Right after she gave birth to her second child in a hospital in the Virginia suburbs, Martha Cameron’s doctor said to her, “Are you sure you don’t want your tubes tied?” As a woman living with HIV/AIDS, Cameron is no stranger to medical personnel treating her differently and poorly, whether that be in the U.S. or in her native Zambia. At last week’s roundtable discussion on maternity care for women living with HIV, hosted by CHANGE, advocates discussed how disrespect and abuse towards women in the maternal and reproductive health care world contributes to the HIV/AIDS epidemic.
Women who experience disrespect and abuse during childbirth are less likely to seek skilled health care in the future, advocates said, and those problems run deep within the maternity services of many countries. According to a recent paper published in The Lancet, disrespect and abuse ranges “from shouting and scolding, to slapping and pinching, to abandonment of patients, discrimination, and non-consented interventions.”
Non-consented interventions include forced sterilization of women living with HIV/AIDS, said Beirne Roose-Snyder of CHANGE. Forced sterilization of women living with HIV is more of the norm rather than the exception, as well as women living with HIV being forced to use certain contraceptives. In an article published in IPS, one woman described how after being diagnosed with HIV, reproductive health workers encouraged her to undergo tubal ligation because they didn’t want to waste hormonal contraception on her, preferring to give priority to women who were not infected with HIV.
African women are prepared from a young age to be strong during childbirth, Cameron, who is an ambassador for the Elizabeth Glaser Pediatric AIDS Foundation, said. “In Zambia, you don’t have a choice but to go to government hospitals where there are two people caring for 20 women,” she said. “And we are told they will be mean and they will shout at you,” she added. Because the capacity of the health care system will not change “unless you build three more hospitals and train 200 nurses,” traditional birth attendants should be trained and empowered to care for all women, she said.
Faced with the probability of abuse and the possibility of coerced medical interventions, many African women seek care elsewhere and put themselves at greater risk for mortality and complications during childbirth while putting their children at greater risk of acquiring HIV as well.
Advocates said local systems and traditional structures need better capacity, and maternal and reproductive health programs should train nurses and counsel them on stress management. Better integration of family planning, HIV/AIDS, and maternal health services would be more efficient for health care systems and would cause less strain and stress for healthcare workers, advocates said.