Regina Pasipanodya
Around 11 pm on September 17, 2023, Memory Sengwa (19) a mother to a two-and-a-half-month-old baby girl from Epworth, which is about 19 kilometers from the Harare Central Business District could barely walk on her own due to a severe backache.
On this fateful day, Sengwa who was experiencing labour pains, struggled to get to Gogo Nyakudanga’s home, where she needed urgent assistance. Gogo Nyakudya is one of the Traditional Birth Attendance in Epworth.
Unfortunately, Sengwa had been turned away from the clinic after failing to present cash for her maternity booking fee.
“When I started experiencing labour pains, I called out for help from the neighbours who then rushed me to the local clinic for medical assistance. On arriving at the clinic, they said that they could not admit me, insisting that I should pay the maternity fees first before they could attend to me,” Sengwa said.
She was forced to leave the clinic despite being in a critical and desperate situation, because she had no money.
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Sengwa is one of the unfortunate mothers in Zimbabwe who are failing to get access to maternal healthcare because of lack of capacity to raise the required fees.
In addition, she could not buy other requirements like gloves, code clamp, cotton wool, surgical blades, which some clinics require before admission.
In Zimbabwe, maternal healthcare booking fees for local clinics range between USD35 and USD50 depending on the area.
However, the amount is too high for many underprivileged women from communities like Epworth.
They are forced to seek assistance from TBAs during childbirth.
“When I left the clinic, my only hope was now with Gogo’ Nyakudanga and I had to try hard to get to her place which is about two kilometres from the clinic. I was fortunate enough to find her at home and she quickly attended to me,” Sengwa said.
“Within a few minutes, I safely delivered a baby girl who I named Kudzwaishe (meaning God be praised) because I feel that I had done something that I did not think I could do in such a dire situation,” she said.
This was her first pregnancy.
Hers is not a unique story as many girls and women in the Epworth community are now seeking maternal care from TBAs since they cannot afford the maternal fees.
Access to maternal healthcare
According to an Amnesty International 2021 , some pregnant women and girls in Zimbabwe shun public healthcare facilities in favour of home-based deliveries due to inadequate health infrastructure, cultural practices, and high hospital costs exposing mothers to childbirth-related injuries like obstetric fistula.
Since 2010, TBAs in Epworth have been bridging the gap in accessing healthcare for the poor. Their services have become a solution to the immediate challenges faced by would-be mothers.
“Access to quality formal healthcare services in Zimbabwe is becoming quite low, a condition that is blamed for the country’s current high maternal mortality figures. At least 10 women die daily due to pregnancy-related factors and a much larger number suffer from short and long-term maternal-related morbidities,” Amnesty International report revealed.
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The report further disclosed that Zimbabwe has one of the highest maternal mortality rates in the world. Many pregnant women are gambling with their lives by opting for home births due to underfunded and under-resourced government hospitals or because they cannot afford the cost of care
Zimstats 2022 Preliminary Results of Housing and Population Census revealed that maternal mortality is currently 363 per 100 000 live births.
Survival strategies
A survey conducted by this reporter in Epworth revealed that many women in this community are now turning to TBAs as a survival strategy to save their unborn babies.
In Zimbabwe, for years TBAs have traditionally been assisting women during childbirth emergencies as well as providing community members with pregnancy monitoring, emotional support, and practical assistance both before and after childbirth.
But for the Epworth community, TBAs are providing underprivileged mothers with a chance towards safe delivery with the care of a self-appointed group of women who are providing maternal health care to desperate mothers.
In an interview with She Corresponds Africa, Melody ‘Gogo’ Nyakudanga a leader of the TBAs in Epworth said access to maternal healthcare has been a challenge in her community.
“As the elders of the community where most of you girls are falling pregnant and do not have support systems, we took it upon ourselves to get the necessary knowledge through maternal healthcare training to prepare ourselves so that we can help desperate mothers in our community,” she said.
“I would like to confirm that here in Epworth things are not well, I know very well that mothers are struggling to put food on the table let alone raise money for maternal bookings. If truth be told, women want to deliver in a safe environment, like a clinic or hospital, but the situation has been putting women in a compromising position.”
Since 2010, several women voluntarily joined the group of TBAs in Epworth offering help towards mothers during childbirth emergencies. Today there are 65 licenced TBAs who are working as a team in Epworth.
“When we started, we had no knowledge on safe childbirth delivery, but with the help of Soroptimist International, we were trained in Mother and Child Care and Emergence Delivery as well as training in First Aid with St John’s Clinic,” Gogo Nyakudanga said.
Many women are opting for home-based birth to escape the demands at clinics.
This has seen the TBAs gaining trust in the Epworth community.
Jessica Mware (21), who also gave birth under the TBAs said that throughout her pregnancy she regularly visited TBAs from Nyakudanga’s team pretending to have come for a casual visit.
“I would go as if I wanted to check up on them but when I got there, they would ask how I was feeling, give some tips on how to have a healthy pregnancy. Although they would always encourage me to go and book at the clinic, I would tell them that I could not afford it,” she said.
“So, when I got into labour, I had to delay going to Gogo’s place knowing that they would force me to go to the clinic since they only attend to emergencies.
“When they heard that I was experiencing labour pains, they rushed to my place to check up on me. By the look of things, I think it was too late to send me to the clinic.
“They helped me deliver my baby girl safely.”
Government position
Analysts believe that government intentions towards improving maternal healthcare are somewhat confusing.
“Although Zimbabwe’s Ministry of Health and Child Care advises women to give birth in health facilities, demographic data indicates that nearly one-quarter of women give birth without skilled assistance due to different reasons like exorbitant maternal healthcare, the fear of being shamed by health professionals and concern over lack of privacy and confidentiality among health care workers in different communities,” reports Amnesty International.
UNICEF has reported that midwifery training in Zimbabwe has been scaling up. Several training schools for midwifery have been opening to lessen the shortage of skilled staff to reduce maternal mortality rates and improve maternal health.
However, the healthcare sector has been failing the desperate mothers as the burden of providing the antenatal care-related kits is now imposed on them leaving the vulnerable with very limited choices but to turn to TBAs.
Zimbabwe National Traditional Healers Association (ZINATHA) believes that the field of maternal health care should also be entrusted to TBAs who can cater for under-privileged mothers.
Kandiero said: “TBAs have always played a critical role in our society, attending to would-be mothers whenever necessary and with the poor performance of the healthcare sector what could the mothers do in such a situation?
“They need to give birth but they cannot afford the hospitals, so I believe that the TBAs should be given the recognition that they deserve because they are doing what the government is failing to do; providing safe maternal healthcare to all mothers in the country
“I believe that until the government of Zimbabwe commits to make maternal healthcare freely available and accessible to anyone who needs it, pregnant women and girls will remain vulnerable to risks related to giving birth.”
An effort to get a comment from Harare Provincial Medical Director Dr Innocent Hove was fruitless. He demanded She Corresponds Africa’s memorandum and registration certificate before commenting.
“You will have to bring them to me because I do not have time to do background checks myself,” he said.
Harare City Council Epidemiologist Dr Michael Vere however confirmed that the TBAs have been filling in the gap within the maternal healthcare.
“It is unfortunate that expecting mothers are faced with several challenges when it comes to access to maternal healthcare like the cost of travel and the cost of the service in the local clinics or hospitals. Therefore, due to financial barriers some women have been turning to the service of the TBAs.
“However, there are dangers and risks that are exposed to expecting mothers who seek help of TBAs since there won’t be close monitoring, antenatal test and even when there is a dire complication that needs surgical intervention. To address these issues the government has been providing free maternal healthcare service in rural areas and as for the Harare City Health our charges for maternal health has been as little as USD25,” said Dr Vere.
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