Rural women struggle to access maternal care Mrs Sibongile Mpofu

Gibson Mhaka, [email protected]

MRS SIBONGILE Mpofu (54) from Mtshina Village under Chief Goledema in Ward 10 of Tsholotsho North, Matabeleland North province not only had her three children delivered at home, but she gave birth without the help of a midwife or doctor. 

 Mrs Mpofu shared her traumatic experiences when she gave birth to the three children. 

She recounted seeing herself lying naked in a pool of blood surrounded by two old women who were assisting her to give birth.

“I gave birth to my first born when I was exactly 17-years-old. I vividly remember being in excruciating pain as I was lying naked in a pool of blood surrounded by two old women.

“I felt like the weight of the universe was crashing from my head to my toes. It wasn’t an emergency but a planned birth at home due to inadequate health infrastructure in our area,” recounted Mrs Mpofu.

She said the older women who were assisting her didn’t charge her but she gave them a token of appreciation.

Also sharing her anxieties on the lack of access to maternal health care services in the area, Mrs Moyo who refused to reveal her first name, said she gave birth to both of her children at home.

Her first-born is now 11 years-old and her second is seven.

“Here at Mtshina accessing healthcare services is a nightmare. The nearest clinic is Sikente Clinic which is about 20 kilometres away. There are also no cars or buses from our area going to that side, meaning if you’re pregnant, you’re forced to deliver at home. 

“Sometimes even if you go to the clinic, there will be no trained midwives or nurses equipped with knowledge and skills that make a difference between life and death,” lamented Mrs Moyo.

The experiences of Mrs Mpofu and Mrs Moyo highlight challenges faced by pregnant women and girls from remote areas like that of the San Community. Many are giving birth at home without the help of experienced midwives thereby exposing them to risks of complications during deliveries.

The situation is dire for expectant mothers particularly those living in rural areas where public health facilities are shunned by medical professionals that include midwives.

Women in rural communities also experience higher rates of life-threatening complications during and after childbirth.

According to a report by the United Nations Population Fund (UNFPA) Zimbabwe, complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age (15-49 years) in Zimbabwe.

The report says every two minutes, a woman dies during pregnancy or childbirth; every 16 minutes, a baby is stillborn and most of these deaths are preventable with access to skilled midwives.

A 2021 report by Amnesty International Zimbabwe revealed that pregnant women have to gamble with their lives by opting for home births due to under resourced Government hospitals and cultural beliefs, which means that some women don’t have a choice but to submit to home births administered by untrained family or community members.

“Although Zimbabwe’s Ministry of Health and Child Care advises women to give birth at health facilities, demographic data indicates that nearly one quarter of women give birth without the help of trained midwives due to cultural preferences, religious beliefs, economic constraints, lack of decision-making power and fears of poor care from the formal health system,” the reports reads in part.

It is clear from the report that a shortage of midwives in Zimbabwe presents a serious challenge particularly in rural areas as women struggle to access maternal care which is one of the major contributors to the high neo-natal and maternal mortality rates in the country.

At a time when Zimbabwe is facing challenges of retaining midwives in rural areas, the shortage of midwives coupled with low recognition have collectively left rural women to experience difficulties accessing maternal care that is readily available in urban centres.

According to research, midwives play a pivotal role in providing maternal care in low and middle-income countries like Zimbabwe.

A statement commemorating the International Day of the Midwife, marked every May 5, UNFPA hailed midwives for their invaluable contribution to health care, particularly in delivering Sexual, Reproductive, Maternal, New-born and Adolescent Health (SRMNAH) care services to millions of people in Zimbabwe as well as globally.

“They’re public heroes, ensuring that a woman plans her family, has a healthy pregnancy, safe childbirth and essential post-natal care for herself and the baby.

“Midwives are needed not only for delivery and new-born health care but for other sexual and reproductive health interventions such as contraceptive services, management of sexually transmitted infections, screening for cancers of the reproductive system and provision of adolescent sexual and other reproductive health services.

“Because of their role in pre-pregnancy, delivery and post-delivery care including management of complications of pregnancies, they significantly contribute to the reduction in maternal mortality. Provision of family planning services by midwives also helps in averting maternal deaths,” the statement reads.

According to the agency, over 4 000 midwives have been trained since 2013 and UNFPA has contributed in various ways by supporting the education, practice and regulatory systems and structures.

Although midwives are the mainstay of providing maternal care to women, just like doctors and nurses, they are shunning rural areas because of poor working conditions.

This critical shortage of midwives has been cited as one of the major factors driving maternal deaths in rural areas. 

A senior midwife at Mpilo Central Hospital in Bulawayo who declined to be named said most midwives shun working in rural areas because of poor working conditions.

“There is a serious shortage of midwives in rural areas or remote communities because of poor working conditions and ill-equipped health facilities. Another issue is that not many nurses are willing to train as midwives because the job is too demanding leaving those few to be deployed in major cities and towns.

“There is no doubt that these challenges can result in a number of negative maternal health outcomes in rural areas including premature birth, low-birth weight, maternal mortality, severe maternal morbidity, and increased risk of post-partum depression,” said the senior midwife, who has worked at the hospital for the past 10 years.

Zimbabwe Confederation of Midwives (Zicom) president Mr Obert Nyatsuro has been on record saying midwives are defenders of women’s rights hence they should always strive to equip women with requisite information for them to make informed decisions during pregnancy, labour and child birth.

“Women have the right to information and it is us who should equip them with information. We should then respect whatever decision they make whether positive or negative. It is our motto as midwives that no woman should die while giving birth and no child should die,” said Mr Nyatsuro.

Globally, there is a shortage of 900 000 midwives and experts say, investing in midwives could save up to 4,3                                                                                                  million lives every year by averting 67 percent of maternal deaths, 64 percent of neonatal deaths and 65 percent of stillbirths.

It is important to note that for the country to achieve universal access to health for all and improve women’s maternal care needs and reduce adverse events associated with delivery particularly in rural areas, there is a need for the Government to invest in training of midwives.

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