The Zimbabwe Demographic Health Survey (ZDHS) is arguably the most authoritative inquiry into the overall state of our health as a people and nation.
The Government and its development partners conduct the study annually and its findings are compiled into a voluminous document which is widely circulated and debated. The report identifies areas where the country is doing well health-wise and the gaps as well. It looks at issues to do with access to health facilities and services, drugs, personnel or lack of it. Additionally, the research covers key diseases and health conditions.
It provides essential data that can be used by the Government in policy making and implementation.
On Tuesday we carried a worrying story, based on the ZDHS report for 2015 that was released in November last year, highlighting the challenges that some mothers face when giving birth. About 20 percent of Zimbabwean births over the past five years, the study revealed, occurred at home.
That institutional deliveries account for an average of 77 percent of all births since 2010 might look an encouraging statistic but it isn’t.
“Seventy-seven percent of live births in the five years before the survey took place in a health facility,” says the report, “while 20 percent were delivered at home. Most institutional deliveries took place at public sector health facilities.
“In Zimbabwe, institutional deliveries declined from 72 percent in 1999, to 68 percent in 2005-06, and 65 percent in 2010-11, and then substantially increased to 77 percent in 2015. Over the same period, home deliveries increased from 23 percent in 1999, to 31 percent in 2005-06, and 34 percent in 2011-10, and then decreased notably to 20 percent in 2015.”
A cursory analysis of the trend shows that home births were higher at the height of the economic challenges. Then many clinics and hospitals did not have enough drugs, equipment or even staff to help patients, including expecting mothers. As the economic situation improved, the number of home deliveries tended to decline while institutional deliveries rose.
Institutional delivery is when a woman gives birth in a medical facility under the overall supervision of trained and competent health staff where there are requisite amenities to handle the situation and ensure the health of the mother and her child. On the other hand a home delivery is when a woman delivers a child at home or any place which is not a designated health facility. In this respect, the woman delivers, in the best case scenario, under the supervision of a traditional midwife and in the worst case, under the supervision of her husband or “own supervision.”
It goes without saying that the process of delivering a baby is one of the most delicate processes that is a matter of life and death. Home delivery is inherently dangerous given the sensitive nature of the process. Hundreds of mothers die during labour, delivery or soon after while in other cases their babies die at these critical stages. The causes of death are many but the common ones include excessive bleeding and high blood pressure.
Also, the mother and her baby can easily get infected by pathogens as a home is not often as hygienic an environment as a clinic or hospital.
It saddens us that the bulk of the women who are subjected to such suffering are the poor, less educated and rural-based.
Bulawayo and Harare metropolitan provinces had the highest proportion of institutional births at about 91 percent, according to the report. Midlands, Matabeleland South and Matabeleland North had high percentages ranging from 81 to 85 percent.
“Masvingo and Mashonaland East had institutional deliveries ranging from 71-80 percent. Mashonaland West, Mashonaland Central and Manicaland recorded the least institutional births ranging from 66 to 70 percent.”
Globally, most home births occur in less developed countries, which illustrates the co-relation between a person or nation’s socio-economic status and access to health facilities.
“Worldwide, about one in four births (25 percent) take place without the assistance of a skilled birth attendant,” says a Unicef report issued last month.
“In 2015 alone, this translated into more than 40 million unattended births in low- and middle-income countries, about 90 percent of which were in South Asia and sub-Saharan Africa. Regional average proportions of births without skilled birth attendant range from about 50 percent in sub-Saharan Africa to two percent in Central and Eastern Europe and the Commonwealth of Independent States.”
To help reduce the number of home births, even eliminate them, there is a need for the Government and its partners to intensify the construction of fully equipped clinics and hospitals countrywide, with greater focus on rural areas. These facilities have to be manned by trained and motivated staff and also provide an affordable service.
The foregoing makes the service available but that is not good enough if the expecting mother lacks an understanding of the importance of institutional delivery. As such we recommend reproductive health education for women to be strengthened and delivered using multiple strategies.
Efforts to get more girls into school, right up to higher and tertiary education should continue too as studies show that an educated person is more likely to seek expert medical attention than one who is less educated.