Oblivious: The report found that mistreatment has become so normalised that two-thirds of those abused did
not recognise their treatment as abuse. Photo: DC Studio

In South Africa, one of the most vulnerable and intimate experiences for women — childbirth — has become a site of systemic abuse. 

A staggering 60% of individuals who have given birth in KwaZulu-Natal and Gauteng over the past decade have experienced some form of obstetric violence, according to the 2025 Extents and Nature of Obstetric Violence in South Africa survey by Embrace, The Movement for Mothers. 

That figure represents roughly 1.79 million women and birthing people subjected to abuse during one of the most critical moments of their lives. 

“The 1.79 million abused individuals represent a public health and human rights crisis. The normalisation of obstetric violence at these levels signals deep-rooted structural, cultural and institutional failings in maternal healthcare.”

The findings reveal not just isolated misconduct but deep-rooted structural, cultural and institutional failures in the country’s maternal healthcare system.

KwaZulu-Natal stands out with particularly high rates of abuse. Researchers link this to chronic resource constraints, weaker oversight in rural health facilities and the persistence of hierarchical, authoritarian models of care that leave patients disempowered. 

Gauteng, despite being better resourced, demonstrates systemic failures across public and private facilities.

“It was a painful experience for me; I’d rather die than go back to that hospital. I even tried to escape because of the pain and the things they did to me. When I tried to
leave, security took me back and shouted at me for escaping,” recounted one survivor. 

“There was this doctor who said I’m a dustbin and she cannot keep a dustbin in her hospital. They put a balloon to open my womb but it left me in pain and bleeding, which is why I even tried to escape.”

The Embrace birthing survey paints a stark picture of mistreatment. About a quarter of respondents who experienced abuse reported that procedures were performed without their consent, including C-sections, episiotomies, sterilisation and the controversial “husband stitch”. Wikipedia describes a husband stitch as a surgical procedure in which one or more additional stitches than necessary are used to repair a woman’s perineum after it has been torn or cut during childbirth.

Physical abuse, such as being slapped, pinched, scolded or humiliated, affected roughly 14% of survivors. One in 10 reported that their newborns were mistreated or injured, highlighting unsafe obstetric practices that extend beyond the birthing person.

Abuse was more prevalent in KwaZulu-Natal. Women in the province were almost twice as likely to be slapped, pinched or scolded compared with Gauteng and were also more likely to be denied pain medication. 

However, the violation of consent during procedures was similar across both provinces, suggesting a systemic disregard for autonomy. 

“It is shocking that, in both provinces, close to four in 10 individuals who were abused were not given an explanation or asked for their consent before a procedure was undertaken,” the report states. 

Episiotomies were the most commonly performed procedure without consent, reported by 42% of respondents, while many were pressured into interventions they did not want.

One survivor described the lasting impact on her trust in the healthcare system. 

“It affected me to a point that I don’t want to give birth at a government facility again. It made me hate government clinics. They were so rude and the mistreatment made me blame myself for not having medical aid. The experience led to anger issues and made me resent the health facility where I was mistreated.”

Verbal and emotional abuse was pervasive as well. 

Nearly three in five respondents experienced disrespect or belittling comments, while more than two in five were shouted at or insulted. Emotional abuse, while less visible than physical mistreatment, can cause long-term psychological harm and undermine trust in
health services. 

“Young, single or low-income birthing individuals were disproportionately affected,” the report said. “They often face discrimination, moral policing and judgemental attitudes from healthcare providers, which reinforce systemic inequalities.”

The report found that mistreatment has become so normalised that two-thirds of those abused did not recognise their treatment as abuse.

Most of the abuse occurred in government hospitals, reflecting both the patient volume and the institutional culture. In KwaZulu-Natal, 94% of reported cases occurred in government hospitals, compared with 87% in Gauteng. 

Private hospitals reported far fewer instances of abuse — 4% in KwaZulu-Natal and 5% in Gauteng. 

Clinics presented a more nuanced picture: in Gauteng, 7% of abuse
was reported in clinics versus just
1% in KwaZulu-Natal, probably because of urban reliance on clinic-based deliveries. 

Across the facilities, survivors recounted being ignored during active labour, insulted or belittled, while private facilities pressured individuals into unwanted procedures, revealing a pervasive disregard for patient autonomy.

Nurses emerged as the primary perpetrators, responsible for three-quarters of reported cases. Mid-wives accounted for 17% and doctors for 14%. 

While doctors’ abuse was less frequent, it often involved procedural coercion, non-consensual surgeries or violations of reproductive rights. 

In KwaZulu-Natal, doctors were implicated in 17% of abuse cases, compared with 12% in Gauteng, reflecting pressures such as staff shortages and reliance on junior or temporary personnel. 

Embrace stresses that mistreatment by nurses and midwives is not simply individual misconduct but a symptom of overburdened, under-supported work environments. High patient-to-provider ratios, burnout, hierarchical pressures and outdated training models contribute to the recurring patterns.

Yet the abuse often goes unreported. Nine out of 10 survivors did not report their experiences and two-thirds did not even recognise that what happened to them constituted abuse. 

Fear of retaliation, trauma, shame, normalisation of abuse, unclear reporting channels and family discouragement all contributed to silence. 

“Even if reporting mechanisms exist, they are often inaccessible, unsafe or mistrusted. For accountability to work, women need clear, safe and confidential complaint systems, protection from retaliation and community education to recognise obstetric violence as unacceptable,” the report said.

The consequences of obstetric violence are profound and enduring. Mental health impacts, including anxiety, trauma and depression, affected 39% of respondents. 

Physical recovery was complicated for 34%, 22% reported impacts on sexual health and 46% said the abuse influenced their decisions about future pregnancies. 

More than half of respondents refused to return to the same facility, while 46% reported fear of interacting with healthcare services. Seven percent said their newborn was injured, 2% reported infant disability and 3% experienced the loss of
a child.

Provincial trends reflected structural differences. Gauteng saw higher rates of psychological harm, with survivors reporting anxiety, trauma and mistrust of the health system, while KwaZulu-Natal’s cases were more often linked to physical sequelae, surgical errors and disability, revealing deeper structural weaknesses in the province’s maternal care.

The findings of the report highlight the urgent need for trust-building in healthcare, integrated mental health support, robust accountability systems and the enforcement of respectful maternity care standards.

The report calls for urgent, multilevel action to end obstetric violence in South Africa. This includes fully implementing the 2024 national integrated maternal and perinatal care guidelines, with an emphasis on dignity, informed consent and privacy; establishing patient-rights and ombudsperson offices in all facilities; and ensuring that those responsible for abuse are held accountable. 

“Strengthening the health system requires increased funding, recruitment and retention of skilled maternity staff, improved supervision
and continuous training in respectful, trauma-informed care,” the report said. 

Empowering women and communities through rights education, guaranteed birth companions and community advocacy is critical. “Finally, improved data systems
and targeted research is needed to track respectful care, monitor patient experiences and test innovative, patient-centred models of maternity care.”

“My self-confidence has been completely destroyed,” one survivor said. “I am even disabled in my genitals, I have lost my identity and I am still heartbroken because I don’t know what will happen when I meet a man.”

Another survivor shared, “Not being able to ask questions when I wanted made me feel like I was going to lose my baby because I didn’t understand why she was connected to pipes or in the NICU [neonatal intensive care unit]. I thought it was normal for healthcare workers to make decisions on my behalf; I didn’t know that I was being mistreated.”