ICPD25: Counting Zimbabwe’s unfinished business

Roselyne Sachiti Features, Health  & Society Editor
Last week, Zimbabwe’s Parliament took note of two important reports which the country made commitments to.

One of the reports was on the 7th International Parliamentary Conference on the Implementation of the International Conference on Population and Development (ICPD) held between October 22-23, 2018 in Ottawa, Canada, while the second focused on the International Conference on Family Planning (ICFP) which was held in Kigali, Rwanda from November 12-15, 2018.

Member of Parliament (Mashonaland West’s proportional representative) Mrs Goodluck Kwaramba represented Zimbabwe at the ICPD meeting, while her counterpart Dr Ruth Labode was at the ICFP meeting.

The two reports come at an important time as the year 2019 marks the 25th Anniversary of the Implementation of ICPD Programme of Action which was adopted in Cairo Egypt in 1994.

The watershed Cairo agreement has been the cornerstone of the global reproductive rights movement for the past 25 years.

At the Cairo meeting, Zimbabwe was one of the 179 governments that adopted a revolutionary Programme of Action (POA) and called for women’s reproductive health and rights to take centre stage in national and global development efforts.

The Cairo meeting also brought out the link between reproductive health and women’s empowerment and how the two are necessary for the advancement of society. ICFP serves as a strategic inflection point for the family planning and reproductive health community worldwide.

It provides an opportunity for political leaders, scientists, researchers, policymakers, advocates, and youths to disseminate knowledge, celebrate successes, and identify next steps towards reaching the goal of enabling women to access voluntary and quality contraception by 2020.

While Zimbabwe has committed to the two, some unfinished business still remains. The journey to go before all women and girls have the power and means to fully realise their rights, make informed choices about their sexual and reproductive health and govern their bodies seems too long.

As outlined by Chairperson of the Parliamentary Portfolio Committee on Health Dr Labode last week, the country has certain commitments it has to meet before the next FP2020 meeting in Nairobi.

To achieve this, she told Parliament, Zimbabwe should ensure that all women of reproductive health ages have access to quality family planning services by 2020.

Parliament also heard of the need to reduce the percentage of women with an unmet need for modern methods of family planning from 14 percent to six percent by 2020.

Dr Labode said Zimbabwe was committed to reduce the number of unsafe abortions by increasing contraceptives.

On reducing the number of maternal deaths averted due to the use of modern methods, Dr Labode said, the challenge is that minors (girls or women below 16) are having sex and getting pregnant.

“After that, they are opting to give birth and sustain complications due to that birth or they opt to get an unsafe abortion in the backyards of Dzivaresekwa and Mufakose,” she said.

“Teenage pregnancies are on the increase and contributing 22 percent of the maternal mortality. Zimbabwe has an SDG which says by 2020/30, we would have reduced our maternal mortality. Right now we have the highest number of women dying because of maternal delivery in the SADC region.

“The reason being our laws, lack of family planning and the fact that some children cannot go to a hospital and say this is what I am doing. So they die. We have a lot of work to do to reduce the number of women who die due to delivery.”

Dr Labode said one in 10 pregnancies in Zimbabwe ends up in abortion and that illegal abortions in Zimbabwe have increased from 60 000 to 80 000 per annum — which is very unsustainable.

“We have unsustainable costs of managing post-abortion complications in already over burdened health institutions,” she said.

“These girls go and have abortions. When they bleed, they come to public institutions which are already burdened with other diseases. Once one goes to a public institution and is bleeding, it becomes an emergency. This patient will use blood which was supposed to be used for a road traffic accident (victims) to ensure that she survives.

“We use the antibiotic which could have been given to a pneumonia case on the same girl to ensure that she survives. She occupies a bed of another patient who could have come there, but we have to provide all these services to her. This cost is not sustainable currently in Zimbabwe.”

Dr Labode called for the amendment of the Public Health Act to include a provision that allows healthcare providers to provide health services to sexually active minors.

“As we stand Mr Speaker Sir, if your daughter who is 15 has an STD; the law currently says you must accompany your child to a health clinic and tell the nurse that you have brought your child who has syphilis to be treated,” she said.

“How many of us would do that? That is what the law says. The child is a minor, yet we know that the child is having sex.”

According to the United Nations Population Fund (UNFPA) Zimbabwe, (ICPD factsheet) the country has recorded successes in the areas of gender equality and women’s empowerment; education; rights of adolescents, youths, older persons and persons with disabilities; HIV and AIDS, sexual and reproductive health and rights; family planning; governance of population and development issues; and data and statistics.

But, the Cairo agenda has yet to be realised for all people in all Zimbabwean communities. UNFPA notes that there is still unfinished business as much still remains to be done, especially in areas of poverty reduction, inclusive growth and economic development; and international cooperation and resource mobilisation.

For example, in the areas of maternal health, UNFPA notes, there have been improvements in all maternal and child healthcare indicators, including increased antenatal care (ANC), and post natal care (PNC) attendance and skilled attendance at birth as well as reductions in neo natal, under five and maternal mortality.

UNFPA says there has been an improvement in access to family planning services, which saw contraceptive prevalence rate increase from 58 to 67 percent. It is estimated that 2 600 maternal deaths and 179 000 unsafe abortions were averted due to use of modern contraception in 2018. The Ministry of Health and Child Care has shown commitment to Zimbabwean women and fulfilling improving their well-being through the development of the Zimbabwe Cervical Cancer Prevention and Control Strategy.

The strategy is addressing gaps in cervical cancer prevention and control. To date, 105 facilities are offering cervical cancer screening and every year, more than 10 000 women are benefitting from this free cervical cancer screening service. Moreover, Zimbabwe’s First Lady Amai Auxillia Mnangagwa (who is the Health and Child Care ambassador) has been at the forefront encouraging women to go for cervical cancer screening, herself having done so.

In the areas of population and development, Zimbabwe has a regular census system of census data collection, analysis and dissemination and has conducted a population census every 10 years since 1982. In between censuses, the country runs an integrated household based survey programme which ensures collection of data in any one year. Through the Zimbabwe Transitional Stabilisation Programme (TSP), the Zimbabwean government has also shown its commitment to ICPD and ICFP.

The TSP document explains how concerted efforts by Government, development partners and communities in recent years have re-galvanised the public health system as evidenced by among other issues:

• Tremendous progress in the HIV response programme with Zimbabwe headed toward epidemic control wherein, among other indicators, nearly every pregnant woman now has access to antiretroviral medicines.

• A reduction in the maternal mortality ratio from 960 per 100 000 live births in 2010–11 to 651 per 100 000 live births in 2015.

• Tuberculosis incidence has dropped by nearly 60 percent over the last decade.

• Improved immunisation coverage and uptake of contraceptives, antenatal care, and enhanced provision of skilled birth attendances.

• The operationalisation and enhancement of the cervical cancer programme.

• The provision by health facilities of clinical and counselling services for sexual and reproductive health and gender-based violence.

• The establishment of an integrated procurement and supply chain management system.

• Maintaining the level of essential maternal, new-born and child health commodities at the primary health care level at an average of 80 percent through coordinated support from the Health Development Fund.

The AIDS and Airtime Levies introduced by Government have also contributed to improvements in the coverage and quality of high-impact health interventions and strengthened broader health systems another step towards achieving ICPD25. The TSP document also notes urgent and critical interventions which are needed to address critical challenges in the health sector.

These challenges include sub-standard quality of maternal health services such as antenatal care, delivery, and postnatal care, including prevention of mother-to-child transmission of HIV and sexually transmitted infections. Other challenges noted by TSP include medicine shortages, as well as family planning and other essential commodities.

The TSP also states that inadequate emergency transport and communication systems also influence the mortality rate. It also notes the growing burden of non-communicable diseases due to suboptimal dietary habits, lifestyle, and poor health services. With such challenges, much more must be done to tear down the barriers that prevent women, men and couples from fully exercising their reproductive rights.

The Ministry of Health and Child Care should also increase its budget for family planning from the current 1.7 to 3 percent of the health budget. When such steps are taken, the three zeros, no unmet need for contraception, no preventable maternal deaths and no violence or harmful practices against women and girls can be achieved.

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