PROCESS OF CHILDBIRTH IN THE ZIMBABWEAN NDEBELE CULTUR

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Education attainment

Education is an important factor that influences an individual’s attitude and outlook on various aspects that have a significant impact on life. Generally, education attainment in Zimbabwe is higher in men than in women; 71% of men and 63% of women attended secondary school or higher education. Rural people are less educated than their urban counterparts; 49% versus 85% and these statistics are similar across the ten provinces of Zimbabwe (ZDHS 2005-2006:47). It should be noted that literacy assessment in Zimbabwe is associated with positive health outcomes. However, even with the high literacy rate of 95% among men95% and 91% among women, the Zimbabwean society remains predominantly traditional; particularly men (ZDHS 2005-2006:25). This may be indicative of a need to conduct research into the acceptance of alternative and thus, unnatural ways, of giving birth; ways that are for the larger part stemming from a Western medical and scientific culture.

General structure of the health services in Zimbabwe

In 2002 the MOHCW reaffirmed its commitment by developing the Health Sector Reforms Strategy to improve the quality of health care services by increasing access of quality care to disadvantaged groups, including all the women in the childbearing age group. All women are expected to utilise the health care services available to them, regardless of their socio-cultural standing, views and beliefs. Some of the government’s commitments included improvements in the distribution of resources to priority activities, and the management and use of the resources that have been allocated (Health sector reforms, Ministry of Health and Child Welfare 2000:1; National Health Strategy (NHS) for Zimbabwe 1997–2007:30). The point of emphasis in the implementation of the decentralisation of health services is that it ensures that women with complicated labour can be assisted in time to save their lives and that of their newborn babies through use of alternative modes of birthing.

Decentralisation

The reorganisation of Zimbabwe’s Health System strengthened the services’ operations, although in essence the authority and control over resources remained with the Ministry’s headquarters (NHS 1997-2007:30). The establishment of Provincial Medical Directors in each of the provinces and the seven provincial hospitals assumed tertiary care in provinces. This revised structure saw the introduction of selected specialist services. Maternal and child health (MCH) services are also included in the specialist services, and these comprise ANC, delivery, postnatal care and family planning services, available at health care centres. The inclusion of MCH services in provincial hospitals was to enhance the hospitals’ role in the referral process within each province. Pregnant women who do not seek these services risk incurring unforeseen complications during the antenatal, intrapartum, and postnatal periods and sometimes throughout their reproductive years.

Childbirth/delivery of the baby/birthing

It is the moment when the foetus, followed by the placenta, exits the mother’s body. The process is also called labour and is defined as the culmination of a human pregnancy or gestation period with the delivery of one or more newborn infants (Pregnancy and childbirth … 2007; Childbirth/delivery of the baby … 2008; The American Heritage Dictionary of the English language … 2008). In the current study, the word childbirth was used in place of delivery, although in some instances delivery is used where the word childbirth is not easy to apply. The Oxford English Dictionary’s acknowledgement of the word “birthing” also applies. This word is also often used depending on the syntax demand and allowance.

Culture

The term refers to the perspectives, practices and products of a social group, comprising the repertoire of learned ideas, values, knowledge, aesthetic preferences, rules and customs, ceremonies and ways of life characteristic of a given group (Cohen & Kennedy 2007:47; A definition of culture … 2008; Culture … 2008). “The culture of a society is the way of life of its members; the collection of ideas and habits which they learn, share and transmit from generation to generation” (Giddens 2001:22). Such “habits” and “ideas” are, as this thesis attests, plentiful with regard to pregnancy, child birth and associated issues.

THEORETICAL CONSIDERATIONS OF BIRTHING

Birthing is a universal natural process, defined as the culmination of a human pregnancy or gestation period with the delivery of one or more newborn infants (Pregnancy and childbirth … 2007; Childbirth/delivery of the baby … 2008; The American Heritage of the English language … 2008). It should be noted that in all African cultures, the Zimbabwe Ndebele culture included, the belief is that the purpose of having sex with a woman in marriage is procreation (Mariano 2004:262; Dube 2008; Comment on  » breath of life » ZTV 1, The news at five.1 4 December 2008, 17:00; Donkor 2008:22). According to Mariano (2004:261) the evident accomplishment of sexuality is the birth of a child which awakens and renews the lineage and attests a man’s potency. On the other hand, birthing gives the woman a new social status as well as identity.

Table of contents :

• CHAPTER 1 INTRODUCTION AND OVERVIEW OF THE STUDY
  • 1.1 INTRODUCTION
  • 1.2 SOURCE AND BACKGROUND OF THE RESEARCH PROBLEM
    • 1.2.1 The geographical location of Zimbabwe
    • 1.2.2 Demographic data
    • 1.2.2.1 Household population and characteristics
    • 1.2.2.2 Education attainment
    • 1.2.2.3 Fertility
    • 1.2.3 General structure of the health services in Zimbabwe
    • 1.2.3.1 Decentralisation
    • 1.2.3.2 Maternal health care services in Zimbabwe
    • 1.2.3.2.1 Background to antenatal care
    • 1.2.3.2.2 Goal oriented antenatal care (GOANC)
  • 1.3 STATEMENT OF THE RESEARCH PROBLEM
  • 1.4 RESEARCH PURPOSE
    • 1.4.1 The research question
    • 1.4.2 Research objectives
  • 1.5 SIGNIFICANCE OF THE STUDY
  • 1.6 DEFINITION OF KEY CONCEPTS
    • 1.6.1 Alternative birthing
    • 1.6.2 Childbirth/delivery of the baby/birthing
    • 1.6.3 Natural birth/normal delivery/vaginal delivery
    • 1.6.4 Instrument delivery (ID)
    • 1.6.5 Breech delivery
    • 1.6.6 Caesarean delivery/section
    • 1.6.7 Culture
    • 1.6.8 Experience
    • 1.6.9 Perception
    • 1.6.10 Traditional midwife/birth attendant
  • 1.7 ASSUMPTIONS
    • 1.7.1 Ontological assumptions
    • 1.7.2 Epistemological assumptions
    • 1.7.3 Methodological assumptions
• CHAPTER 2 LITERATURE REVIEW
  • 2.1 INTRODUCTION
    • 2.1.1 Exploring literature on qualitative research studies
  • 2.2 THEORETICAL CONSIDERATIONS OF BIRTHING
    • 2.2.1 Possible negative effects of natural birthing
  • 2.3 NON-NATURAL MODES OF CHILD BIRTH
    • 2.3.1 Caesarean section
    • 2.3.1.1 Caesarean section birth rates globally
    • 2.3.1.2 Caesarean birth rates in the African Region
    • 2.3.1.3 Caesarean births in Zimbabwe
    • 2.3.2 Instrument deliver
  • 2.4 PAIN DURING CHILDBIRTH
    • 2.4.1 Definition of pain
    • 2.4.2 Labour pain, ethnicity and socio-cultural expectations
  • 2.5 AFRICAN CULTURE
    • 2.5.1 Historical background of the African people in relation to childbirth
      • 2.5.1.1 The Zimbabwean Ndebele culture
• 2.6 PREFERRED PLACE OF BIRTHING
• 2.7 PROCESS OF CHILDBIRTH IN THE ZIMBABWEAN NDEBELE CULTURE
  • 2.7.1 Traditional measures taken during complicated childbirth
• 2.8 THE ROLE OF RELIGION IN AFRICAN CULTURE
• 2.9 CULTURAL RITES ON TRANSITION TO WOMANHOOD
  • 2.9.1 Puberty as a rite to passage
  • 2.9.2 Sexuality
  • 2.9.3 Sex life and marriage
• 2.10 CONCLUSION
• CHAPTER 3 METHODOLOGY
  • 3.1 INTRODUCTION
  • 3.2 RESEARCH PARADIGM
  • 3.3 RESEARCH DESIGN
    • 3.3.1 Dimensions of the research design
    • 3.3.1.1 Naturalism
• CHAPTER 4 DATA ANALYSIS AND PRESENTATION OF THEMES AND CATEGORIES
  • 4.1 INTRODUCTION
  • 4.2 OUTLINE OF THEMES AND CATEGORIES
  • 4.3 DATA ON MOTHERS’ EXPERIENCE
    • 4.3.1 THEME 1: Expectations
    • 4.3.1.1 Category 1.1: Natural birthing
    • 4.3.1.2 Category 1.2: Relative health/Illness degree of pregnancy
    • 4.3.1.3 Category 1.3: Motherhood
    • 4.3.1.4 Category 1.4: Womanhood
    • 4.3.2 THEME 2: Natural proceeding of events
    • 4.3.2.1 Category 2.1: Cultural interventions
    • 4.3.2.2 Category 2.2: Traditional beliefs and practices
    • 4.3.2.3 Category 2.3: Cultural beliefs regarding inability to deliver naturally
    • 4.3.2.4 Category 2.4: Preference for traditional medicine
    • 4.3.3 THEME 3: Unnatural proceeding of events
• CHAPTER 5 RELATING THE FINDINGS TO EXISTING THEORY: PARSE’S THEORY OF HUMANBECOMING
• CHAPTER 6 SUMMARY, CONCLUSION AND RECOMMENDATIONS

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ZIMBABWEAN NDEBELE PERSPECTIVES ON ALTERNATIVE MODES OF CHILD BIRTH