Making pregnancy safer in Mozambique

Situation analysis

In Mozambique, significant progress concerning maternal health was achieved over the last ten years. The Demographic and Health Surveys (DHS) have shown some improvement of the national indicators related to the use of reproductive health services:

• coverage for institutional deliveries increased from 44% in 1997 to 48% in 2003;
• 84.2% of pregnant women attend at least one ante-natal session, and post-natal visits increased from 37% in 1997 to 51%, in 2003
• the contraceptive prevalence rate for the country increased from 6% to 14%.

Maternal mortality ratio decreased from 1,600 per 100,000 live births in 1990, to 408 in 2003. More recent estimates by WHO/UNICEF /UNFPA reveal a rate of 520 per 100,000 live births in 2005. However, this is still high, even when compared to other countries in East Africa.

WHO/Petterik Wiggers

The main direct causes of maternal death are pre-eclampsia/eclampsia, severe bleeding, infection and obstructed labour, representing 75% of the deaths. Indirect causes (25%) are essentially malaria and HIV. The availability of health facilities providing Emergency Obstetrics Care (EOC) is still low: only 1.9 / 500,000 inhabitants.

Substantial inequities exist in the attainment of these outcomes between population subgroups (e.g institutional deliveries constituted 81% in urban areas but only 34% in rural areas, and antenatal care coverage represented 97.1% in urban areas and 78.6% in rural areas, in 2003).

Some other indicators of maternal health such as a high stillbirth rate of 256 per 1,000 deliveries, and a low percentage of deliveries assisted by skilled health personnel are equally worrying.

Several agencies are supporting the implementation of the operational plan for maternal and peri-natal mortality reduction at provincial level. Currently, every province is implementing its own action plan. The main donors are: UNFPA, (NORAD, DFID and AMDD – Averting Maternal Disabilities and Death), WHO, UNICEF and USAID.

Challenges

• Lack of skilled human resources at all levels;
• Ineffective coordination at all levels among services and departments and between partners;
• Inexistence of a functional monitoring and evaluation system;
• Lack of operational research for critical issues in Maternal, Neo-natal and Child Health (MNCH) implementation;
• Weak community component for the reduction of maternal and peri-natal mortality;
• Limited management capacity of the MOH mainly at the provincial and district level.

Achievements

• A National Strategic Plan for Maternal and Peri-natal Mortality Reduction 2001-2005 was developed, using the internationally accepted "three delays model for maternal mortality." The priority interventions of this national strategy are:
  • To increase the access of woman with obstetric complications to adequate emergency care services, including an effective referral system;
  • To empower communities to participate actively in the process of identification and analysis of their own health problems and rights for the improvement of health status;
  • To improve data collection system and analysis on obstetric complications with the aim of improving obstetric and peri-natal health care services.
• The Intermittent Preventive Treatment/Malaria in pregnancy program's interventions were initiated in 2006 nationwide.
• Integration of Prevention of Mother to Child Transmission of HIV within Reproductive/ Maternal Health services.
• Design of the National Sexual and Reproductive Health Policy;
• Formulation of the National Road Map for acceleration of the reduction of maternal and neo-natal mortality;

Next steps

• Conclude national needs assessment of maternal and neo-natal health services;
• Continue integration of MNCH services;
• Promote better coordination among program and partners at all levels;
• Consider the community component as a key priority within the MNCH programs;
• Strengthen the others pillars for Safe Motherhood (Pre-natal and Pos-partum care and Family Planning).