25 May 2010

Zimbabwe: When Giving Life Brings Death


Harare — They are supposed to be giving life, but sadly more and more women are dying in this very sacred act of giving birth.

Statistics from two United Nations agencies show that maternal deaths have trebled since the 1990s, casting Zimbabwe off the course in meeting set targets.

Both the United Nations Children's Fund and the United Nations Population Fund said to reduce these deaths, they were focusing on capacitating skilled professionals and the institutions they serve.

"We are focusing on mobilising pregnant women to deliver at health institutions, ensure that the health institutions are manned by a skilled midwife, and that the facility is well equipped to handle deliveries and related complications," said UNFPA assistant country director, Dr Hillary Chiguvare.

Current data show that the Maternal Mortality Rate has increased to 880 deaths per 100 000 live births compared to 283 per 100 000 live births in 1990 (Zimbabwe Demographic Health Survey 1994).

The 2005/2006 ZDHS reported a MMR of 555 per 100 000 live births.

In 2007, a more accurate estimation (The Zimbabwe Maternal and perinatal Mortality Study) reported the MMR at 725 per 100 000 live births -- meaning the chance of a pregnant woman dying while giving birth had tripled.

However, in line with Millennium Development Goal number 5, the country's target is to reduce the MMR of 1990 by three-quarters to 70 per 100 000 live births by 2015.

"Home deliveries have increased and institutional deliveries decreased. Yet, when expectant mothers are forced to give birth at home, often without a skilled attendant, the risk of death is too high.

Unfortunately, the maternal health indicators are also accurate indicators to reflect the status of a country health system," said Unicef communications officer Miss Tsitsi Singizi.

She added that one in two women were delivering at home.

Worsening the country's MMR is shortage of skilled attendance at delivery with a vacant rate in public institutions as high as 78 percent.

According to the Women's Action Group message on the commemoration of the International Day of Midwives celebrated on May 5 every year, some institutions especially in rural areas are not manned by a skilled midwife.

"Some health centres especially rural areas have no midwives at all.

"This has put so much pressure on the few midwives that are in the country," said WAG.

According to UNFPA, the expected births per year in Zimbabwe are 332 500 and the number of midwives in the country in 2009 was 867.

Hence, the pregnant woman to midwife ratio is equal to one midwife per 384 deliveries.

Yet the World Health Organisation recommendation is one midwife per 175 deliveries.

Although Zimbabwe is far short of professional midwives, traditional midwives are not recommended as an option because of evidence found that they cannot do much to manage the leading causes of maternal deaths namely: hypertension, bleeding and infection among other complications.

In the past, traditional midwives assisted in delivery in instances where there was no trained health midwife.

According to UNFPA, in 2006, 27,4 percent of deliveries were assisted by traditional midwives and of these midwives, 11,2 percent of them were trained while 16,2 percent where not trained.

About 5 percent of births in urban areas were not assisted by trained health professional compared to about 40 percent in rural areas.

Traditional midwives assisted in 85 percent of these deliveries where no trained health professional was available to assist.

"However, the issue is not so much in using traditional midwives, the reason why women to a large extent, do not deliver in health facilities is the issue of user fees, sometimes distance and transport."

"It is crucial therefore for effort to focus on removing barriers which stop women from delivering at health facilities.

"Traditional midwives should therefore play a minor role in Zimbabwe, where infrastructure exists," Miss Singizi said.

"Traditional midwives are only being sensitised on mobilising women to deliver at health institutions and not to do the delivery themselves," concurred Mr Chiguvare.

Members of apostolic sects are among the group of people who rely on traditional midwives services for religious reasons.

According to UNFPA, 29 percent of pregnant women belong to various apostolic sects.

Of the maternal deaths analysed, members of the apostolic sects were at higher risk of death compared to non-sect members.

"Sensitive approaches that respect the right to religious freedom and also asserts women's right to life need to be developed," said Mr Chiguvare.

Other key elements highlighted by the UN agencies for reducing maternal deaths include improving and reinforcing postnatal care and early diagnosis of HIV to enable timely commencement of ARV therapy.

As there has been a marked absence of a robust effort to ensure maternal health, Unicef says it is working with the Ministry of Health and Child Welfare to ensure there is investment towards more integrated maternal health programmes.

Secretary for Health and Child Welfare Dr Gerald Gwinji says to reduce maternal deaths, Government is in the process of revitalising mothers' waiting shelters and improve supply of blood to mothers who need it.

"At the same time, we also now want to keep women for at 24 hours post delivery so that the complications that usually occur during this time to mother and baby are picked up and dealt with.

"A lot of deaths that tend to occur in the first week of life are prevented this way," He said.

He said Government was also aiming at improving transportation of pregnant mothers to health institutions.

Dr Gwinji revealed that a special type of motorbike ambulance -- the "E-ranger" -- was currently under pilot testing in Mashonaland East.

He said Government is expecting to launch a campaign aimed at raising awareness on maternal health.

The Campaign for Accelerated Reduction of Maternal Mortality in Africa will be launched in June.

"It is aimed at increasing awareness to both partners (men/women) as well as the population at large to know when to come for antenatal care, delivery and post natal care as well as Prevention of Mother To Child Transmission of HIV and malaria in pregnancy," Dr Gwinji said.

In Zimbabwe, nearly 2 500 women die every year of pregnancy-related complications.

Worldwide, every minute somewhere in the world a woman dies in pregnancy or childbirth, and the women in the world's least developed countries are 300 times more likely to die in childbirth than those in developed countries, according to Unicef's State of the World's Children report.

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