Zimbabwe’s maternal mortality crisis

Rusape, Zimbabwe – In Cheneka village, about 170 kilometres southeast of Zimbabwe’s capital, Harare, Moses Jemwa recalls the tragic death of his wife. She died in childbirth, aged 31, while being assisted by traditional birth attendants.

“Vananyamukuta [a traditional birth attendant] killed her. She said she had performed several home deliveries before and conducted her business alone in the hut. I have no idea what she did to her, but after running into problems, that’s when she said we must put her in a wheelbarrow and rush her to Rusape General Hospital,” Jemwa explained. “She didn’t make it. It was all my fault, I should have taken her to hospital, but I had no money.”

Each year in Zimbabwe, an estimated 3,000 women die during child birth and at least 1.23 percent of GDP is lost annually due to maternal complications, according to the United Nations. The situation is especially bad for poor women in rural Zimbabwe, who continue to experience difficulties in accessing quality obstetric care.

The “dollarisation” of the economy in 2009, which saw the impoverished country abandon its hyper-inflated currency and adopt several foreign currencies – mainly the US dollar – as legal tender, has worsened the plight facing mothers-to-be, as foreign currency is hard to come by.

Zimbabwe is among 40 countries where the maternal death rate exceeds 960 per 100,000 live births. And the situation is not improving: Maternal mortality in Zimbabwe rose by 28 percent between 1990 and 2010.

The figures lag far behind Zimbabwe’s Millennium Development Goals, which call for a 75 percent reduction in maternal mortality by 2015, according to the office of the UN Resident Coordinator in Harare. Globally, just 287 mothers die per 100,000 live births, and in sub-Saharan Africa the figure stands at 500 per 100,000, according to Zimbabwe’s Ministry of Health and Child Care. 

Gerald Gwinji, the ministry’s secretary, admitted before a health parliamentary portfolio committee on February 4, that Zimbabwe would not meet its target of reducing maternal deaths by 2015. He said women were at heightened risk when they deliver outside health institutions, especially when the delivery requires surgical intervention or is carried out by non-skilled persons.

A UN report issued last year, Maternal Mortality in Zimbabwe: Evidence, Costs and Implications, says Zimbabwe’s fight to lower maternal mortality rates was failing due to growing social inequalities, AIDS, and lack of access to emergency obstetric care.

Around one-third of Zimbabwean women still deliver babies at home, and poorer women often cannot afford basic healthcare. As a result, more than half of mothers do not return for post-natal checkups, says the report. Zimbabwe has no law that compels government clinics and hospitals to provide primary care to women, children or other vulnerable groups for free, although there are state subsidies.

The government says it has a policy barring government health workers from charging fees to expecting mothers, but hospitals have refused to implement the policy, saying there were no subsidies for their ancillary services such as electricity and water.

Traditional midwives such as 61-year-old Mbuya Chisveru are often the only help available for women in labour in remote areas. She insists that her services are superior to those offered by hospital-based obstetricians. “I have delivered many babies. I know how you sever the [umblical] cord. If we run into problems, there are always hospitals,” she says.

Health authorities have been running campaigns highlighting the positive side of hospital-based delivery.

Minister of Health and Child Care David Parirenyatwa said the government had placed a high priority on fighting maternal mortality. “It is a top priority for us, and will be dealt with by looking at what causes it, ensuring that every pregnant woman who is HIV-positive is put on treatment, regardless of their CD 4 count, and unfreeze recruitment to allow employment of qualified nurses,” Parirenyatwa said.

Due to a funding shortfall, Zimbabwe’s government has frozen about 400 nurses’ and doctors’ posts nationwide. As a result, many qualified nurses have struggled to find work.

Parirenyatwa said that besides recruiting more nurses, his ministry will also push for “total abstinence from sex before marriage” to tackle unsafe abortions and unwanted teenage pregnancies.

Dewa Mavhinga, a senior Africa researcher at Human Rights Watch, told Al Jazeera: “Zimbabwe’s unacceptably high maternal mortality points to seriously misplaced priorities of this Zanu-PF government that presides over massive corruption within state institutions, which are draining resources that should otherwise revive the health sector.

“Government should urgently prioritise social services delivery in fulfilment of its human rights obligations enshrined in the new constitution. Maternal mortality must be declared a national disaster deserving urgent national attention and deployment of sufficient human and financial resources to address it.”

Follow Gift Phiri on Twitter: @giftphiri