maternal mortality mozambique

Maternal health in Mozambique is a constant concern as the nation’s maternal mortality rate is one of the highest in the world. While some progress has been made, there is still much that needs to be done to ensure that mothers in Mozambique have to access high-quality healthcare. Recently, two initiatives have been created, the Mozambique-Canada Maternal Health Project and a project by the Maternal and Child Survival Program. They are working to improve maternal health in Mozambique.

The Current State of Maternal Health

In 2015, the maternal mortality rate was 489 deaths per 100,000 live births. Approximately one-fifth of these deaths are women under the age of 20. Maternal mortality has declined since 1990 when there were approximately 1390 deaths per 100,000 live births; however, maternal deaths remain high. It is clear that continued efforts are needed to improve the quality of maternal health in Mozambique. Each day, approximately 800 pregnant women die from preventable causes.

One of the primary factors determining maternal mortality rates is the availability of antenatal care. In regions where more women receive four or more antenatal visits, the maternal mortality rate is generally lower. Globally, 62 percent of pregnant women have at least four antenatal visits with a skilled health professional, while 86 percent of women have at least one. In Mozambique, only 51 percent of expectant mothers have at least four antenatal visits.

Additionally, only 54 percent of births are attended by skilled health personnel. Age is also a factor, with 40 percent of women 20-24 years old reporting that they gave birth before the age of 18. Younger mothers have an increased risk of death during childbirth, particularly if there is not someone with medical training present.

Early marriage logically leads to childbirth at a younger age and improving maternal mortality rates in the nation relies on protecting young women. In response to this, the government of Mozambique created the National Strategy to Prevent and Combat Early Marriage in 2016. This program includes better education about sexual and reproductive rights with the goal of empowering women to seek out appropriate care and understand their legal rights. For poorer women, this knowledge is often not enough, however, as they may not have the autonomy to make a legal case or have a healthcare facility readily available to them.

Maternal and Child Survival Program (MCSP)

The Maternal and Child Survival Program (MCSP) has launched a project in Mozambique’s Zambézia Province focused on treating pregnant women with malaria. Malaria currently accounts for 9.6 percent of deaths in the nation, and the rate in the Zambézia Province higher than the average. This project seeks to improve maternal health in Mozambique by tackling maternal and newborn deaths due to malaria.

Malaria during pregnancy has many consequences, including higher rates of maternal anemia and low birthweight babies. These factors increase the likelihood of maternal death as well as stillbirth. A treatment known as IPTs-SP exists that can prevent malaria in expectant mothers, but fewer than 22 percent of women in Mozambique receive adequate dosages during their pregnancy.

The MCSP project is empowering healthcare providers in Mozambique to treat malaria cases in pregnant women regardless of their complexity. For example, a young pregnant woman who had malaria but was also HIV-positive could not receive IPTp-SP treatments because the drug is incompatible with her HIV treatment. However, a different medication was able to be prescribed by an MCSP-trained nurse who had been trained on how to handle a variety of malaria cases.

The project also implemented a Standards-Based Management and Recognition for Malaria program in 58 health facilities in the Zambézia Province. This program is working to collect better data about malaria cases and more effectively implement initiatives for prevention and treatment.

Mozambique-Canada Maternal Health Project

Improving maternal health in Mozambique is a priority for the University of Saskatchewan as well. Researchers from the university are working with Mozambique’s health ministry and the NGO Women and Law in Southern Africa (WLSA) to empower women in 20 different communities through the Mozambique-Canada Maternal Health Project.

Education is a key piece to this project, providing information on maternal, reproductive and sexual health to community members in a way that is participatory and engaging for adolescents and adults. The project is also prioritizing the education of health practitioners to improve the quality of care for mothers in Mozambique.

Additionally, the project seeks to improve resources in the community that can improve maternal and newborn health. They intend to provide local ambulances, establish maternal waiting homes nearby to clinics and support local midwives. The latter is the most important, as having locals who are trained health personnel can greatly benefit rural women who may not have the time or financial resources (particularly in situations of poverty) to travel to a clinic.

These efforts indicate that maternal health in Mozambique is continuing to be a priority. The work that these organizations are doing is focused on empowering women to make their own decisions about their sexual and reproductive lives, ensuring health personnel are properly trained and accessible and meeting the needs of poorer women.

Sara Olk

Photo: Flickr

maternal health

Saving Mothers, Giving Life is a public-private partnership that works with impoverished communities whose mothers have no functioning health care during pregnancy. The organization facilitates health services in Uganda, Zambia and Nigeria in order to better equip their network to ensure a focus on the most vulnerable period for mothers and their newborns – during labor, delivery and 48 hours after birth.

Maternal and infant mortality often mingle together because when a woman dies during childbirth (which occurs around every 2 minutes) her baby’s chance of dying instantly increases by 10 percent. However, institutionalized deliveries have far less complications and drastically improve the conditions of both the mother and newborn postpartum.

In Uganda and Zambia alone there are an estimated 2 million births annually of which 50,000 maternal and infant mortality rates occur because there is no accessible health care service to provide a safe and sanitary facility for women during their pregnancy. Coupled with the fact that nearly half of all Africans lack essential drugs to treat basic infections, these conditions substantiate the reason why approximately 3 percent of births account for infant mortality in the two states combined.

Saving Mothers, Giving Life offers a solution to the detrimental situation of mothers in Uganda and Zambia through various methods that, since their application, have reduced the maternal mortality ratio in Uganda by 45 percent and in Zambia by 53 percent. The foci of the organization all occur within a couple days and because of this a few approaches have proven to be the most effective in practice:

  • Training and mentoring has been a paramount tactic utilized by the organization. In doing this, they establish a means of aiding communities who have no physician or facilities, creating self-reliance.
  • Generating and providing facilities with essential health care supplies that have increased in number of institutionalized births in Uganda by 30 percent and in Zambia by a staggering 90 percent.
  • Mobilizing the community to vie for a health care service in their region in order to strengthen their network empowers communication and transportation along with stabilizing the means by which people seek treatment or consultations.

Currently, the organization only operates in 26 districts across Uganda and Zambia; however, it has extended its reach into Nigeria where 14 percent of the world’s maternal mortality and 25 percent of newborn mortality occur. Since its arrival in Cross River State in southern Nigeria, a 40 percent increase of women giving birth in a facility marks its success.

Since 2012 when the organization launched, the drops in mortality rates have only solidified that saving women in low-resource settings and reaching the “audacious 50% reduction of maternal deaths in both countries now seems not only possible, but probable,” secretariat of Saving Mothers, Giving Life said in its 2015 Mid-Initiate Report.

Emilio Rivera

Sources: Saving Mothers Giving Life 1, Saving Mothers Giving Life 2, Saving Mothers Giving Life 3, Saving Mothers Giving Life 4Our Africa
Photo: Save The Children

In Pakistan, one in 89 women die because of pregnancy and childbirth-related complications, and Pakistan’s Maternal Mortality Rate (MMR) is 299 per 100,000 live births.

Twenty percent of the deaths of women of childbearing age are caused by maternal complications. The majority of these deaths are caused by postpartum hemorrhaging. Hemorrhages can be extremely problematic, especially if hospitals do not have enough blood for transfusions to replace the blood loss. Maternal mortality is also high due to puerperal sepsis and eclampsia. Sepsis is when infections during pregnancy, even those not directly related to the pregnancy, trigger the body’s inflammatory response to infection. Sepsis is also called blood poisoning, and it can only be cured with the prompt treatment of antibiotics.

Eclampsia, the third leading cause of maternal deaths in Pakistan, is convulsions in a pregnant woman resulting from high blood pressure. Eclampsia is often followed by a coma.

Rural women are less likely to have access to a hospital. The rate of maternal mortality is consequently higher in rural areas than urban areas—23 percent rather than 14 percent. Home births are extremely common in rural areas. A total of 74 percent of women in rural areas give birth at home, compared to 43 percent of women in urban areas.

If women have an education, they are more likely to seek out prenatal care. Ninety-six percent of women with education had prenatal care visits with a doctor, rather than 50 percent of women who were not educated. One-third of pregnant women in Pakistan do not get prenatal care at all, due to feeling it is unnecessary or that it costs too much money. Prenatal care can help prevent complications and decrease the maternal mortality rate. While prenatal care visits have increased, as of 2007, only 28 percent of Pakistani women went to the recommended four prenatal care visits.

Another reason why Pakistan has a high maternal mortality rate is due to the fact that contraceptive use has not increased much in recent years. In 1984, the Total Fertility Rate (TFR) was six children per woman in Pakistan. By 2008, this number declined to about four children per mother, with a rate of about three children per mother for women in urban areas. However, contraceptive use has remained steady, and only about 30 percent of married women of childbearing age use contraceptives. Contraceptive use is still stigmatized by religious members of the community, such as Mohammed Zakaria, the mufti of Jamia Islamia, an Islamic religious school. Zakaria argues that “family planning is wrong and un-Islamic if practiced routinely.” Educated mothers are more likely to use contraceptives, but many women in Pakistan are uneducated. NPR argues that an increase in education would lead to an increase in contraceptive use and a corresponding decrease in maternal mortality, citing Sri Lanka as an example. In Sri Lanka, the literacy rate is 91 percent (compared to 62 percent in Pakistan).

Maternal mortality is also a problem in Pakistan due to a shortage of doctors, nurses and beds at government hospitals. Many of the regular staff members are postgraduate trainees who are not able to handle pregnancy-related complications.

Pakistan currently only spends less than 1 percent of its GDP on healthcare. In order for maternal mortality rates to decrease, more money has to be devoted to improving hospital care and making hospitals more accessible. The stigma around contraceptive use also has to end, and an increase in education would also lead to a lower MMR.

Ashrita Rau

Sources: NPR, UNICEF, NIH, The Express Tribune, USAID The DHS Program
Photo: Pakistan Today