I’ve noticed on the VBAC Facebook page that there are a lot of South African women looking for VBAC— and just plain VAGINAL— birth resources. It’s not surprising considering that the South African cesarean rate is 70% in private hospitals.
There are some fascinating older studies that look at health care disparities as a result of institutionalized racism in South Africa, including this 1998 study which concluded:
In fact, there is growing evidence that discrimination might also have a direct effect on the health and health care of different ‘racial’ groups, because poverty alone cannot explain the differences in health observed among different ‘racial’ groups. For example, there are clear differences in caesarean section rates between women from different ‘racial’ groups, irrespective of their socioeconomic and medical characteristics. In fact, caesarean section rates provide an ideal opportunity for identifying bias in medical decision-making, because a variety of nonclinical factors, including ‘race’, have been found to influence the prevalence of caesarean sections at different health facilities and among different physicians.
A 2007 study examined the inhumane and abusive treatment of South African women in labor and concluded that the quality of state hospitals needs to improve:
In South Africa, the quality of care for women during childbirth could be improved: women are often left alone for long periods during childbirth, and in some instances women are shouted at, struck, or slapped. Staff are under stress due to lack of resources, and this demoralises the work force. However, women will not use a service they judge to be of poor quality, and choosing not to deliver in a health facility can compromise maternal and foetal outcomes.
Here’s what I’ve found. Please add to this list in the comments, even if it’s just your contact information as a midwife, doula, childbirth educator or vaginal birth friendly doctor.
MotherInstinct is a site run by a woman named Elsabé which appears to have mostly natural birth-type resources.
Birthing in Awareness is a list of links and services, including doctor and midwife recommendations, assembled by Rosalia.
Little Footprints Planet has a short list of birth and breastfeeding links.
As far as national or international organizations seeking to eliminate or reduce harmful childbirth practices from a human rights/social justice perspective in South Africa, there don’t seem to be many, especially in a country in which lack of access to medical care is an issue contributing to maternal mortality and preventing the spread of HIV/AIDS is top priority.
The cesarean surgery page on the Atlas of Birth site probably sums the polarized situation up best:
In nearly all countries rich women have a much higher percentage of caesarean births than poor women, so even if the national average seems adequate, poor women may still be unable to access this life-saving intervention. In some countries you find both excessively high rates amongst the rich women suggestive of over-intervention, alongside an unacceptable low rates – suggesting high unmet need – amongst the poorest women.
According to USAID, “South Africa has excellent maternal and child health policies. However, implementation is weak and South Africa is only one of a few countries in the world where under – 5 mortality is increasing. Unless this situation changes, South Africa will not achieve millennium Development Goal number 4 or 5.”