WHO Perspectives on Maternal Mortality in Zimbabwe: A Reflection of the Year 2014
- Maternal Mortality Ratio (MMR) for Zimbabwe has declined from 960 deaths per 100,000 live births in 2010 to 614 deaths per 100,000 live births in 2014.
- This is commendable progress, but the ratio still remains unacceptably high.
- Zimbabwe’s MDG target is to reduce MMR to 71 deaths per 100,000 live births by 2015.
- The media has a critical role to play in promoting social accountability on maternal health.
Why does maternal mortality remain high in Zimbabwe?
We in WHO believe this is better explained through the three delays;
1. Delay in seeking health care;
2. Delay in reaching the health facility; and;
3. Delay in receiving expeditious and effective care at the health facility.
The three delays are common in many countries. However, there are specific concerns in Zimbabwe that should be addressed:
• Religious and traditional objectors to modern medicine, for instance refusal to seek care at the health facilities, refusal of blood transfusion, refusal of modern medicines or surgical procedures, and use of traditional uterine contracting medicines to quicken labour.
• Social Determinants of Health which include poor public transport system, and clarity on application of user fees. Although it is Government policy not to charge user fees for maternity services, some facilities still charge some indirect service fees.
• Inadequate Healthcare Budget which seems to be worsening.
• Human resources challenges which persist in 2014.
• Cost for blood transfusion which when needed remains beyond the reach of many.
Pregnancy is not a disease, but it is associated with some risks before, during and immediately after birth which if not taken care of can result in maternal death. These include:
- Before pregnancy: age of the mother (too young, or too old); nutritional status, anaemia, pre-existing diseases / conditions
- Pre-existing medical conditions may get worst during pregnancy. Such conditions include HIV and AIDS, Diabetes, High blood pressure, Anaemia; and pregnant women are susceptible to certain types of infection – e.g. malaria, flu, genital infection.
- Complications during pregnancy, labour, delivery or following birth. These include abortion and its related complications, bleeding, high blood pressure, and infections.
All these conditions are avoidable. However if not prevented, recognised and managed in time they can lead to maternal death.
What is being done to improve maternal health?
• The Government of Zimbabwe has made efforts to create an enabling policy environment to improve maternal health. This includes;
- Free access to healthcare for pregnant women; and;
- Nurses are now allowed to perform certain life-saving functions like manual vacuum aspirations, to manually remove the placenta, and to insert contraceptive implants
• The Ministry of Health and Child Care and partners continue to procure and distribute essential equipment, drugs and supplies for maternal health.
• They have also supported the Health worker retention programmes. This is a direct response to the human resource gaps identified in the health sector.
• The expanded Community Based Distributor programme to improve family planning services is being revived.
• Health service providers are being equipped with Emergency Obstetric and Neonatal care skills.
What are WHO recommended strategies to reduce maternal mortality?
WHO recommends and is supporting the following strategies to improve maternal health in Zimbabwe:
• Focused antenatal care in pregnancy – this entails encouraging expecting women together with their partners to make at least 4 visits to the health facility, the first being within the first 16 weeks (4 months) of conception, and thereafter on a monthly interval. Prevention of Mother to Child Transmission of HIV (PMTCT) and prevention and management of malaria in pregnancy are key components of this strategy.
• To promote skilled care during childbirth.
• WHO is supporting a basic package of Emergency Obstetric and Neonatal Care at primary health facilities and a comprehensive package at referral health facilities.
• Post natal care especially in the first week of life after childbirth for both mother and child.
To avoid maternal deaths, it is equally imperative to prevent unwanted and too-early pregnancies.
• WHO recommends that all women, including adolescents have access to Family Planning Services.
• Women should also have access to safe abortion services to the full extent of the law.
• To ensure demand and utilisation of available health services, and mitigate the first two delays, WHO recommends engagement of individuals, families and communities in maternal health care. We encourage and support active engagement of the media on matters of maternal health. In our opinion, the media has a critical role to play in promoting social accountability, raising public awareness and highlighting best practices and innovations on maternal health.
For more information please contact:
Mrs Wendy Julias, Communications Officer
WHO Country Office for Zimbabwe
Phone: +263 772155629/32
Mobile: +263 772431408
Email: juliasw [at] who.int