“When I first started working here, and a pregnant woman would tell me she was beaten up the day before, I would feel down and shocked. Eight years later, I am used to hearing these stories.”
So says Liesl Hermanus, a counsellor at the Perinatal Mental Health Project based at the University of Cape Town.
Every week, she meets woman who are struggling with their mental health during pregnancy, and often in the mix are women who are being abused.
Her work provides a human glimpse into that fine line between what’s “normal” and what’s “common” – a fragile thread that still runs through South African society more than two decades after apartheid.
Pushed to the edge by poverty, unemployment, previous abuse and food insecurity, pregnant women in South Africa often have very little to celebrate.
Now, an alarming new study has lifted the curtain on the numbers and nature of the abuse being experienced by women who carry the next generation within them.Just published in the international BMC Women’s Health Journal, the study was carried out by a team from the University of Cape Town and the University of Waterloo, Canada.
The results – based on a sample of 376 women presenting at an antenatal facility – that: 15% are experiencing violence while pregnant.
Of those, a staggering 76% had experienced physical abuse during pregnancy, while 81% had experienced emotional and verbal abuse during pregnancy.
Of those experiencing intimate partner violence (IPV), 58% were unemployed and 62% were food-insecure.
Those who had experienced abuse before pregnancy were four times more likely to experience it during than pregnancy than those who hadn’t, and those who were not pleased with their pregnancy were twice as likely.
Also alarming is that women might have non-violent partners, but then still experience violence from other people in the household while pregnant.
In the qualitative component of the research, it came to light that 55% of those experiencing violence were doing so at the hands of someone else in the household.
Nosipho Langa (not her real name) was a client at the Perinatal Mental Health Project who received counselling.By the time she was 19, her stepfather had been raping her for four years.
She got used to being told by her mother every day: “You are nothing”, and when she fell pregnant by her stepfather, things went from horrific to even worse.
She also discovered through her clinic visits that she was HIV-positive and, when her stepfather found her medication in her bag, he called her a “whore”.
She said: “Through Liesl, I could look at my options and started thinking I can change things in my life.”
According to researchers Sally Field, Michael Onah, Thandi van Heyningen and Simone Honikman: “Perpetrators included fathers, stepfathers, uncles, brothers, grandmothers and brothers-in-law,” while many saw violence as “normal behaviour”.
Common it is. Normal it is not.
And the long-term consequences cannot be overestimated.
“When there is intimate partner violence, it puts women and girls at risk of depression and anxiety. And it can go the other way as well,” says Hermanus, “when they experience violence they are at higher risk of anxiety and depression.”She said she had found that physical violence is “quite common”, as are “emotional and verbal abuse”.
Another form she heard of often from clients was “economic abuse – men withholding money from their partners to buy groceries or if they know they have an appointment at the clinic or for upkeep like toiletries”.
She said clients sometimes missed crucial appointments because they were reliant on their partners for money but were given none for transport.
Where to from here?  The researchers say the study contributes towards a greater understanding of the risk profile for IPV among pregnant women in low-income settings.