By Fortunate Muzarabani
Esnart Jele (29) from Irisvale in Umzingwane delivered her first baby in a scotch cart on her way to the hospital in 2015. The baby had complications, was prematurely born and died in her second week of life.
Her next two pregnancies in 2016 and 2019 were closely monitored and because of her high blood pressure, nurses recommended that she stayed at the waiting mother’s shelter six weeks before she was due for each pregnancy.
Now expecting her fourth child and in her final trimester, she does not feel as excited about spending weeks at the waiting mothers’ facility despite it having helped save the lives of her children before.
She cites poverty, food shortages, as well as the fear of contracting Covid-19 at the health centre.
“Mbizingwe waiting mother’s clinic saved my life and those of my children. Had my first child been born in hospital and not in a scotch cart, she would be alive today. I’m grateful for this place. It’s just that things are different now. Kulendlala (there is hunger), so I cannot come and camp here because I won’t be able to bring food. Another problem is that staying longer in the hospital puts you at risk of getting Covid-19. A pregnant woman died in m village, and the burial was controlled by health authorities. We hear from the news and by word of mouth that people are getting infected in hospitals. I cannot take the risk,” she says to CITE.
Some mothers have more to worry about more than just their health and that of the baby on the way. Some have to worry about where their next meal will come from, as poverty continues to ravage some parts of Zimbabwe.
These problems have led to women in Umzingwane, Matabeleland South shunning special shelters for expectant mothers at health facilities, as they have to bring their own food supplies.
These waiting shelters are meant to ensure that mothers who are almost due for delivery are closer to health experts and can stay there before their delivery date which helps to avoid home births and related complications.
Recent media reports of pregnant women contracting Covid-19 or testing positive at health centres are also contributing to some expectant mothers dragging their feet in seeking maternal health services.
This week a pregnant Hwange woman found herself homeless after testing positive for Covid-19, after her family and employer kicked her out together with two minor children, after discovering her Covid-19 positive status.
The stigma surrounding Covid-19 is contributing to the underutilisation of maternity homes, as women fear to find themselves in the same shoes as the Hwange mother of two.
The pandemic has not only affected health care service delivery but led to a spike in the abuse of women and girls. Many women have said to have experienced disrespect and abuse at health facilities and choose to deliver at home, putting themselves and their babies at risk of complications and death. Currently, 458 maternal deaths occur per 100,000 live births in Zimbabwe, according to the latest Multiple indicator cluster survey of 2019.
The Covid-19 pandemic has exacerbated this crisis by further straining an already weakened health system, particularly maternal health.
According to statistics from Umzingwane Rural District Council, Umzingwane has a total population of 62 000 people, made up of 52 percent females and 48 percent male. The district has 17 health centres, 5 of them are government clinics, 10 are local authority clinics and 2 are private clinics. 8 out of 15 clinics have mothers’ waiting homes and all clinics do deliveries.
Matabeleland South Maternal and Child Health Officer Dr Norbert Singine while responding to questions from CITE said it was important that women continued to use health centres for the safety of both the mother and baby while the province continued to roll out health education programmes to empower communities with knowledge.
“Health education and promotion remain key in addressing some of these challenges that we face as a province in that it empowers the community to make correct decisions regarding the health welfare of pregnant women and their unborn babies. There’s a concept of “Pre-conceptual care” which we routinely provide to all mothers and fathers in the Family and Child Health departments of our hospitals. This covers a lot on planning for pregnancy, birth-preparedness (including the role of waiting mother’s shelter for proper monitoring prior to delivery) and delivery itself,” said Dr Singine.
He said it was worrying that some women in Umzingwane were resorting to home deliveries due to food shortages.
Dr Singine said food provision for expectant mothers in the waiting shelter was a community responsibility and called for community mobilisation mechanisms to ensure that food resources were always available at the mothers’ shelters.
“The case of Umzingwane where women in the mothers waiting shelter have resorted to home deliveries because of food shortages is really worrying. Food provision for expecting mothers in the waiting homes is the responsibility of the community, and for the mothers to go back into the same community/homes which are not providing the food may not be the real solution, rather mechanisms for community mobilisation of food resources should be activated so that women are well supported.”
He encouraged women to continue utilising the services of waiting homes despite prevailing challenges as these were meant to ensure that in their vulnerable state, they were close to health practitioners and could be closely monitored.
“Moreover, the women in waiting shelters are a high-risk group that need close monitoring and management of possible pregnancy-related complications (who will not get timely interventions if they are far away from the hospitals). I still encourage the women to remain in waiting homes while their social needs get attended to by collective efforts of both the community and health sector,” he said.
Lungile Ndlovu a representative from Umzingwane RDC while presenting a report at an SRHR and maternity health dialogue organised by the Women’s Institute of Leadership Development (WILD) recently, said the furthest distance that a pregnant woman walks to a health centre in the district is 16 km.
She said Matopo has 5 wards and 4 clinics, with the furthest person having to walk around 15 km to access medical attention. Nswazi has 4 wards and 2 clinics, and people walk an average of 12.5KM to access medical attention, while Mzinyathini has 3 wards and 4 clinics and the farthest person has to walk around 16KM to access medical attention. Sigola has 2 wards and 2 clinics and the furthest person has to walk an average of 8KM to access medical attention.
The RDC representative said some women preferred to go to Mtshabazi Mission hospital where they were served food, as compared to closer health centres where they had to source their own meals.
Myths and unconfirmed cultural beliefs and witchcraft claims made some women fear some clinics, preferring to go to faraway places.
“Some clinics have no mothers waiting homes and women under these wards end up giving birth at home. Further worsening the situation is cultural beliefs that have contributed to the underutilisation of mothers waiting rooms. For instance, at Mawabeni women’s shelter, it is believed there are goblins. There are no ambulances in the clinics under Umzingwane district and this, coupled with transport challenges has made it hard for women to access medical attention in time. Women also face food shortages in their households, due to this they prefer to go to Mtshabezi because the clinic offers food to waiting mothers compared to Mbizingwe clinic which does not offer them food,” said Ndlovu.
Despite prevailing challenges, using mothers’ shelters, Zimbabwe continues to work towards the global target of reducing the maternal mortality ratio to less than 70 per 100,000 pregnancies by 2030.
However, more effort is needed in ensuring that these shelters are well resourced so that mothers can have enough food as they await their delivery date.
In the latest Multiple Indicator Cluster Surveys (MICS) 2019 report, Zimbabwe recorded a decline in maternal mortality from 614 to 462 deaths per 100,000 pregnancies since 2014. This significant drop is in part attributed to mothers’ shelters such as these ones dotted around Umzingwane, in Matabeleland South.
A shelter close to medical experts equally prevents haemorrhages, which the MICS report of 2019 reported having caused 26% of maternal deaths in 2019.
Sustainable Development Goals on health issues provide an opportunity for countries to accelerate progress to improve maternal health for all women regardless of how wealthy they are and where they are located. SDG number 3 seeks to reduce global maternal mortality to less than 70 per 100000 live births. The maternal health objective is to ensure that mothers and children in every stage of their pregnancy (antenatal, delivery and postnatal care), are healthy and well.
Maternal healthcare is a legal entitlement for every woman to receive care during pregnancy, childbirth and the postpartum period, however, some women still do not fully access the right.
Parliamentary Portfolio Committee on Health Chairperson Dr Ruth Labode while speaking at the WILD SRHR/ maternity health dialogue said user fees remained beyond the reach of many in communities, which added to the troubles that compelled some pregnant women to end up delivering at home.
“User Fees at central Hospitals are exorbitant and therefore, deny equal access to SRHR and Maternal Health Care Services in Zimbabwe. By law, there should not be a mother who pays for maternity user fees. Mpilo Hospital collects nearly $3 million ZWL, which fails to bridge budget deficiencies due to misappropriation of funds to administration instead of health needs,” she said.
She called for the need to provide comprehensive sexual reproductive health rights services for young people to avert cases of complications for very young mothers.
‘We now have sex workers that are nine-year-olds, but we deny adolescents access to comprehensive SRHR services such as the right to contraceptives. We will have to deal with them when they are pregnant, with complications risking the life of mother and baby, said Dr Labode.
According to the Multiple Indicator Cluster survey of 2019, 92 per cent of women in rural areas receive antenatal care while in urban areas the figure stands at 96 per cent. Nationally, in rural areas, 73 per cent of the women visit health centres at least 4 times while in urban areas, the number stands at 68 per cent.
Institutional delivery in urban areas constitutes 94 per cent for both institutional delivery and accessibility of skilled attendance at birth. In rural areas, the figure stands at 82 per cent for the latter and the former.
In terms of postnatal care, maternal check within two days after delivery stands at 91 per cent in urban areas while in rural areas the figure stands at 78 per cent. Statistics of the newborn check within two days stands at 94 per cent in urban areas and 90 per cent in rural areas.
