Radovan Krejcir was the target of an apparent bid to kill him outside his Bedfordview office in July this year.
Deep in the forest of Murambinda, in the Buhera district of eastern Zimbabwe, 16-year-old Netsai (not her real name) lies motionless, dizzy from pain and blood loss. She is seemingly unaware of the traditional birth attendants who surround her. As another wave of pain engulfs her, she clenches her teeth and convulses with agony.
None of the women have been trained as birth attendants. They and Netsai belong to the Apostolic sect of Johane Masowe, which eschews modern healthcare and encourages women to give birth at so-called birth camps in the bush.
The elderly women urge Netsai on while the head birth attendant feels her distended belly and presses down roughly. She orders the girl to push and, as the baby’s head crowns, she grabs it with her bare hands.
Netsai survived the traumatic birth and her boy is now a healthy two-year-old. But many more women like her do not live to tell their stories.
Complications during pregnancy and childbirth are the leading cause of death for women of childbearing age in Africa, according to the United Nations Population Fund. Girls aged 15 to 20 are twice as likely to die in childbirth as those in their 20s.
The single most important intervention for safe motherhood, according to the United Nations Children’s Fund (Unicef), is to ensure a person with midwifery skills is present at every birth, that transport to referral services is available, and that quality emergency obstetric care is available.
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 both mother and baby at risk.
“During labour there is no sterile equipment and infection control procedures are not followed,” says Karen Webb, operational director of research for the Organisation for Public Health Interventions and Development (Ophid), a local trust that works to improve maternal and child healthcare in Zimbabwe.
A study into the birth practices of conservative Apostolic sects, conducted by Ophid in 2014, revealed that members consider the Holy Spirit to be the guiding force in healing. Illness is seen to have a spiritual cause and modern healthcare is seen as “heathen”. Church members who seek medical services are thought to be weak of faith, having elevated the medical system above God.
Sheila Makuvaza, a birth attendant with the Johane Marange Apostolic sect, says: “Miteuro [prayers], holy water and prophesies from anointed elders are used to treat pregnant women in the camp.”
Birth camps operate underground
Apostolic sects are widespread in the country. According to the Zimbabwe National Statistics Agency (Zimstat), 38% of Zimbabwean women identify as Apostolic and 74% of these live in rural areas.
Buhera is in Manicaland, the province with the largest population of Apostolic sects. Zimstat says the maternal mortality rate was 516 per 100 000 live births in 2012. But many of the maternal deaths in the province are not recorded because birth camps often operate underground.
Marian Matiza, from ward 23 in Buhera, knows only too well the negative effect religious doctrine can have on women’s reproductive health. Matiza says she is lucky to be alive, after the birth of her twins, who were born in the breech position.
“I nearly died while giving birth and that gave me the resolve to stand up and walk away from this church,” Matiza says. “They used tsanga [reeds] to cut off the umbilical cord and clamped [it] with ropes.”
Matiza now attends a more liberal sect that allows her to seek medical attention. She has since given birth twice at a clinic, and is part of a local advocacy group that raises awareness among Apostolic members about improving care. The group, known as a health centre committee, is an extension of the country’s health system and has support from the government and nongovernmental organisations such as Save the Children. It has talks with Apostolic leaders, faith healers and prophets on how to reduce the deaths of pregnant or lactating mothers and their babies.
Bernard Madzima, director of the Zimbabwean health ministry’s family health unit, says the health centre committee project “ropes in leaders of the religious groups in programmes like the immunisation of children” and encourages women to attend antenatal care.
The ministry works with community representatives who help to conduct training and meetings. Feedback from the meetings is used to formulate further strategies to suit each group. Political leaders are also involved in such talks.
Madzima says less conservative Apostolic leaders have joined efforts to encourage more radical groups to consider using health facilities.
Change won’t ‘happen overnight’
Charles Ngirau, an Apostolic church leader from Hopley, on the outskirts of Harare, says his congregation started taking children to health facilities after Joice Mujuru in 2013, during her term as Zimbabwe’s vice-president, implored them to seek proper medical services.
“Other [Johane Masowe] church branches are, however, still resisting the change,” he says.
Zimbabwe’s Unicef country representative, Reza Hossaini, says it’s important that Apostolic sects are treated as equal partners in this initiative and that “their needs and belief systems must be understood, respected and accounted for within national health system policy”.
Madzima says the church leader programme has yielded marked improvements in maternal and child health in the area.
Manicaland had a maternal mortality rate of 1 060 in 2002, and that has since been halved. “There has even been a reduction in under-five deaths by 18%,” he says.
Madzima believes the community representative strategy works because “government is not forcing the church to co-operate, but rather engages them in dialogue”.
Ophid’s 2014 report says people should be informed of cost-effective interventions to help mothers and babies survive that include standard precautions for infection control during deliveries, such as the washing of hands with soap and clean water, using surgical gloves, keeping newborns warm and keeping the baby’s umbilical cord clean after birth.
Madzima says, although there’s been progress, it’s important to realise that Apostolic sects have been conducting their own birth camps for years and their systems are firmly rooted in their way of life.
“[Change] will not happen overnight because it has been their way of doing things according to their beliefs, which they take very seriously,” he says. “Much advocacy would be needed to change these deeply entrenched beliefs.”