Summary
- Obstetric violence in Africa is a widespread human rights abuse during childbirth, often hidden and unaddressed.
- Legal reform and strategic litigation are critical tools to ensure dignity and accountability in maternal care.
- Ending this abuse requires cultural change, empowered communities, and systems built on respect and consent.
Labour is one of the most vulnerable moments in a woman’s life, but in many African countries, it’s also when she faces the highest risk of obstetric violence and abuse within health facilities.
Sub-Saharan Africa continues to face a staggering maternal health crisis, accounting for nearly 70% of global maternal deaths. While significant efforts have gone into promoting facility-based births and improving access to skilled care, a deeply harmful issue remains largely unaddressed: obstetric violence in Africa.
Obstetric violence refers to the mistreatment of women during pregnancy, childbirth, and postpartum care. It manifests through verbal abuse, non-consensual medical procedures, physical violence, neglect, abandonment, and the detention of women in health facilities over unpaid fees. These acts are not only unethical and harmful, but they are also violations of basic human rights, including dignity, bodily autonomy, and freedom from torture or degrading treatment.
Uncovering the roots of obstetric violence
A recent webinar hosted by the Socio-Economic Rights Project at the Dullah Omar Institute at the University of the Western Cape titled Combating Obstetric Violence in Africa: Human Rights, Dignity and Accountability in Maternal Health Care, brought together legal and health experts across the continent to examine the issue.
Aisosa Jennifer Omoruyi of the Dullah Omar Institute described obstetric violence as both interactional, tied to individual health workers, and structural, rooted in underfunded systems shaped by discriminatory norms. She noted that many women internalise mistreatment as normal, which prevents them from reporting abuse or seeking redress.
Human rights law as a tool for justice
Achieng Orero of the Initiative for Strategic Litigation in Africa highlighted the role of human rights law in tackling obstetric violence in Africa. She cited global and regional frameworks, including the Maputo Protocol, that affirm every woman’s right to respectful, safe maternity care.
She pointed to the Kenyan case County Government of Bungoma v JOO, where the court ruled that mistreatment during childbirth violated a woman’s rights to dignity, health, and freedom from cruel treatment. The case affirmed that respectful care is not aspirational, it is an immediate, enforceable right.
Litigation as a catalyst for reform
Nyokabi Njogu of the Kenya Legal and Ethical Issues Network on HIV and AIDS shared insights from litigating obstetric violence cases. Though challenging, legal action validates survivors’ experiences and exposes structural failings. Litigation, she argued, is one of the most powerful drivers of institutional accountability.
In countries like Nigeria, Kenya, Malawi, and Ghana, reports show women being slapped, shouted at, insulted, or left alone during childbirth. Some undergo procedures without consent; others are mocked for their age, marital status, or detained over unpaid fees. Adolescents, women living with HIV, and those from marginalised groups face the most severe mistreatment.
A crisis of culture and capacity
These abuses are compounded by staff shortages, crumbling infrastructure, and disjointed health policies. Some healthcare workers justify their actions as necessary for compliance or safety, a reflection of deep-rooted power imbalances and medical paternalism.
Despite growing awareness, most African legal systems still fail to explicitly recognise obstetric violence. While regional human rights bodies have acknowledged the problem, national protections remain weak. Still, court victories like the Bungoma case are paving the way for reform.
Obstetric violence is not merely malpractice—it is a matter of justice, dignity, and the right to give birth without fear.
The cost of silence
The harm is lasting. Women who endure abuse during childbirth often suffer trauma and lose trust in healthcare systems. Many opt for home births or traditional attendants, increasing risks for themselves and their babies. Without meaningful reform, maternal health targets and broader gender equity goals, will remain out of reach.
Building systems of accountability and respect
Ending obstetric violence in Africa requires more than clinical improvements. Legal systems must explicitly define and prohibit obstetric violence. Health systems must center dignity, consent, and accountability. Training must go beyond technical skills to include ethics, empathy, and communication.
Communities also need support. Women and families must be empowered with knowledge of their rights and tools to assert them. Mistreatment data must be collected and monitored. Cultural practices, like birth companions and placenta burial—should be integrated with respectful care.
Reproductive justice at the core
Strategic litigation remains key. By grounding cases in human rights law, advocates can expose systemic abuse and compel reform. Courts can set precedents that shift public discourse and policy.
As Orero stated, obstetric violence is not merely malpractice, it is a matter of justice and dignity. This is a movement for reproductive justice, a call to restore compassion, respect, and humanity to one of life’s most vulnerable moments.
Until that call is answered, maternal health in Africa cannot truly advance.
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