May 2, 2017

A recent study of the experiences of deaf women seeking maternity health-care services in Cape Town, South Africa found reports of linguistic barriers and mistreatment.

Margaret W. Gichane

Margaret W. Gichane

Margaret W. Gichane, MSPH, doctoral student of health behavior in the UNC Gillings School of Global Public Health, is lead author of the article, titled, “‘They must understand we are people’: Pregnancy and maternity service use among signing Deaf women in Cape Town.” The article was published online April 6 by Disability and Health Journal.

“My inspiration for this topic came from my mentors, Drs. Leslie London and Marion Heap of the University of Cape Town,” Gichane said. “I was paired with them through the Mount Sinai International Exchange Program for Minority Students. There are very few articles written about pregnancy outcomes and maternity service use among deaf women, and ours is the first from Sub-Saharan Africa.”

Previous research has shown that women with disabilities are at higher risk for adverse pregnancy outcomes, but limited information exists on deaf women’s experiences during pregnancy. Gichane and her co-authors were curious whether deaf women’s access to maternity health care was being compromised by language barriers related to their disability.

To learn more, the researchers interviewed 42 signing deaf women of child-bearing age in Cape Town using a structured questionnaire conducted in South African Sign Language.

They found that rates of successful pregnancies, miscarriages and terminated pregnancies in this population closely resembled rates among women in the general population of the Western Cape. Most deaf women, however, reported experiencing communication issues due to limited interpretation services.

The deaf women explained that they primarily relied on writing to communicate with health-care providers during antenatal visits and labor/delivery, but expressed that this method was not adequate for quality communication. (On average, deaf adults in South Africa read and write at a below-fourth-grade level; many interviewees reported being confused by unknown medical terms.)

Furthermore, in two cases when family members attempted to improve communication by acting as interpreters, they were restricted to visiting hours and could not help the pregnant women at night.

While a third of the deaf women stated that they experienced kindness and helpfulness from health-care staff during antenatal visits, 15 percent disclosed negative experiences including rudeness from nurses, neglect and yelling. During labor and delivery, only 19 percent of the women reported receiving good care, while 16 percent reported mistreatment.

When asked how to improve maternity services, the women resoundingly suggested increased access to interpretation services. More than 75 percent of study participants suggested that health-care facilities hire interpreters or require staff to receive training in basic sign language in order to improve communication. One participant stated, “They need to have interpreters. A child could die because [they] don’t understand.”

Other interviewees recommended sensitivity training, with one saying, “They need to be patient with deaf people and [not] scream. […] They must understand we are people.”


Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or


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