A recent discussion among legal and human rights experts has brought to light the alarming levels of obstetric violence in Africa, a crisis that contributes to the continent’s disproportionately high maternal mortality rates. The findings, presented during a virtual panel, underscore the urgent need for systemic reforms in maternal health. This article was co-authored by Divyabharthi Baradhan (JURIST employee, Malaysia) and Lana Osei (JURIST employee, Ghana).
On January 28th, Lana and Divya had the privilege of attending one Webinars organized by Human Rights Watch (HRW) with a focus on obstetric violence in African countries. The webinar highlights the inhumane and violent treatment of vulnerable women in maternal health care, a crisis that requires urgent attention and systemic change.
The panel consisted of Achieng Orero, a Kenyan lawyer who chairs the panel Strategic Litigation Initiative in Africa (ISLA); Melinda Mugambi, Member of KELIN’s strategic litigation Team; and Skye Wheeler, senior researcher at HRW.
Obstetric violence (OV) is characterized as the mistreatment of women during childbirth, including physical abuse, verbal abuse, humiliation, forced or non-consenting medical interventions, refusal to provide painkillers, neglect during childbirth and detention of women and newborns in case of unpaid medical fees.
According to the World Health Organization (WHO), respectful care for mothers is important defined as “person-centered care organized and provided for and with all women, gender diverse people, newborns, parents and families during the pregnancy, birth and postpartum period. It prioritizes dignity, protects against harm and abuse and ensures the freedom to make informed decisions.” The various forms of OV are far below this standard.
Wheeler presented The latest report from HRW: “No money, no worries“, with a focus on OV in Sierra Leone. The report was based on 140 interviews and concluded that there is a pattern of “widespread, dangerous” neglect, neglect and verbal abuse, most often linked to informal payments. Due to a lack of public funding, government facilities often require informal cash payments for services, medicines and other goods, including in an obstetric emergency.
Rights groups such as Transparency International Global Health take into account informal payments as a bribe “if it occurs before a medical procedure and the health care provider is proactive.” asks for them, or if it involves cash or expensive items.”
Emma, who gave birth to her son near Sierra Leone Princess Christian Maternity Hospital (PCMH) in 2023 shared her harrowing experience: “(The hospital) only focused on those who had money, and because I lacked money, I had to suffer.” She was abandoned for two hours during labor as her husband tried to raise money from the community. Even though she gave birth to the baby, she said, “I heard the baby, but then it died.” She attributes her baby’s death to the poor treatment she received at PCMH. Emma’s story is a tragic example of how poverty and systemic neglect can have fatal consequences.
Purpose emphasized that Africa has the highest maternal mortality rate in the world and accounts for about 70 percent of maternal deaths worldwide Deathswith a regional average of 442 deaths per 100,000 live births in 2023. While this represents a decrease from 727 deaths per 100,000 live births in 2000, it is still five times higher than the Sustainable Development Goals (SDG). Goal of 70. Mugambi also noted that other forms of OV, while not fatal, are equally harmful and are often underreported.
Although Africa has the highest maternal mortality rate, women in other countries face similar cruelty, such as: Malaysia, IndonesiaAnd India. A study in Indonesia linked OV to the cultural characteristics of a region. For example, in the Indonesian context, in some local cultures such as: Such a tribeBecause of the tribe’s belief that hard work makes childbirth easier, pregnant women are forced to work in the fields and do heavy labor.
Despite various solutions to address the problem in Africa, such as the introduction of the Convention to End Violence against Women and Girls from the African Union and ACHPR Resolution 625 The record high maternal mortality rate is deeply worrying.
According to Achieng, courts in Kenya often avoid the term obstetric violence. Instead, the language used is “respectful healthcare, maternal abuse and neglect,” which they say undermines the extent, severity and gender dynamics of abuse experienced by women and girls during pregnancy, childbirth and the postpartum period. This means that the courts will only partially address the issue of obstetric violence on a case-by-case basis, significantly reducing the effectiveness of the search for remedies.
JURIST employees too asked a question to the panel: How does strategic litigation work in the context of ongoing conflicts in various African countries, such as Sudan and the Democratic Republic of Congo (DRC)? What challenges did you face in this work?
Addressing the question, Achieng said litigation in conflict zones is generally quite difficult due to the complete breakdown of judicial systems and the government implementing court decisions once they are made. She added that there are organizations on the ground documenting the incidents of violence observed throughout the conflict. Legal proceedings before regional courts can also offer solutions that are not possible in domestic courts. She also noted that one potential area of exploration is litigation in regional courts to seek some sort of compensation in the event of ongoing conflict.
In addition, JURIST staff interviewed Diana Pignaa, a midwife based in the northern region of Ghana, about her experiences with obstetric violence in her workplace. Diana, who has been in practice for over seven years, shared her experience of witnessing a pregnant woman being beaten and verbally abused by a midwife, allegedly due to the woman’s lack of cooperation. Diana added that the baby died after delivery. According to Diana, maternal care at her hospital has since made some progress after management “warned” staff against beatings and insults towards maternal patients. However, no legal action was taken against the midwife.
Diana agreed with the staff that this type of treatment had become normal in Ghana. She suggested that the Ghanaian government should adequately train and retrain healthcare providers in obstetric violence and respectful maternal care. She also stated that the government should hire more staff as, in her opinion, a nurse who has to manage a heavy workload tends to pass on her frustration to pregnant women. Diana also reiterated the need for patient-centered policies and greater awareness of OV.
Interestingly, in 2020 a study The study, conducted in Ghana, found that midwives interviewed had “demonstrated some awareness of respectful maternal care, but their support for disrespectful and abusive practices such as hitting, pinching, and implicit blaming of childbearing women for mistreatment suggests a discrepancy between awareness and practice of (respectful maternal care).”
Diana’s recommendation is consistent with a proven model in Tanzania that has proven successful reduced Maternal mortality has increased by 80 percent 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 (EmONC) facilities, more health workers and a stronger referral network – serves as a model for other African countries.
Violence during childbirth is a violation of human rights and a public health crisis. Without strong local governance, accountability and systemic change, women and babies will continue to suffer. Africa and the world must prioritize respectful and dignified care for mothers to end this cycle of abuse.
The opinions expressed in JURIST Dispatches are solely those of our local correspondents and do not necessarily reflect the views of JURIST editors, staff, donors or the University of Pittsburgh.
