THE issue of maternal health is a thorny one that easily pricks the emotional nerves of many women and men in Zimbabwe. Many times stories of how women have been ill treated in public hospitals have been told. Some women have had to endure the agony of being detained for failure to pay maternity fees. This has been done to force their husbands to pay at least half the money required by hospitals. For others, the solution is sneaking out, an experience that is stressful and difficult to forget.
"Plates" full of responses and suggestions on how the issue should be handled and addressed have been put on the table and it does not seem they will empty soon as takers are few. The problems still exist and women, children and health personnel in some cases bear the brunt. It is a mixed bag of problems. Women and their new-born children have died during the birth process because of various reasons. With rising unemployment and the need to fulfil society's expectations, that couples should bear children soon after marrying, young women are having children even when they have no means to pay for maternity fees and worse, take care of them. The issue of human rights also comes into play as everyone has the right to have children, whether rich or poor.
Maternal health problems are not limited to rural areas only but cut across the Zimbabwean society and, on a larger scale, regionally. Following a number of issues raised through stories published in various newspapers, some readers have raised this question. Is this not the time to consider increased use of family planning methods to manage the number of children if a couple does not have the means to go through a pregnancy and moreover take care of the children?
What is the solution to all these maternal problems being faced by women daily? Family planning is having the number of children a person wants, when she/he wants them. It allows couples to plan for their children in terms of health, economic status and goals for the future. Family planning is important as people can consider the number of children a person can support both economically and emotionally.
Women in some rural areas claim they have limited access to contraceptives as a packet of tablets costs US$1 for two in pharmacies and US$1 for four packets in public clinics, money they rarely have. In some cases, use of condoms, which cost a rand and are given free of charge in health facilities, is low in married couples because of the way it was introduced mainly because most people do not view it as a contraceptive. It was introduced as a measure to prevent diseases like STDs and associated with promiscuity by most married couples. Some men leave the duty of choosing the right family planning method to their wives, and blame them for falling pregnant.
But Zimbabwe National Planning Council executive director Dr Munyaradzi Murwira said family planning is by choice. "Every individual has reproductive rights which include the right to have children or not. Therefore the country cannot impose family planning on couples." He explained that the current uptake of contraceptives is dependent on a number of psychological and economic factors, which include but not limited to culture and religion, education, environment, access to and availability of family planning services. "In cultural factors 'African' men play a very critical role because they decide on reproductive issues," he said. He said services are more accessible in urban than rural areas. Dr Murwira added that family planning services are easily accessible through public sector health facilities, outreach services and community-based distribution programmes.
However, there are some under-served areas where there are no service providers, he said. He added that it is difficult to separate prevention of pregnancy and HIV infection because the condoms provide dual protection, that is unintended pregnancy and sexually transmitted infections, which include HIV and Aids. He revealed that the highest use of contraceptives is in the 30 to 34 years age group while the lowest is in the 15 to 19-year group. Women in urban areas have the highest uptake of contraceptives, he said.
Dr Murwira added that Mashonaland Central has the highest uptake of contraceptives while Matabeleland South has the lowest. The Women's Action Group (WAG) director, Mrs Edinah Masiyiwa, says it is unfair to suggest increased use of contraceptives for poor people as a way of addressing maternal health problems. She says this may in the end result in an infringement of their right to have children. Mrs Masiyiwa said family planning methods can be advocated for more when talking about managing abortion issues. She says there is need for measures that will address all the problems associated with maternal health. She, however, points out that more should be done to solve current problems as it is degrading when women are left with no option but flee hospital without paying.
"The issue of parents sneaking out of Harare Central Hospital without paying is very degrading for women. I say parents not women because men should also be involved in pregnancy. It is important to note that these women do not sneak out alone but the husbands also assist in the escape as they are the ones who usually do not provide money for payment," she said. Mrs Masiyiwa added that the hospital is also infringing the rights of the child when it withholds clothes and birth records. "This has future implications, especially on the girl child. This is why we have fewer women in decision-making positions because most would have failed to obtain birth certificates and national identification cards as their parents would have sneaked out of hospital and not obtained birth records," she said. She applauded Government for scrapping maternity user fees in rural areas, saying what now remains is to make sure that this is enforced.
"I hope that city councils will follow suit and also scrap maternity user fees. At WAG we believe giving birth is a national duty," she said. Ghanaian physician and women's health advocate Dr Fred Sai, while speaking at a youth pre-conference on maternal health, said it is crucial to engage young people in discussions about reproductive health and family planning early.
"Youth are one of the world's greatest resources, and we must ensure that they are empowered with the tools and the knowledge they need to lead long, healthy and productive lives," she said. Jill Sheffield, president of Women Deliver, a global advocacy organisation bringing together voices from around the world to call for action against maternal death, says they are at a critical juncture in global efforts to improve maternal and reproductive health. "We have seen time and time again that prioritising girls and women is a good investment and a smart one. Now, more than ever, we need the political will and resources required to achieve the goals we have set and deliver on the promises we have made," she said. She adds that in recent years, sub-Saharan Africa has made progress toward improving maternal, sexual and reproductive health, however, significant challenges still remain.
Since 1990, maternal mortality has decreased by 26 percent across the region, but 39 percent of pregnancies are still unintended, and only 17 percent of married women of reproductive age use modern contraception. On average, a woman in sub-Saharan Africa has a one in 31 chances of dying during pregnancy or childbirth, and 570 women die each day of pregnancy-related causes. About 70 percent of people living in urban areas use contraceptives while only half of the population living in rural areas uses the same method to prevent pregnancy, a study has revealed. The Zimbabwe Demographic Health Survey 2005-2006 showed that only 55 percent of the rural populace used contraceptives. About 70 percent of people living in urban areas use contraceptives while only half of the population living in rural areas uses the same method to prevent pregnancy, according to the study. Manicaland Province recorded a 52,4 percent contraceptive use while Mashonaland Central Province had 61,4 percent and Mashonaland East Province recorded 64 percent. In Mashonaland West Province 62 percent of the population used contraception, Matabeleland North Province had 45,7 percent, Matabeleland South Province 47,2 percent, Midlands Province 63,4 percent, Masvingo Province 54,1 percent, Harare Province 71,9 percent and Bulawayo Province 67 percent.
Rural people have recorded lower contraceptive use due to the failure by health service providers to promote discussions on family planning methods. Inaccessibility and unavailability of family planning services in remote areas of the country was also mentioned in the study as contributing to the low uptake of contraceptives by rural people. This has had a negative impact on the Millennium Development Goals (MDGs). Sadly, of the eight MDGs, progress towards MDG 5 (Improve maternal health) has been lagging furthest behind on the global scale.