One woman waited 1 1/2 hours at the hospital, only to see a nurse who yelled that she was "lying about being in labor." Three hours later, her baby was stillborn. Another woman gave birth on the street, steps away from a clinic that twice turned her away, saying her time had not come.
South Africa's maternal mortality rate has quadrupled while most African countries have improved theirs, according to a scathing report released Monday by the New York-based Human Rights Watch.
The report says some of the increase _ to more than 4,500 maternal deaths a year _ could be the result of better reporting and a massive HIV/AIDS rate that has 18 percent of South Africans infected, some 5.7 million people. But the group says the health indicator also has worsened because of a lack of accountability, corruption and poor health care.
For example, at least three South African hospitals are being investigated for baby deaths including one where 29 babies died within a few weeks in January, apparently from a superbug. The hospital had no gloves, disinfectant spray, soap or toilet paper.
Several other women recalled nurses telling them to "shut up" during labor, saying they had enjoyed the sex that made them pregnant so they should not complain about labor pains.
"All South Africa's good intentions, policies and strategies on paper won't save women's lives without strong accountability systems to make sure policies are carried out," Agnes Odhiambo, the chief researcher for the HRW project, told The Associated Press.
South Africa spends the most on health per citizen in sub-Saharan Africa at $748 a year, and has infrastructure and expertise unrivaled on the continent. Maternity care is free, abortion is legal, and there is a system of confidential inquiries to assess levels and causes of maternal deaths.
Almost 87 percent of women give birth in hospitals or clinics, though several women told HRW they were avoiding government facilities because of widespread stories of ill-treatment.
Yet between 1998 and 2007, the maternal mortality rate leapt from 150 to 625 deaths for each 100,000 live births. That means South Africa, sub-Saharan African's economic powerhouse, has no hope of meeting the U.N. millennium development goals that require 38 deaths per 100,000 births by 2015.
South African Health Minister Aaron Motsoaledi told reporters he agreed with some findings in the report and that officials are "painfully aware" of the problems. But he added that he has been working for more than two years to lower maternal deaths.
Human Rights Watch interviewed 157 women, many nurses and community caregivers as well as health officials between August 2010 and April 2011. Researchers visited 16 health facilities, all in Eastern Cape province, though the report emphasizes that officials acknowledge the problems are nationwide.
The report quotes witnesses saying HIV-positive women are denied care or given it too late. It quoted the mother of one such woman who went to a community health center where the nurse said the baby was dead and called for an ambulance to take her to a hospital.
They did not treat the woman while she waited for an hour, bleeding. As she walked to the ambulance, the stillborn baby came out.
"The ambulance people did not assist her. She got into the ambulance with the baby stuck in her trousers and she was still bleeding. She stayed that way for many hours at Dora Nginza, with the dead baby, without help," the mother says in the report.
A week after delivering the stillborn baby, the daughter was still ill. A doctor ordered blood tests and X-rays and told a nurse she was in critical condition. They waited six hours for a nurse who took her blood pressure and left. Shortly after, she died.
Like most victims, her mother did not complain.
The report does not identify interviewees by name, for fear of repercussions. But one victim, Ethiopian Ruta Araya, agreed to speak about the abuse she suffered when she was admitted to Dora Nginza Hospital in 2008, seven months' pregnant with high blood pressure.
She said nurses "swore at me and insulted me," telling her to go back to her own country _ an attitude reflecting xenophobia in South Africa. A doctor who ordered a scan told her "he couldn't see anything, that I wasn't even pregnant."
She appealed to a doctor from Ghana: "I begged him, please, this doctor doesn't want to help me, they don't want to take the baby out, the baby's dying in my tummy."
The Ghanaian persuaded her doctor to operate. Fifteen days after her admission, Araya gave birth to a one-kilogram (2.2 pound) baby girl. Even in the operating room, the doctors joked that her baby would be so small they would put it in a shoe box.
Nurses refused to change her bandages from a Cesarean section unless she paid bribes, causing the wound to turn septic and painful.
"I'm 28 years old but I feel like a 50-year-old woman, I can't even pick up my own baby ... I don't know when I will feel young again."