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During 16 Days of Activism Against Gender Based Violence, Embrace convened a lekgotla with mothers and mother supporters to deliberate on urgent action needed to tackle the pandemic of obstetric violence in South Africa.
Obstetric Violence refers to the mistreatment of birthing people by health care providers during pregnancy and childbirth and is a violation of their reproductive health rights and basic human rights. It results in physical or psychological harm during pregnancy, birth and post-partum and can lead to on-going physical and psychological trauma for the birthing person, fetus and newborn. Embrace has led the public conversation on this much neglected form of GBV, which is pervasive, systemic and ultimately reflects the broader societal devaluation of women and girls in South Africa as well as the normalisation of violence against them, particularly marginalised and low-income women and girls.
One of the outcomes of this multi-sectoral lekgotla was a joint statement of organisations and individuals working in maternal health and gender justice sectors.
“We have been deeply affected by the ways mothers continue to struggle in systems that often render their needs invisible or inconsequential. The eradication of the violence experienced by women giving birth in our country’s healthcare facilities requires an examination of all the many issues at play. Obstetric violence affects individual health care users and healthcare providers, but it’s also structural – we need to look at how healthcare is organised, resourced and administered, how healthcare workers are trained and supported, as well as existing accountability mechanisms,” says movement leader, Julie Mentor.
Some of the signatories of this statement include mothers affected by obstetric violence and individuals from the DG Murray Trust, Flourish, Treatment Action Campaign, University of the Western Cape (Department of Women’s and Gender Studies), Rhodes University (Critical Studies in Sexualities and Reproduction), International Board Certified Lactation Consultants, Sexual and Reproductive Justice Coalition, Roam Parenting Guidance & Support, South African Registry of Community Midwives, Perinatal Mental Health Project, Gestational Justice Research Hub, Centre for Applied Legal Studies and many more.
JOINT STATEMENT: Urgent action required to address Obstetric Violence in South Africa
Pregnant women, girls, and gender non-conforming birthing people continue to experience disrespect, neglect and abuse including physical and psychological forms of violence by our reproductive health services. For more than two decades of our democracy, verbal and physical assaults and unnecessary medical procedures have been documented in our country’s maternal health clinics, Maternity Obstetric Units (MOU) and hospital obstetric departments. This normalised state of violence against women and birthing people seeking healthcare has an enduring, negative impact on maternal health outcomes and early childhood development. The abusive treatment of women and girls in maternity services is a form of gender violence that reflects the broader societal devaluation of women and girls in South Africa and the normalisation of violence against them, particularly marginalised and impoverished women and girls.
Black and low-income women and birthing people are especially vulnerable to this form of gender-based violence, known as obstetric violence. Women and birthing people are targeted further by multiple and intersecting forms of discrimination based on immigration and refugee status, sexual orientation, gender identity, religion, ethnicity, age, and disability.
The challenges faced by the healthcare system including inadequate human and financial resources, equipment, medicines and other necessary support for those working in maternal care contribute to obstetric violence, and must be transformed. Lack of resources cannot be an excuse to not provide humane quality of healthcare. Poor working environments or perceived unsafe practices by pregnant women and persons cannot justify gender-based violence.
South Africa’s national clinical guidelines for maternity care outline and mandate humane healthcare. The signatories of this statement jointly call upon the Health Ombudsman, the Ministers of Health, and Women, Youth, and Persons with Disabilities, the Heads of Maternal & Child Health, Provincial MECs and District Health Managers to use their authority to urgently take the following steps that will systematically intervene in the pandemic of gender-based violence, by addressing obstetric violence.
We call for:
The recognition of every pregnant person’s autonomy and right to accurate and accessible information delivered and in their language of choice so as to enable them to make decisions about their care. Furthermore, the right of every pregnant or birthing person to dignified, respectful health care throughout pregnancy, and for the recognition of their right to be free from violence and discrimination during childbirth.
The Department of Health to prioritise the prevention of violence and ensuring of humane treatment of pregnant women and birthing persons in the Department’s implementation plan and applications for delivery of the National Strategic Plan Against Gender-Based Violence.
The Minister of Health, and Minister of Women Youth and Persons with Disabilities to develop and cost a measurable and time-bound plan to transform the resourcing of maternal health with the aim to prevent neglect and abuse due to understaffing and under resourcing by December 2022.The Department of Health, and the health system contribute to the power and empowerment of girls, women and birthing persons by strengthening comprehensive sexual and reproductive health and human rights education; and by improving existing reporting structures (e.g. the health ombudsman, professional bodies such as South African Nursing Council and the Health Professions Council of South Africa).
Political and administrative managers throughout the health systems to apply a zero-tolerance response to obstetric violence. Including through education and ongoing training for healthcare workers on the rights-based approach to sexual and reproductive healthcare, and obstetric violence. Applying binding punitive employment sanctions to perpetrators of violence, including directors and managers who fail to investigate and prevent this particular form of violence against women.
We recognise that everyone has the right to live free from violence and call for an end to obstetric violence in all its forms.
Nonkululeko Mbuli, Communications & Advocacy Strategist
Soweto Sunrise News.