Maternal Mortality Among Women With Disability in Rural Areas- a Major Concern Amidst Covid-19
Musa Makina
WHEN she went into labour, Nomsa Nyathi (not her real name) who lives with a speech and hearing impairment condition was transferred from Lukosi Hospital to Mpilo referral hospital in Bulawayo.
Upon her arrival at Mpilo hospital, her labour pains worsened, with nurses struggling to assist her as she cried for help owing to a communication breakdown.
In the end, her cries were in vain as she passed away during labour.
Nomsa’s case is not isolated and is mirrored across the country’s rural areas and in other Southern African Development Community (SADC) countries where women with speech and hearing disabilities continue to face maternal health challenges.
Language barriers are a significant healthcare problem, and this is not just a problem for second-language speakers.
According to Traci Ann Hoglind in her 2018 paper titled Health Care Language Barriers Affect Deaf People Too, she indicates that speech and hearing-impaired people, who communicate using sign language, frequently, do not have access to clear and efficient communication in the healthcare system, depriving them of critical health information and qualified health care. The paper postulates that only 30 percent to 45 percent of what is said by speech and hearing-impaired people is generally understood.
Hoglind further shows that speech and hearing-impaired patients, compared to hearing patients, make less frequent visits to their primary care provider and make more trips to the emergency room, which is likely due to the lack of communication access.
“It’s never easy to be in my situation, I was born like this but the situation in our clinics and hospitals is deplorable,” Loveless speaking through a sign language interpreter said as she highlighted difficulties faced by women with disabilities.
She said it was common that the entire health care facility will have no one who is able to use sign language, a development that has always forced her to rely on an interpreter each time she makes a visit.
Loveless cannot read and write “because I didn’t go to school, so when the nurses ask me to write down what my illness is, I can’t, which is another big challenge.”
In Zimbabwe, Sexual and Reproductive Health Rights (SRHR) issues came to the limelight in 2006 when government formulated the National Reproductive Health Policy. The policy offers services such as maternal health, family planning, treatment for sexually transmitted diseases including HIV and AIDS and adolescent reproductive health.
Surprisingly, a closer look at the policy it proffers few interventions towards women with disabilities.
Scholars, Rugoho and Maphosa (2017) have attributed this omission to the fact that disability issues are still regarded as charity issues hence, funding for sexual reproductive health of women with disabilities is still a challenge. However, in a bid to cover the gap, government launched a National Disability Policy (2020) which attempts to proffer more interventions towards women with disabilities.
Hwange based Disability Agenda Forum (DAF) director Octavia Phiri bemoaned discrimination faced by women with disabilities when seeking health services.
“They are actually discriminated against from the time a pregnant woman with a disability arrives at a health care facility, the infrastructure is not disability friendly. The consultation process is not inclusive but discriminatory. This is where these women are subjected to all sorts of dehumanising questions such as, how can you get pregnant in your state or have so many children?,” she said.
Phiri said it was unfortunate that public health systems, particularly those in rural areas, are not tailored to also support persons with disabilities.
She added that access to information for deaf women is another huge challenge with sign language interpreters’ non-existent at health care centres resulting in their privacy being compromised.
“As DAF we have been lobbying the government as well as conducting dialogues with legislators. We have also mobilised communities through human rights education campaigns. However, most of these activities were adversely affected by the outbreak of Covid-19 and lack of funding to reach some areas,” Phiri said.
Women with disabilities have been cited by the World Health Organisation (WHO) to be the most disadvantaged and alienated group when it comes to accessing sexual and reproductive health services (WHO 2009).
WHO notes that “the chief challenge is the community’s negative attitudes towards people with disabilities, which have been institutionalised and have caused untold pain to women with disabilities. Prejudice, stereotyping and discrimination against people with disabilities have resulted in serious violations of their sexuality and reproductive rights.”
According to a 2017 UN Women study titled Making the SDGs Count for Women and Girls with Disabilities states that one in five women lives with a disability globally with an estimated one in four households having a person with disabilities.
The study notes that women comprise up to three-quarters of persons with disabilities in low and middle-income countries. It also notes that the prevalence of disability is higher among marginalised populations and people in rural areas.
Human Rights and Advocacy Officer at African Union of the Blind, Abraham Mateta argued “infrastructural, structural, inaccessibility, attitudinal, barriers as well as poverty” pose untold difficulties for women with disability in maternal issues.
“When you add the Covid-19 pandemic to it we are talking of more vulnerability. Remember visually impaired people depend on touching surfaces. It means that their environment has to be extra clean because they are more at risk,” Mateta said.
Mateta, who is also a disability rights consultant added: “In terms of communication, the absence of sign language is an issue. When you go to rural areas you have to realise that you are dealing with women who have not gone through the formal schooling system, so their sign language is home sign language which means that even someone who is trained in conventional Zimbabwe sign language, may still be unable to converse with ladies from a rural areas, posing more challenges.”
While the SADC protocol on Gender and Development partially touches on issues to do with people with disabilities, it is silent on maternal health involving this key population.
On the other hand the Zimbabwe Maternal and National Health Strategy which came into effect in 2017 and expires in 2021 has no explicit guidelines that promote or enforce governments to provide specialised maternal health support structures for women and girls with disabilities.
The UNESCO Regional Office for Southern Africa conducted a Rapid Assessment on the impact of Covid-19 on Persons with disabilities in Zimbabwe from August to November 2020, which found out that persons with disabilities have experienced many challenges brought about and/or worsened by the pandemic and the related lockdown and containment measures.
“Access to services such as healthcare, education, justice, and accessible information have been severely affected by the lockdown restrictions put in place to reduce the spreading of the coronavirus. Women and girls with disabilities experience challenges accessing Sexual Reproductive Health (SRH) services, a challenge that has been exacerbated by the pandemic,” reads the report in part.
Dr Welcome Mlilo who superintends maternal health care in Matabeleland North province admitted that while government has put some maternal health care interventions for women with disability, there were gaps.
“I am not aware of a specific policy per se (targeted at women with disability) but we are using the Patient Charter. But Zimbabwe has a National Disability Policy which was launched sometime in 2020 by President Emmerson Mnangagwa,” said Mlilo who is also the acting Provincial Medical Director for Bulawayo.
Regarding the latest statistics of maternal mortality, Dr Mlilo said, “Unfortunately our maternal deaths have not been aggregated to inform numbers of maternal deaths in this special group”.
He also admitted that public health institutions “do not readily have providers trained to cater for this population for example sign language. We however do have some facilities fitted with equipment to promote access for persons living with disabilities.”
This highlights a vivid dilemma that women with disabilities are still faced with in the 21st century.
According to a 2017 study titled ‘Challenges faced by women with disabilities in accessing sexual and reproductive health in Zimbabwe: The case of Chitungwiza Town’ it suggests that Non-government, private hospitals and profit-making organisations should join hands with government in funding health requirements for women with disabilities.
The study postulates that stakeholder collaboration was a great step forward in ending maternal mortality within this special group.
