Poor access to information prevents women from accessing skilled care during pregnancy and delivery – Maria Zulu’s story

Maria Zulu, 33, of Mutendere community in Lusaka, Zambia, is a mother of three and a widow. She came to know of her HIV status during her third pregnancy in 2009 when she was tested during her antenatal visit when she was three months pregnant.

HIV and pregnancy-related complications are major causes of death in women of reproductive age.  Increased access to a comprehensive package of sexual and reproductive health information and services such as prevention of mother to child transmission (PMTCT), family planning, and treatment of HIV and sexually transmitted infections are of major importance to HIV positive women.

Maria Zulu, 33, of Mutendere community in Lusaka, Zambia, is a mother of three and a widow.   She came to know of her HIV status during her third pregnancy in 2009 when she was tested during her antenatal visit when she was three months pregnant.

She was referred to Kalingalinga health centre for her CD4 count test where it was found to be 600 but she was not able to commence antiretroviral treatment (ART) because her CD4 count was above 350 and therefore not eligible for ART.  She was given a Nevirapine tablet and advised to exclusively breastfeed her baby for six months.  However, Maria chose not to breastfeed her baby because she feared that some people might end up giving the baby water since she was often away from home working to provide for her family.

Maria was married for six years to her husband with whom they had two children before he died of an HIV-related illness.  They were separated at the time of his death.  He was in denial when he was taken to hospital but it was too late for him to survive.  Maria explained that, after his death, she engaged in promiscuity and was impregnated by a man who was the father of her third child and who never supported her in any way.

Though accessing prevention of mother to child transmission services was easy for her, Maria could not always get adequate information from the health care providers.  She remembers very well when she was due for delivery in the labour ward, she was attended to by a nurse who was rude and did not care for her properly.  She called for help from the same nurse but it fell on deaf ears until she delivered on her own and that’s when the same nurse came to clean the baby.

Mothers have always been willing to access maternal and antenatal services but the attitudes of some of the health workers towards women living with HIV have made it difficult for them to access PMTCT services.  For women of reproductive age, HIV/AIDS is still the leading cause of death and HIV-related mortality accounts for one fifth of all maternal deaths.

In sub-Saharan Africa, the relationship between antenatal care and skilled attendance at delivery is very poor according to UNICEF’s maternal and newborn health report of 2009.  At an institutional level it has been found that the absence of skilled health personnel during births is the strongest contributing factor to maternal deaths.  In the case of Maria, if she was not brave or strong she may well have died as well as her baby because of what she went through during her delivery period.

Every woman has a right to plan her pregnancies and have access to effective family planning methods to limit births and prevent unintended pregnancies.  Maria admitted that she was happy that she understood it was her fundamental human right as an HIV positive women to choose the number of children she wanted to have.

According to Maria, the PMTCT programme could work well if the government can motivate health workers by giving them good incentives so that they stopped complaining and paying lip service when it came to their duties.  It is the duty of the government and other stakeholders to improve the conditions of service for health workers in order for them to work effectively.

Government and civil society organizations should sensitize the community and the health workers adequately to address challenges and gaps and ensure that women living with HIV and their children do not face maternal and neonatal child health-related mortality or morbidity.

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