman delivered her baby at home and nearly died from complications. The woman had said:

"My uncle advised me to call the ambulance when labor started but I did not want to go to the hospital. I was scared of how I would be treated. I hear the nurses are very rude and they are too rough. After giving birth I developed serious problems. I was bleeding too much and I couldn't breathe properly. Luckily the HIV treatment center took me to hospital, and eventually I got treated."

Human Rights Watch personnel interviewed a large number of women, below are some of the highlighted details from those interviews:
  • Women experience verbal and physical abuse. HIV-positive women are commonly taunted by nurses about enjoying sex and blaming them for getting pregnant if they knew about their HIV-status. Many were told they should receive no care because they were migrants. Being shouted at for "messing up" when they bled on the bed during labor, they were ordered to clean it up.
  • They were pinched, slapped, and handled roughly during labor.
  • Nurses continuously ignored calls for help.
  • Serious treatment delays.
  • Facilities denied referral letters for pregnancy or childbirth related problems.
  • After delivery, the mother and baby are left unattended for very long periods.
  • Women are discharged inappropriately.
  • Women sent home with no antibiotics or pain medication.
  • Women in labor women were refused admission, they were not even examined.
  • Women sent home after Cesarean section with no medications, painkillers, antibiotics, etc.
  • One witness described a woman who had life-threatening obstructed labor. She was refused entry into a community health center two times. Fortunately, she eventually had a C-section when another hospital accepted her.
  • Migrants commonly undergo C-sections without informed consent.
  • Staff asking for bribes and gifts.
  • Families never told why the pregnant mother or newborn died during childbirth.
Odhiambo said:

"These abusive practices are a particular concern in South Africa, where almost 87% of deliveries are in health facilities."

Not only does ill-treatment cause unnecessary suffering and poor maternal health outcomes, it also puts women off using health services, which in turn worsens maternal mortality.

Human Rights Watch urges the South African government and its local health authorities to do more to strengthen its health system.

Complaints procedures in many parts of the country do not function properly, the authors added. There is very poor oversight or accountability for abusive staff and system failures.

Maternity patients appear to know little about their rights or how to lodge complaints - something they hesitate to do anyway, for fear of retaliation. Others said there was no point in complaining because they would fall on deaf ears.

Health centers commonly do not respond to complaints anyway, the authors found. Some medical staff complain that their conditions are so difficult that dealing with complaints is impossible.

Odhiambo said:

"The point of the complaint system is to show that South Africa cares enough about women's lives to fix the problems. 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."

Written by Christian Nordqvist