Despite generations of life-saving work in rural communities, traditional birth attendants continue to face discrimination and legal obstacles more than 30 years into democracy.
In the remote villages of the Eastern Cape, where the nearest healthcare facility can be a gruelling 15 km walk away, indigenous midwives have quietly served as lifelines for pregnant women for generations. Yet despite their crucial role in maternal care, these traditional practitioners remain relegated to the shadows of the country’s formal healthcare system.
This troubling reality has been highlighted by University of the Western Cape researcher Happyness Nokwatu Raselabe, whose recent study exposes the deep-rooted discrimination faced by indigenous midwives and other traditional health practitioners across rural South Africa.
Speaking at the inaugural Scholarship of Learning and Teaching Conference at UWC earlier this month, the master’s student in forensic linguistics painted a stark picture of a healthcare system that pays lip service to traditional knowledge while actively undermining those who practice it.
“South Africa’s policy framework half-heartedly recognises these community practitioners while simultaneously demonising them,” Raselabe argued, pointing to legislation that continues to cast traditional healers in a sinister light.
Colonial laws still casting shadows
At the heart of this discrimination lies an outdated piece of colonial legislation: the Witchcraft Suppression Act of 1957. More than three decades into democracy, this law continues to criminalise aspects of traditional healing, branding practitioners as “witch doctors” and implying harm rather than recognising their legitimate healing work.
The impact of such legislation extends far beyond legal technicalities. In her research across rural Eastern Cape villages, Raselabe documented numerous cases where the life-saving interventions of indigenous midwives were treated as illegal acts rather than medical emergencies.
One particularly striking case involved a woman who gave birth to twins on the side of the road after receiving assistance from a local indigenous midwife. The first twin was delivered normally, while the second was in a dangerous breech position with the umbilical cord wrapped around her neck. Despite the successful delivery that likely saved both lives, the midwife faced reprimand from healthcare workers upon arriving at the clinic.
“She was allegedly warned ‘not to do it again,’” Raselabe recounted. “The life-saving intervention was treated as an illegal act rather than an act of care.”
Dangerous journeys for basic care
Such incidents highlight the harsh realities faced by rural women seeking maternal healthcare. Raselabe’s research revealed that pregnant women in remote areas often undertake dangerous journeys – including crossing overflowing rivers – simply to access prenatal and postnatal care.
“Women were forced to travel under dangerous conditions in search of healthcare,” she noted, emphasising how indigenous midwives frequently become the difference between life and death in these communities.
Yet their contributions remain largely unacknowledged by the formal healthcare system, creating a troubling paradox where those providing essential emergency care are viewed with suspicion rather than gratitude.
International recognition vs local resistance
The disconnect becomes even more pronounced when viewed against international standards. The World Health Organisation has outlined clear guidelines supporting the integration of traditional and Western medicine through its Traditional Medicine Strategy 2025–2034, which promotes universal access to safe, people-centred traditional and complementary medicine.
South Africa’s own National Health Act of 2003 promotes a unified healthcare system and guarantees access to treatment, including free services for pregnant women and children. However, as Raselabe pointed out, this legislation falls short when it comes to recognising indigenous practitioners.
“The Act only gives formal recognition to Western-trained professionals such as doctors and nurses,” she explained. “This effectively places traditional health practitioners outside the mainstream healthcare system.”
Policy contradictions and regulatory gaps
The contradictions within South Africa’s legal framework are glaring. While the Traditional Health Practitioners Act of 2007 finally provides legal recognition for traditional practitioners, including indigenous midwives, significant implementation challenges remain.
Raselabe warns that the absence of properly functioning regulatory councils represents a major obstacle. The single Interim Traditional Health Practitioners Council tasked with overseeing diverse categories of traditional practitioners is simply inadequate given the various disciplines involved in traditional healing.
“If we speak of decolonisation and, as a country, claim to recognise indigenous knowledge systems, why do we still have laws that contradict each other?” Raselabe questioned. “And why does the National Health Act still fail to recognise indigenous midwives?”
A path forward through collaboration
Rather than continuing to operate in separate silos, Raselabe advocates for closer collaboration between traditional health practitioners and Western-trained healthcare workers. She particularly criticises the current one-sided referral system, where only traditional practitioners refer patients to Western doctors.
“This imbalance reflects the lack of trust in traditional practitioners by some healthcare workers, which is deeply problematic, especially in rural areas where hospitals are often 30 to 50 kilometres away and difficult to access,” she said.
Her recommendations include repealing discriminatory laws such as the Witchcraft Suppression Act, properly implementing and regulating the Traditional Practitioners Act, and actively encouraging collaboration between traditional and Western healthcare sectors.
The cost of continued marginalisation
As South Africa grapples with ongoing healthcare challenges, particularly in rural areas, the continued marginalisation of indigenous midwives represents both a moral failing and a practical oversight. These practitioners possess generations of accumulated knowledge and maintain deep community trust – assets that any healthcare system should embrace rather than reject.
The question facing policymakers is whether South Africa will continue to perpetuate colonial-era prejudices or finally embrace the integrated approach to healthcare that both international best practice and local necessity demand.
For the women walking those dangerous 15 km journeys to reach formal healthcare, and for the indigenous midwives standing ready to help them, the answer cannot come soon enough.
