Pregnancy Imperils Zimbabwean Women’s Lives

By Masimba Biriwasha | Global Editor-At-Large | @ChiefKMasimba | 07 January 2013

A Zimbabwean woman, Tendai Chitsinde, 24, died recently while giving birth to her first child. According to news reports, hospital staff called off a Caesarian section operation which could have saved her and her baby’s life. Because she was a television presenter, her death made news headlines and an outpouring of grief.

But Chitsinde is only one of an estimated 3,000 women and girls who die each year in Zimbabwe due to pregnancy-related complications. That’s 8 women dying every day of the year.

Additionally, 26 000 to 84 000 women and girls suffer from disabilities caused by complications during pregnancy and childbirth each year.

Maternal and neo-natal health services in Zimbabwe face severe shortages which hampers the delivery of quality services. As a result, the maternal mortality rate alarmingly stands at 960 maternal deaths per 100 000 live births – three times higher than the global average and almost double that of the Sub Saharan averages.

Maternal mortality is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy, regardless of the site or duration of pregnancy, from any cause related to or aggravated by the pregnancy or its management.

The consequences of maternal mortality are felt not only by women but also by their families and communities. Loss of women during their most productive years also means a loss of resources for the entire society. At least 1.23 per cent of GDP is lost annually due to maternal complications in the country, according to UN.

Most of what needs to be done is already known. However, Zimbabwe’s decade-long political, economic and social fallout has had a terrible impact on the public health delivery system, significantly reducing the quality of services provided to pregnant women.

Many women, particularly in rural areas cannot afford the transport costs required to make frequent travels to health centers during and after pregnancy. Rural women opt to deliver at home which significantly increases chances that they will die, especially when the delivery requires surgical intervention, or is carried out by non-skilled persons.

Shortages in personnel, equipment and supplies continue to plague Zimbabwe’s healthcare infrastructure, putting the lives of pregnant women at risk.

According to WHO, most maternal deaths are avoidable, as the health-care solutions to prevent or manage complications are well known.

It is particularly important for health care workers to be well trained so they can properly meet the medical requirements of pregnant women.

Unless significant action is taken to improve health services, pregnancy will continue to imperil the lives of Zimbabwean women.

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Ethiopia’s Maternal Vision

In Ethiopia, women use herbs, poison, wire or coat-hangers to end unwanted pregnancies.

 

Unsafe abortions are the second leading cause of death for women, after tuberculosis in the country. Though abortion is illegal in Ethiopia, studies indicate that abortion is widespread and generally performed by untrained persons.

 

According to Planned Parenthood, Ethiopia has among the highest fertility and maternal death rates in the world. Approximately 1 out of every 7 women die from pregnancy- or abortion-related complications.

 

Given such shocking statistics, the recent announcement by the Ethiopia’s Ministry of Health to provide family planning services to 8.5 million women across the country during the next Ethiopian year is highly laudable.

 

Political will is a key ingredient to improve the reproductive health status of women, particularly in countries where long-held traditions and customs put women at high risk.

 

“Traditionally, women in Ethiopia have been consigned to strict societal roles, based on cooking, raising children, and a muted voice in decisions affecting them,” says the World Bank.

 

“Most women have accepted tradition without question, subjecting themselves and their daughters to genital mutilation, early marriage, milk tooth extraction, and domestic abuse.”

 

With increased government efforts to expand family planning services, more women will be reached, in the process saving lives and giving women and their families greater hope. But with political will there must be a willingness to also improve the health infrastructure and distribution systems.

 

Although family planning tools are available in Ethiopia, access to them has been a major hindrance for the majority of the women. Planned Parenthood states that only 13% of Ethiopian women – and only 4% in rural areas – use modern contraception. This is despite the fact that studies show that approximately 60% of the women in the country approve family planning.

 

Undoubtedly, improved access to family planning and other reproductive health services in the country could significantly combat the incidence of maternal mortality and improve the state of women.

 

The Global Gag Rule which restricts funding for family planning reinstated in 2001 by President George Bush has been a major factor blamed for the restriction of women’s access to contraceptives.

 

“The gag rule restricts the simplest ways to improve the status of women: funding birth control supplies so they can avoid unintended pregnancies and care for children they already have,” said Dian Harrison, President and CEO of Planned Parenthood Golden Gate.

 

In an October 2007 report, Population Action International also points out the Global Gag rule, abstinence only education, and the anti-prostitution pledge as harmful policies that undermine women’s access to information and healthcare in countries such as Ethiopia.

 

In order to increase the uptake, Ethiopia’s Ministry of Health plans to create accessible, affordable and comprehensive coverage of family planning services for women.

 

More importantly, 600 health professionals will be trained to train nurses currently working at health facilities specifically carry out family planning for women.

 

If the expanded access to family planning services in Ethiopia is to improve the status of women, it must be culturally appropriate, with particular attention to marginalized communities across the country.

 

In addition, the Ethiopian government needs to adequately finance the process both in the short and long term so that access to the family planning services is neither compromised nor cut mid-way. There must be a commitment to make access to services that improve the status of women as much a part of national life as breathing air.

 

Having said that, mechanisms must be put in place to monitor both the costs and the quality of services provided.

 

Indeed, the Ethiopian government can become a model for many countries around the world if it follows through on the plan to improve women’s lives.

 

However, the US must show leadership by revoking the Global Gag rule which only serves to worsen the situation of already marginalized women in poorer parts of the world. According to Planned Parenthood, the resulting lack of U.S. funds has restricted the contraceptive supply, which means that abortion is also very common.

 

For any society to live up to its potential, its women need to have access to comprehensive information and healthcare that can help them to make responsible choices.

 

More than anything else, the Ethiopia government needs to implement policies that promote the liberation of women from traditional, economic, legal and cultural fetters.

 

“Female education and empowerment are critical determinants of fertility, and providing girls with access to education is likely to reduce the fertility rate,” states Kristen P. Patterson in a paper titled “Integrating Population, Health, and Environment in Ethiopia.

Unsafe Abortion Leads to Maternal Death

In many parts of the world, women who have an unwanted pregnancy often find themselves caught up in an isolated and agonizing situation, left alone to decide whether to have a child that they may not be able to support or have an abortion.  

According to the UN, although abortion is commonly practiced throughout most of the world and has been practiced since long before the beginning of recorded history, it is a subject that arouses passion and controversy. 

In Zimbabwe, as in many sub-Saharan African countries, abortion, except in cases of rape, incest, fetal impairment, or to preserve a woman’s health, is illegal – and if caught, women face jail terms.

As a result, many women resort to clandestine, unsafe and life-threatening abortion methods. Backyard abortions are so rife in Zimbabwe in spite of the laws that prohibit the practice, putting the life of women, particularly young women, at risk.

UNICEF estimates that 70,000 illegal abortions take place in the country every year. In sub-Saharan Africa, 70% of women who end up in hospital after an unsafe abortion are under 20. 

Marie Stopes International reports that the risk of death from unsafe abortion is higher in Africa than any other region: nearly half of global maternal deaths related to abortion occur in the region. 

“Unsafe abortion has the highest impact in developing countries whose citizens lack widespread access to high-quality medical care,” the group reports. 

Given the high rates of HIV infection among women in the region – the majority of people living with HIV in sub-Saharan Africa (61% or 13,1 million) are women – governments will have to adopt progressive pro-adoption policies. 

In the absence of Prevention of Parent to Child Transmission (PPTCT) methods, there will likely be an increased demand for abortion services. And, thus, there is need to set up abortion clinics and ensure access to safe abortions. 

“Women living with HIV seek abortion care for the same myriad reasons as all other women. Additionally, the same factors that make some women vulnerable to HIV also often increase their need for access to safe abortion services,” says Barbara Crane, Ipas executive vice president for technical leadership and advocacy.  

Having said that, young women – in particular – left with little choice, face immense pressure to terminate unwanted pregnancies.

Traditional and cultural norms highly stigmatize and discriminate against children born out of wedlock further putting pressure on young women who fall pregnant before marriage to opt for abortion – either conducted by untrained persons or self-inflicted. 

Abortions are usually conducted in unregulated and unsanitary conditions and with methods that kill the young women or render them infertile for the rest of their lives.

To put it bluntly, clandestine abortions are a leading cause of maternal mortality in the country. According to a UNICEF report, illegal, self-inflicted abortion methods are thought to include the consumption of detergents, strong tea, alcohol mixes and malaria tablets; other methods include the use of knitting needles, sharpened reeds and hangers. 

The termination of the pregnancy is permitted in circumstances where a pregnancy endangers the life of a woman or where there is a serious risk that if the child to be born would suffer from a physical or mental defect of such a nature as to be severely handicapped. 

In addition, the termination of pregnancy is permitted if the fetus is conceived as a result of unlawful “intercourse,” defined as rape, incest or intercourse with a mentally handicapped woman. 

Given the high rates of maternal mortality attributed to unsafe abortions in the country, there is need for treating abortion as an issue of health and welfare as opposed to one of crime and punishment in order to save women’s lives. 

The fact is that even though abortion is criminalized, young women affected by high levels of poverty and the social undesirability of children born out of wedlock, resort to abortion as a way to manage their lives and livelihoods.  

According to analysts, abortion laws which are traceable to colonial regimes in sub-Saharan Africa need to be reformed in order to safeguard the rights of women. However, removing women’s criminal liability for abortion is only but one part of the solution.

There is need for widespread educational campaigns about contraceptive methods that are available to women. Access to the methods must be made as easy as possible to women who may face social condemnation for using contraceptives within their communities. 

Also, evidence in countries such as Nepal shows that provision of comprehensive care and support and approving clinics where women can have an abortion safely can significantly reduce the number of women that die due to pregnancy-related causes.  

All in all, a liberalized law in Zimbabwe can help to avert the high rates of injury and death among women associated with unsafe abortion.