JOHANNESBURG ? She waited 1 1/2 hours at the hospital, only to see a nurse who yelled that she was "lying about being in labor." Three hours later, her baby was born dead.
Another woman gave birth on the street, steps away from a clinic that twice turned her away, saying her time had not come.
Several other women interviewed by Human Rights Watch said their legs were pinched and faces slapped while they were in labor. Nurses told some to "shut up," saying they had enjoyed the sex so should not complain about labor pains.
In a litany of abuse published Monday, the New York-based rights organization describes the suffering of scores of women in South African government hospitals and clinics.
It charges the abuse puts women and their newborn babies "at high risk of death or injury."
At least three hospitals are being investigated for baby deaths including one where 29 babies died within a few weeks in January, apparently from a superbug. The hospital had no gloves, disinfectant spray, soap or toilet paper.
The report says poor governance and corruption contribute to thousands of unnecessary maternal deaths.
South Africa's maternal mortality rate has quadrupled while most African countries have cut that crucial health indicator ? from 150 to 625 deaths for each 100,000 live births between 1998 and 2007, the report says quoting government data.
That means South Africa, sub-Saharan African's economic powerhouse, has no hope of meeting the U.N. millennium development goals which require 38 deaths per 100,000 births by 2015.
The deaths continue though South Africa is doing many things right: It spends the most on health per citizen in sub-Saharan Africa at $748 a year, has relatively good access to health care, and infrastructure and expertise unrivaled on the continent. Maternity care is free, abortion is legal, and there is a system of confidential inquiries to assess levels and causes of maternal deaths.
Some 92 percent of pregnant women receive ante-natal care and almost 87 percent deliver in hospitals or clinics, though several women told HRW they were avoiding government facilities because of widespread stories of ill-treatment.
"The tragedy of maternal deaths in South Africa is that many women who eventually die have had contact with the health care system ... meaning that some of the deaths could have been prevented," Human Rights Watch says.
Officials acknowledge the problem. "We are very, very much aware ... painfully aware," Health Minister Aaron Motsoaledi told reporters. He agreed with "some" findings in the report, but added he already has been working more than two years to lower maternal deaths.
The chief researcher for the HRW project, Agnes Odhiambo, said what is most needed is accountability. "The basic issue is lack of oversight and accountability in terms of monitoring what is happening and acting on it," she told The Associated Press. "If nurses are abusive, they need to be held accountable; if people are corrupt they need to be made accountable."
And officials need to act on reports to fix systemic failures.
She acknowledged that nurses are stressed: poorly paid, overworked, understaffed and lacking equipment and supplies. Still, Odhiambo pointed to the title of the report: "Stop Making Excuses."
Human Rights Watch interviewed 157 women, many nurses and community caregivers as well as health officials between August 2010 and April 2011. It visited 16 health facilities, all in Eastern Cape province, but notes that officials admit the problems identified are nationwide.
The report says some of the increase in maternal deaths ? to more than 4,500 a year ? could be the result of better reporting and a massive HIV-AIDS rate that has 18 percent of South Africans infected, some 5.7 million people.
A government report blamed HIV-AIDS for nearly half of maternal deaths between 2005 and 2007. Without the HIV epidemic, it says, South Africa's institutional maternal death rate would match mid-income countries like Brazil. Only 9 percent of maternal deaths in sub-Saharan Africa are related to AIDS.
The HRW report quotes witnesses saying HIV-positive women are denied care or given it too late.
It quoted the mother of one such woman who went to a community health center where the nurse said the baby was dead and called for an ambulance to take her to Port Elizabeth's Dora Nginza Hospital. They did not treat the woman while she waited for an hour, bleeding. As she walked to the ambulance, the baby was born.
"The ambulance people did not assist her. She got into the ambulance with the baby stuck in her trousers and she was still bleeding. She stayed that way for many hours at Dora Nginza, with the dead baby, without help," the mother says in the report.
A week later, the daughter still was ill. At the same hospital, a doctor ordered blood tests and X-rays and told a nurse she was in critical condition. They waited six hours for a nurse who took her blood pressure and left.
Shortly after, the daughter died.
Like most victims, the mother did not complain.
In the few cases when patients and a caregiver did complain, they never got a response, the report says.
The report does not identify interviewees by name, for fear of repercussions. But one victim, Ethiopian Ruta Araya, agreed to speak about the abuse she suffered when she was admitted to Dora Nginza Hospital in 2008, seven months' pregnant with high blood pressure.
She said nurses "swore at me and insulted me," telling her to go back to her own country ? an attitude reflecting general xenophobia in South Africa.
A doctor promised Araya a scan but did not do one for 10 days, though she begged each day and was admitted twice to intensive care while her blood pressure rose.
When she finally had the scan, "he said he couldn't see anything, that I wasn't even pregnant."
She appealed to a doctor from Ghana: "I begged him, please, this doctor doesn't want to help me, they don't want to take the baby out, the baby's dying in my tummy. ... I was supposed to be operated on the day I arrived."
The Ghanaian persuaded her doctor to operate.
Fifteen days after her admission, Araya gave birth to a one-kilogram (2.2 pound) baby girl.
Even in the operating theater the doctors joked that her baby would be so small they would put it in a shoe box.
When a woman died in her ward, "The nurses were talking and laughing ... One asked me, 'Are you still alive?' And the doctor said 'Maybe you are going to be next.'"
Nurses refused to change her bandages from a Cesarean section unless she paid bribes. That caused the wound to turn septic and pain that Araya said she still suffers.
"I'm 28 years old but I feel like a 50-year-old woman, I can't even pick up my own baby ... I don't know when I will feel young again."
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