Promoting Maternal Health
By Rumbidzai Dube
When I reflect on the risk and sacrifices that women make in this world, it makes me wonder when, why and how it came to be that in many parts of the world, they are regarded as second class citizens. What am I saying?
According to the Zimbabwe Demographic Health Survey (ZDHS) of 2011, at least 10 women die every day due to pregnancy-related complications. Did you hear that, 10 women die every day while giving birth to children, some of them sons, who will then turn on their mothers, sisters, aunts, nieces and cousins and treat them as second class citizens. Isn’t that ironic?
Millennium Development Goal 5 is definitely one of the goals that Zimbabwe will not be able to meet. With maternal deaths estimated to be above 960 deaths for every 100 000 live births, the target of reducing maternal deaths by three quarters can remain an aspiration for now. Given that the 960 deaths are official statistics, which God knows how accurate they are, with the way our government is out of touch with the issues on the ground on so many levels, the rate is possibly even higher.
Let us assume for a minute that these statistics in fact are right, I am still perplexed by the worrying trend that factors such as education, class, location and age are no longer critical in determining who is affected. Uneducated and educated, poor and rich, rural and urban, and older and younger women are all dying in child birth. Clearly there are nuances to the problem and successfully dealing with maternal health needs exploring these. For instance, cases of celebrities who passed on in child birth, grabbed the headlines, raising the need for a more concerted effort into addressing the issue of maternal mortality.
What are some of these nuances?
- We simply do not have enough trained health professionals to deal with the delivery of our babies. Our nurses left and we are not doing much to motivate those who remained behind to remain in our service and to be motivated at work.
- The private health-care system has not been effectively regulated. Just in the past year I have had 2 friends and a relative who have had nasty encounters with private health practitioners. The first friend went to a reputable women’s health centre where she was told she had a growth in her uterus and needed to have her uterus cleaned. Fortunately for her, she chose not to do that and sought a second opinion. Guess what-the supposed ‘growth’ in her uterus was a baby. And to think these people have advanced machines for scans and all that other fancy stuff!!
Another friend elected to deliver her baby through a Caesarean and informed her gynaecologist of her choice. However, he kept pushing the dates for the performance of the Caesarean forward, in what she feared was an attempt to create complications in her delivery, leading to her increased stay in hospital and increased bill=more money for the doctor.
My other relative had had two babies, delivered through normal births without any complications. However for her third baby, the doctor dramatically chose to ‘induce’ her labour prematurely. She could not understand why he did so when her labour was not delayed and her pregnancy was advancing normally. Eventually she found out why when the bill came with a breakdown of:
- Costs for inducing labour
- Costs for delivering the baby
- Costs for doing the ‘stitches’ on the mother
- Costs of medication to clean the wounds
She also complained that the same doctor had developed a reputation of forcing women whose babies he delivered to have more ‘stitches’ or proclaim non-existent complications requiring caesarean delivery because doing so meant he would charge more for sewing them back together and performing the surgery. It seems the love for money far exceeds the observance of medical ethics these days.
What have we done well?
- Our implementation of the Prevention of Mother to Child Transmission programme (PMTCT) has significantly reduced cases of HIV/AIDS infections in children at birth. HIV testing has improved and the responsibility lies with the mothers to choose life for their children.
- The adoption of the National Campaign to Accelerate the Reduction of Maternal Mortality (NCARMM) directly corresponding with the African Union (AU) Campaign on the Accelerated Reduction of Maternal Mortality in Africa in itself is an important development as it affirms government’s recognition that maternal mortality is a serious problem that needs addressing.
What have we not done well?
Government admits that most maternal deaths are a result of time taken to seek healthcare because of ignorance or lack of funds to pay for hospital care; time needed to reach a healthcare because hospitals are too far and there is no easily accessible transport to and from the health facility or the cost to do so is high and unaffordable and time taken to access care at the health facility-where there is generally an air of neglect of women in health-care facilities by highly unmotivated nurses.
Generally health services are inaccessible particularly in rural areas where hospitals and clinics are not within easy reach and the transport networks to the major clinics and hospitals are not easily accessible. Increasingly, the service in hospitals, particularly public/government hospitals, has deteriorated and has become poor. Pregnant women suffer neglect in hospitals resulting in some avoidable losses and deaths. Socio-economic challenges, related with the current economic environment significantly impact women’s access to medical services as they cannot afford to pay the user fees. There has been reduced uptake of contraception for inexplicable reasons.
What more can we do?
- We need to adequately fund all our health institutions. Although a government policy stating that women should not pay user fees exists, it is impractical. If clinics do not make women pay, then they will not have the gloves, medication and swabs to attend to the women at child birth. Until and unless government adequately funds these facilities then the assertions that user fees have been scrapped will remain what they are; mere rhetoric!!
- We must address religious and traditional practices that deny women access to medical facilities or that delay until patients are in critical condition. Zvitsidzo (Apostolic sects’ version of maternal wards), located in bushes in the middle of nowhere, secretive and denying access to the public, are an example of how maternal care is being compromised. Because of the veil of secrecy that these sects throw over these spaces, it is not clear how many women actually die and whether there are any complications that women have to live with for the rest of their lives for failing to give birth in certified maternal health care facilities.
- We must maintain our reliable supply of contraception BUT we must find out, through comprehensive research, why there is reduced uptake of contraceptives.
- We must take measures to motivate our nurses to do their jobs effectively. Without the necessary incentives, women will continue to lose their lives in avoidable circumstances.