Chronicle Editor
Hazel Marimbiza
MRS Sihle Sibanda, a village health worker in Mangwe District, Matabeleland South province, vividly recalls the recent death of a 17-year-old girl who died during childbirth while being assisted by a traditional midwife.
“The traditional midwife has assisted several women giving birth at home before so she conducted her business alone in the hut. In this particular case there were complications which forced the midwife and the girl’s relatives to put her in a wheelbarrow and rush her to hospital,” said Mrs Sibanda.
She said unfortunately the girl could not make it and health officials blamed this on seeking help late.
The girl represents several women who die while giving birth at home. Maternal mortality remains insidious, especially in rural areas as pregnancies end in losses, killing the mother, baby or both.
Mrs Sibanda said it’s important for pregnant women to shun homebirths as giving birth at home puts their lives at risk. Bulawayo-based gynaecologist Professor Solwayo Ngwenya said it’s dangerous to give birth at home.
“We don’t encourage pregnant women to deliver at home as that leads to maternal and peri-natal deaths. There are many problems that can occur during pregnancy for instance the baby can die inside the womb or the mother can develop serious complications,” said Dr Ngwenya.
He said pregnant women needed monitoring during labour to reduce maternal deaths.
“Once in labour, both the woman and baby must be monitored by a qualified health care worker. In the absence of such, the baby may die or the woman may suffer a raptured uterus and die while trying to give birth at home,” he said.
Development practitioner, Mr Gerald Gore, said women were at high risk when they deliver outside health institutions, especially when the delivery requires surgical intervention.
“Women die as a result of complications during childbirth if they are attended to by traditional midwives at home. Most of these complications develop during pregnancy and most are preventable or treatable.
“Other complications may exist before pregnancy but are worsened during pregnancy, especially if not managed as part of the woman’s care,” he said.
Homebirths are just one among many other factors which fuel maternal deaths. Besides homebirths, maternal mortality in Zimbabwe is unacceptably high due to several other factors such as infections (usually after childbirth), severe bleeding (mostly bleeding after childbirth), anaemia, obstructed labour (when the size of the foetal head is disproportionate to the mother’s pelvis) and high blood pressure during pregnancy (pre-eclampsia and eclampsia) and illegal abortions.
A United Nations report issued last year titled, ‘‘Maternal Mortality in Zimbabwe: Evidence, Costs and Implications’’, indicated that Zimbabwe’s fight to lower maternal mortality rate was failing due to growing social inequalities, Aids and lack of access to emergency professional medical and surgical care for pregnant women with a special focus on the delivery and immediate post-partum period.
Despite the high levels of maternal mortality in Zimbabwe, international efforts have been made to sensitise the State’s health policymakers so that curbing maternal mortality becomes one of their top priorities.
These efforts are evidenced in high level international policy agreements such as the Millenium Development Goals (MDGs).
However, the United Nations warned that while substantial progress has been achieved in Zimbabwe and globally, many countries especially in sub-Saharan Africa will not achieve the MDGs target of reducing maternal deaths by 75 percent.
According to statistics, Zimbabwe together with Afghanistan, Kenya, Mozambique, Tanzania and Malawi are among the countries with the highest maternal mortality rates of 1 000 or greater in the world.
Each year in Zimbabwe, an estimated 3 000 women die during childbirth and at least 1,23 percent of the country’s GDP is lost annually due to maternal complications, according to the United Nations.
Greater effort is therefore, needed in reducing maternal deaths in Zimbabwe.
Zimbabwe has to work on developing and sustaining its maternal health capacity in order to reduce maternal deaths and achieve the Millenium Development Goals.
Numerous suggestions have been made on how best to curb maternal mortality.
Mr Andrew Pome, a researcher believes maternal mortality is severe in Zimbabwe because the country lacks research on how to reduce maternal deaths and so there is a need for more research on maternal mortality.
“Since 1990 there has been a large and significant increase in maternal mortality in Zimbabwe and this erases any potential gain in maternal survival achieved by safe motherhood programmes. This shows that there is a need to investigate the causes of maternal death in Zimbabwe in order to find solutions.
Efficient services to improve maternal health in Zimbabwe need policies that are informed by reliable data,” said Mr Pome.
He said Government should ensure that drugs to help prevent postpartum haemorrhage, which is the main cause of maternal deaths, are available at public health institutions.
Postpartum haemorrhage is heavy bleeding after childbirth. Losing lots of blood quickly can cause a severe drop in the mothers’ blood pressure. It may lead to shock and death if not treated. The most common cause of postpartum haemorrhage is when the uterus does not contract enough after delivery.
A Bulawayo resident, Mrs Chantel Gaba said there is a need to raise awareness on the dangers of seeking treatment late.
According to the World Health Organisation (WHO), various strategies are needed to improve maternal health in Zimbabwe and other developing countries.
“Strategies should be focused on antenatal care in pregnancy — this entails encouraging expecting women together with their partners to make at least four visits to the health facility, the first being within the first 16 weeks (four months) of conception and thereafter on a monthly interval.
“There should also be promotion of post-natal care especially in the first week of life after childbirth for both mother and child. Also to avoid maternal deaths, it is equally imperative to prevent unwanted and early pregnancies,” said WHO in a report.
Gender equality supporter, Ms Mercy Ndlovu said the Government should give incentives to health workers to motivate them to provide the best to expecting mothers.
“National policies need to support training and deployment of qualified personnel, especially in rural areas.
They must ensure that every pregnant woman registers for delivery and they must also allocate a centre where she will give birth. Antenatal visits must be made compulsory and these visits should give health workers the chance to educate women about the importance of safe delivery,” said Ms Ndlovu.
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