NAIROBI (TrustLaw) - Women giving birth in South Africa are pinched, slapped, ignored, called names, turned away from clinics and even forced to mop up their own blood, Human Rights Watch (HRW) said in a report on Monday.
South Africa has the best health facilities on the continent but its maternal mortality rate has quadrupled in the last decade, rising from 150 to 625 deaths per 100,000 live births between 1998 and 2007, according to government data cited by the rights group.
The report said the abusive practices and substandard care meted out to women put their lives and those of their babies at risk.
"I was really shocked at how inhuman, how scary, it is," said Agnes Odhiambo, author of the report, Stop Making Excuses: Accountability for Maternal Health Care in South Africa.
One woman interviewed by HRW showed researchers a scar on her thigh, which she said was the result of a nurse using a pair of scissors to make her open her legs when she was in labour. Others were told to "shut up" or ridiculed with comments like: "Are you a doctor to know you are in labour?"
"Some of the nurses don’t even recognise that it is wrong, Odhiambo told TrustLaw. "They believe that by shouting at women, by slapping them, they are helping them to comply, to listen to what they are supposed to do so that they can deliver."
DEAD IN THEIR BEDS
The report based on research carried out between August 2010 and April 2011 in Eastern Cape province, also documented instances when women were ordered in their weakened post-labour state to make their own beds and walk with their newborns.
One woman was made to walk while bleeding heavily with the placenta still inside her immediately after giving birth.
"She collapsed and fainted on the way to the other ward. Another patient helped her," her friend told HRW.
Another woman said she was bleeding and the nurse shouted at her to clean the blood up.
"They did not let me use the mop to clean the blood. I had to bend so I could use tissue to wipe it," she told HRW.
Women were found dead in their beds, having been left unobserved for long periods of time. In one case, a woman who died after a Caesarean section was thought to have been left unattended for 16 hours, HRW said.
'YOU DID NOT USE CONDOMS'
The surge in South Africa's maternal death rate was probably due to an increase in cases being reported and actual deaths, especially among HIV-positive women, HRW said. Eighteen percent of the population have the virus that causes AIDS.
Turning pregnant and women in labour away from health centres when they are in pain and ignoring patients when they are calling for help must also contribute, the report said.
"They are not giving women the quality of care that you are supposed to get and that is what can lead to death or to injury," Odhiambo said.
For example, one woman who was bleeding early in her pregnancy twice tried to get help from a local health centre but they refused to refer her for examination.
"When they referred her, it was too late. She died a few days after," said Odhiambo. "It’s very clear that women are getting shoddy care and you cannot rule out the possibility that these abuses do actually contribute to maternal death and do contribute to maternal injuries."
Refugee women and those living with HIV/AIDS face the worst discrimination. One HIV-positive woman said the nurse who was helping her to give birth told her off for not using condoms.
DEATHS DESPITE RESOURCES
Three out of five maternal deaths occur in sub-Saharan Africa. Experts hope to improve survival rates by getting more women to deliver with professional help.
But in South Africa, 87 percent of women already give birth in health facilities.
"It's got the resources. It's got the infrastructure. It's got the expertise," Odhiambo said. "At the same time, women are dying."
The study says accountability within South Africa's public health sector needs to improve. Patients need to know how to complain and the abuses they report need to be followed up systematically.
"Nurses that are abusive are sometimes made to just apologise to patients and it stops there," Odhiambo said.