A new study indicates that the experience of childbirth for many women in the provinces of KwaZulu-Natal and Gauteng was accompanied by humiliation, verbal abuse, physical violence, procedures conducted without consent, and a feeling of helplessness.
According to the 2025 Birth Survey conducted by Social Surveys Africa for Embrace, Movement for Mothers, and DG Murray Trust, it is estimated that 1.79 million women born in KwaZulu-Natal and Gauteng between 2015 and 2025 faced various forms of obstetric violence.
This figure accounts for approximately 60% of all women who gave birth in these two provinces over the ten-year period. The study was based on household interviews with 845 respondents across 24 districts in six municipalities in both provinces, and the results paint a disturbing picture of women's experiences when seeking maternal healthcare.
Obstetric violence describes a wide range of physical, verbal, and emotional treatment that occurs during pregnancy, labor, delivery, or in the process of maternal care. The study found that women reported screaming, insults, humiliation, neglect, and rough treatment.
Some participants recounted being slapped, pinched, or humiliated, while others described medical procedures being performed without their consent. Data analysis showed that women who experienced obstetric violence reported an average of four incidents during labor, suggesting that it was often a series of different forms of mistreatment rather than a single event.
More than a third of women stated that a procedure was performed against their will, either because consent was not sought or due to pressure. Episiotomies accounted for about four out of ten such procedures. For a woman in labor, it is critically important not only the medical justification for the procedure but also whether she was informed, understood what was happening, and if her consent was respected.
One of the most striking findings was that many women did not recognize their experience as violence. Bhekisisa reported that only one in three women who experienced mistreatment recognized that they had been treated improperly. Furthermore, only 7% reported their experience, meaning that the vast majority of incidents never became official complaints.
For women who have heard for years that mistreatment is part of life, screams or humiliation during childbirth may not immediately be perceived as something they have the right to challenge. Rachel Juuks, a research specialist at the South African Medical Research Council who has spent decades researching obstetric violence, noted that women may have low expectations regarding quality of care because they face violence in other areas of their lives. This leads to a cycle where mistreatment can become normalized and thus difficult to measure or challenge.
The latest study raises an uncomfortable question: why do women continue to describe similar experiences decades after researchers in South Africa began documenting obstetric violence? Juuks participated in some of the earliest studies in South Africa on violence and mistreatment during childbirth almost 30 years ago. Nevertheless, the latest survey contains evidence analogous to what was documented previously, including reports of women being hit, screamed at, and shamed during labor.