By Tendai Makaripe
Tanatsiwa* from Musambakaruma Village in Kariba was only 16 when diagnosed with obstetric fistula. This is a devastating birth injury described as the “most devastating birth injury” by both the World Health Organization (WHO) and the United Nations Population Fund (UNFPA).
It’s a hole between the vagina and bladder or rectum, caused by prolonged obstructed labour pressure. Leaving school at 15 to marry, she quickly became pregnant.
Her traditionalist husband insisted on home delivery to verify paternity, leading Tanatsiwa through a painful, four-day labour, significantly endangering her life and health.
While labour typically lasts less than 24 hours, obstructed labour can span several days, placing women’s lives and health in significant jeopardy.
“I was instructed to keep pushing even though I sensed something was amiss. Despite my utmost effort to push, I was reprimanded for being too lazy,” said Tanatsiwa.
When the severity of Tanatsiwa’s complications was realized, it was tragically late.
Kariba Hospital staff couldn’t assist, forcing her rushed transfer to Chinhoyi Hospital for a cesarean section.
Her baby had already perished, leaving her with serious injuries.
Cultural beliefs against medical center deliveries contributed to the loss of her son, leaving Tanatsiwa physically and emotionally wounded.
Her situation is far from unique, echoing through many rural and marginalized areas of the country. Cultural beliefs often favour home deliveries led by untrained Traditional Birth Assistants TBAs, leading frequently to complications like obstetric fistula.
The WHO notes that obstructed labour, linked with obstetric fistula, is a primary global cause of maternal mortality.
Studies show that 90.1 percent of pregnant women who develop fistula also experience stillbirth, exacerbating the emotional toll on the mothers.
Obstetric fistula affects 50,000 to 100,000 women worldwide, predominantly in lower-income nations in Africa and Asia.
Although the exact prevalence in Zimbabwe is unknown, the 2022 Housing and Population Census reports a maternal mortality rate of 363 per 100,000 live births.
Despite recognizing obstetric fistula as a public health issue in 2015, a 2021 report by Amnesty International highlights that many Zimbabwean women and girls still have limited access to maternal healthcare.
Cultural practices favouring home births with Traditional Birth Assistants continue to limit their options.
To understand the rationale behind these beliefs and how they impact the maternal health of women in rural and marginalised communities,263Chat carried out an investigation that took it to areas like Musambakaruma and Nebiri Nehande in Kariba; Mashonaland West Province, Chakonda Village in rural Shamva, Mashonaland Central Province, and parts of Mbire District.
The investigation revealed that the problem of home births is more entrenched than is generally reported, a situation that is worrisome considering the lasting consequences like obstetric fistula.
A village elder in Mbire district, Takafira Mukangate told 263Chat that there is nothing amiss about home births because ancestors guide the TBAs.
“We trust the ways of our ancestors. Our mothers and grandmothers all gave birth at home with the help of TBAs. They knew the ways of nature, and the ancestors protected them,” he said.
A traditional healer in Nebiri Nehande, Ambuya Chimutsavaviri, noted that not all pregnancies need medical attention as some newborns require protection from evil spirits and witches during childbirth.
She added that many kill newborns for rituals, and her presence at birth is essential to provide protection unattainable at medical facilities for both mother and child.
“There are many women who give birth at my shrine without any complications because the spirits guide me and I can fend off those who want to kill the child,” she said.
Historian and social commentator Aaron Muchatuta noted that some communities prefer home births due to a belief that medical workers, perceived as money-driven and careless, cannot adequately assist expecting mothers.
“They believe home births better honour childbirth customs and rituals, such as cutting the umbilical cord, burying the placenta, and naming the child. Some women feel these practices shield the child from evil spirits and ensure their health and fortune,” he said.
Investigations in the mentioned communities noted that most TBAs lack formal training, sterile equipment, and access to skilled assistance for complications.
A doctor at Shamva General Hospital stated: “In Zimbabwe, 20 percent of births are assisted by unskilled individuals, including traditional birth attendants and village health workers. This percentage rises among uneducated, impoverished women in rural areas.”
Research has found that some of the traditional methods used to deal with labour complications increase risks in cases of obstructed labour.
“We have always been using elephant or donkey dung to speed up labour,” said Gogo Munhuweyi, a TBA at Pasco Farm in Shamva.
“In some instances, we take sand from a molehill mix it with water, and give it to the expecting mother. It speeds up labour,” she said.
However, experts note that such methods can result in strong contractions and foetal distress and worsen the risk of injuries in cases of obstructed labour.
Beyond the issue of unskilled birth attendance, the investigation highlighted the significant impact of the delivery location on obstetric complications.
Respondents pointed out that the homes of TBAs lack the essential hygiene standards needed for safe and healthy childbirth.
“The places where many women are compelled to give birth often lack clean water and sanitation, increasing the infection risk for both mother and newborn,” said veteran nurse Tracy Nyamusa. “The inadequately ventilated, dim, and cramped rooms used are not conducive for effective childbirth management. The unsterilized materials used at home, like cloths, blades, and ropes, further heighten health risks.”
Sexual Reproductive Health expert and programs coordinator at Katswe Sistahood, Fadzisai Mawunganidze, emphasized the importance of training TBAs.
She noted that it could standardize knowledge about, and encourage timely referrals for, emergency obstetric cases while also enhancing understanding of the causes and prevention of obstetric fistula.
“However, for full efficacy, training must pair with enhanced collaboration between biomedical and traditional health personnel, and improved infrastructure to prevent patient mistreatment by medical staff,” she said.
Amnesty International executive director Lucia Masuka said human Rights education in the communities will help change the mindset of people on home births and this will also increase knowledge among the people on how home births can expose women to complications and injuries such as obstetric fistula.
“Raising awareness and ensuring the availability of information in communities and families, specifically for husbands, older women, and traditional birth assistants, on the causes of obstetric fistula and the importance of giving birth with skilled medical care will also ensure mindset change.”
She recommended that the government should develop a national obstetric fistula strategy, which addresses the prevention, treatment, and rehabilitation of obstetric fistula and ensures the participation of women affected by obstetric fistula in its development. The government should also ensure the availability of healthcare facilities.
A director in the Ministry of Health and Child Care said the government is committed to enhancing awareness in communities and families, especially among husbands, older women, and TBAs.
“There’s also a pressing need for immediate government action to prevent and address acts of violence and mistreatment against women during childbirth. It’s essential to ensure no third parties or harmful practices interfere with access to prenatal and postnatal care.”
UNFPA communications specialist Bertha Shoko noted the importance of investing in midwifery education to efficiently deliver Sexual, Reproductive, Maternal, Newborn, Child, and Adolescent Health (SRMNCAH) services.
“Investing in midwifery education as well as strengthening the interdisciplinary roles of midwives can meet about 90 percent of the need for essential SRMNCAH interventions across the life course,” she said.
Immediate action, focused on education, improved healthcare infrastructure, and the dismantling of harmful traditions, is crucial to protect the lives and dignity of countless women, ensuring that no woman has to suffer in silence and darkness.
*Name has been changed to protect the identity of the individual.
