By Lorraine Ndebele
Faced with high maternity costs and a lack of well-equipped clinics, expectant mothers in Epworth – a densely populated peri-urban community south-east of Harare – are opting to deliver babies at home.
However, home births in Epworth often occur without proper medical equipment or trained midwives in attendance, exposing mothers and babies to potential health risks.
This is despite the fact that the government as confirmed by Health and Child Care minister Dr Douglas Mombeshora, scrapped maternity user fees at all government facilities.
The five clinics in Epworth clinics are all run by the local board
However, all the five clinics in Epworth are owned and run by the Epworth local board and still charge maternity user fees.
Helen Dzapasi (35) of Epworth Ward 1 is among those who resorted to a home birth. She had hoped to secure funds for the hospital maternity bill before delivering in 2020, but financial hardships persisted and she delivered at home instead.
“I gave birth at home with the help of a traditional midwife because I could not afford the hospital bill,” Helen said. The fee at Dombo Clinic, one of only two clinics in densely populated Epworth, was USD 40 for maternity care. “Additionally, the clinic required that I bring my own gloves and cotton wool to be used during the delivery,” Helen added.
Helen ended up delivering at the home of a traditional midwife who did not have the requisite medical equipment and materials for a safe birth. “The midwife only had a razor blade to cut the umbilical cord as well as rubber clips that were used to clamp the baby’s navel,” she said, noting that she personally bought the cotton wool and gloves used during the delivery.
Despite the dangers posed by poor sanitary conditions and a lack of essential equipment like a sterile blade and blood pressure monitor, Helen felt her birthing experience went smoothly. “With my husband by my side, I felt very comfortable during the whole process, which went on well without any complication,” she said.
The experience of Judith Mhofu (25) was very different. “After cutting my baby’s umbilical cord, the midwife tried to secure the naval with a makeshift thread which kept coming off, resulting in fear and trauma for me,” Judith said. She added that the traditional midwife assisting her had to use a wooden spoon to make way for the baby.
Judith opted for a traditional midwife after failing to secure timely transportation to the hospital when labor pains started suddenly. “Although I had registered to give birth at the clinic, I was unable to find transport to take me there when labor began, so I ended up being taken to a traditional midwife,” Judith said in an interview.
According to the Zimbabwe Ministry of Health and Child Care’s National Health Strategy for Maternal, Newborn, Child, Adolescent Health for 2021-2025, home births account for about 50% of total births in the country. In densely populated, impoverished urban areas like Epworth, home birth rates are estimated to be even higher due to limited access to well-equipped health facilities.
Authors Munyaradzi Kenneth Dodzo and Marvellous Mhloyi note various factors that discourage women from utilizing formal healthcare facilities for childbirth in their 2017 paper titled “Home is best: Why women in rural Zimbabwe deliver in the community.” These factors include financial constraints, unfavorable attitudes of hospital personnel, prolonged waiting periods, considerable distances to travel, and negative past experiences associated with hospital deliveries.
Dodzo and Mhloyi assert that “The diminishing appeal of the public health system has been identified as the primary driver behind the preference for community deliveries. This recognition offers insight into the growing inclination to choose the community as a preferred birthing location.”
Epworth resident Sarah Njanji says the maternity hospital requires expectant mothers to provide their own birthing essentials like gloves, clamp cords, and cotton wool. Additionally, they must bring money for blood pressure checkups. Notably, there is only one maternity clinic in Epworth.
“Another issue is that we have only one maternity ward and some fail to even get transport to go to the clinic when they are in labor so they just find traditional midwives to help them,” said Njanji.
Initial results from the 2022 national census released by ZimStat, the national statistics agency that conducted the census in April, ranked Epworth as the fifth largest urban council area in Harare with a population of 206 365. People of Epworth are advocating for more maternity clinics to be built in their area because as of now they only have two maternity clinics.
Melody Nyakudanga is one of the Traditional Birth Attendants (TBAs) residing in Epworth who has helped hundreds of women deliver. Nyakudanga said she started providing midwifery services in 2003 upon realizing the challenges facing expecting mothers.
“I started doing this work with the help of only five women in 2003, after we saw the challenges that were faced by poor expecting mothers, we wanted to help,” said Nyakudanga.
Despite directives to cease attending to pregnant women, Nyakudanga says witnessing mothers giving birth unaided in the middle of the road, without preparation or assistance, compelled her and the group to persist in performing home births.
Midwives also say authorities have taken no action to address or support them. These practitioners conduct deliveries in their homes, with some utilizing their bedrooms as makeshift delivery rooms.
Nyakudanga and her TBAs group, initially numbering 105 and registered under the Traditional Medical Practitioners Council, has since reduced to 65. This decline occurred following advisories from nurses and authorities instructing them to cease home birth practices.
“Most pregnant women only come to us when they are already in labor and it will be too late to send them away so we just help them,” Nyakudanga said.
Nyakudanga recounts how, initially, they used broken bottles to cut umbilical cords and makeshift plastic as gloves. “Then later, organizations like Mother and Child Care, as well as Emergency Deliveries, provided training at St Johns for Traditional Birth Attendants (TBAs), teaching essential childbirth and emergency handling skills, including cases when a newborn is having difficulties with crying after being born,” she said.
Majory Tundumula, a 71-year-old midwife, also recounts instances where desperate mothers, unable to afford clinic registration, turn to them for assistance. “Most nurses in Epworth maternity make fun of the situation faced by poor pregnant women who won’t be having any preparation so they end up coming to us because they know we will welcome them wholeheartedly,” says Tundumula.
Despite being registered under the Traditional Medical Practitioners Council, Traditional Birth Attendants (TBAs) face significant constraints in their roles due to insufficient backing from the Ministry of Health and Child Care, their parent ministry.
Epworth Residents Development Association Chairperson Peter Nyapetwa attributes the growing prevalence of traditional midwives assisting home births to socioeconomic challenges, characterizing Epworth as one of the most impoverished communities, marked by high unemployment and a scarcity of healthcare facilities with only two community clinics.
“These clinics do not have enough staff and at the same time there is a high level of bribery, with staff demanding USD10 from pregnant women for assistance, despite mandatory maternity fees being paid,” said Nyapetwa.
He recounts a tragic 2022 incident where a woman died at Overspill Clinic due to a lack of timely assistance.
“We have raised the issue of poor healthcare service with the councilors even in the Epworth administration but nothing has been resolved and the nurses are saying we are getting poor remuneration, they must improve our salaries,” Nyapetwa explains.
According to an article published by Newsday in 2012, the government scrapped off maternity fees from all its provincial and central hospital countrywide to ease pressure on underprivileged expecting mothers.
Epworth local board chairperson, Nobody Makoni said as an authority they were aware of the difficulties faced by expectant mothers due to high maternity user fees.
He blamed the prevailing economic situation which he said makes it difficult for the Epworth local board to scrap or reduce maternity user fees.
“We as the authority are also fighting for the decrease of maternity fee at local clinics but it’s difficult because the country is going through a financial instability”, said Makoni.
Reached for a comment, Health and Child Care minister, Dr Douglas Mombeshora urged expectant mothers to use government hospitals and clinics where they do not have to pay user fees.
“There is no maternity user fees at government hospitals but there are cases where expecting mothers are asked to buy their own supplies such as cotton wool and gloves”, he said.
