Pregnancy related causes of disability

Dr Christine Peta Disability Issues
Giving birth is usually a celebrated event, but not all childbirths end in joy as some turn out to be gruesome torture for thousands of women who either die or end up with disabilities. This article will examine the pregnancy related causes of disability amongst Africanwomen.

The view that death is the only serious outcome of pregnancy is rather distorted because about half of the 120 million women who give birth each year end up with some kind of disability (Ashford 2002, WHO 2013), resulting in the “hidden suffering” of  omen. Several pregnancies close to each other arise from women who race to give birth to sons in order to fulfil a key component of their “job descriptions” in the institution of marriage. Part of the objective is to please husbands who view sons as symbolic in elevating their lineage (Adeyele and Okonkwo 2010).

Boys are more valued than girls, alongside a perspective that girls are raised to become a husband’s property and to inherit a husband’s surname upon marriage. Consequently, some women in countries like Kenya, Nigeria and Zimbabwe may be provoked to give birth to too many children close to each other, until a male child is born.  Some of these births may be attended to by traditional birth attendants alongside a backdrop of poor nutrition and overworking, leading to general maternal depletion resulting in poor health, and disability (Boylan 1991).

Other major causes of poor health and disability are instigated abortions that result from fear of punishment from a husband, when a wife unintentionally falls pregnant after a husband has decided not to have any more children (Dulobo & Haanyama 2012).
In some families, the responsibility of taking decisions on the number and timing of children rests with the man of the house, alongside a traditional belief that children belong to men and not to women.

As a result, unexpected pregnancies are secretly terminated through backyard abortions, as women try to avoid punitive punishment from husbands who do not want to have any more children.  However, by resorting to backyard secret abortions, women risk hazardous termination of pregnancy in unspeakable settings with the potential outcome of death, disease or disability.

Young unmarried women who fall pregnant outside of marriage, also resort to secret abortions out of fear of punishment from families who blame them for bringing the family name into disgrace by having sex before marriage (Dulobo & Haanyama 2012). “…a 14-year-old unmarried girl who was nine months pregnant was sentenced by the Criminal Court in Nyala to 100 lashes”, in Sudan (Amnesty International Report 2004).

Disability and poor health that arise from the process of giving birth to children, is illuminated in approximately 60 percent to 80 percent of births that are attended to by traditional birth attendants, outside of the formal health-care delivery systems (Berer & Ravindran 1999). Such attendants operate within the communities in which they live in and their role is widely accepted as part of the traditional norms and practices of their respective ethnic groupings.

In some countries such as in Kassena Nankana district in northern Uganda, most births are either not attended to or are attended to by female relatives or community members (Berer & Ravindran, 1999). Roads in the district are almost non-existent, as they are accidentally created by vehicles that once in a while cut through the virgin flora. In addition, flooding is common during the rainy season, rendering it impossible to get a passage through these routes to the nearest health care centre.

As such, communities have limited access to formal health care services, thereby fuelling childbirth related disabilities when complications arise. In Zimbabwe, there is at least one Government or mission hospital in every province, with clearly demarcated dust roads leading to the healthcare centre. Critical cases are often referred to major or city healthcare centres.

However, other challenges arise – particularly for women with disabilities – if the public transport system demands payment for a wheelchair in addition to the normal transport fare, thereby complicating the childbearing process for women with disabilities who may then run the risk of acquiring more disabilities in a delayed process of reaching a health care centre.

In Zimbabwe, the power of the traditional mid-wife appears to have stood the test of time, given that some communities have not ‘resigned’ from some traditional beliefs that surround issues of pregnancy and childbirth. Traditional healing prescriptions may undermine non-traditional modes of maternal health care, in instances where traditional healers tell pregnant women that they should not anger the ancestors by consulting clinics and hospitals.

In cases where there are fully functional and accessible health care centres, proclamations by some religious prophets may direct a woman against seeking medical health care, on the grounds that this may be symbolic of a lack of faith in God. In some families, the responsibility of selecting a health care option rests with a member of the family who is in charge of the family budget, usually a husband or father.

Depending on priorities and the viewpoint of the person in charge of the family budget, babies may be delivered in homes or in unhygienic backyard labour wards attended to by untrained midwives with limited obstetric skill, medicine, equipment or facilities (Ashford 2002).

Problems include a “lack of blood transfusion, poor referral systems, insufficient intensive care unit facilities, and lack of appropriately trained staff to manage obstetric emergencies” (Human Rights Watch 2011). Commonly cited maternal problems are “severe anaemia, incontinence, damage to the reproductive organs or nervous system, chronic pain and infertility” (Ashford 2002).

WHO (2014) raises the aspect of obstetric fistula – for a woman who goes through very long hours and days of obstructed labour, the head of the baby will be repeatedly pushing against the woman’s pelvic bone and contractions may prevent the flow of blood, thereby causing tissue to be destroyed (Winsor, 2013).

In such cases it is not uncommon for the baby to die, but even if the mother survives, the result may see the woman leaking urine all the time and in some cases she is also unable to hold her faeces. The irony of the matter is that such a health outcome may be quickly assigned to witchcraft and the woman, without even herself knowing what obstetric fistula is, and amidst religious and traditional mid-wives who are unable to perform a caesarean, usually resigns herself to her fate, abandoned by her husband and shunned by her community (Winsor, 2013).

Way forward
Considering the reality of maternal disabilities, both men and women should refrain from giving low priority to the health of women compared to other family issues, thereby avoiding unnecessary suffering, not only for the woman but for an entire family whose emotional well-being and expenditure patterns may ultimately be affected by the resultant disability (Ashford, 2002).

Family planning programmes should raise awareness in both rural and urban areas, on the importance of seeking adequate antenatal care to avoid not only death but disability as well; WHO recommends at least four antenatal visits which should begin in the first three months of pregnancy. The significance of a qualified and skilled birth attendant, the detection of warning signs of complications and the planning for emergency care should all not be underestimated.

Dr Christine Peta is a public healthcare practitioner who, among other qualifications, holds a PhD in Disability Studies. Be part of the international debate on how best to nurture a society which is more accessible, supportive and inclusive of disabled people. Partner with Disability Centre for Africa (DCFA): WhatsApp +263773699229, www.dcfafrica.com; and [email protected]