Global leaders must act urgently to ensure that safety and dignity in pregnancy and childbirth become automatic, integral parts of the maternal health care experience of all women.
On 18 September 2020, a harrowing video appeared on Twitter. It showed a woman, Jackline Faustina, giving birth on the road outside Nairobi’s Pumwani maternity hospital. The woman, it was said and later confirmed by city authorities, had been denied entry into the hospital. It was the second day of a ‘go-slow’ industrial action by hospital staff.
Nairobi Metropolitan Services (NMS), the city agency in charge of delivering essential services to residents of Kenya’s capital, released a statement saying it “regrets the incident”. But an apology doesn't fix the problem. Neither does the public outcry that follows such incidents.
Far too often, women suffer abuse and violence while giving birth. Tragically, these traumas have only increased during the COVID-19 pandemic. openDemocracy is documenting childbirth experiences during the pandemic. Since mid July alone, we have received stories from women in 19 countries recounting trauma, neglect and abuse.
A woman from Bukavu, Democratic Republic of the Congo, told openDemocracy that “the health of women in general has been completely violated: no water, no soap, to wash their hands in the markets”. She said healthcare resources and attention have been concentrated on fighting COVID-19 at the expense of expectant mothers.
Before asking women to send us their stories online, openDemocracy reporters interviewed women around the world and identified cases of “traumatic” childbirth experiences in at least 45 countries.
A 31-week pregnant woman in Venezuela had a stillbirth and a hysterectomy after she waited for hours, bleeding in a plastic chair, to be seen by a doctor who turned her away from a public hospital. The woman and her relatives told openDemocracy that the hospital’s haematologist had been off sick since the lockdown began on 17 March, and the blood bank was closed, making transfusions impossible.
When these stories are made public, outrage from sympathetic onlookers ensues, especially on social media. Women leaders hold press conferences and issue press statements demanding better. Powerful organisations and individuals who have the money and authority to prevent these abuses acknowledge reported abuses. Better is promised.
Like a wash and rinse cycle, it repeats at the next reported incident of abuse. This cycle suggests a tacit understanding that the violence, neglect and abuses women suffer in childbirth are inevitable. But are they?
Last month, Nairobi authorities reportedly dismissed Pumwani hospital nurses’ concerns about unpaid wages, insurance cover and lack of personal protective equipment, thereby triggering the go-slow action that led to Faustina being turned away at the hospital’s gates.
These nurses typically earn about KSh48,000 ($442) a month, with no insurance, housing or transport allowances. When they sought to renegotiate their terms, they were reportedly told to “go to the media” – as they had allegedly done before. This was a reckless dismissal of legitimate labour concerns, for which Faustina paid with her dignity.
No political will, no accountability
“What saves women’s lives and protects them from harm is political will,’’ says health rights campaigner Asia Russell, director of Health GAP (Global Access Project), an international advocacy group dedicated to ensuring all people with HIV can access life-saving medicines.
In too many parts of the world, politicians are simply not driven to tackle the problems affecting maternal health. “Why aren’t they?” you might wonder. Russell told me this is “because people who die from these preventable causes are often seen as expendable”.
It doesn’t help that politicians are not held accountable for their failings. In countries such as Kenya and Uganda, governments and charities from the global north could help to change this; after all, they foot much of the bill for the maternal health services that do exist.
Many domestic laws and regional treaties could also be used to hold authorities to account. For example, human rights lawyers have said that maternal deaths resulting from African state action and negligence violate the Maputo Protocol and some domestic laws.
However, as Russell points out, “the reality is, donors have been unwilling to spend their political capital [on] Sexual, Reproductive Health and Rights (SRHR), unsafe abortion and maternal deaths.’’
Instead, people with power, and access to scarce resources, seem to rehearse outrage, condemning reports of abuse before quickly slipping back into apparent docility, while women’s rights continue to be assaulted.
‘What saves women’s lives and protects them from harm is political will’
Maternal health rights are often depoliticised by those with policy-making powers, who seem to insist on framing them only as services from the state rather than inalienable rights violated by the politics of the day. But those who oppose these rights highly politicise them and get their allies to invest political capital in backlash to them.
Kenya is currently debating a reproductive healthcare bill that seeks to address various reproductive health risks, including sexually transmitted infections, HIV, unsafe abortion and unplanned pregnancies.
The bill has come under heavy fire from conservative religious groups within the country, but it has also faced opposition from Western ultra-conservative Christian groups such as Madrid-based CitizenGo.
Western aid donors, however, have mostly been silent observers, instead of making a strong political case for the bill, which promises a policy fix for some of the maternal health problems their funding addresses.
Local policy-makers should also politicise their outrage. Take an unblinking look at the fatal cost of moralising women’s bodies within sexual and reproductive rights and health legislation and practice. Allocate resources in a way that ensures equal access to quality healthcare for all women, irrespective of social class.
Send adequately trained and paid health workers where they are needed. Pay attention to fair labour practices in public health facilities.
The social narrative that motherhood is ‘sacred’ and that ‘our’ mothers should be respected is useless without the material means in place to ensure pregnancy and childbirth are safe and dignified for all women.