The devastating effects of COVID-19 on maternal health in Zimbabwe
By Vongai Chikwanda, Amnesty International Campaigner for Southern Africa
Rutendo* was getting close to her due date when the government announced the 21-day lockdown to tackle COVID-19. She stays in a farming area, 35 kilometres from the nearest healthcare facility, and her chances of getting an ambulance in time for emergency care were always minimal. Rutendo’s older sister died five years ago from complications in pregnancy and her mother, not wanting to take any chances, sent Rutendo to the nearest district hospital to ‘sit and wait’ for a safe delivery before the lockdown came into effect on 30 March. Rutendo delivered a bouncing baby girl the very next day. In pain, she expected to stay at least two days under observation, but she was discharged after one night when the lockdown began.
Rutendo had heard that soldiers were beating people up on the streets to enforce the lockdown and she was afraid to go and buy medication
Within two weeks her baby fell sick. Rutendo’s mother thought that the baby needed stomach medication. Rutendo had heard that soldiers were beating people up on the streets to enforce the lockdown and she was afraid to go and buy medication, but her baby was in pain so she gathered courage to go to the nearest shopping centre in Norton, 40 km west of Harare.
Upon arrival Rutendo found that the pharmacy had reduced its operating hours and was closed. She returned the next day, but the pharmacy did not have the medication she was looking for and she was advised to go to Harare. Rutendo told Amnesty International that she was afraid to travel to Harare because of the numerous check points and the risk of police brutality, given that she had no documentation to justify her journey. When community members advised her to travel with her baby as proof, she told Amnesty that she said “how do I travel with a child who is less than 6 weeks to Harare just to get medication. I will be placing the child in more danger.”
Many new mothers are now facing impossible decisions like this due to the pandemic. As well as travel restrictions and medication shortages, some are cut off from the women relatives they rely on for postpartum support. Rutendo explained, that culturally older women’s support is a critical support for new mothers. Rutendo praised her mum for taking care of her, cooking nutritious meals, nursing her and helping take care of the newborn whilst she is recovering. Research indicates that social support can help prevent postpartum depression. Countless other new mothers do not have the benefit of having their mothers or other relative nearby who can give them the levant support during this lockdown. Isolation has meant that some new mothers are alone, without any help or social support.
The lockdown has placed an extra burden on women and girls, who already perform 2.5 to 3 times as much unpaid care work at home, compared to men
Tryphine* lives in a township outside of Harare and her mother could not travel from Masvingo which 297 kilometers from Harare to be with her when she gave birth. Tryphine needed a caesarean delivery and has struggled to recover. She is still expected to cook, fetch water and look after her two other young children. With no one to help or talk to, she has had to ask her eldest child to assist with care work at home and is neglecting her recovery.
For some mothers, the situation is worsened by living in a large family set-up, without access to running water and where other family members may need to be taken care of. Care work mothers in these situations are having to do includes making sure that family members have water to bath and drink, and their meals prepared. The lockdown has placed an extra burden on women and girls, who already perform 2.5 to 3 times as much unpaid care work at home, compared to men.
Many families are also facing increased poverty as a result of being unable to work during the lockdown. Many pregnant women and girls will be unable to afford the costs of transport to health facilities to give birth. Those with no support like Rutendo’s have no option but a home delivery with unskilled birth attendants, risking delivery in unhygienic conditions. Some nurses have told community activists of a reduction in the numbers of women who are going to maternity waiting homes, clinics or hospitals for skilled delivery. Yet, pregnant women have raised concern about the difficulty of getting transport during the lockdown and their fear of police brutality. Home births with unskilled care places women and girls at risk of maternal mortality and morbidity and can have devastating consequences for the baby, including risk of mother to child transmission of HIV.
During the ongoing lockdown period, the government must prioritise maternal health care
Already Zimbabwe is battling high maternal mortality rates. During the ongoing lockdown period, the government must prioritise maternal health care. Authorities must make arrangements to ensure women and girls have to access antenatal care, maternity waiting homes and skilled medical care to give birth. They should also allow for medical and social support in the postpartum period and ensure access to medication and health care.
*Real names withheld to protect their identities.