At the United Nations Sustainable Development Summit on 25 September 2015, world leaders adopted the 2030 Agenda for Sustainable Development, which includes a set of 17 Sustainable Development Goals.
Before signing the sustainable development goals, Malawi had already achieved Millennium Development Goal number four on the reduction of child mortality rate. However, this was just a scratch on the surface, as statistics indicate a swelling percentage of maternal and newborn mortality rates.
According to the Millennium Development Goals End line survey of 2014, there are 31 deaths per every 100 births, a surge from 29 deaths per 100 newly born in 2010.
Malawi Demographic Health Survey compared to infant mortality rate which was at 53 children per 100 in 2014 from 66 per 100 children in 2010. These records are a clear testimony that efforts to reduce preventable deaths of new-borns are misfiring.
It is no secret that certified medically trained midwives play a pivotal role in ensuring the smooth handling of pregnant women from the pre-natal, up to the post natal periods. Midwives need to provide support, respect and proper guidance to these expectant women. That is supposed to be the norm.
Realities on the ground however, are not only shocking, but disheartening as well. Sad stories are emerging from various corners of Malawi that medical personnel are verbally abusing their patients whilst in the line of duty.
A lot of expectant mothers from various northern region districts of Malawi are narrating their shocking ordeals courtesy of unprofessional birth attendants in various public health facilities.
To such mothers, it is becoming a living hell accessing maternal health services in these public health facilities. As a result, many are resorting to securing unsafe routes of traditional birth attendants, as the customer service, is way ahead of the legitimate medical facilities.
One of such victims, Elizabeth Phiri, a mother of three, from Enukweni in Mzimba narrates how negligence of qualified medical personnel at a certain public health center cost a life of her child.
Phiri claims medical birth attendants left her in agony of labor as they were rushing to have their lunch breaks, at the expense of her life and the life of the unborn.
“They told me that they were going for lunch and I had no one by my side; that was when I gave birth to a dead child.
The tendency by medical to ridicule women seeking maternity care is becoming an urgent problem and creating a growing community of concern,” said she.
Apart from Phiri’s case, a growing body of independent research, experience and case reports collected in various maternity care systems in the northern region confirm of what Phiri and some expectant mothers face in their endeavor of accessing safe maternal health facilities, more especially in public health facilities.
Investigations reveal horrific number of expectant women who are on the negative receiving end of physical and verbal abuse, non-consented clinical care, non-confidential care, and discrimination based on specific patient attributes, from the medical attendants.
Equally disheartening is the revelation that some patients do also face abandonment or denial of care and detention in these facilities.
Grace Mukonda, a resident of Geisha area in Mzuzu lost her closest friend who opted for unskilled traditional birth attendant after she was verbally abused by midwives (in a public health facility) for being impregnated in her teens.
“Medical officials mocked and ridiculed my friend (Chawanangwa) for being impregnated whilst in her teens. She couldn’t withstand such verbal abuses,” recalls Mukonda.
“She then opted for a traditional birth attendant where she was given herbs. Unfortunately, it did not go well and she was later referred to a hospital” she added.
Sadly, the doctors could save neither Chawanangwa nor the unborn child as the damage was already done. Few weeks later, Chawanangwa and the unborn child lost their lives due to complications during delivery.
Discourteous and abuse of women seeking maternity care is becoming a menace to the society as it is infringing the victims on their various human rights, and health service delivery.
While acknowledging that her office has received reports of abuse in women seeking maternity care, Rutie Kayira, Deputy Safe Motherhood Coordinator for Mzimba North District Health Office, said the whole issue revolves around the mentality of health workers.
“Of course, I can say reception is always very good though some midwives do misbehave” said Kayira.
She added that most expectant women prefer delivering at traditional birth attendants to hospitals.
“We don’t encourage them to deliver at those facilities because whenever something goes wrong there, the cases are referred back to us; mostly the cases are usually critical,” Kayira added.
And to Nancy Kamwendo, a Health rights Activist, who is also the National Coordinator of White Ribbon Alliance for safe Motherhood Malawi, a number of factors do contribute to these abuses and according to her, lack of recognition as well as motivation for the midwives who are the core providers of these services are some of the major factors.
Kamwendo said that while many interventions aim at improving access to skilled birth care, the quality of relationships with care givers during maternity care has received less attention.
“There are a number of issues; there is a problem of distance, some people are coming from very far and other hospitals are in hard to reach areas.” Kamwendo said.
She added that there are few skilled midwives who are attending to a lot of women.
This according to Kamwendo, this is forcing women to seek maternal health care from traditional birth attendants (TBA, s) for close contact.
On his part, Head of Policy in the ministry of Healthy, Dr Dominic Nkhoma, said government reforms that will strengthen the operations of hospitals and district health services to make them efficient, are already in the offing.
“To deal with these challenges the government is proposing to re-look at the arrangement with religious healthy providers to see how we can achieve universal health coverage, he emphasized.
Nkhoma added that government was doing its best to improve the health sectors despite the numerous challenges the country is facing.
“We have to decide how we want it to be efficient as well as making sure that every citizen has access to quality health care”, Nkhoma added.
Echoing Nkhoma sentiments, President Peter Mutharika recently warned medical personnel against drug theft and other malpractices as their behavior is derailing efforts of providing quality health services.
“Productive citizens are dying just because the critical medicine which would have saved that person has been stolen.
“We have bought enough medicine but most of them is being stolen, like that young man who was apprehended in Mzuzu. So let me warn you that your time is over, the honey moon is over!” warned Mutharika.
From the ordeal narrated, it is evident the health care system in the country’s public health centres is rotten. If the country is to make strides in achieving the sustainable development goals, there is need to bring attention to this issue, and make sure the rights of all expectant women are respected, during and after child birth so that all women have access to quality midwifery care.
All child bearing women need and deserve respect, care and protection; that includes special care to protect the mother-baby pair as well as women in a context of marginalization or heightened vulnerability.