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.
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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.
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
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.
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
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.