The Herald (Harare)

7 May 2012

Zimbabwe: Time to Tackle Maternal Deaths Head-On

With a population close to 13 million, Zimbabwe has one of the highest maternal mortality rates in Africa. It is estimated by the Zimbabwe Demographic and Health Survey that the maternal mortality rate in Zimbabwe has risen from 700 to a shocking 960 deaths per 100 000 live births over the last two years.

At this rate, Zimbabwe is unlikely to attain Millennium Development Goal 5.

This is unacceptable in a scenario where simple interventions by all stakeholders can contribute to reducing these deaths.

Such deplorable figures are attributable to a range of reasons including but not limited to inability of women to access health facilities due to cost barriers, illegal abortions, unavailability of skilled birth attendants, lack of medication, equipment or basic emergency services in the event of haemorrhaging or other complications.

Women in rural areas are particularly most affected due to their disadvantaged position.

Subsequently, limited access to comprehensive maternal health services at district level and basic maternal health services at rural clinic level are major contributors to the increase in Zimbabwe's maternal mortality rate.

In general, sexual and reproductive health rights remain a central development challenge and the state of maternal mortality is a key indicator of a functioning health system.

The Zimbabwe Women's Resource Centre recently led a campaign -- which was launched in April under the banner "Ridza Mhere/Hlab'umkhosi" for improved maternal health services in rural areas -- calling on society to speak out against needless maternal mortality. Twelve other civil society organisations working in sexual and reproductive health, women's rights and gender equality are spearheading the campaign in Zimbabwe in partnership with ZWRCN.

The launch of a campaign advocating for improved maternal health services in Zimbabwe is motivated by a realisation that maternal mortality in the country remains unacceptably high.

The campaign is also timely in that recently released statistics indicate a marked increase in maternal mortality.

It therefore seeks to reduce the number of maternal deaths by advocating for improved accessibility of basic maternal health services at rural clinic level and comprehensive maternal health services at district hospital level by 2014 through adequate, targeted and timeous allocation of and transparency in spending of resources directed at maternal health.

In this campaign, it is strongly believed that adequate financing and mobilisation of a critical mass of affected persons advocating for improved health services will reverse the situation such that the cost, in terms of lives and finances, is not passed on to women.

The "Ridza Mhere/Hlab'umkhosi" initiative is the beginning of a new resolve to eradicate this scourge and is aimed at reinforcing the commitment of public authorities, community and religious leaders as well as civil society to get involved in the fight against maternal mortality.

It is a great opportunity for Zimbabwe to work towards reducing maternal mortality.

Evidence indicates that the most important cause of high MMR in Zimbabwe's rural areas is women's socio-economic vulnerability, consisting of poverty and inability of pregnant women to pay for maternal services.

Consequently, most maternal deaths occur because women deliver in unlicensed private maternal homes, primary health centres with limited clinical facilities and in homes of traditional birth attendants where costs are cheaper but quality of care is compromised.

The campaign for improved maternal health services is not particular to Zimbabwe alone. It follows on the heel of a regional campaign on "Accelerating the Right to Sexual and Reproductive Health Services for Women and Girls" being fronted and supported by the Amanitare Sexual Rights Network active in Zimbabwe, Zambia, Mozambique, Uganda, Kenya and South Africa.

Tackling the great injustice of high maternal mortality will demand a number of high impact interventions to include, among other things:

l Improvements on existing integrated health plans

l Investment in universal access to family planning

l Ensuring women and communities are well informed about their entitlement on maternal and child health issues

l Focused primary and antenatal care to reduce risk and prompt management of complications, for example, haemorrhaging

l Skilled birth attendants who are motivated and supervised -- distributed across all health facilities, especially in rural areas

For reduction in maternal mortality, Zimbabwe's poorly functioning health system will need to be strengthened, and a holistic strategy will need to be adopted within civil society.

Civil society organisations can effectively monitor various interventions and hold Government accountable by exerting collective pressure on the latter to translate promises related to maternal and sexual and reproductive health rights into reality.

Of particular importance is the need for political will and sustained political commitment with strong financial backing to revamp the health care system so that women do not continue to die needlessly due to avoidable complications.

Most importantly, collaboration of all relevant stakeholders towards the fight against maternal and child mortality will accelerate progress towards achieving MDGs 4 and 5.

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