Caroline Ngosha (23), from Shurugwi is expecting her third child in a few months’ time. In both her previous pregnancies, she delivered her children at home in line with the dictates of her religion, a white garment apostolic sect. Some apostolic sects in Zimbabwe do not allow their followers to use family planning or contraception methods. Neither do they sanction female followers to register with the Anti Natal Clinic (ANC), later on deliver in a health institution.
By Michael Gwarisa in Shurugwi
She remembers vividly how life threatening giving birth under the care of religious birth attendants at home or at a Shrine can be.
I have two children,” said Caroline. “I am expecting my third child this year. However, giving birth at a shrine or at home is not an easy thing. I delivered my two children, at home and another one I wanted to deliver at our church shrine.
“However, it’s not easy knowing very well that anything could go wrong in the absence of experienced midwives. Women my age have died. So many young women have been in my situation and unfortunately, some die while delivering or their children might die soon after birth. Anything could go wrong.”
Women from apostolic sects across the country risk life-changing childbirth-related injuries, including obstetric fistula due to increased home-based deliveries as they shun institutional deliveries. A report by Amnesty International found that nearly one-quarter of women in the country give birth without skilled assistance, citing cultural and religious beliefs, economic concerns, and fears that they will receive poor care in a formal health setting.
However, to drive behavior change and increase uptake of healthcare services in Shurugwi, the Apostolic Women Empowerment Trust (AWET), a local non-profit organization has been implementing behavior change health interventions among apostolic sects. AWET has been driving apostolic women into ANC booking and this has also led to an increase in the uptake of Prevention of Mother Transmission of HIV/AIDS (PMTCT) services. They are implementing projects through support from the National AIDS Council (NAC) and the Ministry of Health and Child Care (MoHCC).
Through the empowerment she and her fellow women from apostolic sects have received from AWET, Caroline is optimistic that her unborn baby will be delivered under the watchful eye of qualified health personal at Chironde Clinic.
“I am grateful of the work AWET is doing here. As a pregnant woman, I have already registered with the ANC through the support I receive from AWET,” said Caroline adding that registering with the ANC has seen her receiving numerous services such as HIV testing, STIs screening among other health checks.
“This is a welcome move. The HIV test has assured me that both me and my unborn baby, we are HIV free.”
[pullquote]AWET is operating in two wards in the in the Midlands Province, in Shurugwi particularly. They are Ward 19 in Chironde and other village as well as ward 18.[/pullquote]
Mrs Tombizodwa Revesai, the AWET District Health Officer said their behavior change programs are already paying dividends.
“This program came about because we realized that the apostolic sect members have their belief systems that hinder them from accessing health related services. We are working hand in glove with the National AIDS Council and the Ministry of Health and Child Care (MoHCC). Our major thrust is to create demand for services. We are looking at demand creation for both family planning services and also for institutional deliveries. As you know, apostolic sects prefer home deliveries to institutional deliveries,” said Mrs Revesai.
She added that when they started the program in Shurugwi, there was low uptake in institutional deliveries services by apostolic women but of late, the numbers have swelled beyond the capacity of the health facilities in the area. Under their health component, AWET has a drive to push women to come for instituti0naol deliveries.
“We have realized that the number of people that we drive for the services has actually surpassed the services that are available. As a way of motivating apostolic women to deliver in health facilities, we have tokenised it and we are giving every women who come to deliver here a branded towel which has our logo and our funder’s logo and two nappies.”
The boost in ANC bookings has also led to increased HIV test and treat services among adults in a bid to reduce the HIV burden in Shurugwi. According to the National AIDS Council Midlands provincial manager, Mr Mambewu Shumba, “The leading district in terms of both prevalence and incidence, is Shurugwi. The district has a prevalence of 16.62 percent and an incident of 0.40 percent which is quite high in terms of transmission.”
Meanwhile, National AIDS Council Shurugwi District AIDS Coordinator (DAC), Mr Peter Muzarakuza said AWET has made it easy for HIV interventions to reach apostolic groups which under normal circumstances, are hard to reach.
“I think we have really gone a long way in terms of penetrating the apostolic sects. Recently, we had a behavior change facilitator training and AWET was part of that training. We have a good synergy with AWET. We trained behavior change facilitators that are already accepted into the apostolic sect communities and I think that is really helpful because we already have individuals on the ground who understand those specific religious beliefs that hinder access to healthcare and HIV services,” said Mr Muzarakuza.
He added that their partnership with AWET has also helped several young adolescent girls through linking them to critical health services such as HIV/AIDS prevention, treatment as well as other referral services. He said in the month of January, about five individuals accessed HIV related services whereas in February, three more have come forward to receive services.
“Apart from HIV, we also have high incidence of Sexually Transmitted Infections (STIs) here. We are really looking at how we can strengthen our interventions in so far as HIV is concerned. We have specific target groups that we feel are very pertinent and critical if we are to lower the HIV incidence. We have young female sex workers, artisanal miners, small scale miners, vendors, adolescent girls and young women.
“We need to reach out to these groups to ensure that they have adequate combination prevention methods that are available. If you fail to use a condom, be able to use Post Exposure Prophylaxes (PeP), if you feel you won’t be able to use the condom, use Pre-Exposure Prophylaxes (PrEP).) We intend to use mobile clinic outreaches, outreach campaigns that really focus on information dissemination in way that creates demand.”