Gender Action Plan

2014-2017

UNICEF Executive Board, Annual Session, 4 June 2014

Apostolic Maternal Empowerment and Newborn Interventions (AMENI) Package:

Improving MNCH Outcomes among Apostolic Religious Groups in Zimbabwe

Brian Maguranyanga, PhD 26 August 2015, UNICEF, Harare

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Operations Research and AMENI Process

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Social Ecological Model

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Background

• Growing concern with religious objection to

utilization of modern MNCH services

• Nagging questions: – What are the strategies for generating demand for MNCH

services among Apostolic religious groups / VaPostori,

particularly key religious objectors?

Comparison of religious groups with respect to Maternal Health & Child Immunization

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0.0%

20.0%

40.0%

60.0%

80.0%

100.0%BCG

Polio

Measles

DPT0.0%

20.0%

40.0%

60.0%

80.0%

100.0%

ANC at leastone visit

ANC at leastfour visits

Delivery athealth

institution

Skilled birthdelivery

Apostolic faithOther christiansTraditionalOther religions and no religion

UNICEF 2011

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Apostolic Religion

• African - Independent, Initiated, Indigenous,

Instituted – Churches (Chitando 2014; Daneel 1970) –

AIC movement

– Divine commissions of the founding fathers

• Umboo Utsva hwavaPostori (Johane Marange – Johane

Marange Apostolic Church founded in 1932)

• Johane Masowe – similar divine call with Johane Marange

• The Divine Commission of Paul Mwazha of Africa (Paul

Mwazha – African Apostolic Church founded in 1959)

• Madhidha (in Matebelaland)

• Samuel Mutendi – Zionist Christian Church (ZCC founded in

1922)

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Prophet and members at a faith healing session

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Apostolic Religion(s) - Objections

– Religious objection to modern healthcare

• Discourage use of modern health services, medicines & family

planning

• Diversity of views on MNCH services / biomedicine

(Maguranyanga 2011; OPHID 2014)

• Roles of prophets / faith healers & AtBAs

• Birth camps & Zvitsidzo

• Divine / faith healing,

• Healing rituals & concoctions

– Anti-western (modern) education

• Discourage western education – secular (Machingura 2014)

• The “poverty trap” or “cycle” - illiteracy, poverty, limited

opportunities, child/forced marriage, school drop-out, polygamy

etc.

– Radical opposition to “all European things” or ‘white inventions’

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…Apostolic Religion and Gender Issues

• Gender issues & patriarchy in the AICs

– Gender dynamics within AIC (Mukonyora 2007 –

“Wandering a Gendered Wilderness: Suffering &

Healing in an African Initiated Church”)

– Female healers and AtBAs command influence

– Women’s conformity to Apostolic doctrine, beliefs and

restrictions on use of certain modern health, family

planning interventions

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Apostolic Health Seeking Behaviors

A

15 Year Old Pregnant Girl (7 months pregnant), Ward 22 BuheraPhoto taken with permission

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Adolescent Pregnancies

Adolescent Deliveries, Murambinda Mission Hospital,

May-November 14, 2014

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Adolescents

• Limited education opportunities & poverty

– “In Marange, …most girls get married early as soon as

they finish Grade 7; they get married off to older men.

They preach that they should marry so that they

‘multiply like sand’”

– “Some parents marry off their young girls so that they

get food and material assistance. Poverty pushes

young girls into marriage. Some girls are married off

because of hunger or starvation at home…Other girls

marry old men because of financial and material

benefits”

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Religious Beliefs, Dreams & Virginity Testing

• Religious convictions

– Should marry men in the Apostolic church

– Marry virgins in the church

• ‘Dreams’

– Facilitate early and child marriages:

– “They believe in ‘dreams’ [kurotswa / kuroteswa]. When

a man has a dream marrying a particular young girl,

then that girl should be married off to the older man”

• Virginity testing

– Girls who fail the virginity test are humiliated and

become easy prey for older men

– “If one isn’t a virgin, she will be given to an old man

with no choice”

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Adolescent Pregnancies and Abortion

• Use of TBAs

– Aborting unwanted pregnancies

– Religious and social pressures faced by adolescent

girls

– Vivid, graphic descriptions of the abortion process

• Crushed herbs (munhanzwa / kabatana) mixed with

water, inserted into the vagina to enlarge birth canal,

and bare hands inserted to pull out the foetus; and

often damages the girl’s vagina or womb

• Drink boiled Omo or Surf (commercial powdered

washing detergents)

• Whole pack of tea leaves boiled for the pregnant

adolescent to drink to terminate pregnancy

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Pre-pregnancy, Family Planning and Religious Beliefs

• Modern family planning

– Prefer the “withdrawal method”

– Antithesis to God’s purpose for big families and

multiplication of Apostolic members

– “women must get pregnant as many times as

divinely possible and avoid contraceptives”

– “Our religion doesn’t allow us family planning [pills and

modern methods] because it’s murder. The Bible says,

‘do not kill’. The Ten Commandments say, ‘do not kill’.

So we have a way that we teach at the women’s

meetings on how women can plan their families” (FGD

with AtBAs)

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Religious Objections

• Modern family planning

– “…women who take FP pills should be aware of God’s

rod that will come upon them. If you’re not giving birth,

death will come upon you. As a woman, I get scared

and run to confess that I took pills or got injected with

Depo Provera [birth control injection] because I don’t

want to die. Only then can I be released from the curse

and have a child” (FGD with ultra-conservative

Apostolic women)

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During Pregnancy

• Faith Healers and AtBAs

– Deal with pregnancy-related matters

– Apostolic healing systems and Zvitsidzo – religious

embedded antenatal care (ANC)

– Church doctrine, beliefs

– Spiritualization of illness and pregnancy complications

– Care – prayer, spiritual diagnosis, divine / faith healing,

prophecy

– Pregnancy or high pregnancy rate socially valued

• “the more pregnancies a woman carries during

the course of her life, the more she is socially

valued”

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Views on the Value of a Child

• Upon pregnancy termination or death of a

newborn

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Childbirth

• AtBAs, Zvitsidzo and Home Deliveries

– Lack the requisite skills and equipment to deal with

childbirth complications

• Hemorrhaging, cord prolapse, prolonged labor,

breach presentation

– Spiritualization of childbirth complications

– Sin, evil spirits, adultery, witchcraft

– Confessions of pregnant women during delivery

• Subjected to torture, beat up, emotional abuse

– Limited knowledge of danger signs; of essential care

for the mother during childbirth or for the neonates

– Poor diagnosis of childbirth complications – emphasis

on ‘spiritual diagnosis’ and faith / divine healing

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Post-Partum / Post Natal Care for Mother & Newborn

• Ultra-Conservative Apostolic Groups

– Seek care from AtBAs, spiritual healers / prophets and

Zvitsidzo

– Never openly use PNC services

• Semi-Conservative Apostolic Groups

– Seek PNC from health facilities after home deliveries or

AtBA assistance

– Go to health facility to facilitate birth record for the child

and first immunization

• Refer OPHID report and presentation – “Exploring

the Forgotten Variable”

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Post-Partum / Post Natal Care for Mother & Newborn

• Glaring weakness:

– management of postpartum complications & neonatal

illnesses

– HIV prevention & management

– Care of pre-term babies, including kangaroo mother

care

– Immediate emergency care for newborn babies

– Hardly promote exclusive breastfeeding

– Encourage mothers to give newborn babies holy water,

anointed oil, thin porridge, fizzy drinks and cold tea

– Discourage immunization and use of healthcare

services (ultra-conservative Apostolic groups)

Apostolic Maternal Empowerment &

Newborn Interventions(AMENI)

Objectives for Improving MNCH Outcomes

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Reduce Apostolic maternal &

neonatal morbidity &

mortalityEmpowered Adolescents -

advancing educational opportunities

Improved SRH -Family Planning;

ASRHR; Self-efficacy

Increased/early ANC uptake with

4+ ANC visits

Increased institutional delivery/SBA

Improved PNC

- Maternal & newborn care

Improved links between AtBAs / faith healers &

health providers

Increased ASRHR & MNCH knowledge among

Apostolic religious leaders –sensitized leaders aware of

influence of Apostolic doctrine/beliefs on MNCH

outcomes

Gender Equality -empowered women;

addressing GBV

Improved enabling environment – policy

& social

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Apostolic Engagement and Relationship Building

• Increase engagement

and dialogue with

Apostolic leaders,

AtBAs, faith healers and

prophets

• Build relationships with

Apostolic religious

groups, especially key

religious objectors

-Apostolic leaders at

various levels

supportive of MNCH

services & addressing

key social issues

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• Increase access to &

use of ASRH

services, & equip

adolescents with

knowledge to prevent

unwanted

pregnancies, early

child marriages

- Empowered

adolescents

Adolescent Empowerment

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Maternal Empowerment

• Increase acceptability

and utilization of

MNCH and family

planning services

• Strengthen agency

and self-efficacy of

Apostolic women

- Increased use of ANC,

SRH, institutional delivery

& PNC services

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AtBA Engagement & Capacity Strengthening

• Engage AtBAs in

referrals to health

facility

• Promote harm

reduction

strategies within

Apostolic health

systems (OPHID

2014)

- Increased referrals

to health facilities for

ANC, institutional

delivery & PNC

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Is this the best care for pregnant women?

- Rethinking policy /

practice position on

TBAs and informal

‘clinics’

- Saving mothers & babies

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Health Systems Strengthening & Capacity Bldg

Website: bulawayo24news; MCHIP & zimbabwelatestnews.com

• Engage AtBAs & faith healers

in promoting optimal

healthcare seeking behaviors

& use of health services

• Build trust with Apostolic

women

• Service delivery innovations• Community gardens as ‘clinic’

platforms

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Policy & Advocacy

• Strengthen enabling

environment for

improved MNCH

outcomes, rights of

women & children

• Improved enabling

environment & reduced

religious objection to

utilization of SRH &

MNCH services

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RECOMMENDATIONS

• Strengthen soft techniques –

– Effective engagement of Apostolic ecumenical bodies,

surviving founding fathers (e.g. Paul Mwazha), leaders

and AtBAs

– Promote dialogue around MNCH, socioeconomic and

education issues within Apostolic religious groups

– Steer introspection and reflection

• Understand harmful practices and their mitigation

• Reexamine the role of TBAs in health delivery

– Policy, practice, and harm reduction strategy

• Multi-sectoral approach to health, social and

developmental challenges [inclusive

developmental thrust]

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RECOMMENDATIONS

• Harness positive shifts, transitions and

doctrinal modifications within Apostolic

churches

– Understand ‘double-burden’ of religion and tradition

• Strengthen political will to engage the Apostolic

community for improved MNCH and

development outcomes.

• Leverage ongoing legal reforms for improved

human rights in religious communities

• Innovations: supply-side and demand-

generation

• Recognize the diversity of religious objections

Apostolic Religion

“Is religion the forgotten variable?” – Ha et al. (2012)

“Too important not be taken seriously” – Prof. Ezra Chitando, UZ

“Overriding influence on behavior, perceptions of self and others” (Maguranyanga 2011; Mpofu et al 2011)

“Martyring of people over radical beliefs” – Machingura (2014)

THANK YOU• Ministry of Health & Child Care• UNICEF Zimbabwe• UDACIZA• Apostolic leaders, members and AtBAs who participated in

this operations research• Local authorities in Buhera District• Traditional leaders in Ward 22• Government officials at Provincial and District Levels

(Manicaland and Buhera)• Co-consultants: Prof. Geoffrey Feltoe, Ms. Charity Hodzi• Our Research Assistants

Dr. Brian Maguranyanga (Team Leader), Prof. Feltoe

(Legal Consultant)

Brian Maguranyanga: +263-77-2410919;

brianm@mconsultingafrica.com

Cover photo: © Brian Maguranyanga 2013