Zimbabwe has a high HIV burden and high HIV/TB coinfection. Women suffer from high rates of cervical cancer, mother to child transmission (MTCT), and maternal mortality. Maternal experiences are also marked by persistently high neonatal mortality, infant mortality, and under-five mortality. Zimbabwe continues to experience high fertility rates and teenage pregnancies.
Severe economic challenges facing the country have precipitated a state of foreign donor led systemic and crisis management interventions to address HIV and AIDS, and sexual and reproductive health (SRH) challenges. These foreign donors provide only limited funds directly to the government; the bulk is allocated to, and managed by, non-governmental organisations. The donor influence on health provision in Zimbabwe is deepened by the limited domestic investment in health which stood at 8.5% of government expenditure in 2015 (falling well short of the 15% pledged in the 2001 Abuja Declaration).
The right of access to basic health care, including SRH and for chronic conditions, is enshrined in the 2013 Constitution of Zimbabwe, but a sub-clause explicitly makes realisation of these rights conditional on resources available. Future research that identifies why Primary Health Care and antiretroviral treatment programmes have particularly poor coverage in rural areas may therefore have advocacy and policy implications. Furthermore, the reach of the Prevention of Mother to Child Transmission programme is limited, and there is little evidence of systematic interventions in key populations.
World Databank (2015) Health expenditure, public (% of government expenditure) https://data.worldbank.org/indicator/SH.XPD.PUBL.GX.ZS Accessed 23.02.2018
Factors contributing to high rates of maternal mortality include adolescent SRHR challenges, limited reach of Primary Health Care services, critical shortage in trained midwives, lack of integration between SRH and HIV and AIDS interventions, and complications from unsafe, unsanctioned abortions. While there are no national estimates regarding unsafe abortions, records obtained from Harare Hospital indicate that the number of admissions for unsafe abortion-related complications have increased over time, and have resulted in high rates of mortality. Where women are able to access Primary Health Care services, they face demands of user fees even where services are supposed to be free.
Zimbabwe’s most recent Maternal Mortality Rate measurement of 443 per 100,000 in 2015 is close to its first ever national survey in 1990, of 440, a time period that encompasses a high of 657 in 2003. Although below the average Maternal Mortality Rate of 547 for sub-Saharan Africa, this trend is likely to remain a focus for Zimbabwe’s SRHR efforts in accordance with Sustainable Development Goal 3.1. The World Bank manages the Results-Based Financing Programme to facilitate people’s access to, and improve delivery of, mother, newborn, and child health services.
Sources: World Databank, Maternal mortality ratio (modelled estimate, per 100,000 live births) https://data.worldbank.org/indicator/SH.STA.MMRT Accessed 02.02.2018
Knowledge gaps exist for all key populations, but one study (2011) on Female Sex Workers, conducted across a range of locations, revealed 50-70% HIV prevalence with only 26-38% of those infected receiving treatment. Female Sex Workers reported harassment and stigma as major barriers to accessing HIV treatment. Likewise, 23% of Female Sex Workers reported having Sexually Transmitted Infections yet only 66% of those individuals sought treatment. Reports of police confiscating condoms suggest challenges to prevention efforts. In the same study, 13-24% of Female Sex Workers experienced physical violence, and 8-23% experienced sexual violence.
Mtetwa, S. et al. (2014) “You are wasting our drugs”: health service barriers to HIV treatment for sex workers in Zimbabwe, BMC Public Health, 13:698
UNAIDS (2014) The Gap Report 2014, p7
Cowan, F. Et al. (2014) Engagement with HIV Prevention Treatment and Care among Female Sex Workers in Zimbabwe: a Respondent Driven Sampling Survey, PLoS ONE 8(10): e77080
Adolescent SRH is characterised by a high adolescent birth rate and civil resistance to sex education in schools. There are misperceptions about legal age of access to contraceptives (16 without parental consent) reinforced by health staff who frequently turn away sexually active schoolgirls requesting contraception as they are perceived as too young to be having sex, or they are unmarried. This may contribute to the situation where adolescent and young adult women have a significantly greater HIV burden than men of the same age. Trends of contraception rates amongst adolescents is uneven and divergent between rural and urban areas. In response, UNFPA implemented a national Adolescent and Youth SRHR programme establishing ‘youth friendly’ health facilities.
Policies and programmes have been supported by renewed investment of resources in health services by the Zimbabwean government since the late 2000s that led to a number of initiatives tackling HIV and AIDS, and SRHR with improving trends in areas such as maternal mortality.
National Adolescent and Youth Sexual and Reproductive Health Strategy, 2016-2020 is the successor to the National Adolescent and Youth Sexual and Reproductive Health Strategy which expired in 2015 which provided a standard framework for sexual health and highlights three different approaches: health facility-based, school-based and community-based models. UNESCO and other partners provided technical support for the development of 2016-2020 Strategy which focuses on the sexual and reproductive health needs of 10 – 24 year olds, who constitute a third of Zimbabwe’s population
‘National Policy on HIV/AIDS’ 1999 to guide programmes aimed a combating HIV/AIDS and introduced an AIDS Levy. Implementation of the national policy is spearheaded by the National AIDS Council and the disbursement of funds managed by the National AIDS Council Board.
Zimbabwe National HIV and AIDS Strategic Plan (ZNASP) 2015 – 2018 is a multi-sectoral framework commitment towards fast tracking ending aids by 2030 and 75/90.90.90 targets by 2020. The development of the plan is premised on a human rights based planning approach that is complemented by evidence and results based management approaches.
African Charter on Human and Peoples’ Rights (also known as the Banjul Charter)
United Nations Convention on the Rights of the Child (UNCRC)
Convention on the Elimination of All Forms of Discrimination against Women (CEDAW)
Protocol To The African Charter On Human and Peoples’ Rights On The Rights Of Women in Africa
African Charter on Democracy, Elections and Governance