Obstetric Violence in Sub-Saharan Africa: Addressing Maternal Care Abuse and Systemic Failures

In August 2013, Josephine Majani, a mother of three from Bungoma County in Kenya, endured an appalling birth experience. Despite her desperate cry for help during labor, hospital nurses ignored her plight. Struggling to walk to the labor ward amid excruciating pain, she discovered that all the beds were occupied. With no alternative, she was forced to give birth on the cold concrete floor.

Majani’s ordeal did not end there. The attending nurses subjected her to verbal and physical abuse, even compelling her to carry her placenta back to the labor ward. Seeking justice for this traumatic experience, she turned to Kenya’s judiciary. In February 2024, Kenya’s Court of Appeal upheld an earlier High Court decision in her favor—a ruling that came six years after the initial judgment and eleven years after the incident.

Her story sheds light on obstetric violence, a widespread but underreported form of abuse in maternal healthcare across Sub-Saharan Africa. This case underscores urgent systemic failures that allow such mistreatment to persist, raising critical questions about the state of maternal care in Kenya and beyond.

The Silent Epidemic of Obstetric Violence

Obstetric violence, as defined by the United Nations Special Rapporteur on Violence Against Women, encompasses verbal and physical abuse, neglect, non-consensual medical procedures, and unlawful detention for unpaid medical bills during childbirth. It is a gender-based violation of women’s rights to health, dignity, autonomy, and freedom from cruel, inhumane treatment.

Despite its prevalence, obstetric violence remains underreported, earning it the label of a “silent epidemic.” Data on the issue is sparse even globally, limiting understanding of its true scope. Where data does exist, the findings are alarming. For instance, 20% of women in Kenya report mistreatment during childbirth—a figure mirrored in countries like Tanzania, Ghana, Nigeria, and Ethiopia. Given the lack of comprehensive statistics, the actual rates are likely higher.

Addressing obstetric violence requires a multifaceted approach, including increased research funding to illuminate its prevalence and nuanced solutions tailored to specific countries.

Abuse and Neglect Across the Region

Kenya:
Even with initiatives like Linda Mama, which offers free maternity services, Kenya’s public hospitals remain chronically underfunded, understaffed, and overwhelmed. Reports indicate that approximately one-third of adolescent mothers experience stigma or abuse from healthcare workers, with 10% suffering outright neglect during childbirth.

Although Kenya’s Constitution guarantees the right to the highest attainable standard of health (Article 43(1)(a)) and the Maputo Protocol affirms women’s rights to dignity and health, implementation remains weak. Josephine Majani’s court victory, while a step forward, underscores the systemic obstacles women face when seeking justice.

Uganda:
In Uganda, one of the most egregious forms of obstetric violence is the detention of women post-delivery for failing to pay medical fees. This practice not only violates international human rights laws but also highlights the systemic inequalities in access to maternal care. With a maternal mortality rate of 375 deaths per 100,000 live births, women—especially in rural areas—face compounded risks from inadequate healthcare access.

Despite ratifying international human rights instruments, Uganda struggles with enforcement, leaving countless women vulnerable to mistreatment.

Nigeria:
In Nigeria, chronic underfunding of the healthcare system exacerbates obstetric violence. In 2024, Nigeria allocated just 4.47% of its national budget to healthcare, falling far short of the 15% target set by the Abuja Declaration. High maternal mortality rates and widespread mistreatment during childbirth remain stark reminders of systemic inadequacies.

While the African Commission on Human and Peoples’ Rights acknowledged the gravity of Nigeria’s maternal health crisis in a 2024 decision, aligning these efforts with international human rights standards remains a critical challenge.

The Systemic Drivers of Obstetric Violence

The persistence of obstetric violence is rooted in intersecting systemic issues:

1. Weak Accountability Mechanisms:
   Healthcare systems often lack oversight structures to prevent and address mistreatment. This allows abuse to continue unchecked, particularly in resource-constrained settings.
2. Societal Norms:
   Deeply entrenched gender inequalities marginalize vulnerable women, especially those from rural or impoverished backgrounds.
3. Resource Deficits:
   Chronic underfunding of maternal healthcare leads to overwhelmed facilities, inadequate staffing, and insufficient training, creating environments where abuse thrives.

Strategies for Addressing Obstetric Violence

Combatting obstetric violence requires a multi-pronged approach:

1. Strengthen Accountability:
   Ombudsman systems should be established in hospitals to provide women with transparent, impartial avenues for reporting mistreatment. This model, effective in countries like Malawi, could be adopted in Kenya, Uganda, and Nigeria.
2. Legal Advocacy:
   Strategic litigation, like Josephine Majani’s case, plays a pivotal role in setting legal precedents and compelling governments to address systemic violations.
3. Enhance Research and Data Collection:
   Governments and international bodies must prioritize funding for research to accurately capture the prevalence and drivers of obstetric violence. Such data is essential for crafting targeted, effective policies.
4. Increase Healthcare Investment:
   Nations must align with international commitments, such as the Abuja Declaration, by allocating adequate resources to maternal healthcare. This includes addressing staffing shortages, improving infrastructure, and providing essential medical supplies.
5. Training Healthcare Workers:
   Mandatory training on respectful and dignified maternity care is essential to curb abuse and ensure adherence to human rights standards.

A Path to Dignity

The battle against obstetric violence is not just about improving healthcare systems—it is about affirming women’s fundamental rights to dignity, respect, and safe maternal care. Governments across Sub-Saharan Africa must translate human rights commitments into actionable reforms that prioritize the well-being of mothers.

Ending obstetric violence requires a collective commitment to systemic change, driven by accountability, advocacy, and investment. Only then can women like Josephine Majani give birth in environments that honor their humanity rather than degrade it.

AR Managing Editor (2024). Obstetric Violence in Sub-Saharan Africa: Addressing Maternal Care Abuse and Systemic Failures. Retrieved from https://www.africanresearchers.org/obstetric-violence-in-sub-saharan-africa-addressing-maternal-care-abuse-and-systemic-failures/