Zanzibar — Saving the lives of both mothers and their infants during childbirth is one of the most challenging problems facing many countries in Africa. In Zanzibar out of every 100,000 live births, 378 women die in labour or in complications related to childbirth.
The common factors contributing to the high level of maternal and newborn deaths in Zanzibar and Tanzania in general include limited access to reproductive health care; insufficient number of skilled health workers including midwives; poor quality of health-care services; and poverty.
But high lighting on poverty linked to maternal mortality, many women and legislators in the isles were complaining that child delivery charges in public hospitals are a big burden to many pregnant women.
Legislators including Mr Rashid Seif Suleiman (CUF- Ziwani), Mr Makame Mshimba Mbarouk (CCM- Kitope), and Ms Mtumwa Kheir Mbarak (special seats) were among members of the House of Representatives who strongly oppose the charges.
"Motivating pregnant women to deliver in hospitals cannot be successful by charging them. Most of them cannot afford and therefore opt to give birth on their own homes or rely on the Traditional Birth Attendants (TBA)," says Rashid.
Pregnancy and childbirth are natural processes in a woman's life, and there have been an international call for the reduction of maternal mortality in individual countries to be able to meet both the national and the Millennium Development Goal (MDGs) No. 5 to "improve maternal health," and reduce by three quarters the maternal mortality ratio by 2015. Different countries are working hard to meet the MDGs target, a move which has also made the Zanzibar President, Dr Ali Mohamed Shein, last week to announce the scraping off of child delivery charges in all public hospitals.
Dr Shein said the move to abolish child delivery charges is aimed at promoting safe motherhood and reduce maternal mortality in the Islands. "There will be no child delivery charges in all public hospitals," Dr Shein said arguing that he does not find genuine reasons why pregnant women in Zanzibar were asked to contribute for the delivery services. For more than five years, women in childbirth process or in labour were required to contribute 40,000/- as delivery charges whilst the government subsidized the rest.
Health officials say the cost of giving birth range between 100,000/- to 400,000/-. "We can manage to meet the charges for women giving birth in public hospitals. There is no justification for the charges, therefore, we have to abolish the contributions because it adds almost nothing, it is not helpful to the government," said Dr Shein. According to records from Mnazi Mmoja hospital, a referral hospital in Zanzibar, between 20 and 30 women give birth everyday including those born through caesarean section.
Dr Shein, a medical doctor by profession said his government will meet all the costs required for mothers giving birth, mainly making sure that delivery sundries were available for all mothers in labour room. In addition, "the government has planned to increase budget for medicines and hospital equipment. Abolishing delivery charges should not be an excuse for poor services in the maternity ward,"Dr Shein cautioned.
Mothers in Zanzibar such as Khadija Omar, 32, are celebrating the news about abolishing the child delivery charges, saying it is a big relief to them. "Thanks to President Shein's move. In fact it was a burden to many poor women," she said.
However, Ms Khadija was worried about the future of childbirth services, "some staffs in public hospitals may not be honest. Some corrupt medical staffs may hide the delivery kits, and demand to be paid secretly." But President emphasized that abolishing child delivery charges should NOT mean heavy reliance on donors support, "we should practise self reliance.
I believe we should strive for our own development, instead of waiting for donors support." The UN assesses that women, the chance of dying in childbirth is three times higher in many African countries than in developed nations, and that the situation may be worse for rural women who do not manage to get to medical attention and facilities in time.
Midwives are still inadequate to reduce maternal mortality; the few skilled ones leave the islands because the government cannot pay them enough, or "what they need."
In another move to save pregnant mothers, Zanzibar government has planned to upgrade with delivery facilities about 35 health centres in Unguja and Pemba Islands where mothers will be able to give birth.
The links between pregnancy-related care and maternal mortality are well recognized, and over the last three decades national and international programmes and plans have stressed the need for universal strategies to save pregnant women from dying when giving birth.
Zanzibar's first president late Abeid Karume declared free education, water, and medical care to people shortly after the 1964 revolution (independence), but due to rising cost of operation, demand and aid conditionality the government was prompted to introduce contributions.
In late 1990s and 2000s residents in Zanzibar have been required to start contributing in schools for each student, for water, and health services particularly on medicines, major body examination, and surgery.