Pregnant women in South Africa – specifically in Gauteng and KwaZulu-Natal – are subjected to alarming levels of obstetric violence during their pregnancies, childbirth and postpartum care, with at least 60% experiencing some form of mistreatment.
The results of a survey over the past 10 years found that six out of 10 women giving birth in Gauteng and KwaZulu-Natal have experienced obstetric violence, but researchers say this is just the tip of the iceberg as the problem extends right across the continent.
News24 reports that the recent 2025 Birthing Survey, commissioned by Embrace: The Movement for Mothers, and conducted by Social Surveys Africa, suggested that this treatment affected around 1.79m women between 2015 and 2025.
The findings were presented last week at the launch, at the University of the Witwatersrand, to mothers, researchers and health officials.
Presenting the report, Social Surveys Africa CEO Bev Russell said the report aimed to measure the scale and impact of obstetric violence in South Africa.
“Our study found that around 60% of women in Gauteng and KwaZulu-Natal experienced some form of mistreatment during pregnancy, childbirth or postpartum care,” she said.
“When we extrapolate this to the population of women who gave birth in those provinces during the study period, it represents around 1.79m women.”
She said the abuse took many forms, including verbal abuse, neglect, lack of informed consent for procedures and denial of support during labour.
“Twenty-five per cent of respondents said healthcare workers did not ask for consent before performing procedures like episiotomies, Caesarean sections or sterilisation.”
Verbal abuse was also common.
“Fifty-seven per cent of respondents said healthcare workers spoke to them disrespectfully or belittled them.”
Russell added that two-thirds of women who reported mistreatment did not initially recognise it as abuse, assuming it was “normal and part of the childbirth experience”.
Julie Mentor, project lead at Embrace, said the survey was commissioned after years of hearing troubling birth stories from women.
“When mothers gather, stories of birth naturally emerge. But what we started hearing were stories of pain and shame – stories of being abused and disrespected when seeking antenatal care, giving birth, or during postpartum care.”
Many women struggled to name their experiences, she added.
“Society has done such a tremendous job of normalising disrespect, neglect and abuse during pregnancy, childbirth and postpartum that many of us struggle to even name this violence.”
Professor Lesley Bamford from the National Department of Health acknowledged the seriousness of the issue.
“It is not easy to stand here this morning. Many of us went into healthcare because we believed it was a caring profession, so findings like this are deeply shocking.”
Obstetric violence – in all forms – was unacceptable, she added. “And that is the position of the National Department of Health and provincial departments responsible for maternity services.”
She said the department would prioritise implementation of the national guidelines on respectful maternity care introduced in 2024.
The Office of Health Standards Compliance said the report highlighted gaps in accountability.
“One of the issues… consistently complained about is the attitude of nurses,” said executive manager Winnie Moleko, who added that “facilities may be clean, but that does not mean much if patients are still being abused”.
A total of 92% of women said the abuse involved nurses or midwives. Doctors were identified in 14% of cases, mostly in relation to coerced consent or unnecessary medical interventions.
This reflects the fact that nurses and midwives are the primary caregivers in maternity wards, particularly in public facilities.
Dr Kagiso Tukisi of the Society of Midwives of South Africa said midwives played a central role in maternity care.
“If respectful maternity care is going to be implemented successfully, midwives must be the ones guiding and driving it. However, systemic challenges, like staff shortages and infrastructure constraints, also need to be addressed.”
Dimakatso Sebopa, deputy general secretary for operations at the Democratic Nurses Organisation of South Africa (Denosa), called the results shocking, but said staffing shortages often made it difficult to provide adequate care.
“In some maternity wards, there may be only two midwives on duty looking after many women in labour. That is not acceptable, and has a direct impact on the quality of care.”
Several attendees noted that if the findings reflect only Gauteng and KwaZulu-Natal, the scale of obstetric violence nationally could be far greater.
A continental crisis, experts warn
In fact, a recent discussion among legal and human rights experts has revealed just how widespread this is across the whole of Africa, reports Jurist.
In a webinar organised by Human Rights Watch (HRW), which included panellists Achieng Orero, a Kenyan lawyer who leads the Initiative for Strategic Litigation in Africa (ISLA); Melinda Mugambi, a member of KELIN’s strategic litigation team; and Skye Wheeler, a senior researcher at HRW, some alarming insights were revealed.
A report by HRW – No Money, No Care, focusing on obstetric violence in Sierra Leone and based on 140 interviews – showed a pattern of “widespread, dangerous” abandonment, neglect, and verbal abuse mostly linked to informal payments”.
Due to a lack of public funding, informal cash payments are often solicited in government facilities for services, drugs, and other commodities, including in an obstetric emergency.
One woman, whose son was born at Sierra Leone’s Princess Christian Maternity Hospital (PCMH) in 2023, said she abandoned for two hours while in labour, as her husband tried to collect funds from their community. Despite delivering the baby, she said, “I heard the baby, but then it died.”
Mugambi said Africa has the world’s highest maternal mortality rate, accounting for 70% of global maternal deaths, with a regional average of 442 deaths per 100 000 live births in 2023.
While this marks a decline from 727 deaths per 100 000 live births in 2000, it remains five times higher than the Sustainable Development Goals (SDG) target of 70.
Despite various solutions to address the problem in Africa, like the adoption of the Convention on Ending Violence Against Women and Girls by the African Union, and ACHPR Resolution 625 by the African Commission on Human and Peoples’ Rights, to develop guidelines on the elimination of obstetric violence and promotion of maternal healthcare in Africa, the record-high maternal mortality rate is concerning.
Orero said the courts in Kenya often avoid the term obstetric violence. Instead, the language used is “respectful maternal healthcare, mistreatment, and negligence”, which she says undermines the scale, severity, and gendered dynamics of abuse experienced by women and girls during pregnancy, birth, and postpartum.
This means the courts will only partially address the issue of obstetric violence on a case-by-case basis, substantially diluting the effectiveness of seeking legal remedies.
Diana Pignaa, a midwife in Ghana, had seen a woman being beaten and verbally abused by a midwife, purportedly due to the woman’s lack of co-operation. The baby died after delivery.
While maternal care in her hospital had since made some progress after the management “cautioned” its staff about beatings and insulting maternal patients, she said no legal action was taken against the midwife.
She said this type of treatment has been normalised in Ghana, and suggested the government should train and re-train healthcare providers adequately on obstetric violence and respectful maternal care.
Her recommendation aligns with a proven model in Tanzania, which has successfully reduced maternal mortality by 80% in seven years, from 556 deaths per 100 000 live births in 2016 to 104 per 100 000 in 2022.
Tanzania’s success, achieved through expanded Emergency Obstetric and Newborn Care facilities, more healthcare workers, and a stronger referral network, serves as a model for other African countries.
See more from MedicalBrief archives:
Mothers call for probe into obstetric violence at state hospitals
Obstetric violence must be recognised as endemic in SA
Abuse of women by healthcare professions demands urgent intervention
HIV-positive women sue KZN Health for ‘forced sterilisations’