Pregnant women in marginalised communities are struggling to access prenatal care due to the current lockdown, it has emerged.
news in depth:BY NOKUTHABA DLAMINI
Zimbabwe commenced a 21-day lockdown on March 30 and extended it by two weeks last Sunday to curb the spread of the novel coronavirus that has already killed four people, while a total 28 cases had been confirmed positive by Friday.
There are stringent in-country travel restrictions that include the temporary ban on public transport operated by private business.
An informal survey carried out by The Standard, working in collaboration with Information for Development Trust, has revealed that rural and urban women, particularly from low-income households, are being forced to deliver at home in Matabeleland North and other parts of the country.
Fungisai Sithole from Citizen Health Watch said her organisation was receiving reports that pregnant women were not only failing to access prenatal care services, but were also struggling to buy materials to prepare for the birth of their babies as shops were closed or difficult to reach due to a public transport ban.
“Women and their unborn children are at risk especially those from rural areas, the underprivileged and those with complications,” Sithole said.
“Reports that we are getting show that pregnant women are not only stranded due to lack of transport, but are also struggling to get food and clothing for (delivery) preparation since clothing shops are closed.
“If this is not addressed quickly, it could defeat government’s efforts to prevent deaths.”
According to the 2019 Multiple Indicator Cluster Survey, Zimbabwe’s maternal mortality rate dropped from 614 mother deaths per 1 000 000 live births in 2014 to 462, a figure considered to be still high.
Ethel Mpofu from Mhlabuyatshisa village in Nkayi had registered to deliver at the district hospital — some 50km away — in early May, but has lost all hope because there is no public transport in the area.
Only the government-owned Zimbabwe United Passenger Company is allowed to transport people, but it is not available in her area.
But even if she could find private transport to ferry her to the clinic, the unemployed 32-year-old mother of two, whose husband is also jobless, cannot raise the fare.
She has the option to walk the 50km to the clinic, but the idea scares her as she could develop complications along the way, so she would rather deliver at home.
“We have a number of elderly women who have helped with deliveries in this village and I will have to approach them when the time comes,” Mpofu said.
“But I am scared because in 2011 I had to be transferred to Mpilo Central Hospital in Bulawayo for a Caesarean section due to complications during the birth of my last-born child.
“I don’t know how my other children would survive if I were to die during childbirth,” she added.
It is the same story with many other pregnant women in Matabeleland North province, which has a poor road network and the few health centres are hard to reach.
A nurse at Tsholotsho District Hospital, also in Matabeleland North province, said more women in the area were now being forced to deliver in unsafe
environments, where they are prone to infections and have limited options if complications arose.
The nurse, who asked not to be identified, said traditional midwives often conducted deliveries without drugs and sanitisers, and feared that could complicate deliveries and spike maternal deaths.
Seventy-two-year old Gogo MaZimbili from Nkayi, a community midwife, said she had assisted at least eight women give birth in her village since the lockdown began and described the number as unusually high.
She said under normal circumstances, she could go for two months without helping a woman deliver.
Gogo MaZimbili said she was grateful that none of the women developed any complications while giving birth as she does not have the means to take them to hospital.
She said she had helped numerous women who could not afford hospital fees to deliver and charges a goat for a delivery.
The widowed midwife has turned a thatched hut into a maternity room and works without protective clothing such as gloves and hand caps, and uses an ordinary hanging line peg to cut the umbilical cord.
She has heard about the coronavirus and has her own fears that she might contract it, but puts the village mothers first.
“Hospitals and clinics are too far away for the expecting mothers so they can’t use donkey- or ox-driven carts to get there.
“I give a traditional herb called umankunzane to drink for those women who experience complications or delays. It helps quicken delivery.”
Sithole said pregnant women also faced the danger of dying at home due to other complications that include excessive bleeding while their children could miss out on vaccinations.
She said the outbreak of the coronavirus had also added more pressure on a thinned-out health care system, which already struggles to provide adequate services to protect pregnant women.
Fortune Nyamande, the Zimbabwe Association of Doctors for Human Rights spokesperson, said both rural and urban expecting mothers were vulnerable to the coronavirus.
Even though health centres still had dedicated maternity wards, he added, staff was overstretched and did not have adequate personal protective clothing, while mechanisms to prevent the spread of the Covid-19 disease remained poor.
“Most hospitals are now delaying attending to patients with conditions such as diabetes and pregnant women as they give priority to coronavirus cases,” said Nyamande.
Bernard Madzima, the director of family health in the Health and Child Care ministry, admitted that expecting mothers could fail to access health care centres during the lockdown and that authorities had not put any measures in place to assist them.
“Definitely there will be issues of complications in terms of unavailability of transportation during the lockdown period and it will need community efforts to ensure that a pregnant woman who needs to get to a health facility manages to do so,” Madzima said.
He said government was in the process of dedicating maternity wards to Covid-19 positive expecting mothers, adding that this would be complemented with intensive training and awareness building for frontline health workers.
A Victoria Falls woman, who has just entered her third trimester, said she had started buying secondhand clothes for her unborn child after she lost her job as a tour guide, but was unsure if it was safe for the new life.
“I lost my job last month, and I had not managed to budget for my unborn child’s clothes,” said Soneni (not her real name).
“My neighbour led me to a lady in Chinotimba who sells secondhand clothes for babies and I went to buy from there but, unfortunately, most of them are too worn out, faded and too big for a newly born child.
“But that is the only choice that I have.”
The lockdown extension will expire on May 3, but experts project that it could be stretched as positive cases and deaths are on the increase, while testing is still low.