A Mixed Methods Analysis of Behavioural and Structural Drivers of Matenal, Sexual and Reproductive Health Services Disruption During and Post Covid-19 in Zimbabwe

Imagine the human body as a bustling city, and the healthcare system as the city's emergency response network. In this city, there are special "Mother-and-Baby" districts that need constant, gentle care to keep the population growing safely. But sometimes, a massive storm hits the city. This storm isn't just wind and rain; it's a virus that scares everyone, making people afraid to leave their homes or even walk into the city's hospitals. When this happens, the roads get blocked, the emergency trucks break down, and the people who run the hospitals get exhausted. The big question scientists ask is: When the storm hits, why do some people still try to get help, while others give up? Is it because they are scared of the storm, or because the roads are too broken to travel? To answer this, researchers look at two main things: the "feelings" (like fear or trust) and the "facts" (like money, distance, and broken equipment). Understanding this helps us fix the roads and calm the fears so that when the next storm comes, the city can keep everyone safe.

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The Great Zimbabwe Health Audit: When the Storm Hit a Broken City

In Zimbabwe, a team of researchers decided to investigate what happened to the "Mother-and-Baby" districts when the COVID-19 storm hit. They didn't just count how many people got sick; they wanted to know why people stopped going to the hospital. They used a special detective kit called the BeSD Framework, which is like a map that divides the reasons for behavior into four zones: Thinking and Feeling (what's in your head), Social Processes (what your friends and leaders say), Motivation (your plan to act), and Practical Issues (the real-world obstacles like money and buses).

They went on a massive journey across all ten provinces of Zimbabwe, talking to 472 people in group chats (focus groups) and interviewing 79 officials. They also handed out surveys to over 600 people, including mothers, teenagers, and doctors. What they found was a story of a city that was already shaky before the storm, and then cracked even more when the wind blew.

The "Dual Fear" and the Infodemic

The first thing the researchers discovered was a "dual fear." Imagine you are sick and need to go to the hospital, but you are terrified of two things at once: the disease you have, and the hospital itself, which everyone thinks is a "germ factory" where you might catch something worse. This fear was so strong that many pregnant women stayed home.

To make things worse, a "noise storm" (called an infodemic) blew through the air. This wasn't wind, but false stories spreading faster than the truth. People heard rumors that vaccines were a "global depopulation tool" or would stop them from having babies. Because of this noise, trust in the health system crumbled. The numbers show this clearly: only 66% of pregnant women got the COVID-19 vaccine, and a tiny 21% got the booster shot. The study found a direct link between fear and action: if a person thought the vaccine was "very safe," 69.1% of them got it. But if they thought it was "not safe at all," only 11.8% got it. The fear wasn't just a feeling; it was a wall that stopped people from getting help.

The "Ubuntu Paradox": A Broken Promise

The most surprising and sad part of the story is what the researchers call the "Ubuntu Paradox." In Zimbabwe, there is a beautiful philosophy called Ubuntu, which means "I am because we are." It's the idea that we are all connected and should take care of each other like a big family. If a neighbor is in trouble, the whole village helps.

But the healthcare system was doing the exact opposite. Even though the government promised "free" maternity care, the reality was that women had to buy their own gloves, syringes, and even water to give birth. It was like a family saying, "We love you and will help you," but then handing you a bill for the bandages and telling you to walk to the hospital yourself. One woman in Masvingo asked the perfect question: "You are on your own when the pain starts. You must have your money, your things, your transport. Where is the 'we' in that?"

This paradox meant that the system forced individual women to carry the whole weight of their care alone, breaking the spirit of community.

The Broken Roads and the Angry Gatekeepers

The "Practical Issues" zone of their map was full of potholes.

• The Money Trap: Even though maternity was supposed to be free, urban clinics charged registration fees of USD 5 to USD 25. Plus, women had to buy their own "sundries" (medical supplies). This made many women choose unsafe home births instead.
• The Staff Shortage: The city was running out of doctors. Only 17% of deliveries were helped by a doctor; 75% were handled by nurses who were already exhausted and overworked.
• The Broken Trucks: Over 90% of clinics didn't have working ambulances. If a woman needed emergency help, she often had to find a private taxi or a donkey cart, which was dangerous and expensive.
• The Angry Gatekeepers: The researchers found that the relationship between patients and doctors had turned sour. Nurses, stressed and underpaid, sometimes shouted at or shamed young mothers and teenagers. One nurse admitted, "We serve them because we are not allowed not to, but we make our own assessments." This made teenagers afraid to go back for help.

Who Got Help and Who Didn't?

The study showed that help wasn't distributed equally.

• Religion and Leaders: In some places, traditional leaders said, "Get the vaccine!" and people listened. In other places, religious groups said, "Don't trust the vaccine; God will protect you," and people stayed away.
• The Teenagers: Young people faced a double wall: they were scared of being judged, and the clinics often didn't have special "Youth Friendly Corners" where they could talk privately.
• The Rich vs. The Poor: People in cities with NGOs (non-governmental groups) had better access to free medicine and cancer screenings. But in rural areas, these services were rare or only came once in a while, leaving people with no choice but to use traditional herbs or go without.

The Verdict: Resilience is a Team Sport

The researchers compared their findings to a previous study that looked at a big city hospital. That study said the big hospital was "resilient" and kept working well. But this new study says that "resilience" at the top doesn't matter if the roads leading to it are broken. The big hospital was only safe because the smaller clinics were failing, pushing the sick people to the top, while many others were left behind at home.

The paper concludes that fixing the system isn't just about buying more ambulances or giving more vaccines. It's about fixing the "Ubuntu Paradox." We need to move from a system where everyone fights alone to a system where the community and the government share the burden. The researchers suggest that if we want a healthy future, we must make care truly free, treat doctors with respect so they don't get angry, and listen to the voices of the people who are actually living through the storm. The evidence is clear: the system is broken, but the path to fixing it is visible. We just need the will to walk it.