Zimbabwe's Growing Crisis of Maternal Deaths

In the last few years, advocates have made steady progress in putting maternal mortality on multiple international agendas. It was a momentous occasion in June of this year, for example, when the United Nation's Human Rights Council finally recognised maternal mortality as a human rights issue, pushing past the reluctance of some countries to highlight a problem that has a lot to do with unsafe abortion.

Maternal mortality refers to deaths caused by complications of pregnancy childbirth, or delivery up to 42 days following birth.  Reducing maternal mortality--measured by the maternal mortality ratio, or the number of maternal deaths per 100,000 live births--is a key indicator of progress toward the Millennium Development Goals (MDGs) and has been a stated goal for at least 30 years under various international agreements.  

Yet despite these proclamations, relatively little progress has been made toward actually reducing maternal mortality. MDG 5, for example, calls for improving maternal health in part by reducing maternal mortality by three quarters between 1990 and 2015.  We are, however, far from achieving this goal. The World Health Organization (WHO) states that to meet MDG 5, maternal mortality needs to decline by 5.5 percent each year.  But a report by WHO, UNICEF, UNFPA and the World Bank shows an annual decline of less than 1 percent per year since the early nineties.  In 2005, 536,000 women died of maternal causes worldwide, compared to 576 000 in 1990.  Ninety-nine percent of these deaths occurred in developing countries.

In some countries, maternal mortality is not only high but has in fact risen.  Zimbabwe is one of the starkest examples of skyrocketing maternal mortality rates. According to some statistics, the maternal mortality rate in Zimbabwe was about 138 deaths per 100,000 births in the early to mid nineties.  In 2005, according to WHO, that number had risen to 880 deaths out of 100,000 live births, with estimates ranging from 300 deaths to 2,000 deaths per 100,000 lives births.  Estimates quoted by USAID suggest that roughly between 1,300 and 2,800 women and girls die in Zimbabwe each year due to pregnancy-related complications. Additionally, another 26,000 to 84,000 women and girls in Zimbabwe suffer from disabilities caused by complications during pregnancy and childbirth each year.

Complications of unsafe abortion are a leading cause of maternal mortality in the country.  Zimbabwe's Termination of Pregnancy Act 1977 permits abortion to save a woman's life or health and in cases of rape, incest and foetal impairment. However, in practice the requirements necessary to obtain even legal abortions create such high barriers that real access to abortions even for these legal reasons is incredibly limited.  For example, an abortion may take place only at a designated hospital, with the written permission of the hospital superintendent. In cases of suspected birth defects, or in life and death situations, the authority of two medical practitioners is also required but may be impossible to obtain in urgent situations due to a shortage of doctors. These barriers have created a black market of 70,000 unsafe abortions every year, according to UNICEF data released in 2005. 

The decline in the state of maternal health in Zimbabwe reveals how quickly a country's maternal mortality record can slip. Zimbabwe has been in a state of political and economic upheaval for the last decade. According to one report, shortly after Zimbabwe attained independence in 1980, the government built maternity wings at all major hospitals and recruited well-trained midwives. At one stage, the government had abolished maternity fees at all health institutions, with the exception of the central hospitals. However, health standards have fallen drastically as experienced health personnel have left the country in the midst of political turmoil and there has been a marked reduction in government funds allocated to the health sector. A 2007 resolution by the World Medical Association on health and human rights abuses in Zimbabwe, noted the failure of the government to provide essential resources for provision of basic health care, stating:

The declining health status of Zimbabweans, dual loyalties and threats to health care workers striving to maintain clinical independence, denial of access to health care for persons deemed to be associated with opposition political parties and escalating state torture.”

Alarmingly, a more recent report from January 2009 report by Physicians for Human Rights,  which describes the collapse of the health system in Zimbabwe as a “man-made disaster,” reports that the deterioration in the health care system has “accelerated dramatically” since August 2008, including closure of hospitals and clinics.

The Maternal and Neonatal Program Effort Index provides country-specific data, based on an assessment of maternal and neonatal health services in 49 developing countries in 1999 by around 750 reproductive health experts. Though obviously outdated, the data for Zimbabwe revealed some of the specific challenges when it comes to maternal mortality.  The review found that the least available service in health centers is vacuum aspiration of the uterus (MVA) for post-abortion care—a critical intervention in cases of incomplete abortion or complications from unsafe abortion. Furthermore, in most developing countries, access to safe motherhood services in rural areas is more limited than in urban areas. With 68 percent of the Zimbabwean population living in rural areas, this shortcoming becomes particularly problematic. Comments from Alice Mutema, an official at the Southern African HIV/AIDS Information Dissemination Service (SAfAIDS), also reveal how maternal mortality has been sidetracked for other health issues.

According to Mutema:

The health sector has to get its act together and avail more funds for other projects other than HIV/AIDS. Maternal health is not being given the attention it deserves, but even if this happens, I do not think we can achieve the 2015 target. But at least we can get closer to the target.

Despite this last note of optimism, it is hard to imagine in light of the reports of the collapse of the health sector and the drastic increase in maternal deaths, that the 2015 target of a 75 per cent reduction in maternal mortality is anywhere in reach for Zimbabwe.  Moreover, Zimbabwe continues to be on the global radar for its multiple human rights violations. As the world calls on the Zimbabwean Government to account for its human rights violations, we must not forget that the international community has agreed that maternal mortality is a human rights issue, and a pressing one in Zimbabwe.