May 13 this year was celebrated as Mothers’ Day worldwide as we all gave focus to the women whose hard labour and life investment resulted in the over 7 billion-strong global population and 12 million Zimbabweans counted today. We love our mothers for giving us a chance to experience life and some of us thank God for giving us an additional chance to appreciate our living mothers for their sacrifice. Life is a gift and I believe we can only fully appreciate the value of life by acknowledging the gravity of death, this view will allow us to value the lives of mothers as we acknowledge the 520 women who die every-day from the complications of pregnancy and child-birth in Africa. For motherhood to be the gift it really is, it must be protected and we must all work to make sure that mothers don’t die whilst they bring new life into the world. This view has been accepted at various levels and has generated emotional and political support but the focus of this support has been for older women who are the more acceptable mothers of our age. The truth is, the younger the mother, the higher the risk of death and birth complications and as young people, we are asking for the same protection and support to be availed to our young mothers.
On the 30th of June 2010, Zimbabwean youth renewed their hope as the nation launched the Campaign for Accelerated Reduction of Maternal Mortality in Africa. This launch came after the formulation of this continental campaign initiated by the African Union in May 2009 in order to accelerate maternal mortality reduction in the region. Now nearly three years later, we as young people still hope that the African plague of hiding behind words and commitments will be cured through expedient actions to save the lives of young expecting mothers. The situation of young women has been the most difficult in the face of maternal death, and has become more pronounced with more than 1 billion young people entering their reproductive lives. According to statistics, every year an approximated 14-16 million adolescent girls aged between 15 to 19 years give birth in the world and in Zimbabwe approximately 101 adolescents out of 1000 women give birth each year.
During a training workshop for Members of Parliament, convened by the Zimbabwe Parliamentarians on HIV&AIDS (ZIPAH) in Kadoma this year, Ms Margaret Nyandoro the Deputy Director Reproductive Health in the Ministry of Health and Child Welfare highlighted the key drivers of maternal death in women. She pointed out the challenge as being that of three delays which in her words were “… the delay in seeking care… the delay in reaching care… and the delay in receiving care”. If Zimbabwe is going to register success for young women in its efforts as part of the CARMMA initiative, it must undoubtedly address these delays in enabling expecting young mothers to seek expert health care early, reach health facilities on time and receive assistance from health care workers as soon as the need arises. Despite the necessary urgency of addressing these delays, the cornerstone of reducing maternal death in young women still lies in preventing early and unplanned pregnancies particularly in adolescent girls.
Pregnancy related deaths are the leading cause of death for young women in Africa (Women Deliver-2010), furthermore, adolescent girls aged 10-14 years are five times more likely to die in pregnancy and childbirth and those aged 15-19 years are two times more likely than women aged 20-24 years. Early pregnancy is very dangerous especially because of the underdevelopment of an adolescent girl’s reproductive system which results in various birth complications like obstetric fistula, obstructed labour, premature labour and low birth weight (obstructed labour is a condition when the cervix is fully stretched but the baby won’t come out; obstetric fistula is a severe medical condition in which a hole develops between either the rectum and the vagina or between the bladder and the vagina after a severe or failed childbirth. Statistics point out that 60% of all obstetric fistula cases occur in girls under the age of 18). In addition to this, early and unplanned pregnancy in adolescent girls and young women lead to high levels of unsafe abortion as the individuals try and find a way out of the financial, emotional, physical and spiritual challenges associated with the pregnancy.
It is important therefore to prioritize interventions for the prevention of unplanned and early pregnancies, and emphasis must be placed on equipping young men and women with information, skills and services to prevent these pregnancies. Parents, teachers, churches, sports teams and other social players must take time to give information and negotiation skills to young people to abstain from sex or take alternative measures to prevent pregnancy. The same community stakeholders must refer young people to health service staff and peer educators at youth centres and health care centres for them to receive more comprehensive information, skills and access to contraceptives. Health care workers are also encouraged to provide sexual and reproductive health services to young people in a manner that is respectful, confidential and youthful so that young clients gain value from the service and refer others to the health centres.
In the view of the already existent and future young pregnant mothers, we must curb the three deadly delays so that both the young woman and her baby’s life are preserved. Regarding the delay in the decision to seek care, efforts must be made to address the underlying factors influencing this delay. These factors include the lack of knowledge of danger signs in pregnancy, labour and delivery; the delay in decision making at individual level; and the lack of decision making power. Government and all other stakeholders need to create mechanisms to empower women and their partners with comprehensive information on the need to seek health care before, during and after delivery. Structures must also be put in place to enhance the decision making power of the young woman through economic empowerment and the engagement of husbands, partners and families to support health seeking behaviour on the part of pregnant young women.
In relation to the delay in reaching care, factors such as the poor state of roads, low household income and the distant location of some health centres to the population, continue to fuel this delay. Government infrastructural development programs must be hyper-sensitive to the need to build good road and transportation systems, as well as to bring health service points closer to communities through decentralization programs. In this regard, community health worker programs must be instituted or scaled up in areas where they already exist. Furthermore, young people must be placed at the centre of the country’s poverty reduction strategies, and efforts to empower young people must be scaled up to enable them to access health care centres.
In addressing the final delay, which is that of receiving care, the three ills of inadequate skilled staff, inadequate equipment and consumables, and low staff motivation, must be dealt with. These challenges are purely service delivery based and must be taken up by the Ministry of Health and Child Welfare in increasing the proportion of skilled health service staff at health centres whilst ensuring staff retention through increased remuneration and improving overall working conditions. Logistics Management Information Systems must be strengthened to maintain the country’s commendable stock-out rate of less than 5%, whilst efforts must be made to decentralize provision of essential reproductive health commodities to the lowest level possible.
We as a nation must realize that the pursuit for maternal health of young people is a matter of life and death. Whilst the country rejoices at the creation of life, it mourns the huge cost of the loss of life of a productive young woman. We cannot maintain this precedence for whatever reason and must instead join the Campaign for the Reduction of Maternal Mortality in Africa, not through words of solidarity but actions that make a difference in the lives of young women. Let us all work to ensure that every young Zimbabwean woman will live to celebrate their own mothers’ day.