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Critical shortage of midwives
IRIN News
May 12, 2011

http://www.irinnews.org/report.aspx?reportID=92698

Tafadzwa Kazingizi, a 19-year-old mother from Chitungwiza, about 30km south of Zimbabwe's capital, Harare, has been haemorrhaging since she gave birth four months ago. She did not visit a prenatal clinic during her pregnancy.

"When I got to the hospital, the only midwife on duty told me that I was supposed to be monitored for blood pressure and possible heart problems, but it turned out that their machine was not working well and as I waited for it to be fixed, I started experiencing labour pains," Kazingizi told IRIN.

"The midwife was attending to another woman in the labour ward and there was another one ahead of me, so I had to wait. Unfortunately, she took too long and I gave birth with the help of three student nurses," she said. The student nurses did not appear to have experience in midwifery.

"I was discharged about six hours after delivery and no one cared to monitor my condition after giving birth," the teenage mother said. "My child is constantly coughing and wheezing, and it could be because there was no one skilled enough to help me deliver." She thought the bleeding was probably a result of poor sanitary precautions.

She has since returned to the family home, but her parents were not supportive. "Our health [hers and the baby's] will continue to deteriorate if no one comes to my help".

Deteriorating maternal health

A recent report on Zimbabwe's progress toward achieving the Millennium Development Goals, complied by the UN Population Fund (UNFPA), the UN Children's Fund (UNICEF) and the World Health Organization (WHO), said about 80 percent of the posts for midwives were vacant in the public sector.

"The shortage of skilled and competent midwives can avert 80 to 90 percent of maternal deaths. The shortage of skilled and competent midwives can result in women and their newborns dying from the complications that could be prevented by a health worker with the right skills, the right equipment and the right support," the report pointed out.

The lack of midwives has severely hindered Zimbabwe's chances of meeting Millennium Development Goal Five, which seeks to reduce maternal mortality by three-quarters by 2015 while also improving the ratio of pregnancies attended by skilled health professionals.

A midwife at Harare Central Hospital, which provides healthcare to low-income communities in an area about six kilometres southwest of Harare, told IRIN that it was not unusual for pregnant women to die during delivery.

"There is a serious shortage of midwives at this hospital, just like at the other government health institutions," said the senior midwife, who has worked at the hospital for the past 15 years.

"On a daily basis, we have more than 30 women needing the services of midwives but we hardly cope. The skeleton staff that is here struggles, and we are sometimes forced to be on duty for 24 hours, with little time for rest," she told IRIN.

Skills shortage

"Not many nurses are willing to train as midwives because the job is too demanding. The government has advertised for posts on numerous occasions but student midwives are not forthcoming," said the senior midwife, who declined to be identified.

She attributed the critical shortage of midwives to better salaries and working conditions in neighbouring countries like South Africa and Botswana, or further afield in Europe.

"Salaries are poor, working hours are long, we risk contracting diseases because of poor sanitary conditions, and the wards are poorly equipped," she said.

Zimbabwe has been locked in an economic recession for more than decade, resulting in a large-scale exodus of doctors, nurses, teachers and other skilled professionals.

Health facilities for maternal care in the rural areas are also scarce. Jennifer Masara, 28, from Guruve, made a 200km journey to the capital in the lasts stages of her pregnancy after the local clinic's only midwife was retrenched.

"I was told a few days before I was due to deliver that the nurse [midwife] had suddenly left her job," Masara told IRIN. "Officials from the ministry of health wanted to fire her after a mother died during delivery at the hospital."

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