As Zimbabwe’s public health system continues to crumble, many pregnant women are turning to independent midwives to deliver babies.
A dim candle flame lighting the room can be seen from outside through the open door of a backyard maternity ward in Mabvuku, a populated and high-density suburb east of Harare, Zimbabwe’s capital.
Inside the small room, Rosemary Rambakupetwa, 21, sits on a mat, gazing intently at her new baby boy lying on brightly colored baby blankets.
It’s Rambakupetwa’s firstborn, and less than two hours after giving birth, she can’t hide her excitement.
“Becoming a mother has always been my dream,” she smiles.
Rambakupetwa, who has been here since dawn, spent 16 hours in labour. Angeless Kunzara is the midwife looking after her. Known as Mbuya Nyamukuta, a Shona name that translates to midwife in English, Kunzara, 68, had a midwife mother. She started helping women give birth in 1986 at her home in Goromonzi, a rural community 32 km southeast of Harare.
“One day a pregnant woman came to give birth and my mother was not there. I had no choice but to help her. When my mother arrived she said that I had done things properly,” Kunzara recalls. This was the beginning of her work as a midwife.
Trained by the best
Kunzara, a mother of 10, says that although not professionally certified as a midwife, in 1995 she was trained as nurses in clinics in her home area and as senior midwives in her church.
In 2004, when she moved to Mabvuku following the death of her husband in 2001, she had extensive experience in home deliveries. She quit her job at a security services company in 2008 to become a full-time midwife, a job she loves.
Kunzara does not know the exact number of women she has helped deliver. Rambakupetwa is one of hundreds of women who gave birth in her rented house in Mabvuku.
Zimbabwe is experiencing its worst economic crisis in decades with unchecked inflation, stagnant wages, widespread poverty and shortages of essentials such as water and electricity. The health sector has seen sporadic nationwide strikes by health workers for three years over poor pay.
The situation has been aggravated by the Covid-19 pandemic. In 2020, nurses went on strike over shortages of medicines and personal protective equipment (PPE) which affected most medical facilities around Harare. Among them was the Mabvuku Polyclinic, a clinic owned by the Mabvuku Residents’ Council that sent pregnant women elsewhere to deliver their newborn babies.
Finance Minister Mthuli Ncube has allocated 14.9% of the 2022 national budget to health. Although up from 12% last year, the allocation remains below the 15% threshold recommended by the Abuja Declaration.
Public health in ruins
Seeking medical care in the country’s private medical facilities is beyond the reach of many workers whose wages have been eroded by high inflation.
Health authorities have also sounded the alarm over staffing shortages due to an exodus of healthcare workers. Nurses earn less than US$200 per month.
According to the Health Services Board, 2,000 Zimbabwean healthcare workers left the country for countries including the UK, US and Australia in 2021.
“Pregnant women denied at Mabvuku Polyclinic are unacceptable and they violate women’s rights,” said Obert Nyatsuro, president of the Confederation of Midwives of Zimbabwe.
“Some of the clinics are closed due to lack of staff. The nurses are going in search of greener pastures. We have limited staff to run the clinics that are open.”
Faith-based midwives became popular in 2019 when nurses and junior doctors went on strike that lasted several months. Public health facilities like Edith Maternity Clinic in Mbare, the largest maternity care provider owned by Harare City Council, have been turning away pregnant women.
Kunzara says that from 2020, when Zimbabwe recorded its first Covid-19 related death, she witnessed an increase in the number of pregnant women visiting her maternity ward. In 2020, at the height of the pandemic, Kunzara helped four women give birth on the same day – the most in a single day since she started this job.
About 2 km from Kunzara’s house in Mabvuku is another maternity hospital run by 63-year-old Ivy Gatsi. Gatsi’s premises are near the Mabvuku polyclinic.
Like Kunzara, she is a member of the Church of Apostolic Faith and helps women in her church and non-church members, including those not accepted by the nearby clinic.
“A woman was turned away from the clinic and her unborn baby was presumed dead. When she came to my ward she delivered a healthy baby girl,” says Gatsi, who started her career as a midwife -woman in 1992 in her native village of Murehwa. , a township about 90 km from Harare.
In the small room that Gatsi uses as a maternity ward, there is a single bed where the expectant mothers sleep. There is a plastic “mat” on the floor where they lie during childbirth.
This is where Jose Verde Kersteen, 34, gave birth to twins Akiela and Kaylah Biswasi less than a month ago.
Kerstean, whose three children all gave birth in clinics, says she was supposed to give birth at Mabvuku Polyclinic but changed her mind when she feared having a caesarean section.
“I just opted for Gogo Gatsi and gave birth safely,” Kerstean says, while watching her twins in a bed wrapped in brightly colored blankets and under a mosquito net.
It is work that Kunzara and Gatsi do as an extension of their church work. Their church bylaws prescribe that pregnant women are supposed to give them groceries or money as a thank you, but they don’t turn away those who can’t afford the gesture, they say.
Kunzara and Gatsi say they use PPE in their maternity units to prevent the transmission of diseases, including Covid-19.
“We buy PPE or ask expectant mothers to bring it. These include surgical masks, umbilical cord clamps, razor blades, alcohols and medical aprons,” Kunzara explains.
They say complications are rare. However, they refer pregnant women with complications to Parirenyatwa Hospital, one of two relatively functional public hospitals in Harare.
“In November 2021, there was a pregnant woman who had high blood pressure. I referred her to Parirenyatwa Hospital where she delivered safely,” Kunzara explains.
After childbirth, says Gatsi, she encourages mothers to seek treatment at health facilities.
For Kerstean, her twins received injections required for newborn babies in Zimbabwe at the Mabvuku Polyclinic. Bacille Calmette-Guérin, a vaccine given to babies to protect them from tuberculosis, was administered to them.
Not without risk
Itai Rusike, executive director of the Community Health Task Force, says home births are risky because pregnant women need services to support pregnancy and prevent mother-to-child transmission of sexually transmitted infections.
The Zimbabwe Demographic and Health Survey estimates infant mortality rates at 651 deaths per 100,000 live births in the country.
Even though Zimbabwe’s maternal mortality rate over the past five to ten years shows a decline, Rusike describes it as “relatively high”. This is regardless of the interventions instituted to date, he says, adding that the increase in the maternal mortality rate is attributed to the poor quality of care within the country’s health system.
“Contributing factors include limited access to appropriate and timely obstetric care services, attitude of staff, lack of reliable transportation system, inadequate medications and shortage of trained personnel in health facilities,” says Rusike .
Emmanuel Mahlangu, chairperson of the Government Association of Zimbabwe Nurses and Midwives, said families should seek care at approved health facilities.
“Nurses and midwives at these health facilities have undergone special training to ensure they can handle emergencies that arise during childbirth,” he says.
Meanwhile, Kunzara dreams of having enough housing to house future mothers. “I need more space,” she says.
Rambakupetwa has sworn to return to the Kunzara maternity hospital to deliver her next child. “Gogo is caring. I’m going to deliver my children here,” she says, as she struggles to get into the car to drive home with her newborn baby.