6 Improve maternal health
Where we are?
- Maternal mortality continues to be a major challenge in Zimbabwe with most deaths related to inadequate maternal care.
- According to 1992 and 2002 population censuses and 2003 PASS, the Maternal Mortality Ratio (MMR) increased from 1,068 deaths per 100,000 live births in 2002 to 1,237 in 2003. However, the demographic and health survey have estimated much lower MMRs of 578 and 555 deaths per 100,000 live births for the five years preceding 1999 and 2005/06 ZDHS reports.
- Contraceptive prevalence which is one of the principal determinants of fertility shows that 98 percent of married women have knowledge of family planning methods (ZDHS 2005/06).
- The contraceptive Prevalence rate(CPR) which measures percentage the percentage currently married women /or in unions aged 15-49 years using family planning methods, was 65 percent(MIMS, 2009).
- 93 percent of women aged 15-49 years who gave birth prior to the MIMS survey 2009 received antenatal care during pregnancy at least.
- Nationally, 61 percent of women aged 15-49 years who gave birth two years prior to the MIMS survey 009, delivered in health institutions.
- It is of great concern that rural areas had 50 percent of mothers' delivery at home.
- Child birth registration for children under the age of 5 remains low, with only 37 percent having birth certificates with no gender differential. Urban areas have higher percentage at 55percent and rural areas at 30 percent, respectively.
- Early marriage which is an indication of the exposure of women to risks and a violation of human rights for the development of girl child indicates 5 percent of women aged 15-49 years were married before the age of 15 years.
- The proportion of early marriages is declining (before age 15) with Harare and Bulawayo being at the lowest rates.
- 32 percent of women aged 20-49 years currently in marriage were married before the age f 18 years but the rate is highest in ages 45-49. At 40 percent. Compared to 31 percent in the rest of ages (MIMS, 2009).
- Nationally, 21 percent of women aged 15-49 years in Zimbabwe were married or in union at time of MIMS 2009 survey.
- To mitigate the challenge of maternal health, there has been creation of supportive environmentÂ such as Antenatal care Programmes, Sexual Offences Act adopted in 2003, domestication of the international campaign on the Roadmap to Safe Motherhood policy, free public health services pregnant women, etc.
Status and Trends
The maternal mortality ratio (MMR) in Zimbabwe has worsened significantly over the past 20 years. In 2007 the MMR was esti¬mated at 725 per 100,000 live births. This is much higher than the MDG target for MMR for Zimbabwe which is 174 per 100,000 live births. The proportion of births attended by skilled health per¬sonnel has fallen over the past 20 years. In 2009, the proportion stood at only 69%.
The high levels of at least one antenatal care (ANC) visit (94%) are followed by fewer women completing at least four ANC vis¬its (71%). Even fewer women return to deliver in the institutions where skilled attendance at birth can be accessed. It is estimated that in 2009 39% of women who gave birth in the two years prior to the survey delivered without the assistance of a skilled birth attendant.
Demand for modern methods of contraception has increased, rising from 63% in 1994 to 71% in 2006. The contraceptive preva¬lence rate also increased further, rising from 48% in 1994 to 60% in 2006, and increasing to 64% in 2009. The method mix is mainly pill-dominated and public health facilities remain the most common source of the contraceptive products. However, the contribution of the community-based distribution network as a source of contraceptive commodities, a key driver of the family planning programme over the past two decades has declined to below 5% in the past few years.
Consistent with these improvements, the fertility rate has grad¬ually declined from 4.3 to 3.6 children per woman, as has the adolescent fertility rate, dropping from 102 births per 1,000 women aged between 15 and 19 to 99 births for the same age group over the same period. Disparities in the contraception prevalence rate on the basis of place of residence, social status, and age group continue to manifest in most of these key indicators.
Major challenges to achieve MDG 5
Progress across the targets for MDG 5 has not been uniform. Major challenges and constraints still exist in order to accelerate progress towards meeting MDG 5.
The Maternal Mortality Ratio 3
The leading causes of maternal mortality are:-
- AIDS-defining illnesses (25.5%)
- Post-partum haemorrhaging (14.4%)
- Puerperal sepsis (7.8%)
- Complications arising from abortion (5.8%)
- Malaria (5.8%)
- Institutional delivery, skilled attendants at birth, and the type of religious affiliation are factors that significantly affect the risk of maternal deaths.
From these causes, the policy and service delivery constraints are thus noted as:
- The deteriorating capacity of and responsiveness of the healthcare system. For example, 80% of midwifery posts in the public sector are vacant.
- The implementation of maternal health interventions that do not address the HIV and AIDS risk and burden on women and families. Despite the fact that HIV is the leading cause of mater¬nal mortality, only 5.4% of pregnant women knew their HIV status before pregnancy, and just 34% of pregnant women were tested for HIV during pregnancy.
- Health services are organised in a manner that does not adequate¬ly address the religious concerns and beliefs of certain faith groups.
- A health system financing mechanism that is not pro-poor. User fees remain a significant barrier to access to reproductive health.
- Task-shifting or task-sharing related to scaled-up HIV and maternal health services.
Universal Access to Reproductive Health
The unmet need for family planning has remained static for the past 20 years. Major challenges remain, namely:
- The need to strengthen the relatively poor method mix. Currently, the programme is dominated by the oral contraceptive pill, thus limiting the choice for women
- The declining contribution of the community-based distribution network as a source of contraceptive products and information. Public health facilities have become the dominant source of con¬traceptive commodities, making them less accessible to women
Requirements for Achieving Goal 5
- Increased efforts and investment to strengthen the healthcare system and scale-up coverage of maternity waiting homes, including adopting and implementing pro-poor, predict able and enhanced health-financing policies
- Coverage by village health workers and ad dressing those religious and cultural practices that limit institutional deliveries
- Investing in improving the contraception method mix, strengthening the availability of information and commodities at community level, and sustaining the current support to commodities supply chain management.
The 8 Millennium Development Goals
- 1 Eradicate extreme hunger and poverty
- 2 Achieve universal primary education
- 3 Promote gender equality and empower women
- 4 Reduce child mortality
- 5 Improve maternal health
- 6 Combat HIV/AIDS, malaria and other diseases
- 7 Ensure environmental sustainability
- 8 Develop a global partnership for development
Targets for MDG 5
- Reduce by three quarters the maternal mortality ratio
- Most maternal deaths could be avoided
- Giving birth is especially risky in Southern Asia and sub-Saharan Africa, where most women deliver without skilled care
- The rural-urban gap in skilled care during childbirth has narrowed
- Achieve universal access to reproductive health & inadequate funding for family planning is a major failure in fulfilling commitments to improving women’s reproductive health
- More women are receiving antenatal care
- Inequalities in care during pregnancy are striking
- Only one in three rural women in developing regions receive the recommended care during pregnancy
- Progress has stalled in reducing the number of teenage pregnancies, putting more young mothers at risk
- Poverty and lack of education perpetuate high adolescent birth rates
- Progress in expanding the use of contraceptives by women has slowed & use of contraception is lowest among the poorest women and those with no education