Delice Gwaze - Reproductive Health in Zimbabwe

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Maternal mortality in Zimbabwe

Delice Gwaze

Introduction

Situated in Southern Africa, Zimbabwe shares its borders with South Africa, Mozambique, Botswana and Zambia. Its population is estimated to be 11 million with over 3 million living outside Zimbabwe. The country's political and socio-economic situation deteriorated starting from 2000 leading to a vast majority of skilled professionals leaving the country for greener pastures in the neighbouring countries and abroad. Health professionals have also been a major part of the skills flight, leaving hospitals seriously under-staffed and in urgent need of trained personnel.


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Context

The deterioration of the socio-political and economic situation in Zimbabwe has had a negative impact on the country's health sector. This has been characterised by severe shortages of skilled health professionals, drugs, essential equipment and frequent power cuts which affected some medical procedures and put lives of numerous patients at risk (1). Expecting mothers and their newborns have been particularly affected.

Zimbabwe's maternal mortality rate rose from 570/100000 live births in 1990 to 1100/100000 live births in 2005 (2), mostly due to a combination of the effects of HIV/AIDS and the decline in availability and quality of maternal health care (3). The majority of health professionals remaining in Zimbabwe are recent graduates with little work experience, inadequate supervision and poor remuneration. Low salaries have led to the demoralisation of the health workers as it resulted in them going on frequent strikes, some selling off hospital equipment and the little available drugs.

Many expecting mothers give birth on their own without a midwife attending to them which is risk in case of complications arising and they find it difficult to use bathrooms during labour (4), they go to the toilets alone resulting in some women giving birth in the toilets and the baby falling in the latrine.

In many hospitals throughout Zimbabwe even the most experienced doctors struggle to assist expecting mothers and their infants because of a severe lack of obstetric and other equipment, drugs and emergency transport (5). Most pregnant women died as a result of lack of basic items that are readily available in most parts of the world. Due to lack of maintenance most public hospitals are in dilapidated conditions. The bed linen is torn and the beds are not comfortable for the patients (6). At the Edith Opperman Clinic in the poor, high density suburb of Mbare, ZimHealth, a Zimbabwean organisation mobilising support for the country's health system, found only one Blood Pressure machine being shared between the maternity ward and the main clinic which receives hundreds of patients.

Most pregnant women are not aware of their HIV status and very few go for medical check up before deciding on getting pregnant. If the required monitoring and evaluation is not provided during pregnancy it can be difficult to assess whether the pregnancy needs natural delivery or caesarean section (7).

In certain cases expecting mothers die because they are made to deliver naturally instead of delivering through a caesarean section -this is in the case where the baby is too big to be delivered naturally. There is also not enough post-partum care and information provided after delivery on how the mothers should take care of themselves and their infants or reach out for emergency help in case of complications arising after delivery, for example high blood pressure, haemorrhage and to follow up on their status in case of a caesarean section (8).

At the height of the political and economic crisis in 2008, many public maternity hospitals were shut down leaving many mothers particularly from poor backgrounds without access to care. However the situation has slightly improved since the new coalition government was formed in March 2009. In one of its first actions the new inclusive government suspended the local currency and adopted the United States dollar and South African rand. This has however meant hospitals are now charging in foreign currency which is out of reach to the majority of people  and as a result many resort to the cheapest means of support for example delivery by traditional midwives and going through the pregnancy with no check-ups. The emergence of the illegal 'parallel market' in Zimbabwe also saw counterfeit drugs being sold on to desperate patients.

There are also cultural and societal practices that inhibit women from accessing the health information they need (9). For instance women have no absolute right in reproduction and some follow traditional procedures of giving birth such as using the elderly women from within the community.

References

  1. Zimhealth - Health in Zimbabwe. ZimHealth - Zimbabwe Network for Health - Europe [Internet]. 2009 Mar 9 [cited 2009 Sep 8]. Available from: http://www.zimhealth.org/health.htm
  2. Country Health System Fact Sheet 2006. Zimbabwe. World Health Organization - Regional Office for Africa [Internet]. [cited 2009 Sep 8]. Available from: http://www.afro.who.int/home/countries/fact_sheets/zimbabwe.pdf
  3. Kurewa EN, Gumbo FZ, Munjoma MW, Mapingure MP, Chirenje MZ, Rusakaniko S, Stray-Pedersen B. Effect of maternal HIV status on infant mortality: evidence from a 9-month follow-up of mothers and their infants in Zimbabwe. J Perinatol. 2009 Aug 20.
  4. Fawcus S, Mbizvo M, Lindmark G, Nyström L. A community-based investigation of maternal mortality from obstetric haemorrhage in rural Zimbabwe. Maternal Mortality Study Group. Trop Doct. 1997 Jul;27(3):159-63.
  5. Fawcus S, Mbizvo M, Lindmark G, Nyström L. A community-based investigation of avoidable factors for maternal mortality in Zimbabwe. Stud Fam Plann. 1996 Nov-Dec;27(6):319-27.
  6. ZimHealth Switzerland. ZimHealth - Zimbabwe Network for Health - Europe [Internet]. [cited 2009 Sep 8]. Available from: http://www.zimhealth.org/MbarePolyclinic.htm
  7. Feresu SA, Harlow SD, Woelk GB. Risk factors for prematurity at Harare Maternity Hospital, Zimbabwe [Internet]. Int. J. Epidemiol. 2004 Dec 1; 33(6):1194-1201. [Cited 2009 Sep 8] Available from: http://ije.oxfordjournals.org/cgi/content/full/33/6/1194
  8. McKenzie AG. Operative obstetric mortality at Harare Central Hospital 1992-1994: an anaesthetic view. Int J Obstet Anesth. 1998 Oct;7(4):237-41.
  9. Mathole T, Lindmark G, Ahlberg BM. Competing knowledge claims in the provision of antenatal care: a qualitative study of traditional birth attendants in rural Zimbabwe. Health Care Women Int. 2005 Nov-Dec;26(10):937-56.
 
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Edited by Aldo Campana,