By MISHECK NYIRONGO –
“The labour of childbirth is known to the mother,” goes one African proverb, although another says, “It takes the whole village to raise the child.”
These are clichés that apply to childbirth which in Africa is a matter of life or death.
Women living in rural areas, mostly among poor communities, face challenges when giving birth.
According to current statistics, 62 per cent of maternal deaths and 39 per cent of newborn deaths occur in sub-Saharan Africa.
Nearly all of these deaths could be prevented with skilled care before, during, and after childbirth.
The death of a mother in pregnancy or childbirth is not an isolated tragedy, but one that can also devastate the health and economic wellbeing of her family because the entire family crumbles.
According to the World Health Organisation (WHO), about 830 women die from pregnancy, or childbirth-related complications around the world every day.
Zambia has not been spared from these statistics.
The country ranks 156th out of 180 for maternal deaths with an estimated 2,600 mothers and 20,400 newborn deaths annually.
This is according to Saving Mothers, Giving Life – 2015.
However, Zambia has made progress in reducing its maternal mortality ratio from 729 to an estimated 398 per 100,000 live births between 2001 and 2014.
But much remains to be done in order to contribute to accomplishing the third Sustainable Development Goal (SDG), in particular SDG 3.1: ‘By 2030, reduce the global maternal mortality ratio to less than 70 per 100,000 live births.’
“Our mothers continue to face challenges to access maternal and child health services, due to three primary reasons, such as delays to seek care stemming from cultural beliefs and myths, gender roles in the decision making and lack of awareness,” Lundazi District Medical Officer Davie Zulu lamented.
Dr Zulu said delays in reaching the health facility in time and delays in receiving adequate care once at the health facility presents a formidable challenge.
He said as a result of these delays, home births remain common in Zambia and only 39 per cent of mothers are starting antenatal clinic before 14 weeks of pregnancy in Lundazi District.
Dr Zulu disclosed that women fear to have early booking for antenatal services because of the strong traditional belief that a pregnancy will disappear if a woman discloses her pregnancy to the people too early.
In order to give hope to rural child bearing mothers, Africare Zambia is implementing the Zambia Maternity Shelter (ZaMS) project in collaboration with Zambia Center for Applied Health Research and Development (ZCAHRD).
The organisation has University of Michigan and University of Boston as its evaluation partner. The university will establish and evaluate the impact of a community-driven and entrepreneurial home maternity model.
Mothers’ shelters by definition are residential dwellings located near heath facilities where women in the late stages of pregnancy can stay to wait for delivery and receive postpartum services.
This is a promising development in maternal health delivery that will provide women who face distance as a key barrier, the possibility to access skilled birth attendance.
“ZaMS project will build and strengthen 24 maternity waiting homes throughout the country – all of which will be located near high-functioning health facilities equipped to provide quality care and manage life-threatening emergencies that can arise during pregnancy or childbirth,”Lundazi Constituency Member of Parliament Lawrence Nyirenda said.
The lawmaker was speaking at the official opening of one of the facilities.
ZaMS seeks to contribute towards the decrease of maternal and infant mortality rate by allowing pregnant women to avoid covering long distances just before delivery.
The project further seeks to provide pregnant women easy access to skilled healthcare professionals in the weeks prior to delivery.
“A total of 1,014 pregnant women from Nyangwe, Mwase Lundazi and Nkhanga rural health centres have been registered and are being supported to attend antenatal care and undertake birth preparedness planning to deliver at the health facility.
“In our tradition, we are told either not to buy the clothes before a child is born or to not name a child that is not born,” said Loveness Munga, 36, an expecting mother at Lundazi District Hospital’s Mother’s Shelter.
Loveness explains that, “While here ( at the hospital), we are learning a lot of things like general cleanliness, breastfeeding, danger signs in pregnancy, child care and what is required to buy, like baby clothing, or nappies.”
Loveness said the expecting mothers are taught what type of nutritious food to eat when pregnant, as opposed to cultural beliefs that a pregnant women should not eat eggs because she will give birth to a child without hair like an egg, which is not true.
She said the women get examined frequently by the qualified health staff to make sure they have a safe delivery, which was not the case when one was at home.
Africare Zambia Country Director Isaac Sakala said, “Using a two-group comparison design, Africare, working together with the University of Michigan, will evaluate and determine whether the presence of a ZaMS in a rural catchment area addresses the ‘distance problem,’ and also evaluate its effectiveness in reducing maternal and neonatal mortality.
The partner-specific evaluation project of ZaMS uses both a traditional evaluation design and an operations research design to evaluate ZaMS.
“This operations research design will allow us to determine the financial viability and cost-benefit of the ZaMS model as well as to determine whether the ZaMS are scalable (for example, whether they are able to be replicated into a larger number of catchment areas) and sustainable,” Mr Sakala explained.
Mr Sakala said maternity homes are a potential solution in reducing maternal and the infant mortality rate.
He said the homes have shown a correlation between maternity home utilisation and improved maternal and newborn health outcomes.