When 17-year-old *Alice Mwale had her first sexual encounter then as a 15-year-old, it was out of peer pressure. Her 19-year-old friend, then 17, had told her to “try it” so “we become normal like other teens”.
Periodic and at times regular sexual encounters with her boyfriend, Joseph Mudyariwa, led to an unplanned pregnancy. Mudyariwa denied responsibility of the pregnancy and paid a few dollars’ lobola ‘settlement’ to Mwale’s parents after they had threatened to have him arrested for bedding a minor.
Now a single parent, *Alice struggles with her 11-month-old baby boy. Unfortunately, she suffered a complication known as obstetric fistula. The complication developed as a result of failure to access sexual reproductive health care. She currently awaits obstetric fistula surgery and reconstruction services. Hers was a delivery done due to lack of a safe and medically indicated caesarean delivery. It was one done by untrained midwives from her area.
Obstetric fistula is an abnormal connection between the vagina and the bladder or the rectum resulting from obstetric causes, mainly prolonged obstructed labour. According to statistics, Zimbabwe currently has two obstetric fistula repair centres. The repair programs use specialist surgeons from outside the country and hence they are organised in quarterly camps with a target to repair 90 women per quarter. According to the World Health Organisation (WHO) and the United Nations Population Fund (UNFPA), “obstetric fistula is the most devastating birth injury.”
A deep conversation with *Alice revealed that her increased sexual desire was aroused by friends who ‘leaked’ information to her about some practices conducted at chinamwari after their attendance.
“There are some issues my friends told me which today I feel was bad advice. Maybe, if they learnt more on sexual reproductive health, shared that with me, I would have made some good choices,” says *Alice.
The setup and form of ‘education’ received by *Alice’s friends at chinamwari has consequences to be guarded against. Chinamwari is a traditional practice where young women, usually those who have reached puberty, are taken into camp and taught about adult life. In some cultures like the Chewa, Shangaan, Venda, Tonga, Nsenga and Tambuka in Africa, they practice this tradition and has its roots in Malawi and Zambia.
Cultural practices like chinamwari have since not been modelled to suit the existing environment and the evolving flow of information. It has remained a closed society that exposes adolescent girls to the risk of early teen pregnancies and marriages. According to sexual reproductive health and rights advocates, there is a link that exists between chinamwari practices and some ultimate results seen as consequences.
“There is poor information sharing and young girls and women seem to be misinformed more during this practice. If there was proper information sharing, then it means we would avoid some of these cases like obstetric fistula,” says Shuvai Maruma, a SRHR advocate.
Apart from being regarded as a ‘closed and occultic entity’, Maruma notes that “there is a likelihood some girls are coerced” into chinamwari where they are “only” taught how to “satisfy men in bed, are exposed to sex-styles and positions that seduce men.”
This also forms the base on some misfortunes and health consequences that end up trailing girls like *Alice.
“I used to hear about chinamwari in our community and as a young girl, out of mischief and peer pressure, I practiced what I heard was done at chinamwari yet I could have waited and made my own choice,” adds *Alice with a grin of regret.
Traditionally, when girls started their menstrual cycles in their early teens, they were taken to secluded environments where they were taught by elderly women about bodily hygiene and how to adapt to these occurrences of nature. Today, because of “mischief” among teens, some communities no longer take girls under the age of 18 and the practice has become a commercial venture.
At Chimupukutu farm in Zvimba East constituency, three women are at the centre of this practice as instructors.
“It is a culture we have as black people. At chinamwari we teach about ubuntu mostly and only do this to those above 18 years of age. We have now modified the teachings so that they also enhance sexual skills between couples, but people have to pay. Long back, it was done out of care for the young girl but now we charge a small fee.
“We train women with stiff bodies, for example, to be flexible in bed. For girls that are over 18, we also teach them how to seduce men,” Esther Mutota said, while flanked by her two assistants.
Mutota, 43, told this publication that she has been in the chinamwari for nearly three decades now after she was “invited” by her granny into the practice aged fifteen.
While both young and old women have an equal opportunity to learn about “sexual reproductive health and rights at the chinamwari shrine” it has however become a ‘secret society’. What women learn, they are not allowed to share, for “there are consequences and heavy penalties to that.”
“One risks heavy penalties when they do not abide by the rules of chinamwari. What you learn you should never share. It is our secret,” said another instructor, Marian Masumba.
Because of risks associated with poor information sharing, some now advocate for better ways to share information on sexual reproductive health and rights to young girls and women.
A gynaecologist, Dr. Sarah Maisva, said there is need for government to have a synergy and roll-out campaigns in farming communities and rural areas to give people access to information on sexual reproductive health and rights. She says instead of keeping chinamwari as a ‘secret society’ it can be opened up and become a “support group for sexual reproductive health education.”
“This practice (chinamwari) has been there for a long time and it is high time those behind it need to open up and get adequate information they share with their constituents. They should no longer be seen as a ‘secret society’ but as support group centres that have people committed to sharing knowledge and ready to complement government initiatives.
“Through that, complications like obstetric fistula can be easily tackled because to some extent we would have avoided some practices that entice young girls into child marriages. At the same time, it is incumbent upon communities to come together and call out whenever child marriages are happening especially in the name of these cultural practices. Some of the girls are vulnerable and unable to access medical care or information on SRHR. We need to give people adequate professional and scientific information to avoid problems like obstetric fistula because they are coming from uninformed arenas,” said Dr. Maisva.
Going through obstetric fistula can lead to “isolation” and without “dignity” in women, UNFPA country representative in Zimbabwe Dr. Esther Muia said. She also acknowledged progress that is being made in coming up with mechanisms to provide sexual reproductive health care and information.
“We have accounts of women who have spent so many years in isolation with no dignity because of the lack of obstetric fistula repair surgery yet so resilient and strong in the face of such suffering and humiliation. By all accounts, it is encouraging how far we have come in ensuring universal coverage to sexual reproductive health and rights. More needs to be done to ensure that facilities are easily accessible to women suffering from this condition regardless of their location,” said Dr. Muia.
Dr. Muia also indicated that communities have a role to play in preventing obstetric fistula by discouraging practices that promote child marriages as young girls often get fistula injuries during child birth as their bodies would not have matured for child birth.
Zimbabwe is keen to meet Sustainable Development Goal (SDG) 5. The target of SDG 5 is ensuring universal access to sexual and reproductive health and reproductive rights as agreed in accordance with the Program of Action of the International Conference on Population and Development; and the Beijing Platform for Action.
Zimbabwe’s Reproductive Health Unit housed under the ministry of Health and Child Care says proper health care facilities should be used by women and young girls to avoid obstetric fistula complications. In its Maternal and Neo-Maternal policy, government says obstetric fistula can be avoided when people desist from harmful cultural practices and stopping all forms of child marriages and girls’ exploitation.
Dr. Maisva concurs with the government: “Obstretric fistula is regarded as an accident at childbirth. This accident is avoidable if things are done timely. Young girls should not be involved in sexual practices and cultural practices that infringe a woman’s right should be stopped. Government policies should be complemented to avoid these childbirth accidents.”
A 2021 report by Amnesty International (AI) shows that globally, obstetric fistula affects over 70 000 women every year, with low income countries in Africa and Asia having the highest rates. In Zimbabwe, according to AI, the actual rate of obstetric fistula is unknown, but a latest Multiple Indicator Cluster survey from 2019 indicates that the government is doing well to reduce the country’s maternal mortality ratio which is among the highest in the world.
