Tafadzwa Mwanengureni
In September last year, Abigail Mukwada (39), gave birth to her sixth child at a traditional midwife’s home in Mazwi village, Bocha, Manicaland.
The rest of her children, except the first born who was also born at home, were delivered at a clinic.
Her decision to have a home-based delivery was a result of a horrific incident she witnessed at a clinic in July when she went for antenatal care at within district.
” I witnessed a woman who was in labor. She was left without anyone to look after her yet she was about to give birth at that clinic. The nurses had gone to a camp meeting,” she said.
“It’s meaningless that you visit the clinic and encounter such a situation”.
Many rural healthcare institutions have acute staff shortages. The dire situation has been worsened by the migration practitioners to the United Kingdom over the past years.
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The shortage has resulted in an increase in the number of people seeking the services of traditional midwives.
Aa survey conducted by She Corresponds Africa in Bocha revealed that some clinics have two nurses, serving a ward with more than five villages consists of more than 100 households each.
Zimbabwe is among the African countries that was listed as having a vulnerable health workforce together with Rwanda, Comoros and Zambia, by the World Health Organisation.
Statistics by the Health Services Board revealed that more than 4 000 nurses and doctors have left Zimbabwe since 2021.
The figure above clearly indicate how the country’s health system is crumbling.
The situation is particularly dire in rural areas.
Mukwada who has been assisted by both professional and traditional attendants, now perceives home birth delivery as a better resort.
Of her six children, four of them were delivered at a clinic and the other two were conceived with the help of a traditional midwife.
One of the renowned traditional midwives in Chigonda area Tanyara Dukwende (65), who is popularly known as Mbuya Madhende, says she assists pregnant women at any given time.
“I started midwifery in 1982, and to date, l have assisted the delivery of almost 400 babies”.
“As a prophetess, I first pray and examine the womb to see if she can push, if she requires a Cesarian Section I hire a taxi to rush her to hospital.
“From the time l started I only referred 5 women to the hospital and they definitely had the C Section, but the rest had a self-delivery here,” said Mbuya Dukwende.
She is one of the midwives that the majority of women in her area rely on.
She gained popularity in Chigonda because for many years because for many years, the nearest health centres were Chikwariro and St Andrews which are more than 10 kilometres. The poor road network meant that patience used carts to reach the facilities.
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The construction of Chinyamazizi Clinic in Buwerimwe Ward 23 came as a rescue to the surrounding villages such as Mazwi, Maanhu, Mafunde and Muteeri among others as they shared the same burden of long distances to reach nearest health centres.
Although it can be perceived as a milestone in the community development, the clinic is not enough to cater for the needs of the population as it is staffed with two nurses only.
The scarcity of nurses has led to Mukwada and other pregnant women portraying clinics as a place to get cured of other diseases instead of natal care.
“You can find that home-based delivery is better because a traditional midwife can assist you anytime and they have a warm welcome to pregnant mothers,” said Mukwada.
However, the blame should not be put on the health practitioners because they try their best but are overwhelmed by the heavy workload.
“We suffer burn outs, because sometimes I knock off at 4 am monitoring a patient the whole night and at 7am in the morning another patient knocks at the door. l am forced to attend to them despite being tired,” said a nurse from a local clinic.
Therefore, in some instances they just refer pregnant mothers further to district hospitals for delivery even if they have no complications.
“Sometimes, they just judge your body and ask your shoe size, if you are small-bodied they refer you to Mutare despite the fact that you had no complications in your previous delivery”, said Brenda ** (29) from Nyanga village.
Zimbabwe Rural and Urban Nurses Association president Simbarashe Tafirenyika lamented the collapse of the health adding migration has caused havoc in the maternity section.
“The situation in the maternity wards is very dire and sorrowful and this might actually increase of maternal deaths,” said Tafirenyika.
“Due to nurse-patient ratio you find that most of the pregnant women even when there is no any complication, the midwives sometimes just refer them further even if they can deliver normally.”
But for many patients, the situation at the clinics is not good either.
Due to her history of giving birth through cesarian section, Ever Myambo, a mother of three was referred to Sakubva District Hospital, where she stayed for two weeks waiting for the operation.
“I was supposed to have a C-Section the next day after l was referred, but they took long to attend to me. They hurried after they saw me experiencing labor pains”, she said.
In most cases, a person giving birth through C-Section should be operated at 36-37 weeks.
Myambo is fortunate to have a supportive and working husband who hurriedly sent money for travelling to Mutare since the clinic had no ambulance.
Absence of ambulances in rural clinics is another factor that forces many women to opt for home-based delivery because they cannot afford to hire transport to reach district hospitals.
According to World Bank Poverty & Equity Brief for Africa Eastern & Southern Zimbabwe Report (2020) “extreme poverty has traditionally been high in remote and poorly connected but densely populated rural areas where agricultural conditions are not optimal, forming severe spatial poverty trap”
Due to poverty in rural areas, money that should otherwise be channeled to ferry a pregnant woman to the institution she got referred, can be used to buy food and other household basic needs, resulting in a home delivery.
Travelling from Chigonda to Mutare costs $4 but in many cases an emergency arises when affected persons do not have money leaving them to turn to traditional midwifes.
In 2021, Amnesty International Director for East and Southern Africa Dr Deprose Muchena raised concern over maternal deaths in the country.
“Zimbabwe has one of the highest maternal mortality rates in the world and pregnant women have to gamble with their lives by opting for home births due to underfunded and under-resourced government hospitals or because they cannot afford the costs of care”, said Dr Muchena
Preliminary Results of the 2022 Housing and Population Census shows that maternal mortality in Zimbabwe is 363 per 100 000 live births.
If the country had enough health practitioners, it could have by now made great strides in meeting its target of ending maternal deaths by 2030.
Tafirenyika called on the government to intervene to address the maternal shortcomings in Zimbabwe so as to meet the goal. She said the government needs to ensure the availability of drugs; beds specialised for labor as well maternal vaccines.
“The policy makers have to pull up their socks if we are to meet the 2030 target of ending maternal mortality because the situation is actually going down,” Tafirenyika said.
“Looking at the maternity infrastructure as well as blankets used by patients you can find that they are dilapidated and no one is monitoring if they are well maintained.”
In his speech at the Zimbabwe Medical Association (ZIMA) congress which was held in September at Cresta Lodge in Harare, UNICEF representative Dr Tajuddin Oyewale raised concerns over postnatal care in public health centres.
“With the increase in facility-based delivery in Zimbabwe, there is a great opportunity to provide essential newborn care and identify and manage high risk newborns.
“However, few women and newborns stay in the facility for the recommended 24 hours after birth, which is the most critical time when complications can present.
“In addition, too many newborns die at home because of early discharge from the hospital, barriers to access and delays in seeking care,” said Dr Oyewale.
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