Traditional Midwives Not Allowed In Zim Says Gvt

THE Ministry of Health and Child Care (MoHCC) does not encourage traditional midwives to deliver babies nor offer maternal health related services to pregnant women, a top government official has warned.

By Michael Gwarisa

The development comes in the wake of what has been described as “heroic works” of one Mbare traditional midwife, Mrs Esther Gwena who has since delivered more than 100 babies at her home. However, the babies are being delivered in the absence of critical health sundries such as, disinfectants, safe delivery kits, running water and proper waste disposal facilities a situation health experts fear could trigger an even worse health crisis.

In an interview with HealthTimes, Director Family Health in the ministry of Health and Child Care (MoHCC), Dr Benard Madzima said traditional midwives were not qualified to offer midwifery services and it was against the World Health Organisation (WHO) international guidelines.

In Zimbabwe, the program for maternal health is guided by the World Health Organisation (WHO) recommendations and the current recommendations are that traditional midwives are supposed to give health education to pregnant women and encourage them to go to established health facilities.

“This is because if a women then complicates or needs further help other than a normal delivery, traditional midwives will not be able to offer that help. For example, if a women suffers from post-partum hemorrhage, they will not be able to stop the bleeding, neither will they be able to give blood,” said Dr Madzima.

He added that Zimbabwe does not allow traditional midwives to offer services as this could result in even worse health complications.

“This is the background why it is not encouraged to have traditional birth attendants attending to pregnant women. They are not able to solve the complications which might arise. They are not able to give caesarean sections, the issues of integrating with other programs like HIV program like the immunization programs also come into play.

“So we don’t encourage traditional birth attendants delivering our women in Zimbabwe.”

In the early 80s Zimbabwe was advocating for the use of traditional birth attendants as part of the health delivery package. However, that was stopped in 1994 soon after the International Conference on Population Development (ICPD) following evidence that traditional midwives were not capable of handling birth related complications and other services that require skilled personal such as blood transfusions among others.

According to evidence based research, women who develop complications while at a traditional health attendant are most likely to lose their lives or that of  the baby.

Community Working Group on Health (CWGH) Executive Director, Mr Itai Rusike said government should address concerns of doctors and stop issuing licenses to traditional midwives.

“By endorsing Traditional Birth Attendants (TBA) instead of addressing the concerns of the doctors and other health workers, the government risks losing all the gains achieved in Maternal Neonatal and Child Health programs as the TBAs are not equipped with the requisite skills needed in the event of a complication or excessive bleeding.

“This is a tragedy and  the government is failing women and new-borns as the home deliveries are going to derail the country’s PMTCT programs and the postnatal care services that are supposed to be offered to both the mother and new-born. It is going to be very difficult to stop or discourage the TBAs from continuing practicing even after resolving the incapacitation crisis as they have been given a license and go ahead to operate and the long term consequences are going to be dire,” said Mr Rusike.

He added that the only noble thing to do was to get skilled health workers back in the clinics and hospitals so that the public health institutions can become functional again instead of celebrating medieval health practices that have long been forgotten in other parts of the world.

“We are not blaming the TBAs that are capitalizing and filling in the gap created by the non-availability of health workers in public health institutions but we need to hold the government accountable for sleeping on duty and failing to resolve the prolonged impasse and incapacitation crisis.”

Zimbabwe is currently battling numerous health challenges at the back of the obtaining industrial action by medical doctors and council nurses due to incapacitation. According to the latest Zimbabwe Demographic Health Survey, an estimated 614 women from every 100 000 who give birth die in the process, making it one of the highest in the world.

Public Health Expert, Mr Enock Msungwini however said engaging traditional midwives was not the best option to resolve the prevailing maternal health burden but government could capacitate them to ensure they complement qualified healthcare workers.

“It is not in the best interest of the public health context to engage traditional birth attendants. Factors like the reasons why women go there may vary. Is it about money, privacy, care, myths etc. These fall under the social determinants of health where one social system life style. Beliefs, economic status place of stay, diet and food have a bearing on health.

“The way forward however is to train them so that they complement the health system no to abruptly cut them completely,” said Mr Msungwini.