The high cost of motherhood: A silent maternal healthcare epidemic in Zim
WHEN Grace Chindume finally cradled her newborn baby against her chest, a fragile life that was brought forth in dire circumstances, she was the happiest mother on earth. Little did she know that an hour later the harsh reality awaited her.
Chindume (18) from Epworth, about 17 kilometres south east of Harare's central business district, gave birth at home in the early morning of March 12, 2024, after her water broke and immediately followed by the baby before she could leave the house for the hospital.
“I had a very short labour that by the time the car that was supposed to take me to the hospital arrived, the baby's head was already out,”said Chindume who gave birth to a baby girl with the help of the elderly from the house next door.
This is the first part of a series, The high cost of motherhood: A silent maternal healthcare epidemic in Zimbabwe, supported by the International Women's Media Foundation's Howard G Buffett Fund for Women Journalists.
“The midwife used a razor blade which we had found in the house to cut the umbilical code and tied it with a string,” she said with pain in her eyes.
Determined to take the infant and herself to a local medical facility for examinations since she had given birth with no sterile hospital equipment and no skilled hands to guide her, Chindume made her way to the local clinic soon after she gave birth.
When she got to the local clinic, the nurses on duty demanded payment before they could attend to Chindume and the baby.
“US$55 in total, they declared; US$25 for the baby, US$25 for my check-up and US$5 for the umbilical cord clamp,” she told NewsDay.
The young mother was left helpless as the very system that was meant to ensure their wellness had become a stumbling block, demanding money over care and service.
This is not an isolated incident but one thread in the intricate maternal health struggle in Zimbabwe.
A silent epidemic
In Zimbabwe, motherhood is no longer measured in joy alone but exacts a toll that stands as a silent epidemic.
The country bears witness to one of the highest maternal mortality rates in the world.
According to the Zimbabwe Coalition on Debt and Development (Zimcodd), a non-governmental organisation that advocates citizens' involvement in public policy, the “persistently high rates of maternal and infant mortality” reflect a systematic failure to prioritise and invest in maternal health while the right to basic health is guaranteed in Section 76 of the Zimbabwean Constitution.
“In Harare, cases of medical negligence, disrespect and demeaning experiences in maternal care and lack of accountability by health professionals in local clinics and hospitals have been making headlines with some women seeking justice through litigation after being failed by the health delivery system,” Zimcodd said.
While the National Development Strategy 1 advocates quality healthcare services, the maternal mortality rate remains moderate to high in Zimbabwe at 363 per 100 000 live births by 2030 according to the World Health Organisation.
This is worrying as the maternal mortality rate is considered a primary and important indicator of the country's overall health status or quality of life.
The alarming trend indicates the urgent need to improve maternal health services in the country.
Zimcodd urged the government to prioritise and invest in maternal health services to ensure the well-being of mothers and infants highlighting that the lack of accessible clinics and lack of essential supplies leaves countless women vulnerable.
“Pregnant women often face financial, logistical and systemic problems when seeking care, making them gamble with their lives as they would be forced to choose between underfunded hospitals or the uncertainty of home births,” the policy advocacy organisation added.
Poor service
For Chindume the health officials failed her.
“I was so hurt that the nurses could not even check on my baby, all they cared about was money. The baby was bleeding but they couldn't care and when I paid the US$5 for the code clamp the nurse just asked me to lift the baby's top and put the clamp without checking how and what was causing the bleeding of the baby,” Chindume said.
As far as the wellness of the mother is concerned, the nurse did not examine her to see if she had delivered the baby safely without getting damaged.
Primrose Bhude (18) also faced the same predicament after she failed to get access to a local clinic as they officially demanded money for maternal booking before they could attend to her.
“I had booked in Gokwe but unfortunately I went into labour while I was in Harare. When I got to a local clinic, the health officials refused to even check out the hospital card that I had with me but demanded that I first pay US$40 maternal booking fees. They started mocking me calling each other to come and see what they regarded as ‘drama',” Bhude said.
In Zimbabwe, a maternal booking card is valid only if it is being used in the same province, especially for those in the cities.
“They told me that the booking card that I had from Gokwe does not work here in Harare. I had to go through the same stage again, make the payment and get a new card in Harare,” said Bhude.
She decided to give birth at home with the help of traditional midwives despite the risks she and the baby might face but she did not have an option.
She gave birth in March and up until now she has not yet been able to get the baby card.
Rumbidzai Nyakudanga, one of the women in Epworth who has been helping desperate women to deliver their babies in cases of emergency, said most people in her community were underprivileged.
They cannot afford a normal meal daily let alone raise money for maternal booking, she said.
“This has been hard for all of us as we have to reach out whenever a pregnant mother gets into labour.
Sometimes we deliver the babies with our bare hands or wear plastic bags. This is a risk to the baby, the mother as well as us the midwives due to lack of sterilised hospital equipment but what can we do? Our hands are tied, we do not have any other option,” Nyakudanga said.
Daniel Molokele, Health and Child Care Parliamentary Portfolio Committee chairperson and Hwange Central MP, said the maternal healthcare service in Zimbabwe has been on the decline, an indication of the government's failure to provide for the fundamental right to primary healthcare as enshrined in the Constitution.
“User fees are very unpopular in Zimbabwe at the moment and there must be ways for the government to invest in healthcare services. For those that can afford, they now rely on private care services which are beyond the reach of many.
“As Parliament our push is to increase funding for health so that free maternal healthcare services are provided even at the primary healthcare level,” Molekele said.
AS we explore and navigate the complex terrain of climate change adaptation, harnessing the power of volunteerism is key to community development. While many people are serious about climate change adaptation and mitigation, it is the spirit and culture of volunteerism which is missing for people to transform community landscapes and infrastructure.
It is important in this regard to first unpack the troublesome words that are sometimes used interchangeably in public discourses. Volunteerism is viewed as an act of contributing to community service or supporting a non-profit organisation. Therefore, volunteerism is a system of providing time and energy towards a greater cause such as changing the lives of the community without necessarily being paid. Volunteering allows one to connect with their community and make it a better place. Volunteering, volunteerism and voluntary are understood to be activities undertaken for the public good, for which monetary reward is not the motivating factor.
The passion for climate action and justice being displayed by diverse groups, organisations and institutions is not necessarily motivated by volunteerism. The act of volunteering should be intrinsically driven, motivated by the love of the environment and climate justice issues not necessarily financial rewards. Volunteering should stem from interest in community development issues, the love for nature and sustainable development, not monetisation.
Although climate meetings, workshops and conferences are necessary for planning and climate mapping purposes, the rate at which time is spent in this regard and not on the ground, is quite alarming just for one reason, that is greasing of palms. We all live and work for money but the financial requirements have retarded climate adaptations on the ground. Although monetary benefits are everything, they are not the answer to complex climate change problems destroying livelihood options. The need to shape the environment and transform it through intrinsic motivation is the missing link.
In the presence of donor funds, endless meetings, workshops and conferences, the climate problems are firmly upon us, in fact they are accelerating. Lack of transformation of knowledge and information workshops into desired actions, results and solutions is quite evident and nothing can mask that. Current and unfolding eclectic climate interventions are failing to inspire the climate foot soldiers in communities where climate change impacts are raging.
Local communities' knowledge of local landscape ecology, physical features and social structures should make it possible for climate volunteerism to take place. Volunteering is about doing things for others and the environment without expecting financial rewards in return. These initiatives cannot be realised if there are two climate worlds apart, one for those that think, plan and benefit for the marginalised and poor while the other world is for the marginalised, who have never set foot in the boardrooms, are not called to meetings and workshops but their plight is key in sourcing donor funds. The marginalised communities are ever ready to perform voluntary community duties and climate change adaptation programmes if guidance and motivation are available. People engage in climate volunteerism to tackle complex environmental issues, disasters and poverty, improve quality of lives and build resilience.
Through volunteering, communities can inspire and motivate each other, demonstrate to authorities how things can be done so that they become accountable and transform policy. Volunteerism is motivated by climate justice concerns, amplifying marginalised climate voices and groups such as women, children, the youths, the physically challenged and the elderly, among
others. It is, therefore, important to respond to the needs of the abovementioned groups so that they are empowered to take charge of their lives, take care of their environment and establish reciprocal relations with it.
Without taking anything away from established institutions and organisations driving climate initiatives, most of the interventions end up as pledges, promises, information bribery, social media frenzy and competition including the need to be number one, in principle not action while being blinded by self-interests and rigidity.
Climate action volunteers in communities who plant trees, conserve landscapes, participate in land restorations, repair damaged roads, build small-scale water reservoirs for market gardening and livestock require motivation and reinforcements. These people remain unnoticed and unsung heroes, away from the media, social media and boardroom frenzy. These community heroes do not need television crews and cameras following them everywhere, they do not need unnecessary publicity, grandstanding and posturing, they just do their work quietly while their actions are testimony for the work they do.
It is also difficult to combat climate change if climate interventions are an act of drama and pretense and if the gap between climate activism and action is not bridged.
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