How South African women’s HIV status impacts the obstetric care they receive

“Some women talked about feeling supported by nurses and having positive birth experiences,” Weber said. “But we also heard powerful stories about mistreatment. For instance, a few women shared that they had to give birth without any assistance, even having to catch their own babies. These stories raise questions about the efforts of clinics and hospitals to better support pregnant women living with HIV; in some cases, the support isn’t actually there.”

This qualitative study arose out of efforts led by Pellowski since 2015 to help keep South African women living with HIV engaged in antiretroviral treatment and annual checkups across the perinatal period. Pellowski and Weber have been collaborating with a team in South Africa, with interviews led by Zanele Rini, a research assistant at the University of Cape Town.

“Women are often really engaged in care during pregnancy, with health care visits focused on monitoring the baby,” Weber said. “But after the baby is born, the attention shifts and there might only be one postpartum visit. It’s easy for women to fall out of care at that point. Dr. Pellowski has been exploring how to support women through that transition from pregnancy to postpartum, keeping them engaged in their own health care.”

As part of Pellowski’s longer-term project, researchers conducted a series of interviews with women during pregnancy and postpartum to understand the challenges they face. 

“In the postpartum interviews, we asked for general reflections on how their births went,” Weber said. “Through these conversations, stories of obstetric violence emerged, even though we hadn’t directly asked about it. Women began sharing their experiences, not because we specifically asked about mistreatment, but simply because they were reflecting on the births of their children.”

Weber suggests that addressing the stigma around HIV will be a long process. However, thanks to effective antiretroviral therapies, people living with HIV are leading lives similar to those with other chronic conditions. As the symptoms of HIV diminish over time, the associated stigma may lessen, leading to improved health care interactions.

In terms of directly mitigating obstetric violence, Weber says one actionable policy change would be to allow a support person, like a partner or family member, in the birthing room. “Currently, this option is often restricted due to privacy concerns, as multiple people might be giving birth in the same space,” she said. “But having a known support person present can really help counteract any mistreatment and ensure the birthing person has an advocate.”

Weber points out that the health care system in South Africa is underfunded and understaffed, especially in lower-income areas. “The clinics we looked at serve communities in former township areas with low socioeconomic status, where resources are stretched thin and patient needs are high,” she said. “This is a significant structural challenge that will take time to address.”

While researchers have identified the obstacles to better care, the challenge now lies in overcoming them. “Researchers need to communicate findings effectively and work with policymakers to translate research into action,” Weber said. “Science alone isn’t enough; it has to partner with policy.”