JOHANNESBURG Aug. 10, 2011 -- South Africa may be the only country in the world with a national public holiday celebrating the achievements of women. "Women's Day" is a celebration of the protest 55 years ago when 20,000 women took to the streets to fight oppressive apartheid laws.
But activists say women in South Africa are still fighting for some basic human rights, none more so than the right to safely give birth.
A new Human Rights Watch Report says in Sub-Saharan Africa's most developed country, many expectant mothers are living in peril due to inadequate health care.
The scathing report, "Stop Making Excuses: Accountability for Maternal Health Care in South Africa," chronicles scores of stories of pregnant women who were either mistreated, or in some cases not treated at all at government hospitals, resulting in needless health complications or death for themselves or their babies.
"We hoped that the awareness surrounding women in South Africa around Women's Day would raise the profile of issues related to maternal death and also injury related to pregnancy," Liesl Gerntholtz the director for the women's rights program for Human Rights Watch told ABC News.
Unlike other Sub-Saharan African countries South Africa enjoys some level of professional healthcare and health workers. The country spends $748 a year per citizen on healthcare, more than any other country on the sub-continent and includes free maternity care. An estimated 87 percent of women have babies in a hospital or clinic.
But nurses, who are the first line of defense in care at government hospitals, complain about being overworked, and under-resourced. That frustration, according to the report, is transferring to the treatment of patients.
Discrimination against immigrants and HIV positive women is a particular problem. Abeba M., an Ethiopian immigrant, talked of having a difficult pregnancy turn dangerous by neglectful and abusive nurses.
"The nurses swore at me and insulted me," she said in the Human Rights Watch report. "Now you are saying you are sick and next year you will come with another pregnancy. This is not a place to enjoy or be on holiday," she remembered the nurses saying to her. After her procedure she was forced to clean up her own blood on the floor.
"The women we interviewed that were migrants and refugees talked about being called names and being denied services because they were foreign," said Gerntholtz.
Other women told stories of being pinched, slapped and chastised for being pregnant. Several told Human Rights Watch that nurses yelled at them during labor with taunts about how they enjoyed conceiving the baby so they had "no right" to complain about the pain of giving birth.
The report is not just about mean nurses. The unprofessional behavior is translating into an increase in deaths.
South Africa's maternal mortality rate has quadrupled over the last few years, to now being more than 4,500 maternal deaths per year.
Human Rights Watch acknowledges that the increase could be the result of better record-keeping and South Africa's continuing HIV/AIDS epidemic.
But the report points to factors hospitals can control, such as corruption and accountability. Three hospitals are currently under investigation for high infant mortality rates. One hospital was found to not be using gloves, disinfectants or soap, and 29 babies died last January from an apparent superbug.
South Africa's Health Minister Aaron Motsoaledi told reporters that the government realizes nurses and hospital staff are under tremendous pressure, and are often working in difficult circumstances, but that the health system has to do better.
"The nurses adopted the nurses pledge about the conduct of nurses. It was the rule under the nursing council that all of them must adopt that pledge," said Motsoaledi. "I told the nurses we are going to take action once [problems] have been reported," he said.
Gerntholtz says the South African government has been very receptive to the report and is committed to instituting changes at a national level, but she hopes that commitment will trickle down to the local healthcare facilities, where these expectant mothers in peril often end up.