The Hidden Cost of Giving Birth: Bribery and Barriers to Maternal Care in Zimbabwe
In Zimbabwe, the promise of free maternal healthcare clashes starkly with the reality faced by many pregnant women. Despite government policies intended to provide accessible and affordable care, corruption within the public health system forces vulnerable women to pay bribes for essential services, jeopardizing their health and well-being. The consequences are dire, contributing to the country's already high maternal mortality rate.
A Daily Struggle for Expectant Mothers
The antenatal care (ANC) section of Chitungwiza General Hospital serves as a stark illustration of this crisis. As early as 7 a.m., pregnant women gather, hoping to register their pregnancies or receive routine check-ups. Registration is meant to secure a place to give birth at the facility, but the process is often fraught with challenges.
Fortunate Chingwara, 39 weeks pregnant with her third child, recently experienced these difficulties firsthand. Unemployed and struggling financially, she sought to register at the hospital, hoping to avoid the US$35 delivery fee at her local clinic, an amount she simply could not afford. However, she soon discovered that registration was not guaranteed.
A nurse announced that only women with specific conditions – those who had previously undergone cesarean sections, underage pregnancies, or were aged 38 and above – would be accepted for registration. Chingwara did not meet these criteria.
After waiting for hours, Chingwara and many other expectant mothers were told that the registration books were finished, and they were instructed to go home. Desperate, Chingwara pleaded with a nurse, who offered to help for a payment of US$15 or US$20. Unable to pay, Chingwara left without registering.
Corruption Undermines Free Healthcare Policies
Chingwara's experience is not an isolated incident. Across Zimbabwe's public hospitals, pregnant women are routinely forced to pay bribes for services that are officially free. An undercover investigation at Chitungwiza Central Hospital revealed that midwives demand between US$10 and US$25 for basic pregnancy registration.
A 2021 survey by Transparency International Zimbabwe found that 74% of respondents reported being asked for bribes when accessing healthcare services. This widespread corruption creates a hidden financial barrier that undermines the government's free maternity care policy and contributes to Zimbabwe's high maternal mortality rate, estimated at 365 deaths per 100,000 live births.
Hospital Response and Internal Perspectives
Raphael Makota, the chief medical officer at Chitungwiza Hospital, stated that the hospital had not received any complaints regarding corruption in pregnancy registration. He emphasized that such allegations would be taken seriously and investigated, with disciplinary procedures for any staff found in violation of standards. He also mentioned the reinforcement of accountability systems and whistleblower mechanisms to ensure transparency and protect patient rights.
However, Memory Zhou*, a nurse at the hospital, offered a different perspective. Speaking anonymously for fear of retribution, she said that demanding money from patients is a common practice, driven by poor salaries and a lack of motivation among staff.
"The issue of selecting specific women is aimed at ensuring that they don't get too many people because they are not motivated to work due to poor salaries," Zhou explained. "Announcing that books are finished is a strategy they use to try and coerce women to pay for a service they should get for free because of desperation."
Makota stated that the hospital receives an average of 50 pregnancy registration books per week, with the flexibility to scale up when demand increases. However, Zhou alleged that the bribe syndrome extends to medication as well, with nurses sometimes diverting government-supplied drugs and offering them to patients for a fee.
A Pan-African Problem
Corruption in maternal healthcare is not unique to Zimbabwe. It is a widespread and deeply entrenched barrier to care across Africa, particularly for poor women seeking services in public facilities.
Research by Transparency International has shown that informal payments and bribes are a common financial obstacle in sub-Saharan Africa. A study across eight African countries found that over 30% of respondents paid bribes to access healthcare, with the poorest being the most affected. A review of data from 33 African nations revealed that patients who encounter absent staff, drug stockouts, or long waits are significantly more likely to report being asked for bribes.
Even in countries with programs promising free maternal services, such as Sierra Leone, a significant percentage of women are forced to pay bribes during labor or delivery to receive attention.
The Impact on Women and the Need for Systemic Change
Edna Masiiwa, a women's rights advocate and former director of Women Action Group, emphasized the devastating impact of these corrupt practices. She argued that they create a hidden "cost barrier" that prevents vulnerable pregnant women from accessing essential maternal health services, undermining both equity and health outcomes.
Masiiwa, a former nurse, also noted the decline in maternal healthcare in Zimbabwe, with women now required to pay for scans, tests, and X-rays despite the policy of free maternal health. She called on the government to adequately resource the health sector, arguing that under-resourcing fuels corruption. She recalled a time when service delivery was better, corruption was non-existent, and hospitals provided everything needed without demanding extra payments.
The stories of women like Fortunate Chingwara highlight the urgent need for systemic change to combat corruption and ensure that all pregnant women in Zimbabwe and across Africa have access to the free, quality maternal healthcare they deserve. *Not real name
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