Like many women in hospitals in the Democratic Republic of Congo, Sara was a victim of violence during childbirth. Two years after the birth of her first child, she says she will never do it again.
Sara, 31, said she had undergone an episiotomy – a surgical incision in the perineum – during her delivery, and that the doctor at the hospital in the capital, Kinshasa, had tried to stitch her up without anesthesia.
Giving birth again would be like reliving a "traumatic experience," she added.
In the DRC, where more than 90% of the population is Christian and where traditional views of women and sexuality prevail, this kind of story is a taboo subject.
But in recent weeks, more and more people have spoken out after the release of a video that went viral and stunned the country.
Filmed in the delivery room of a public hospital in Kinshasa, the video shows a young naked woman screaming just after giving birth.
Large bloodstains are visible on the hospital bed from which she leaps.
A doctor hits her with a metal instrument and tries to forcibly keep her lying down with her legs spread apart, to continue a treatment that she clearly refuses.
Unable to control her, he starts slapping her.
Prime Minister Judith Suminwa described the violence as "totally unacceptable", while First Lady Denise Tshisekedi condemned the "heinous" acts and called for swift intervention.
In the DRC, maternal mortality stands at 427 deaths per 100,000 live births, according to the World Health Organization, compared to only 11 per 100,000 in Europe.
The UN described the situation as alarming, citing the lack of resources and qualified personnel as the main causes.
In a rare occurrence in this country, the doctor seen in the video was tried and convicted.
During the trial, he admitted to hitting the patient, claiming that she was suffering from postpartum hemorrhage but that she was preventing him from treating her.
He stated that he attempted to stitch her without anesthesia, as the hospital did not have any.
Saving lives
"I did everything I could to save a life," the doctor told the court. He explained to the judges that he had asked a colleague to film the scene in order to "protect himself" in case the woman died.
Earlier this month, he was given a two-month suspended prison sentence for assault and battery and for filming the video.
The Congolese state, which manages the public hospital, was ordered to pay $2,500 in damages.
For activists, this case has highlighted a deeper, systemic problem.
"Violence in delivery rooms has become commonplace, as doctors claim they are saving lives," said Anny Modi, director of the women's rights organization Afia Mama.
She stated that they receive at least one woman traumatized by childbirth every week.
According to Modi, obstetric violence is sometimes motivated by moral judgments.
"A young single woman is facing violence that resembles punishment for having sex outside of marriage," she said.
AFP spoke to several women who said they had been victims of medical abuse; one of them said she fainted from the pain.
"After the delivery, the doctor removed fragments of placenta by thrusting his entire forearm into my uterus," said Rose, a mother of four.
"I asked if it was possible to have anesthesia, but I was told that it wasn't available."
Health Minister Samuel-Roger Kamba told AFP that kits containing anesthetics and medications are regularly distributed to public hospitals that care for pregnant women.
He did, however, acknowledge that "verbal or physical violence in delivery rooms is an abuse that we have observed."
The president of the Congolese Medical Council, Berthier Nsadi, stated that this case had prompted reflection on improving continuing education for doctors and other health professionals, particularly midwives.
According to estimates from the country's main doctors' union, the DRC has one midwife for every 16,000 inhabitants, which is far from the WHO recommendation of one midwife for every 5,000 inhabitants.
