A key focus of work in the field of safe motherhood has been on increasing deliveries in medical facilities with access to skilled birth assistants and emergency obstetric care. In many places more and more women are reaching clinics to deliver. However, there has been too little focus on the quality of services, on the capacity of health centres to provide care to all who need it, and training of staff to provide timely, skilled and compassionate care.

Stories of women dying preventable deaths and enduring serious injury in health facilities demonstrate that accessing a hospital is not enough if the health professionals women depend on for their care are callous, negligent or corrupt.

By sharing these true stories of women who were injured or died during childbirth we hope to shine a light on what is happening in sub saharan Africa.

Case 1
This woman is languishing in hospital after losing both her baby and her uterus and rupturing her bladder while trying to give birth. Three months previously she was rushed to hospital after she failed to deliver her six-pound baby.

According to her best friend, on arrival at this referral hospital, she was not attended to as the medics on duty said the theatre was closed for the day and there was not much they could do. With the baby halfway out, she had to bear the pain till midday the following day when the by-then dead baby was removed.

By that time her uterus had ruptured and also had to be removed, while her bladder muscles were so damaged that she can no longer control the flow of urine or stools. Although she was sent home after the ordeal, she had to return three weeks ago after her condition worsened.

She needs urgent surgery, and a nurse on duty said she was on the list for surgery. Meanwhile, she is experiencing a lot of pain in her abdomen, private parts and legs.

She does not understand why she can’t be operated on in the hospital. According to her friend, doctors said that she would need to pay (equivalent to USD 1,223) for the operation. Often, such cases are transferred to other areas.

Case 2

When the contractions started at dawn. this woman, a primary school teacher, knew it was time, so she did what was expected – checked into a hospital at 6am so she could give birth with expert attention at her disposal. But that was not to be. For more than 10 hours after she checked in, she was ignored, neglected and writhing in pain in the labour ward until 8pm when she breathed her last.

Her crime? She did not have the money (equivalent to $US122) the medical staff demanded before they would attend to her. So she wasted away as her husband ran desperately around the village to raise the money. It was only the hospital cleaners who tried to help remove the baby from her womb.

A neighbour, who had helped to transport her to the hospital, said she and the woman’s husband could not raise the money as they had spent the little money they had to purchase surgical equipment. “When I came back, I found her in pain, crying, there was no help. The medical workers looked on as they asked for money,” the neighbour added.

After three hours of waiting and sensing that the woman’ s condition was deteriorating, the neighbour approached a midwife and asked her to attend to her but the midwife and a doctor allegedly also declined. “At about 6pm, she started gasping; she fell on the floor and was bleeding.”

That was when the doctor responded and took her into the theatre, but it was too late; her life could not be saved and she died.” The doctor emerged from the theatre after about 10 minutes and announced that both the mother and her baby had died.

The woman had been going with her husband for antenatal check-ups at the hospital and the midwives had told them the baby was big, and that it would be difficult for her to have a normal birth, and they had apparently recommended a caesarean section. Causes of death were obstructed labour, uterine rupture and haemorrhage.

A complaint was filed with the police and the doctor was being investigated for neglect. The police surgeon who carried out the autopsy said this was not the first case at this hospital; many women had died in labour due to neglect.

The district police commander said he had summoned the medical staff on duty that night and day to furnish evidence.

However, the hospital director said at the time of the woman’s death, there was another woman in the operating theatre and that it had been inadvisable to halt that operation.

“And in any case,” he said, “it is not the patient who asks for theatre but we examine the patient and recommend.

“Doctors on duty examined her and by the time they recommended her for theatre she had already ruptured her uterus… She was bleeding and we could not save her life. I can’t rule out the issue of [staff] asking for money. Some staff do it but we need to investigate this further because it has no proof.”

He said the people who operated on her to remove the baby were not hospital workers but imposters who had sneaked into the hospital.

Case 3

The woman died after giving birth and failing to expel the placenta for several hours. She had called for the help of the nurses on duty, according to eye witnesses, but got no attention. In an interview with the local newspaper, the doctor on duty said that after the call, he had rushed to the hospital to save the situation but it was already late to save her life. He denied the claim that the woman died out of negligence because an unqualified hospital staff member had helped her instead.

The district chair said serious action must be taken against the implicated health workers to serve as a warning, as negligence in hospitals is forcing women to visit traditional birth attendants.

Case 4

An expectant mother of five died aged 37 in the regional referral hospital soon after being admitted.

Not even the simplest effort was made to help her. The doctor was raised on the phone to come and attend to her, but she kept saying that she was too tired to come that night and that she would attend her the next day.

The next morning, however, no one attended to her till she met her death. When she asked for help, the midwives were shouting at her, and the poor women fell off the bed due to severe labour pain.

She died with her baby still in the womb. As one enters the maternity ward at this hospital, there is a smell of death and fear among the expectant mothers.  death has left many of them wondering if they will survive delivering in the hospital.

Though these stories are sent from sub-Saharan Africa, they are a perfect echo of the case studies from India in Reproductive Health Matters’ May issue on Maternal Mortality in which discrimination and neglect led to preventable deaths .

In India human rights law has been used for the first time to bring compensation to the family of a woman who died a preventable death and to enshrine the principle that a woman has the right to lifesaving treatment during and after childbirth .

In Uganda, human rights organisations and families of women who died in childbirth are filing a landmark lawsuit to hold the government accountable for maternal deaths ; while in Latin America landmark decisions by the committee on the elimination of discrimination against women (CEDAW) have called for appropriate maternal health care, in Brazil, and decriminalisation of abortion to safeguard women’s health in Peru .

To read more about how people are using the law and human rights conventions to commit governments to improving maternal health care see May’s issue of Reproductive Health Matters Maternal Health and Maternal Mortality: rhetoric vs reality.

Lisa Hallgarten is the social media manager at Reproductive Health Matters; sexual health trainer, educator and blogger at Education For Choice; and advocate for better sex education for all young people.