Pregnant women and girls face barriers to accessing health facilities and risk life-changing injuries

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Amnesty International


PREGNANT women and girls are at risk of childbirth-related injuries, including obstetric fistula, as many people avoid public health facilities in favor of home births due to inadequate health infrastructure, cultural practices and high hospital costs, Amnesty International said Thursday. in a new report.

Zimbabwe has one of the highest maternal mortality rates in the world and pregnant women have to gamble their lives opting for home births because of underfunded and underfunded public hospitals or because they do not. cannot afford the costs of care.

Deprose Muchena, Amnesty International Director for Eastern and Southern Africa

The report, “I never thought I could be cured”, exposes the physical and psychological trauma suffered by women and girls who experience obstetric fistula in Zimbabwe.

The disease, described as the “most devastating birth injury” by the World Health Organization (WHO), causes a continuous and uncontrollable leakage of urine or feces, leading to social stigma and emotional scarring. life.

The report also finds that the trauma of obstetric fistula is exacerbated by the lack of information on the causes and treatment of the disease and by the persistent difficulties in accessing postnatal health services and treatment for maternal injuries due to the Zimbabwe’s poor health system.

“Zimbabwe has one of the highest maternal mortality rates in the world and pregnant women have to gamble their lives opting for home births because of underfunded and underfunded public hospitals or because they are cannot afford the costs of care. Cultural beliefs also mean that some women have no choice but to undergo home births administered by untrained family or community members, ”said Deprose Muchena, Director of Amnesty International. for eastern and southern Africa.

It is unacceptable that women and girls remain exposed to this life-changing condition during childbirth. Zimbabwean authorities must urgently address root causes of obstetric fistula

Deprose Muchena

“It is unacceptable that women and girls remain exposed to this life-changing condition during childbirth. Zimbabwean authorities urgently need to address the root causes of obstetric fistula – childbirth should not pose health risks that could easily be avoided.

Obstetric fistula-associated obstructed labor has been identified as a leading cause of maternal mortality worldwide, and in 90% of cases women who experience obstetric fistula also suffer from stillbirth.

According to the WHO, obstetric fistula is preventable by reducing the number of early and unplanned pregnancies, ending harmful practices (such as child marriage) and ensuring access to quality emergency obstetric care , in particular access to cesarean sections. When access to quality treatment is available, obstetric fistula is also curable, with surgical success rates of up to 92%.

Barriers to Obstetric Fistula Prevention and Treatment

Although the Zimbabwe Ministry of Health and Child Welfare advises women to give birth in health facilities, demographic data indicates that almost a quarter of women give birth without skilled assistance due to cultural preferences, beliefs religious, economic constraints, lack of decision-making power and fears of poor care on the part of the formal health system.

Unskilled people, such as untrained traditional birth attendants, village health workers, relatives and friends attend 20 percent of births, while three percent of births go unattended.

Community members also raised fear of being humiliated by health professionals and the lack of privacy and confidentiality among health workers as other reasons to stay away from the formal health system. One woman said that “the nurses at the hospital don’t take care of pregnant women, it can be difficult and people stay away.”

Economic challenges have left women with limited choices. Even in cases where women may have wished to give birth in health facilities, they were unable to do so because they were economically dependent on their partners or families who were unwilling or unable to pay the related costs. during childbirth.

Another key barrier is the lack of information about obstetric fistula and potential treatment. Women who spoke to Amnesty recounted how they struggled to find information about the causes and treatment of obstetric fistula.

Growing cases of obstetric fistula and abuse in home births

In 11 cases encountered by the organization, women with a medical diagnosis of obstetric fistula reported experiences of abuse and severe suffering during labor, including at the hands of their in-laws. In most of these cases, a home birth began in the marital home under the guidance of older women who were not trained to deal with the complications and in some cases were reportedly violent and abusive.

Shuvai *, a 29-year-old woman, has lived with obstetric fistula for 11 years. She was forced to give birth at home after her husband refused a hospital birth. Her labor lasted four days and her baby was stillborn. She was then taken to hospital where she was diagnosed with obstetric fistula and retained placenta.

Childbirth should not pose health risks that could easily be avoided

Deprose Muchena

Another survivor, Chenai *, was 16 when she suffered a long and traumatic obstructed labor and was forced to push, but she found that the baby was dead. She started to leak urine but spent two weeks at home before receiving medical attention.

“Until the government of Zimbabwe lives up to its commitment to make maternal health care available free and accessible to all who need it, pregnant women and girls will remain vulnerable to the risks of childbirth, including childbirth. obstetric fistula, ”said Deprose Muchena.

Background

Globally, obstetric fistula affects between 50,000 and 100,000 women each year, with low-income countries in Africa and Asia having the highest rates. In Zimbabwe, the actual rate of obstetric fistula is not known, but the latest Multiple Indicator Cluster Survey of 2019 indicates that the country’s maternal mortality rate is among the highest in the world, suggesting a prevalence and rate of devastating incidence of maternal morbidities, such as obstetric fistula in the country.


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