Address gender-based violence in maternal care

Lazarus Sauti

Disrespect and abuse in maternity care is an institutionalised form of gender violence, and this abusive care during delivery is directed at women’s sexuality, their reproductive role, as well as their capacity to make decisions regarding their own bodies.

It targets women when they are least powerful and most vulnerable, and negates their autonomy over their bodies.

“Disrespect and abuse of pregnant women in health facilities take in physical abuse, non-consented clinical care, non-confidential care, non-dignified care (including verbal abuse), discrimination based on specific patient attributes, abandonment of care, and detention in facilities,” said Marian Ndimani, a maternal health care researcher.

She added: “There is mistreatment of pregnant women in most maternity facilities as health care providers sometimes beat them or use harsh words among other forms of abuse, and women who experience violence during their pregnancies potentially face a number of complications to maternal and newborn health.

“Studies have shown that violence against pregnant women is associated with increased likelihood of miscarriage, still-birth and premature labour.”

An HIV activist, who requested anonymity, says pregnant HIV positive and negative women are also treated differently.

“Some maternal health care workers are still stigmatising HIV-positive women. Despite all the campaigns and awareness programmes on HIV/AIDS, they still mistreat them simply because they are HIV-positive,” said the activist.

Miriro Chitengu, a resident from Budiriro suburb in Harare, believes she was violated as she was detained in the maternity facilities of one of the biggest public hospitals in the capital simply because her husband failed to raise the needed fees in time for her to be discharged.

Women in Zimbabwe and other southern African countries are disrespected and abused on a daily basis in maternity wards, and this violence – as with other forms of gender-based violence – is an extension of existing structural inequalities.

Disrespectful and abusive behaviors are often a by-product of stressful working conditions, as (often female) healthcare workers are overworked in a health system that is frequently understaffed and strained for resources.

Many facilities also have poor ambulance services or none at all whilst others work in amenities that lack sufficient space and supplies – one facility had no water, another had no toilets, and yet another had problems with electricity.

Grace Mushambadzi, a women’s rights activist, says disrespect and abuse during childbirth not only echoes other forms of GBV, but also contributes to women’s underutilisation of skilled delivery services, which can negatively impact women’s health.

She also said promoting respectful and dignified maternal health care is central to upholding human rights and improving the provision of women’s healthcare.

“Women in Zimbabwe and other southern African states experience a range of disrespectful and abusive behaviour at the hands of the health system: including, physical abuse, disregard for privacy, and unfair requests for payment.

“Accordingly, promoting respectful maternal health care is critical if we are to stop gender-based violence in maternal care,” she said.

Women activist, Dr Fatima Lamishi Adamu, in her paper titled ‘Relationship between Gender Based Violence and Maternal Mortality in Africa’, noted that domestic violence is rampant in maternal care in most African states, and also urged individuals, Governments and other stakeholders to adopt a systematic model that suggests effective interventions to eliminate the problem.

She added that tackling GBV in all its forms also requires the government to go beyond individual-level interventions to address the structural contexts and power inequalities that enable gender-based violence and disrespect and abuse during childbirth to occur in the first place.

“Health sectors and workers in Africa can and should adopt human-rights based approach and to go beyond individual-level interventions if the continent is to break the silence around violence against women, especially in maternal care,” Dr Adamu said.

Another researcher, Tsitsi Mutasa, says maternal care workers, just like other health care workers, are life savers; therefore, they should be friendly to pregnant women as they deserve love, care, respect and protection.

She also said stakeholders should not only promote the adoption of supportive policies to address gender-based violence and raise awareness of the connection between gender violence and other key health priorities, but work to eliminate the occurrence of gender-based violence in facility-based maternal care.

“While many interventions aim to improve access to skilled birth care, less attention has been focused on the quality of such care. This calls for the government, local and international non-governmental organisations as well as civil sector players to join hands and promote respectful maternity care for all women during pregnancy, childbirth, and in the time after birth,” she said.

Gender and human rights advocate, Heath Nhandara believes to effectively promote gender balance and the right to human dignity as enshrined on by Section 17 (gender balance) and 51 (right to human dignity) of the Constitution respectively, the country needs to eradicate gender-based violence in maternal care.

“The Constitution, particularly Section 51, provides that “every person has inherent dignity in their private and public life, and the right to have that dignity respected and protected.

“All stakeholders in the country, thus, need to clearly label the problem of gender based violence in maternal care for what it is and begin to address the underlying power imbalances if women’s rights to dignity are to be effectively protected and promoted,” he said.