Obstetric Violence & Colonial Conditioning in South Africa's Reproductive Health System

This dissertation outlines the relationship between obstetric violence, and colonial era conditioning. Examining South Africa’s post-1994 public health system, I argue societal norms, political-economic arrangements, health systems, and their policies, have established structural violence which generates and spreads a continuum of violent practices within reproductive health services. The rationalisation and obfuscation of violence against Black women throughout the colonial and apartheid periods, including coercive contraception protocols, indexes more than simply gender-based violence in health services. I propose a theoretical underpinning: obstetric structural violence to explain what I argue is a particular type of violence against women. I interrogate the systematic violation of sexual and reproductive health rights enacted by health systems, resulting in: 1) non-consensual constraint of reproductive autonomy, 2) preventable maternal and neonatal disability, 3) mortality. Part 1 analyses the colonial conditioning that led to health services becoming constitutive of racial, and gendered structural violence. Historical stereotypes of sexuality are linked to rationalisations of contemporary obstetric violence. Examining the political-economy of the democratic period, Part 2, demonstrates how constant reform and limited power undermine low-level managers capacity to ensure the functioning of accountability, thereby propagating obstetric violence. Drawing on extensive qualitative fieldwork within seven primary–tertiary hospitals, I describe how routine, as well as episodic, physical and psychological forms of direct obstetric violence are pervasive. I argue these outcomes prove the connection between obstetric violence, adverse health, and obstetric malpractice, a fact often absent from related literature. Lastly, I argue the resultant case law and individual awards from obstetric malpractice for incurred patient harms, encourages the invisibility of obstetric, and obstetric structural violence.