CLAIM: Almost 95 % of our maternal and perinatal death cases are deemed to be avoidable
SOURCE: Community Working Group on Health
VERDICT: Inconclusive
The claim was made by Community Working Group on Health (CWGH) director, Itai Rusike, as quoted in the NewsDay newspaper in an article headlined, ‘Zim likely to miss SDG target for reducing matenal (sic) mortality’.
In the same article, he also claimed that, ‘Furthermore, neonatal mortality has remained stagnant for the past decade at 321/1 000 live births and under five mortality remains high at 65/1 000 live births’.
This is false as he is using old statistics. The statistics from the 2022 census show that the national Neonatal Mortality Rate (NMR) and Post-neonatal Mortality Rate (PNMR) is 9.5 and 14.7 per 1,000 live births, respectively, while Under 5 Mortality Rate is now at 39.8.
Maternal and Perinatal Mortality
Maternal mortality refers to those deaths which are
caused by complications due to pregnancy or childbirth. These complications may be experienced during pregnancy or delivery itself, or may occur up to 42 days following childbirth.
42 days is a measure recently adopted as per the SDG indicator definition. Previously, the indicator of maternal mortality ratio was defined as any death during pregnancy or within two months of delivery or termination.
The new measure that additionally excludes deaths due to acts of violence or accidents, produces more precise estimates, although due to large confidence intervals, this is not expected to make an impact on ratios.
Maternal deaths are in general more likely to be underreported than over-reported.
Currently, MMR in Zimbabwe stands at 363 per 100 000.
The perinatal mortality rate is the sum of the number of perinatal deaths (stillbirths and early neonatal deaths) divided by the number of pregnancies of seven or more months’ duration (all live births plus stillbirths).
FactCheckZW could not find statistics for this as official documents only refer to neonatal mortality rate, post-neonatal rate, infant mortality rate, child mortality rate and under 5 mortality rate.
Causes of Maternal Mortality
According to the United Population Fund, complications during pregnancy and childbirth are leading causes of death and disability among women of reproductive age (15-49 years) in Zimbabwe.
According to the Ministry of Health and Child Care, the top 5 causes of maternal deaths are: bleeding after giving birth (26%); Hypertensive Diseases (16%) (High blood pressure which leads to violent fits during pregnancy); Puerperal Sepsis (10%) – fever & pain due to infection of the genital tract of a woman that occurs from the breaking of the waters (rapture of the membrane) or labour up to 42 days after giving birth; Post & Peri Arbotal sepsis (9%) – serious infection of the uterus (fever & pain) due to induced abortion and C-section (5%).
In a study in order to identify which avoidable factors were involved most frequently in the Midlands in the 1990s, the main causes of death were uterine rupture, eclampsia, haemorrhage and caesarean section related accidents. An avoidable factor was identified among 87% of these deaths involving the health system in 57% of the cases and the patient in 33%.
Since most maternal deaths occur during delivery and during the postpartum period, emergency obstetric care, skilled birth attendants, postpartum care, and transportation to medical facilities if complications arise are all necessary components of strategies to reduce maternal mortality.
Although Zimbabwe’s Ministry of Health and Child Care advises women to give birth in health facilities, demographic data indicates that nearly one quarter of women give birth without skilled assistance due to cultural preferences, religious beliefs, economic constraints, lack of decision-making power and fears of poor care from the formal health system.
Unskilled persons, such as untrained traditional birth attendants, village health workers, relatives and friends assist in 20 percent of births, while three percent of births receive no assistance.
The tragedy – and opportunity – is that most of these deaths can be prevented with cost-effective health care services. Reducing maternal mortality
and disability will depend on identifying and improving those services that are critical to the health of women and girls, including antenatal care, emergency obstetric care, adequate postpartum care for mothers and babies, and family planning and STI/HIV/AIDS services.
Room for Improvement
There are interventions that can be employed to mitigate against the death of women and infants before, during and after birth.
Interventions that can be implemented at various levels of the health system include: policy development, training of personnel, providing access (maternity waiting homes, removal of user fees), monitoring and evaluation to achieve this impact.
The World Health Organisation says efforts to reduce maternal mortality and morbidity must also address societal and cultural factors that impact women’s health and their access to services. Women’s low status in society, lack of access to and control over resources, limited educational opportunities, poor nutrition, and lack of decision-making power contribute significantly to adverse pregnancy outcomes. Laws and policies, such as those that require a woman to first obtain permission from her husband or parents, may also discourage women and girls from seeking needed health care services.
Conclusion
The claim that almost 95 % of Zimbabwe’s maternal and perinatal death cases are deemed to be avoidable, has been rated as inconclusive due to lack of data. While most literature does allude to the fact that the top five causes of maternal mortality are avoidable: haemorrhage, eclampsia, sepsis, abortion and c-section; it is not clear if this accounts for 95% of all MM cases. There was no data available for causes of perinatal deaths.
