Seventeen-year-old, Nozipho (not real name) of Mapirimira Village in Zvishavane, who had an ultrasound scan that recommended a Caesarean section, but disregarded medical instruction all in the name of religion, died in labour at an Apostolic shrine recently.
Nozipho lost a lot of blood as the Apostolic midwife tried to help her to deliver the baby without success.
Disturbingly blood loss is accepted as being common or a self-cleansing procedure by the body, according to Rudo Moyo, a birth attendant with the Johane Marange Apostolic sect.
“Bleeding after delivery is normal. If a woman experienced many problems during her pregnancy, she usually bleeds too much. That is good because she has to take out all the bad blood that was causing her sickness. But if it persists it may be due to retained dirt in the womb or wounds caused by delivery or plain evil spirits,” said Moyo.
Sect members consider maternal death to be part of God’s plan if it occurs when prayer and healing rituals aren’t successful.
“Some women die, but the majority safely give birth,” said Moyo. “When someone dies, we should not be excessively troubled because at least they have gone to Heaven.”
While some Apostolic sects in Zimbabwe are now liberal and allow pregnant mothers to seek medical attention others still shun hospitals and have been a major contributor to the high rate of maternal mortality in Zimbabwe. Nozipho is just one example of the countless teenagers who die or continue to risk life-changing childbirth-related injuries, due to ultra-conservative religious beliefs.
These existing beliefs have hampered efforts to reduce maternal mortality according to a Millennium Development Goals (MDGs) progress report.
The report said the worsening maternal mortality in the country is caused by a number of interlinked factors, including Apostolic church members’ reluctance to have pregnant women and children taken to hospital.
“About a quarter of pregnant women who die are between 15 and 19 years of age. Most are affiliated to an Apostolic group. The pregnant teenagers are not allowed to visit health institutions and are made to deliver their babies at home, often leading to maternal deaths due to complications,” the report reads.
According to Apostolic sects which shun health institutions, birth attendants (anambuya nyamukuta) are trained by the Holy Spirit to conduct deliveries and to help women with problems. Some are believed to even tell women about complications in advance. Prayers are made and holy water and anointed oil are prescribed to avert the complications.
“At church we identify well-behaved girls who are trained for this kind of work. The Spirit guides us in everything. Although we train them, the Holy Spirit imparts them with skills to bring life to earth.
“We do not allow pregnant women to go to hospitals or clinics. Instead, we ask them to be prayed for and to use anointed oil, stones, milk or water. Modern medicines are evil. We depend on God, given our direct communion with the Holy Spirit,” said Moyo.
A male member of an Apostolic sect who spoke on condition of anonymity concurred with Moyo.
“Once a pregnant woman goes to the clinic, it shows that one does not have faith in God. We stand by God and the Bible during and after the pregnancy. People are just like animals. Animals can give birth without any assistance. So this issue of specialist medical personnel is not necessary,” he said.
He added: “We do not know what is in the injections and tablets, maybe it is something that our church forbids like pork. If there are any problems arising related to the pregnancy, God will inform us and then we will pray and everything will be in order before it is late. People don’t have to waste their wealth going to hospitals and on medicines.”
But conditions at Apostolic birth camps are often unsanitary and birth attendants lack the training and medical equipment to deal with childbirth complications such as excessive bleeding, infection, high blood pressure, cord prolapse, prolonged labour and breech presentation, which can put the lives of mother and baby at risk.
“During labour there is no sterile equipment and infection control procedures are not followed,” said Karen Webb, operational director of research for the Organisation for Public Interventions and Development Trust (Ophid), a local trust that works to improve maternal and child healthcare in Zimbabwe.
She added: “There is no HIV testing which is done prior to giving birth to ensure that pregnant women receive medication (Nevirapine and appropriate ARV regime) to prevent mother-to-child transmission of HIV. At the makeshift Apostolic maternity centres, women live in unhygienic environments that may increase risks to communicable diseases and still are encouraged to rely on prayer to get through pregnancy challenges and obstetric complications. The women are not exposed to modern knowledge about HIV prevention, child killer diseases, and immunisation.”
Since Apostolic religion is a key social structural factor influencing maternal and child health there is a need for engagement with Apostolic churches still lagging behind on several maternal health developmental issues.
If Zimbabwe is to achieve its MDGs four and five, it has to address health-generated social inequities reinforced by religion and effectively tackle the conflict between the right to religion and the right to health. Religion should never be the vehicle for delivering death and undermining the rights of women and children.
“Possible strategies for this include partnering with Apostolic members in maternal health promotion for behavioural and social change. The same cadres can be co-opted as champions for clinic referrals of maternity cases from the community. Lastly, the existing spiritual maternal care services can be made safer by engaging skilled workers and providing drugs, equipment and medical sundries. However, this should be done with a longer term objective of assimilating religious extremists into the public health system,” said researcher Munyaradzi Kenneth Dodzo.
According to the United Nations Children’s Fund (Unicef) it’s important for members of the Apostolic sects to be educated on the fact that the single most important intervention for safe motherhood, is to make sure that a trained healthcare provider with midwifery skills is present at every birth, that transport is available to referral services, and that quality emergency obstetric care is available.