Zimbabwe is a signatory to the 1994 Cairo ICPD/Programme of Action and as such it is one country that has committed itself to providing the highest level of reproductive health to its citizens.
To this end, the country has several policies, strategies and guidelines to ensure that it maintains the highest health standards.
The health care services that a mother receives during pregnancy, child birth and the immediate postnatal period are important for the survival and well-being of both the mother and the infant.
Worldwide, a woman dies in child birth every minute. Girls in their teens are twice as likely to die in child birth as women in their twenties.
Maternal death is the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and state of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes.
According to the Zimbabwe 2012 Millennium Development Goals Progress Report, a study by the Ministry of Health and Child Care revealed that the median age at maternal death was 28 years, with a maximum of 47 years and a minimum of 14 years. About a quarter of the the deaths were of those aged between 15 and 19 years of age. Eighty-two percent of those women who died of pregnancy related complications were married. A majority were also HIV positive.
According to the report, three quarters of maternal deaths can be attributed to three types of delay, that is, time taken to seek health care, time needed to reach a healthcare facility and time taken to access care at the health facility. Most women die at the height of their reproductive years, that is, before the age of 30.
Harmful cultural practices such as child marriage and female genital mutilation as well as other forms of violence against women contribute to maternal mortality.
The other critical factor is the reduced proportion of births attended by skilled health personnel. The proportion of births attended by skilled personnel according to Multiple Indicator Cluster Survey (2014) was 93.7 percent. The majority 80.1 percent received antenatal care from a nurse. Urban women are three times more likely than rural women (18 percent versus 6 percent) to receive antenatal care from a doctor. According to the Demographic and Health Survey antenatal care coverage by a skilled provider is highest in Matabeleland North (98 percent); Matabeleland South (96.4 percent) and Bulawayo.
The other prohibitive factor to pre-natal care is unavailability of critical drugs, socio-cultural and religions issues, long distances to clinics and lack of communication and information especially in the rural areas. Women need to have constant and up to date information concerning their health.
During antenatal care women and their partners are informed about risks and danger signs of pregnancy, labour and delivery and the post-natal period. Antenatal visits also provide an opportunity for women to get information on birth spacing, tetanus immunisation during pregnancy, prevention and treatment of malaria, management of anaemia during pregnancy and treatment of Sexually Transmitted Infections (STIs).
Apart from that, antenatal care also helps particularly for the prevention of HIV transmission from mother to child. Pregnant women should start attending antenatal care within 12 weeks of gestation for early detection and prevention of conditions that could negatively affect both the woman and her baby.
There is a correlation between education and maternal health. The mother’s level of education is highly correlated with the uptake of healthcare services. Educated women tend to have fewer healthier and better educated children. Education also increases women’s health and nutritional levels. Apart from that, births to mothers with secondary education are likely to take place in a formal health facility unlike mothers who have little or no education. As such, the maternal mortality rate for women with tertiary education was lower than those who had no higher learning.
Antenatal care is also related to poverty. Mothers from the poorest households were less likely to receive antenatal care the four or more times recommended by World Health Organisation and adopted by the government of Zimbabwe. Mashonaland Central had the lowest proportion of women with at least four antenatal care visits (63 percent), followed by Midlands (64.9 percent) and Harare (66.7 percent).
During the antenatal visits, it is important for husbands and partners to also attend. The wellbeing of a pregnant woman the unborn baby should not be left to the mother but the husband and partner should have an upper hand too. In most instances pregnant women go for the antenatal visits on their own and this should be discouraged.
The information after examination is critical for both partners so that together they get the appropriate treatment or medication especially as it relates to (STIs) and HIV/Aids.
After giving birth, it is important for the mother and father to receive the post natal services. The time of birth and immediately after is a critical period to ensure the health and safety of both the mother and child.
During the post natal period information and checks include the assessment of the baby, exclusive breastfeeding, cord care, assessment of the mother and counselling/psychological support.
According to ZimStat Multple Indicator Cluster Survey (2014), 85 percent of all new born babies received a post natal health check with the urban area recording 93.7 percent compared to 81.4 percent in the rural areas.
Vaidah Mashangwa is Bulawayo’s Provincial Development Officer, Ministry of Women Affairs, Gender and Community Development. She can be contacted on 0772111592 email [email protected]