MONICA KAYOMBO, Lusaka
FOR Doris Banda, 45, a mother of five children and resident of Chainda in Lusaka, giving birth in a health facility is not a debatable matter. This is because she has seen some mothers within her community succumb to child-birth related complications after giving birth from home. She says myths driven by elderly women that herbs could help speed up the process of childbirth have greatly contributed to women shunning health facilities and giving birth in homes. But Mrs Banda has always refused to fall prey to unfounded myths. “All my five children were born in the hospital. I cannot take risks because I have seen women die after delivering from home,” she says. Mrs Banda makes sure to start attending antenatal as soon as she discovers that she is pregnant. She said antenatal clinics are good for pregnant women because healthcare providers use them to monitor both the expectant mother and her unborn child. Further, women are taught how to take care of themselves and their unborn children. Mrs Banda said although healthcare providers have been doing a lot to sensitise mothers on the importance of both antenatal and postnatal care, the advice seem to be falling on deaf ears because of the strong traditional beliefs that women in the communities hold. To have delivered all her five children in health facilities, she had to rebuff wrong advice from relatives and friends in the community. “I know the consequences of using herbs to help in delivery. Many women have died and I don’t see any reason why I should do it when we have many health facilities with sufficient qualified staff to attend to us,’’ she said. Loraine Mwanza, a journalist and mother of four, is sympathetic to mothers in rural areas, but feels pregnant women in urban areas have no reason to give birth in homes. Ms Mwanza says women in rural areas resort to using herbs to speed up child delivery due to limited access to healthcare facilities. She says it is a pity that some mothers die or lose their babies because they opt to be attended by unskilled birth attendants, who mainly depend on herbs and unsterilised tools to undertake a delicate medical procedure. “These herbs are either taken orally or applied on private parts. This, in most cases results in infections which might lead to maternal mortality,’’ she said. Mrs Mwanza has proposed the re-introduction of mobile hospitals to enable women in far-flung places have access to quality anti-nental and post-natal care. “The Ministry of Health should consider re-introducing mobile hospitals in very remote areas as one way to help reduce maternal mortality in the country,’’ she said. She said having health facilities nearby could help women in rural areas to get good pregnancy and postnatal care as well as be attended by qualified midwives during delivery. Susan Mwape, also a journalist, prefers giving birth in a health facility for many reasons. Ms Mwape believes public health facilities are well-equipped to handle any child-birth-related complication. She also says that they have sufficient health staff and specialist doctors. Ms Mwape says pregnant women, especially those with underlying health conditions should not take the risk of giving birth from home. “If you have medical complications, you are more likely to survive if you are being attended in a health facility,’’ she said. Ms Mwape, however, notes that although home deliveries are common in Zambia, the situation is worse in rural areas. She called on Government to improve access to healthcare services in rural areas for Zambia to make significant progress in improving maternal health. In the report dubbed: Maternal mortality trends and correlates in Zambia, presented by some experts from Zambia National Public Health Institute (ZNPHI) in 2018, globally about 830 women die each day due to complications during pregnancy and childbirth. Ministry of Health acting director public health and research Mupeta Bobo said the direct causes of maternal mortality are obstetric hemorrhage, hypertensive disorders, sepsis also known as infection and abortive outcomes.
“Abortive outcomes or complications of abortions including ectopic pregnancy are some of the direct causes of maternal mortality in Zambia,’’ she said. Dr Bobo also cited malaria, cardiac conditions, HIV/AIDS, pulmonary embolism and edema and tuberculosis as indirect causes of maternal mortality in this country. She explained that many interventions have been put in place to reduce maternal mortality in Zambia. One of these interventions is to sensitise communities on the importance of attending antenatal and giving birth in health facilities. “We have embraced new innovations such as the use of WhatsApp technology, use of Zoom platform, targeted mentorship where the targeted audience is mentored on maternal health and mortality,” she said. She said another intervention that the Ministry of Health has employed is reverse mentorship where subordinates are given opportunities to mentor senior and experienced medical staff. She said that way, both parties are able to learn from one another on maternal health and mortality. Since nurses are key in addressing maternal mortality, Dr Bobo said the Ministry of Health has introduced the midwifery programme at many of nursing schools to address the shortage of midwives in health facilities. The ministry has further introduced the use of Tranexamic Acid for treatment of postpartum hemorrhage which is one of the common causes of maternal deaths. In as much as pregnant women are free to choose where they would want to deliver from, the Ministry of Health is encouraging women to go to health facilities that have the full capacity to manage any maternity complication. ” What is encouraged is for [healthcare] providers to refer when there is no capacity to manage any case to where better management can be assured as much as possible,’’ Dr Bobo said. According to the ZNPHI 2018 report on maternal health, in 2015 an estimated 303,000 maternal deaths occurred worldwide, the majority of which happened in low and middle income countries where Zambia falls. World Health Organisation (WHO) defines a maternal death as: the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and the site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management, but not from accidental or incidental causes. Maternal deaths are subdivided into two groups: direct obstetric deaths and indirect obstetric deaths. The report further states that in 2018, maternal deaths were reported from public facilities in all of Zambia’s 10 provinces, and in 101 of the country’s 117 districts. Lusaka Province reported the highest number of maternal deaths at 115 followed by Eastern with 87 deaths, and Southern Province in third place with 82 deaths. The report says 37.5 percent maternal deaths were reported from district level hospitals, 25.3 percent from central hospitals, and 15.3 percent from general hospitals.
The remaining deaths were reported from health centres at 10.7 percent, health posts 1.8 percent, and the community 8.8 percent. Seventeen percent of the maternal deaths reported among first-time pregnant women also known as primigravida were due to obstetric hemorrhage. However, hemorrhages accounted for 34 percent of maternal deaths among women classified as multiparas (with 1-3 previous births) and nearly half or 51 percent of maternal deaths reported among women classified as grad multiparas (four or more previous births). The most common cause of death among first-time mothers was indirect causes accounting for 39.0 percent. Indirect causes were also the most common cause of death among pregnant women aged 10-19 and 20-29 years. Obstetric hemorrhage was the most common cause of death among pregnant women.
For Ruth Musonda, 35, encouraging women to give birth in health facilities goes beyond building more hospitals and training more health workers. She says midwives should improve patient care. Ms Musonda says some expectant mothers are repelled from health facilities by the bad attitude of health staff. “Sometimes you could come early to the health facility [when in labour], but negligence among the health workers might result in death,’’ she said. Ms Musonda also said there is a tendency by midwives to ignore distress calls from patients. “Some women have ended up giving birth in the absence of the medical staff. Some nurses are always busy on phones and pretend they are not hearing anything when someone in the labour ward is calling for help,’’ she said. From the foregoing, reducing maternal deaths requires concerted efforts by pregnant women, policy makers and health staff.
(Article courtesy of AIDS and Rights Alliance for Southern Africa- ARASA)