Changing the mentality of abuse towards pregnant women in health care

A number of organisations across the African continent are working hard to improve the mentality of both health care providers and patients over the taboo surrounding pain. One of the concerns is the mistreatment of women during childbirth and pregnancy where verbal or physical abuse is common.

Senegalese women at Mboune village. Respectful maternity care is a right. Across the continent, organisations are working to shift the mentality of health workers and pregnant patients who have normalised mistreatment. © RFI/Sylvain Cherkaoui

“There is this normalisation of pain. So, when one accepts that, then any form of violence endured is not felt as a mistreatment,” said Khadidiatou Tida Dansokho, the chairperson of Plus jamais ça (Never again) association.

The NGO, set up in 2020, strives to give a safe platform for women and girls to speak freely. Plus jamais ça also embarked on an awareness campaign to educate women and girls on their rights.

The organisation was present at a feminist conference, discussing the prevalent taboos affecting the well-being of women, held in Senegal at the weekend.

“Pain relief is not a privilege but a right," the NGO says, spelling out what women and girls should not accept.

For example, a curettage procedure after miscarriage without anaesthesia is not acceptable, and neither is the stitching of the perineal tear without any anaesthetic.

Doctors and midwives are widely regarded as figures of authority with women considering themselves their inferior, or in a subordinate position. This makes it very difficult for the women and girls to speak up for their rights or simply voice how they feel during any interaction with health workers.

Disrespect and abuse of women seeking maternity care is a problem so widespread that, in 2019, the World Health Organisation (WHO) developed a charter for respectful maternity care.

“A woman’s relationship with maternity care providers during pregnancy and childbirth is vitally important…women’s experiences with caregivers at this time have the impact to empower and comfort, or to inflict lasting damage and emotional trauma,” the WHO wrote in the charter.

Abuse ranges from subtle disrespect and humiliation to overt violence.

A study carried out in Nigeria showed that it is acceptable for a health worker to slap, shout or refuse to help a woman at any time during her labour or childbirth.

Plus jamais ça reports that a Senegalese midwife was instructed by the mother of a pregnant girl, giving birth for the first time, to slap her so that the girl would “cooperate” and open her legs.

Pain is normalised

“In our culture, a woman must not cry when giving birth. Her honour and that of her family is at stake there. I used to tell the mothers to stay calm and keep quiet,” said retired midwife, Florence-Marie Sarr Ndiaye.

According to the Senegalese NGO, foreign obstetric students in Ghana wrote in a report, following a residency at Aflao hospital, that the level of pain endured by the patients appeared to be of no importance for the nurses.

“We saw episiotomy [incision in the perineum] being carried without anaesthesia,” they said.

“In fact, it was not a question of lack of resources; the hospital’s pharmacy was fully supplied in drugs and equipment for local anaesthetic. But given how expensive they are, the drugs are only administered to patients who have the means to afford the high prices,” they added.

Young girls, unmarried women and victims of sexual violence are discriminated against and face obstetric violence because they do not conform to the acceptable social norms of being pregnant while being married or living with a male partner.

'Treat us with respect'

“What is your one request for quality reproductive and maternal healthcare service?”. This is the one simple question the NGO White Ribbon Alliance (WRA) asked women and girls around the world in its What Women Want campaign.

Out of its 1.2 million responses, the most pressing demand is to be treated with respect by healthcare providers.

“I would like the nurses to be patient with us and treat us with respect. They should also guide us through the process and care for us,” said one of the women who responded to the campaign.

“I want to be treated with dignity regardless of my financial status,” said Ayshatu Ayuba from Nigeria.

An interactive dashboard has been set up by WRA allowing anyone, anywhere to see exactly what women want when it comes to their healthcare.

Societies still accept and tolerate obstetric violence or abuse against pregnant women. Its eradication is a complex affair, as those perpetrating the abuse may not even recognise their actions as abusive.