Hundreds of pregnant women and girls are dying needlessly in South Africa, partly because they fear their HIV status may be revealed if they access antenatal care services, according to a major report published by Amnesty International today.

There were 1,560 recorded maternal deaths in 2011 and 1,426 in 2012. More than a third of these deaths were linked to HIV. Experts suggest that 60 per cent of all the deaths were avoidable.

Struggle for Maternal Health: Barriers to Antenatal Care in South Africa, details how fears over patient confidentiality and HIV testing, a lack of information and transport problems are contributing to hundreds of maternal deaths every year by acting as barriers to early antenatal care.

Amnesty International Secretary General Salil Shetty said:

'It is unacceptable that pregnant women and girls are continuing to die in South Africa because they fear their HIV status will be revealed, or because of a lack of transport or basic health and sexuality education. This cannot continue. “The South African government must ensure all departments work together to urgently address all the barriers that place the health of pregnant women and girls at risk.'

Antenatal care is free in South Africa’s public health system. However, Amnesty’s research found that many women and girls do not attend clinics until the later stages of their pregnancy because they have been led to believe that the HIV test is compulsory. They fear both the test and the stigma of being known to be living with HIV. Nearly a quarter of avoidable deaths have been linked to late or no access to antenatal care.

Worryingly, these fears are not without foundation. Amnesty’s report, based on field research conducted in Mpumalanga and KwaZulu-Natal provinces, contains testimonies from women and girls who said that health care workers openly discuss HIV test results with others.

'The nurses are talking about people and their status,' a woman from KwaZulu-Natal explained.

Amnesty also found that several clinics it visited used processes for pregnant women and girls living with HIV that disclosed their status, including separate queues for antiretroviral medication, different coloured antenatal files and different days for appointments.

'[I]f I go for antiretroviral, my line is that side. All the people in this line they know these people are HIV. That’s why people are afraid to come to the clinic,' one woman in Mpumalanga told Amnesty International.

'During antenatal care, if women come out of the counsellor’s room with two files, then everyone knows they are HIV positive,' said another woman.

Women and girls said they feared discriminatory treatment even from partners and family members as a result of testing positive for HIV, and that HIV-related stigma remained a problem in many communities.

Salil Shetty added:

'While HIV testing is an important public health intervention it must be done in a manner that respects the rights of women and girls and does not expose them to additional harm. It is deeply worrying that the privacy of pregnant woman and girls is not respected in health facilities. The South African government must take urgent steps to correct this. It is vital that health care workers in South Africa receive additional training on providing quality care that is both free of judgement and stigma and that women and girls accessing sexual and reproductive health services are able to trust that their confidentiality will be respected.'

Lack of information about sexual and reproductive health

Also identified in Amnesty’s report is a lack of information and knowledge about sexual and reproductive health and rights increases risks of unplanned pregnancies and HIV transmission, especially among adolescents. Likewise, women and girls are often unaware of the importance of early antenatal checks.

Persistent problems relating to transport

The report also documents the lack of progress made in KwaZulu-Natal and Mpumalanga to ensure that women and girls can physically access health services. Problems persist relating to shortages of public transport and poor road infrastructure. The roads in some areas visited by Amnesty are in such poor quality that they become impassable when it rains.

Even when it is dry, ambulances will not go beyond a certain point on some roads. Amnesty documented the same problems in both provinces in a 2008 report.

Salil added: 'The South African government must build better road networks in these rural provinces to guarantee access to healthcare facilities. The government must also ensure that ambulances are always available to transport those who are in need.'

Amnesty International is also calling on the government to:

Ensure that all health system procedures uphold patient privacy, particularly for people living with HIV.

Improve knowledge about sexual and reproductive health and rights, including through comprehensive sexuality education that involves men and boys.

Urgently address the persistent lack of safe, convenient and adequate transport, and the poor condition of transport infrastructure.

Additional information

This report builds on Amnesty’s 2008 report, ‘I am at the lowest end of all’ Rural women living with HIV face human rights abuses in South Africa, in which the organisation documented gender, economic and social inequalities as barriers to health care for women with HIV. ENDS

For more information or to arrange an interview please contact Amnesty International UK’s press office: Eulette Ewart 020 7033 1548, eulette.ewart@amnesty.org.uk

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