Dying to be a mother

from The Mail and Guardian

Miriam Madziwa

Odinarily, falling pregnant should be a joyous experience for every woman.

And with just eight years to go before the 2015 target for achieving the Millennium Development Goals one would expect to hear accounts of how motherhood is increasingly becoming a safer experience for women as countries strive to fulfil the fifth development goal of “improving maternal health”.

Sadly, this is not the case for the majority of Zimbabwean women. Instead, with each passing day, motherhood has become a nightmare best avoided.

The dilemma starts at conception. For most Zimbabwean women the choice whether to fall pregnant is not there. For a start, accessing contraceptives is not easy.

Even the hard to find, low-cost contraceptives are too expensive for most women.

Female condoms are not readily available in supermarkets and, again, are expensive. On the other hand, male condoms are cheaper and more widely accessible but, as most women will point out, these are used only at the discretion of the male partner. Therefore, women are falling pregnant against their wishes.

Terminating an unplanned pregnancy is out of the question. Abortion is illegal in Zimbabwe except in cases of rape or where there is medical proof that carrying the pregnancy to term poses a threat to the life of the mother.

All too often the responsibility of antenatal care and bringing up the child rests entirely with the woman.

The plight of a Bulawayo woman who recently appeared in court on charges of illegally terminating a pregnancy illustrates the magnitude of the dilemma.

Patience Matsetlo told the court she she terminated the pregnancy because she was “stressed” because her monthly salary was not nearly enough to meet hospital bills and look after the unborn child.

The 26-year-old Matsetlo said she was already struggling to look after a two-year-old child. Her partner disappeared to South Africa soon after she conceived.

Even for those who plan to start a family, accessing antenatal care is a challenge. Local authorities offer the cheapest maternity services in urban areas. But, even these are proving too expensive for most women. As a result, expectant mothers are foregoing antenatal care and praying they do not have any complications when they go into labour.

Some women are turning to traditional midwives despite being aware of the inherent dangers of doing so. Some of these women eventually end up in hospital. Midwives often botch complicated deliveries, leaving the mothers-to-be with no option but to seek medical care to save both the baby and their lives.

At some point, hospitals were detaining mothers until they settled their bills. The “detentions” stopped after women’s groups protested. Hospitals have since devised a subtle but more sinister way of pressing for payment; withholding birth-record cards.

This mode of debt collection has far-reaching effects on the welfare of the child.

Without hospital birth records, a child cannot be issued with a birth certificate and without a birth certificate, a child cannot be enrolled in school, cannot apply for a national identity ... the list is endless.

A friend recently recounted how six months after giving birth she still has not received a birth certificate for her daughter. She owes Mpilo Central Hospital Z$1 500 000, enough for just one loaf of bread. My friend admits it’s a small amount and is fully aware of the implications, but she points out, “there is always something that I need to buy urgently for the baby, so I keep putting it off”.

For the few that can afford antenatal care, the quality of care is poor, as nurses and doctors are few and overworked with limited resources. Towards the end of last year Gweru City Council was forced to close one of its maternity clinics citing lack of resources to pay staff. The clinic reopened after a well-wisher living abroad offered to pay the nurses’ salaries for two years.

Giving birth is a nightmare. Even while the woman is having labour pains, getting to hospital is a problem because ambulances are often off the road because of fuel shortages. Instead of concentrating on getting to hospital, women in labour also have to think of where to get clean water before they will be assisted. Water shortages mean that health institutions often do not have running water and insist that patients, including women in labour, bring their own buckets of water.

Another challenge that Zimbabwean mothers-to-be are facing is purely economic -- how to clothe and feed their newborn babies? Queues are a common sight in Zimbabwe these days. We queue for cash, water, milk, bread and meat, almost everything. Like most items, disposable diapers are in short supply and few shops still stock nappies.

It’s still a surprise, though, to see expectant mothers, hands in the small of their backs and with protruding tummies, queuing outside a shop for nappies. In Bulawayo, one shop that intermittently stocks nappies insists on selling to “visibly pregnant mothers only”. So individuals wanting to help cash-strapped relatives and friends buy nappies cannot do so. Desperate mothers are tearing up old T-shirts and accepting old nappies from relatives and friends so that they can raise their children.

Clearly, Zimbabwe’s health delivery system is failing to take care of pregnant women. Women are dying from pregnancy-related complications because they lack access to antenatal, delivery and post-natal care. Southern Africa Aids Information Dissemination Service official Alice Mutema notes that women continue to die because “maternal health is not being given the attention it deserves”.

For women in Zimbabwe, there is not much joy left in becoming pregnant. Though Zimbabweans struggle to cope with the shortages with a brave face, when you have a new life inside you, or are struggling through a difficult labour, or trying to care for a precious newborn, it is all the more difficult.

Miriam Madziwa is a freelance journalist based in Zimbabwe. This article is part of the Gender Links Opinion and Commentary Service that provides fresh views on everyday news