High cost of motherhood: a silent maternal epidemic in Zim

IN Zimbabwe’s remote rural villages, a silent epidemic is affecting many women, leaving them isolated, ashamed and desperate for attention.

Characterized by continuous urinary leakage and an unpleasant odor, obstetric fistula has been stealing the dignity of Janet Munetsi* (22 years old) since 2019.

Hailing from a small village of Nyamhondo in Mberengwa, Midlands Province, Munetsi’s ordeal began after she gave birth to a bouncing baby boy.

This is the third article in a series titled The High Cost of Motherhood: A Silent Epidemic of Maternal Health Care in Zimbabwe, supported by the Howard G Buffett Fund for Women Journalists of the International Women’s Media Foundation.

Orphaned after losing her parents to a cruel twist of fate, Munetsi now faces a different kind of tragedy – one that has robbed her of her dignity and silenced her cries.

“I had accepted my fate because I had no name to call it. All I knew was that I was leaking urine and I couldn’t control it,” she told NewsDay.

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This is how countless women in Zimbabwe find themselves trapped in the silent suffering of obstetric fistula, often unaware of this debilitating disease.

The World Health Organization (WHO) describes obstetric fistula as an abnormal connection between the vagina, rectum, and/or bladder that can develop after prolonged, obstructed labor.

If not corrected, it leads to ongoing urinary or fecal incontinence.

Globally, obstetric fistula affects between 50,000 and 100,000 women each year, with low-income countries in Africa and Asia most affected.

Although the true rate of obstetric fistula in Zimbabwe is unknown due to a lack of public awareness, it is reasonable to assume that the country has a devastating prevalence and incidence rate given the high rate of maternal mortality. , as reported in the most recent report. 2019 Multiple Indicator Cluster Survey.

Munetsi’s condition began when she began giving birth alone while working on a farm as a caretaker in Masvingo.

“When I started experiencing labor pains, I was home alone and my phone battery was dead because I couldn’t go to one of our neighbors’ houses where I had the habit of charging my phone.

“My body was just weak and I didn’t want to leave the house,” she said.

She didn’t know it was time to give birth.

“Labor got worse around 11 p.m., but I couldn’t call for help and even if I wanted to, the local hospital was such a distance that I couldn’t get there alone at night.” , she said.

“The whole night I couldn’t sleep a wink. I was in so much pain.

Munetsi’s water broke early in the morning, but the baby had not yet arrived.

In the morning, when a young boy came to her house asking for a lighter to make a fire while he was getting ready to go to school, he did not find it and went home to tell his mother that he couldn’t find it.

“Considering that I had spent a night prey to overwhelming emotions, my voice had wavered, lost in the midst of tears. When the boy knocked, I struggled to find my voice, but I couldn’t say anything. That’s why the boy went home and told his mother that he couldn’t find me,” Munetsi said.

Knowing the condition Munetsi was in, the boy’s mother rushed to see if she was okay.

She forced Munetsi’s cabin open and found her tired, lying in a pool of water.

In a frantic rush, she took her to the hospital, only to find that the nursery ward was overflowing with patients.

“I couldn’t be admitted right away because the maternity ward was full and all the midwives were taking care of other patients,” Munetsi told NewsDay.

Despite the chaos at the health facility, she gave birth to a baby boy.

However, this moment of joy was overshadowed by a lingering condition that she would endure in silence for almost a year.

Munetsi’s journey hasn’t just been physical.

These were multiple situations where, on the other hand, she had to deal with societal norms that perpetuated the silence around obstetric fistula.

During this time, she suffered from misconceptions that labeled her as cursed.

In September 2020, Munetsi’s destiny changed when a young woman who visited their village for the holidays became his savior.

“I always call this lady a good Samaritan. She encouraged me to go see a doctor and that’s when I was referred to Parirenyatwa (Group of Hospitals), where I had surgery,” Munetsi said.

She did not know that obstetric fistula was a medical problem that could be corrected.

Although obstetric fistula repair was formalized in Zimbabwe in 2015 as a public health initiative, little has been done to raise public awareness of the problem.

Many women and girls in Zimbabwe have limited access to maternal health care, which could help prevent and treat obstetric fistula, according to a new study by Amnesty International.

“Our research found that obstetric fistula appears to affect the most marginalized members of society: poor, young and often illiterate girls and women in remote parts of the country. And this is where access to maternal health is limited, as most people live far from public health facilities,” said Roselina Muzerengi, campaigns coordinator at Amnesty International.

Mercy Rukudzo* from Chirumanzu, Midlands Province, also endured the misery that comes with obstetric fistula.

“I have had genital sores for two years and the humidity prevents them from healing. I’m afraid to go out in public,” she said.

“The last time I attended a function, the terrible smell scared people away.

“It put them off. I am limited to this place so that I can shower every time I urinate.

Obstetric fistulas, which are caused by obstetric causes, usually prolonged and obstructed labor, are an abnormal communication between the urinary tract or gastrointestinal tract and the genital tract, and are called “the most devastating birth injuries » by WHO and the United Nations Population Fund.

According to the WHO, obstetric fistulas can be treated provided they receive quality care.

However, amid an ever-deteriorating economic situation in Zimbabwe, as well as a persistently low budget allocation for health, the situation is dire, according to the chairman of the parliamentary committee on health and welfare. childcare, Daniel Molokele.

“Recently, we visited several government health institutions as well as those of mission hospitals. The impression we got there was devastating, a sign that the government of Zimbabwe has failed to allocate enough resources to the health sector,” Molokele said.

Despite the declaration of a policy of free maternal services, this sector has not been fully funded or operationalized by relevant initiatives.

Ultimately, the prevalence and incidence of obstetric fistula serve as markers of the inability of a country’s health system to provide women and girls with timely, appropriate and accessible maternal care, thereby violating their right to health.

Molokele said that as Parliament, their role in such a situation was to urge government to adequately fund and implement a comprehensive maternal health public policy, ensuring that such policy was in line with the international standards of availability, accessibility, acceptability and quality.

*These are not their real names