Lucy Macheka (26) is an aggrieved woman after having been forced by circumstances beyond her control to risk her health by delivering her first child at home recently. During her pregnancy, she had visited the hospital only once for a check-up.
“I was frightened for my life,” she recalls. “I was bitter that people at the hospital think money is more important than human life.”
Macheka had failed to raise the $50 booking fee required at clinics and government hospitals which, for many low-income earners, is unaffordable. A lot of women are unjustly punished for their inability to afford maternity fees and this means they have to compromise their health through unsafe deliveries and lack of check-ups.
Interventions within the continuum (range) of care are essential for the health and wellbeing of mothers and children, according to the Status of Women’s and Children’s Rights in Zimbabwe (2005 – 2010) report. The report, which calls for the reduction of disparities and increasing equity, was compiled by the government, United Nations agencies and civil society players.
The report says with the exception of antenatal visits, the country is providing less than adequate care along this continuum which, in ideal circumstances, should see women getting professional medical care from pre-pregnancy and childbirth — and their children through childhood up to age five.
“The risk of maternal death increases significantly with deliveries occurring at home, operative delivery, delivery by a non-skilled person and membership in the Apostolic church,” notes the report.
Although all district hospitals and rural health centres should offer skilled birth attendance and essential maternal and newborn care, this is not done. With the near collapse of the public health system over the last decade, rural areas have been the most affected, and often have had to rely on mission hospitals that had access to international support.
But in some cases, the report says, lack of supervision has seen some professionals neglecting duty, although primary care nurses receive basic training in essential maternal and newborn care.
“However, systematic supervision is weak and both PCNs (primary care nurses) and prospective clients lack confidence in the PCNs’ delivery skills. As a result, women are referred to district hospitals, which can increase the delay in receiving the necessary skilled care,” observes the report.
According to a social commentator, Robert Mhishi, socio-economic factors have in many ways contributed to the “laxity in professionalism and a sense of duty especially in medical care” and unless such issues are resolved, negligence of duty is likely to remain a problem.
He however added that while there was need for care starting at the pre-pregnancy level, through the pregnancy and childbirth to the early years of life, such would be asking for too much from economically-hard-pressed women, some of them single mothers.
According to a midwife at a private Harare hospital, effective and timely antenatal care is essential to protect the health of both mother and child.
“This can make the difference between life and death. While things are difficult economically, parents need to do all they can to ensure their children and the expectant mothers receive the requisite care,” she said.
The risk of maternal death, according to Mhishi, increases significantly with deliveries occurring at home, operative delivery and delivery by a non-skilled person.
“Access to care at delivery is limited due to user fees, low coverage of obstetric care in rural areas, and difficulty in getting to services in rural areas. The provision of maternity waiting homes has in the past helped women get to facilities in good time, but there is currently very limited availability,” he said.
Deputy Prime Minister Thokozani Khupe has called for the scrapping of maternity fees. In April this year, she urged the government to scrap maternity fees to curb incidents of maternal mortality related to shortage of money.
“The maternity fees should be scrapped as most women don’t have money. Why are women being punished for doing a national duty? We are giving birth to future presidents, prime ministers and doctors,” said Khupe.
Khupe said Zimbabwe has one of the highest maternal mortality rates, saying at least eight women died every day while giving birth in Zimbabwe. This, she said, translated to a maternal mortality ratio of 725 deaths per 100 000 live births and said this should be reduced by 75% by the year 2015. Khupe said high maternity fees were discouraging rural women from getting access to pre-natal care resulting in pregnancy complications not detected much earlier.
But for the likes of Macheka, they can only hope for the day when they can access maternal health services for free, or at least for an affordable charge.