Apostolic Religion, Health and Utilization of Maternal and Child Health Services in Zimbabwe
This qualitative study on determinants of healthcare seeking behavior among Apostolic Faith community (Vapostori) was commissioned in December 2010 by the Collaborating Center for Operational Research and Evaluation (CCORE, UNICEF) in response to the need to understand beliefs and practices that lead to acceptance or rejection of preventive and promotive health and social practices among Apostolic religious groups in Zimbabwe, focusing on those practices that affect women and children. It sought to provide in-depth, rich description and understanding of the different groups within the Apostolic community, and offer evidence that would be used in generating and informing future communication strategies for health and social development in Apostolic communities as well as strategic recommendations for program interventions. In addition, the study also highlighted “best practice situations” where optimal collaboration between the Apostolic community and formal healthcare providers was identified by the respondents.
The Holy Spirit (Mweya) plays a central role in the spiritual life, beliefs, and faith healing of the Apostolic religious community. Mweya is believed to foretell and forewarn about any impending disease outbreak, tragedy, complications as well as how to treat illnesses. Mweya works through prophets and church (spirit-filled) members, and endows them with special healing and prophetic powers and gifts.
Some religious beliefs, tenets and adherence to practices of the ultra-conservative Apostolic groups have negatively affected members’ decisions about their healthcare by objecting to uptake of modern healthcare services and encouraging practices that increase risk to HIV and AIDS through polygamy, wife inheritance and pledging young girls to marriage. These factors contribute to negative health outcomes. However, it should be noted that some Apostolic tenets have positive implications for health outcomes and public health.
Health Context: Maternal and Child Health Situation in Zimbabwe
In Zimbabwe, the under-five mortality rate has risen from 77 per 1000 live births in 1994 to 82 per 1000 live births in 2005, and has continued to rise to about 86 per 1000 live births in 2009 (CSO 2009). When adjusted for HIV and AIDS-related mortality, the under-five mortality is approximated at 96 per 100 live births. However, HIV and AIDS remain one of the leading causes of under-five mortality in Zimbabwe, and approximately 95% of the pediatrics cases of HIV in children in this category are from mother-to-child transmission during pregnancy, childbirth, and/or breastfeeding. Given this challenge, preventing mother-to-child transmission and screening infants for HIV after delivery and throughout the breastfeeding phases could help reduce the numbers of children dying from HIVrelated conditions.
According to UNDP (2011), factors such as institutional delivery, skilled attendants at birth, and the type of religious affiliation significantly affect the risk of maternal deaths. It is extremely worrisome that only “5.4% of pregnant women knew their HIV status before pregnancy, and just 34% of pregnant women were tested for HIV during pregnancy” (UNDP 2011:9) despite the fact that HIV is a leading cause of maternal mortality. In the context of the Apostolic community, it is important to understand the influence of religious beliefs, teachings, and practices on factors that shape maternal health and healthcare seeking.
Perspectives on HIV/AIDS by Ultra-Conservative Apostolic:
- HIV and AIDS result of sin or sinful living including promiscuity
- HIV/AIDS caused by demonic/spiritual forces
- HIV/AIDS is a “worldly disease” that does not exist among righteous and dedicated Apostolic members
- HIV/AIDS can be avoided by marrying virgins or women within the Apostolic community, and being faithful and prayerful
- Mweya foretells or forewarns if partner or prospective partner is HIV positive
- Church forbids use of antiretroviral treatment (ARVs)
- Skeptical about HIV testing since Mweya can diagnose HIV status
Perspectives on HIV/AIDS by Semi-Conservative Apostolic Groups with relatively ‘liberal’ views (e.g., Mwazha, some Masowe subgroups, other minor Apostolic groups):
- Mixed views about HIV and AIDS
- Some groups encourage HIV testing and use of ARVs
- Generally, HIV/AIDS is associated with sin, promiscuity, adultery, and evil spirits
- Widespread view that HIV/AIDS can be avoided by marrying women within the Apostolic community, and young men are encouraged to marry virgins
- Mweya foretells if partner or prospective partner is HIV positive (UNICEF/mconsultingroup 2011).