Stop Making Excuses’: Accountability for Maternal Health Care in SA

This report is based on research conducted between August 2010 and April 2011. During this period, Human Rights Watch researchers interviewed 157 women who received maternal health services, or accompanied other women seeking such services, in Eastern Cape public health facilities over the past five years, and observed health facilities in Eastern Cape Province. In addition to interviewing other experts, Human Rights Watch also reviewed laws, policies, official health strategies, and reports by academics, national and international organizations, and United Nations agencies.

Human Rights Watch visited 16 health facilities (clinics, community health centers, and hospitals providing maternity services) in O.R. Tambo, Amatole, and Nelson Mandela Metropolitan Municipality districts in Eastern Cape Province. These districts had the highest maternal mortality ratios in the province in 2008 and 2009.1 The National Department of Health listed Amatole and O.R. Tambo districts (among others in Eastern Cape) among the “18 priority districts” in the country with poor health outcomes and in need of health service delivery improvements. Human Rights Watch interviewed women individually and in small groups. Most group interviews involved four to six women, but others were larger. Almost half of those interviewed in groups were community care givers that interact closely and regularly with
women needing health services and with health workers. As a result, they were able to relay experiences of other maternity patients in the communities they serve. Nongovernmental organizations (NGOs) providing services to women and individual advocates assisted Human Rights Watch in identifying women and families to interview. Interviewees also referred other women to Human Rights Watch. Human Rights Watch interviewed thirty nurses—mostly working in maternity units—and four emergency medical services staff (three drivers and a supervisor), quality assurance officials, facility managers, and managers in maternity units. This is in addition to maternal health experts, staff of NGOs working on health and women’s rights, an official with a professional association for nurses, representatives of international donors and UN agencies, and government officials at the national, provincial, and district levels.