South Africa maternity care abuse affects millions yearly
New data on obstetric violence show that an estimated 1.79 million women who gave birth in KwaZulu-Natal and Gauteng over the past decade experienced mistreatment, according to a report by the DG Murray Trust and Adopt. The findings cover two of South Africa’s most populated provinces, including both urban and rural health facilities. Researchers calculate that the 1.79 million affected women represent about 60% of all deliveries in the region during that period.
The figures reveal that roughly 490 women face disrespectful or abusive care each day. This means 12 out of every 20 births in the two provinces involve some form of obstetric violence. Only a third of those women recognized the mistreatment as wrong, and just 7% reported the incidents to health authorities. In practice, this leaves 11 out of 12 cases unreported and unaddressed by the system.
Multiple forms of abuse were nearly equally common. Physical slaps, verbal shouting, and emotional belittling often occurred together, with respondents describing an average of four separate incidents during a single labor. Analysts estimate more than 7.7 million individual mistreatment events over ten years, averaging about 2,100 incidents daily across the two provinces.
The health department has announced an online training course on respectful maternity care, set to launch on September 22 via its Knowledge Hub platform. The three-lesson program, lasting approximately 3.5 hours, will be available for self-paced completion. Deputy director general for maternal health Fikile Ndlovu stated that the course will become mandatory for all staff in maternity settings, from security personnel to doctors. She emphasized that respectful care begins with the attitudes of all officials.
A persistent issue remains the denial of birth companions. The survey found that 75% of women were not allowed a support person during labor, while 40% reported no privacy barriers, such as curtains, between birthing areas.
Procedural consent violations also emerged as a significant problem. Over one-third of respondents said a medical intervention was performed without their prior agreement, with episiotomies accounting for about four-tenths of these cases. These findings align with earlier research from the late 1990s, indicating that entrenched attitudes have persisted despite decades of advocacy.
Researchers attribute the persistence of obstetric violence to leadership failures. A 1998 study by the South African Medical Research Council identified the same patterns, slaps, verbal abuse, and unconsented procedures, yet no structural changes followed. Julie Mentor of Adopt described the issue as having become normalized, with even grandmothers now viewing abuse as an inevitable part of childbirth. She said survivors often hear abuse framed as an accepted tradition.
