The Guardian

In agonising labour pain and turned away from a Harare health centre, Aurage Katume feared that, like many other Zimbabwean women, she could lose her unborn baby.

She struggled to another clinic in the country’s capital. The midwives there were not ready to help her either.

“What did you bring us?” one of them said, a subtle bribe request, as Katume’s mother pleaded with them to be merciful.

“My mother quickly realised that they were asking for money, and she handed $5 (£3.90) to the one who appeared more senior. There was no receipt and all of a sudden I was taken to a bed in the delivery room,” she said in court documents seen by the Guardian.

As Zimbabwe’s once enviable healthcare sector collapses under the weight of dilapidated infrastructure, a lack of drugs and poorly paid staff going on frequent strikes, pregnant women are being forced to pay bribes to get help with giving birth, with reports of babies being born in queues outside maternity clinics.

The Zimbabwean constitution guarantees the right to healthcare, and, after her experience giving birth, Katume and another woman, Melody Mapani, took city authorities to court to force them to reopen 42 clinics. A high court judge this month ordered the council to do so, and ensure women get the services they need. In the court papers, Katume said her baby could have died had her mother not paid the bribe.

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“The midwives flatly refused to attend to me. My mother pleaded with them to be merciful. In the discussion, one of the ladies asked: ‘What did you bring us, what’s in it for us,’” Katume said.

Her lawyers allege corrupt staff in clinics give priority to clients who pay in US dollars.

“Since only a few clinics are operational, this has resulted in rampant corruption from healthcare workers who are giving priority treatment to those paying US dollars which employers are pocketing,” the lawyers said.

“The violation of rights is ongoing and any delay in arresting puts the lives of Harare residents in grave danger, especially pregnant women,” argued the lawyers.

“Lives have been lost, especially of babies during the birth, some dying before birth owing to delayed or non-attendance by healthcare workers at these clinics.”

Many have resorted to back yard delivery homes or home deliveries, which increase the risk for the mother and child.

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The court documents also allege negligence and lack of care at the council clinics, with pregnant women reportedly being tossed from one clinic to another without due care.

Under these circumstances women with pre-existing conditions risk losing their babies, as happened to Melody Mapani. She went from one clinic to another looking for help before suffering a stillbirth linked to high blood pressure, which hadn’t been picked up on because a clinic had closed, according to the court documents.

The women allege scores of pregnant women in Harare are being turned away at the few clinics that are open, while some endure long queues where social distancing is impossible.

There are also cases of patients fainting while in long queues, unsafe home deliveries being done by unqualified people, and a thriving of a black market for drugs, the women said.

An untrained midwife, whose house has served as a makeshift maternity ward.

According to the Zimbabwe Demographic Health Survey, while the trend in the past five to 10 years shows a decline, the estimated maternal mortality ratio for the country is still high, at 651 deaths per 100,000 live births.

Zimbabwe’s deteriorating health sector has worsened since the start of the Covid-19 pandemic and suffered following a general strike by frontline workers.

In June, seven babies were stillborn at Harare hospital after urgent treatment was delayed because of staffing issues.

Local NGOs have called on the government to prioritise maternal health issues to reduce maternal mortality. The majority of deaths can be prevented if women receive the right care throughout their pregnancies and during birth.