When Isabel realized she was going to be a mother, she thought that childbirth could be one of the happiest acts of her life. But her dream became a nightmare, marked by dark memories that time has not removed yet.

“Today, months the childbirth, I’m afraid to go to the hospital. When I think about going to the hospital, I get terrified”, she says, as she takes her son out of her lap to hand him to her cousin.

The memories of aggression, perpetrated by the nurses of Ndlavela Health Center, make her think “I wouldn’t like to have another child so soon. I don’t understand how those nurses are so bad, although they are young.”

In this series of reports that The Citizen Observatory for Health (OCS) carries out in partnership with Saber Nascer Association, in order to report cases of obstetric violence in Mozambique, the sources ask for anonymity for fearing reprisals. Therefore, the names present here are fictional. 

Isabel’s childbirth service initiated in the midnight. Hours before the service, the midwives, with arrogant attitude, warned the patient to “tie capulanas.”

“By tying capulana, they mean that the parturient must pay some money for the assistance”, she explains.

She was laying on sheets full of dried blood. It wasn’t her blood. Certainly it was from another parturient who had been there days before. Noticing the presence of blood, before the start of childbirth service, she used her capulana to cover it.

“At night, or in the absence of the medical nurse, midwives mistreat parturients. They respect the medical chief, who is totally against all these practices, but unfortunately she does not work at night”, she lamented.

In the middle of the night, while walking inside the maternity ward, she had the signs that the moment had arrived. She leaned on the bed and cried out for help, but it was intentionally slow.

“I was standing but I rested by myself in bed to start the childbirth service”, she said.

One of the nurses, from a distance, badly gazed at Isabel resting in bed and making effort to get the baby out on her own.

“She looked at me, calm. That was my first childbirth time and I didn’t know how to behave” she states, in a house somewhere in Matola City.

“While I was in pain, the nurse looked at me and asked how much I had to pay.”

In the maternity room, another nurse was sleeping in a corner. Her sleep was so deep that the next day she woke up and asked her colleague wanting to know if the childbirth took place.

“I could have lost my baby”, she says.

“As the pain increased, the nurse looked at me. At moments like these, you can’t do anything. They know we are psychologically and physically down. We just want to have our son.”

“She didn’t want to help me in the childbirth service without being promised some money. A girl before me paid 200 meticais. I didn’t have any money.”

She started striking her

Facing this situation, Isabel promised to pay 200 meticais to the nurse, similar to other parturient who was by her side, but the nurse refused. Negotiations have risen to a thousand meticais. Just then, we closed the deal. Sense I didn’t have any money, I told the nurse that my husband would bring it next day.”

In addition to the pains of childbirth, caused by the effort she was making to bring the baby out, she was feeling, on the other hand “the pain of the nurse’s hits. She should help me instead of hitting me.”

“This all traumatized me, but somehow I wasn’t surprised because, during the check-up days, that nurse was treating me badly0.”

The next day, in the morning, the nurse was willing to lend Isabel her cell phone so she could call her husband, asking him to go to the hospital with 1,000 meticais.

“She was just worried about the money I had promised her”, she stresses.

In the same hospital, a young woman lost her baby in front of the nurses’ helpless gaze. This type of scene can be identified in so many other health unites throughout the country. The World Health Organization (WHO) considers obstetric violence a violation of Human Rights.

Violence began before the Childbirth

At the eighth month, Lucia had complications with her pregnancy. She was in continuous pain. Sometimes, with her husband, she used to go to the hospital, thinking the childbirth would occur prematurely.

One day, in daylight, Lucia was assaulted by intense pain. She immediately went to Ndlavela sanitary unit. Her slow steps forced her to drag the feet.

Arriving at the hospital, the health professional started screaming “what are you doing here? You should stay at home and not give us work”, she remembered.

“You know, this was frequent in Ndlavela. I was scared. And it still scares me to this day”, Lucia adds.

Lucia only confirmed her suspicions.

The coldness of the nurses, their sad faces and the only concern with money frightened her.

“What matters the most to these nurses is the money. They only start to help you, and barely, when you promise them money. All parturients in Ndlavela hospital pay money to be assisted.”

Lucia is sure of two things “when a woman goes to that hospital, she is mistreated and exposed to illegal payments.”

What are the implications of this type of violence?

Camila Fanheiro, activist of the Saber Nascer Association, says that there are several manifestations of this type of violence. However, she underlines the physical and psychological violence.

One of the consequences of this type of violence is anxiety, postpartum or perinatal depression, and even psychoses. In the second case – physical violence – the woman may have uterine problems, can also develop the obstetric fistula till genital mutilation, when the “surgical” procedures of childbirth have not been correct.

“The patient needs a very thorough screening to identify the consequence of the problem. It requires the intervention of obstetricians, gynecologists. Multidisciplinary treatment is required.”

According Fanheiro, “every pregnant woman may be a victim. For obstetric violence, there is no social class, no races or ethnicities. We have women who complain of obstetric violence in private clinics, as well as in public hospitals.”

Camila Fanheiro explains, without giving numerical data, that this type of aggression is increasingly common in Mozambique and occurs because many professionals are not aligned with the recommendations of the World Health Organization (WHO) and the pillars of obstetric treatment.

“Although we know it’s a reality, we still have no evidence. We don’t have a clear study that shows the real situation of obstetric violence”, she says.

For the activist, this is a fundamental step at a time when the government does not seem to pay attention to the problem.

 “It shows that we have no entity in the country that deals with this problem. The issue is still taken for granted.”

Obstetric violence can only be overcome with greater investment, especially by investing in the training of health professionals, so that they know how to deal humanely with people.

Matola also understands that violence contribute to the dry of maternal milk

“Remember that we are in a society that does not look kindly at breastfeeding through other ways.”

In Mozambique, the state itself makes women victims of this evil, taking into account the distances that the woman must travel to have access to health.

In fact, data produced by the Ministry of Health (MISAU), indicate that, in 2014, 62% of women stated having problems to have access to health care and they also faced illegal charges.

The psychologist regrets the fact that there is not yet a psychological assistance to pregnant women in Mozambique, before and after the childbirth.

In addition to the aspects raised by the activist, it is necessary to stress the crucial urgency in the legislation investment so that these practices can be criminalized.

“We can not refuse, not even accept the existence of these cases” Director of the Health Center, Saide Omar Momade

In conversation with the OCS, the director of Ndlavela Health Center said that he is not aware of the existence of this type of problem in the institution he runs. nevertheless, he promises to investigate.

“We cannot say that it exists or not. It is novelty for us too. We have all the conditions to prevent the occurrence of these cases. We have created several complaint mechanisms, which means that parturient can report abuse.”

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