Zambian Community Debates Traditional Belief Linking Infidelity and Rising C-Sections

LUSAKA, ZAMBIA – Standing by the door of her cracked, two-room brick house, Mailesi Tembo hands a cup full of a black concoction to her firstborn daughter, Gertrude Banda, who is nine months pregnant.

Banda drinks the herbal concoction while standing next to her mother. With a deep frown on her face, she lets the cup slip from her hands.

Tembo, who lives in Kanyama compound, one of largest slums in Lusaka, Zambia’s capital, sends a boy to pick the cup up from the doorway. As part of the ritual, a boy who has never had sex is supposed to pick it up, she explains.

Banda has to drink the bitter concoction to ensure she does not have complications during childbirth, Tembo says. Tembo is one of many Zambians who believe that infidelity causes complications during labor, which often culminates in a cesarean section.

“I want her to have an easy labor,” she says. “I don’t want her to go through a cesarean section like I did. You can’t trust these men. You can end up dying in labor.”

The mother of six says she divorced her first husband 25 years ago because she had complications during the births of her first and second children, which led to her undergoing C-sections.

“My husband was promiscuous,” she says. “I failed to give birth normally on two occasions, and the unfortunate part is that my mother did not know any herbs to help me ease my labor.”

Another popular belief is that a mother can die if she encounters her husband’s lover – or her own – shortly after giving birth. After Tembo had her second child, she almost died when she met her husband’s lover in a nearby slum, she says.

“As if the cesarean was not enough, I met his girlfriend within the compound, and upon seeing her, I developed a pounding headache,” she says. “And from nowhere, I started bleeding heavily. I almost died, but elders came to my aid, and I was given herbs that healed me. That is when I decided not to go back to my husband’s place. That was the end of our marriage.”

Zambian men and women attest that infidelity is common, especially during pregnancy. Women and traditional midwives say infidelity causes childbirth complications and use traditional medicine to avert them. Medical experts reject the belief that infidelity directly causes complications, but they acknowledge it may have an indirect effect – through HIV infection – as one of various factors leading to the rise in the use of C-sections. Some lay members of the society call the traditional belief and accompanying rituals nonsense. Although medical professionals advise women against taking herbs, they agree fidelity helps protects mothers and their unborn babies from sexually transmitted diseases.

Three percent of babies born in Zambia are delivered by C-section, according to the 2007 Zambia Demographic and Health Survey. That is the latest official nationwide statistic, Ministry of Health spokesman Dr. Kamoto Mbewe says. That was an increase from the 2 percent rate recorded in the 2001-2002 survey. 

According to the World Health Organization, countries with C-section rates under 10 percent are underusing the procedure, while countries with rates above 15 percent are overusing it.

The University Teaching Hospital in Lusaka, Zambia’s largest referral hospital, recorded about 5,500 C-sections in 2013, says Dr. Bellington Vwalika, head of the hospital’s obstetrics and gynecology department. The number rose by more than 500 from 2011 to 2012 and by another 500 from 2012 to 2013. Thirteen to 15 C-sections are performed at the hospital each day.

Community members say infidelity is common in Zambia.

A court clerk in Lusaka, who declined to publish his name because he is not allowed to speak to the press, says infidelity is commonly cited as grounds for divorce. On average, the court dissolves two marriages every day on the basis of infidelity.

Malizani Chindongo, a married man who works as a cameraman, says that women are more faithful than men, especially during pregnancy. When asked if he was faithful, he laughed, saying it was not necessary to know.

“It is very rare that you would find a woman cheating, especially when she is expecting,” Chindongo says. “But I have seen men cheating on their pregnant wives, and normally, a cheating man in our society would be tolerated, not a cheating woman.” 

Agnes Ngulube, known locally as Banakulu Musonda, which means “grandmother of Musonda,” has been a traditional midwife for 20 years. She says that women, unlike men, are usually faithful during pregnancy because they know the consequences.

Zambian women and traditional midwives say they believe infidelity causes childbirth complications. They rely on traditional medicine to avoid complications.

Tembo sells her herbal concoction from her home to at least two women every day. She charges 100 kwacha ($15) for a cup. Two of the herbs Tembo uses in her concoction are locally known as “mono” and “palibe kantu.” She does not know the scientific names. She also mixes soil into the concoction.

She believes the herbs work because when she remarried and became pregnant again, she used them and was able to have a vaginal birth even though her doctors had scheduled her for a C-section.

“During my third pregnancy, I was booked for a cesarean because the doctors said I already had two cesareans and allowing me to go through labor would be dangerous,” she says. “But I concentrated on using herbs and never went for the operation until my labor started, and I delivered normally. My other three pregnancies were also normal delivery.”

Banda says she used the herbs during her two previous pregnancies and had no complications when she gave birth, she says. She takes the herbs just in case her husband cheats on her.

“I need to take precautions,” she says. “I don’t know how my husband’s movements are. He can’t tell me that he has had sex with another woman, but I have to make sure that I don’t have any complications [at birth] just in case.”

Gift Mpundu, a preschool teacher who is expecting her second baby, believes she might even die in labor if she or her husband cheats.

“I have heard of how some women have died in labor because they were unfaithful,” she says. “We are lucky we have hospitals nowadays that quickly conduct C-sections, but that should not be a way of giving birth. A woman should give birth the natural way.”

During Mpundu’s first pregnancy, her mother gave her some herbs, she says. Her grandmother told her and her husband to be faithful to each other during the pregnancy as she could die if either of them cheated.

Ngulube says the link between infidelity and complications at birth is no myth.

“Years back, we never saw women giving birth through the knife because couples were told how to behave when a woman is pregnant, but nowadays people think this is just a belief,” Ngulube says. “No wonder we have all these operations.”

A woman can die in labor if she or her husband is unfaithful, Ngulube says.

“It is worse when a woman is cheating,” she says. “She can die in seconds upon seeing her blood during birth.”

Ngulube prescribes herbs to pregnant women to avoid complications at birth, she says. Still, she has had to refer three women to the hospital after they were unable to have vaginal births despite drinking her herbs.

The risks of cheating continue after labor, she says.

“Even just eye contact with your husband’s lover or your own lover, one can die,” she says. “We call this ‘inchila.’”

Chiiwa Ngoma, a trained midwife at University Teaching Hospital, believes infidelity can lead to complications at birth even though she says there is no medical evidence for the belief.

“I am an African, and having being brought up knowing that infidelity leads to complications at birth, I believe it,” she says.

But the lack of medical evidence that infidelity directly leads to childbirth complications prevents Ngoma from discussing it with patients, she says.

“I can’t professionally preach that to a woman,” Ngoma says. “All I do is to outline the medical conditions the woman is likely to suffer if any of them is unfaithful, such as HIV.” 

Most pregnant women eat poor diets and do not exercise, which is not healthy for their babies, she says.

“Medically, it’s just the lifestyle,” Ngoma says. “Most people eat a lot of junk food, and most of it is genetically modified. Hence, the babies grow so big such that a woman can’t give birth normally. Even exercise lacks. The muscles become so rigid that they fail to flex up during labor. All this may lead to a cesarean birth.”

Doctors dismiss the belief that infidelity itself causes complications during childbirth, though they recognize possible indirect effects.

Dr. Francis Manda, a urologist at University Teaching Hospital, attributes the rise in the number of C-sections performed in Zambia to early pregnancies and the prevalence of HIV infections.

“Partly, lifestyles have contributed, but cesarean has also been used to mitigate HIV so that the baby being born from an HIV-positive mother is 100 percent safe from getting the infection,” Manda says. “Early marriages also contribute. Most of the first mothers are young, and their pelvis is still small.”

C-section births are more common among first-time mothers, mothers in urban areas and mothers with higher education, according to the Zambia Demographic and Health Survey. The reports do not specify why C-sections are higher among educated and urban women.

But Manda says it is because educated women are well-informed about HIV and those who are HIV-positive prefer C-sections to prevent their babies from contracting HIV. Educated and urban women sometimes opt for C-sections to avoid vaginal delivery.

Infidelity could cause HIV infection, which could lead to C-section, he says. But infidelity itself does not doom pregnant women to complications.

Vwalika says labor is a complex matter so it is not easy to pinpoint the cause of complications, but he rules out infidelity.

“It is difficult to determine what is causing the rising number of cesareans because labor is determined by three factors, which we call the three P’s,” he says. “The three P’s are the baby’s power and position, the passage of the mother – how it dilates – and the power of the mother to push the baby.” 

Edford Mutuma, the executive director of Planned Parenthood Association of Zambia, a reproductive health nongovernmental organization, says there is not a direct link between birth complications and infidelity.

“However, we encourage faithfulness, whether a woman is pregnant or not,” he says.

Mutuma recognizes that infidelity could be an indirect cause of birth complications.

“Although the belief that infidelity causes complications at birth is a myth, there is a link in that women require a lot of love when they are pregnant, and cheating on them puts them at a risk of having high blood pressure, hence having complications at birth,” he says. “The risk of STI’s also puts the woman’s and the baby’s health at risk. So, even if there is no scientific proof that infidelity causes complications, there is some link.”

Mbewe, the Ministry of Health spokesman, says linking complications at birth to infidelity is just a myth. The ministry advises pregnant women to attend antenatal clinics with their husbands for health examinations to prevent complications.

Outside the medical realm, some lay Zambians also deny that infidelity causes childbirth complications.

Jackson Banda, whose baby died from fetal distress two years ago, dismisses the belief.

“It is total nonsense,” he says, visibly annoyed. “My wife and I do not believe in it, but the elders insisted that my wife had complications because I was not faithful.”

He had to adhere to a traditional remedy for prolonged labor.

“I was forced to remove my belt and soak it in water for my wife to drink,” he says. “It didn’t work. She just had to go for a C-section. But it was too late. The baby got tired and died.”

Community elders required him to give his in-laws a cow as penalty for infidelity, he says.

“Honestly, I was never unfaithful to my wife, and she knew that,” he says. “But my in-laws made a lot of noise, and my wife suggested that we give in to their demands for the sake of peace.”

His wife, Margaret Banda, also disputes the belief.

“We need to understand that there is no connection between a couple’s infidelity and how a woman gives birth,” she says. “Giving birth is a complicated matter, and no one should be blamed for it. But faithfulness is vital if we are to have healthy children.”

Chindongo also does not believe that complications during birth result from infidelity.

Medical officers encourage pregnant women to consent to surgery in case complications occur during labor. They urge them to avoid taking traditional herbs, though they do recognize the benefits of fidelity.

Traditional midwives are authorized to attend to mothers who cannot access health centers in time to give birth, Mbewe says. The Ministry of Health strongly discourages women from taking herbs recommended by traditional midwives, but it cannot stop them from taking the herbs when they do not give birth in hospitals.

“We do not mix traditional medicine with conventional medicine because, as medical doctors, we don’t know the composition of the herbs and the dosage,” he says.

Vwalika says traditional herbs could be dangerous.

“We don’t encourage women to drink herbs to ease labor,” he says. “Those herbs are dangerous to both the mother and the baby because we don’t even know the dosage.”

Manda advises women to quickly consent to C-sections if they have complications to avoid risking their lives and those of their unborn babies.

Ngoma says she does not encourage women to take traditional herbs before or during labor because it would be against her medical ethics. She has seen pregnant women carrying bottles of concoctions to take during labor, and some of them resist undergoing C-sections. The refusal to have a C-section could lead to the deaths of both the mother and her baby.

“Personally, I tell couples to be faithful,” she says. “I don’t encourage them to take herbs. Herbs may be hazardous as they speed up the labor process, and that could rupture the placenta and lead to other complications.”

Ngulube advocates fidelity.

“I tell the young people how to behave, although not all of them get an opportunity to be counseled,” she says.

In this respect, the belief that infidelity causes complications during childbirth has its benefits, Ngoma says.

“This belief has helped women have healthy babies,” she says. “Most couples believe this, and they remain faithful during the period of pregnancy, which is to the advantage of the mother and the baby.”

Manda says he would like society to uphold the belief because it discourages infidelity, which raises the mother’s risk of contracting HIV.

“It is one good traditional belief that I would like to be maintained because it protects women, [and] it makes men to be faithful,” he says.

Likewise, Mutuma says that even though the belief is just a myth, it helps ensure that women are not infected with sexually transmitted diseases that could be passed to unborn babies.

“I wish the belief would be extended to the lactation period so that the baby can be protected in the event of HIV,” he says.

GPJ translated interviews from Nyanja and Bemba.

Jackson Banda and Margaret Banda are not related to Gertrude Banda.