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Report: Mozambique making childbirth safer

For 25 years, Danida has supported the health sector in the Tete province in northern Mozambique. The support has helped to ensure that more women give birth in hospitals and clinics instead of in the villages. This has reduced maternal mortality, which is a key component of the efforts to promote sexual and reproductive health and rights.

Manita Egge
Manita Egge gave birth yesterday to a healthy girl. She is now the mother of seven children and hopes that the seventh will be her last.
Photo: Joacim Præst/Danida

After a four-hour drive from the province capital, Tete City, you arrive to the town of Furancungo in the Macanga district, close to the Malawi border. Located here is the district hospital, where five women gave birth during the night. All the births went well, and some of the mothers are getting ready to go home.

These mothers are a small sample of the many women in the Tete province who choose to give birth in clinics or hospitals with trained staff rather than out in the villages with the help of a traditional birth attendant, mother or sister.
In the Tete province, the proportion of women giving birth in health centres has risen from 35 per cent to 55 per cent over the past decade. And when women give birth in a clinic with trained staff, the chances of a safe birth are significantly greater. As a result, maternal mortality in Tete has fallen over the past 20 years from 1,000 to approx. 400 out of 100,000 births.

Hospitals offer more help

One of the women who have just given birth to a healthy and well-nourished girl is Manita Egge. This is her seventh child, and she is pleased to be able to give birth in hospital:

”I have delivered six of my seven children in a hospital. I have chosen to give birth there as I get more help from the hospital and can get drugs if I am in pain. At home, there would only be my mother to help me”, she says with a face indicating that her mother’s help is not the most desirable solution.

She gave birth to her first child at home, but like many other women she prefers to give birth in a clinic or a hospital. ”Earlier, most women gave birth in their own homes, but now most go to the maternity clinic in the village or the hospital in Furancungo,” says Manita Egge.

Neither she nor her husband wish to have any more children, and the plan now is to start using contraception. ”I started going to family planning, but then stopped. Now I want to start having the injections again.”

At the hospital, they offer three methods of contraception: an injection that prevents women from becoming pregnant for three months, the contraceptive pill and an implant that prevents women from becoming pregnant for five years. The most popular method of contraception chosen today is the injection, as it is easier to remember than the daily contraceptive pill. In addition, it is also more discreet if the husband, for example, wants to have more children.

A complicated birth

Elsewhere in the maternity ward lies Maria. She is 19 years old and delivering her baby in the village 25km from Furancungo was not without complications. ”The delivery took a very long time. I first had to make my way from my house to the birth attendant, where I gave birth to the child. I lost a lot of blood and ended up in hospital.”

Maria, 19 years old
Maria lost a lot of blood during the delivery and does not have adequate reserves in her own body to produce milk for her new-born son.
Photo: Joacim Præst/Danida

At the hospital, it was clear that the afterbirth process had not gone well, and Maria reports that the placenta was not delivered until a whole day after the birth. Between giving birth and the placenta coming out, she bled and became anaemic. In the village, they feared that Maria would die and therefore drove her to the hospital. At the hospital, Maria was given iron and put on a protein-rich diet as well as given a lot of fluid through a drip that quickly helped to produce new blood cells.

The support helps alleviate a difficult problem

Reducing maternal mortality and the number of birth complications in Mozambique is more difficult than it looks, as having children is deeply embedded in the culture, and if a woman does not have any children it is socially devastating – particularly in rural areas.

It is also the norm to have many children and to have them at an early age. In Mozambique, slightly over half of all girls get married and become pregnant before turning 18 years of age and before their bodies are fully developed. Consequently, many girls experience birth complications, and today one in 43 women in Mozambique dies in childbirth.

The health authorities in the Tete province are very much aware of the complexities, and they know it will be difficult to reach the UN target of a maternal mortality rate under 250 deaths per 100,000 live births. Nevertheless, Dr. Carla Lázaro Mosse, the director of health in Tete, emphasises that the Danish support is beneficial in a large number of areas:

”Unfortunately, we must recognise that we will not reach the UN goal on maternal mortality. There are too many obstacles in the way right now. The greatest challenge is the distance to health care facilities in the province. That is why the support is so important, as it enables us to buy ambulances and cars, build new facilities and train more nurses and doctors”, she says.

Facts

  • Denmark has supported the health sector in Mozambique for 25 years, but in general we have provided assistance to Mozambique for much longer.
  • Danida’s support for improving health, including sexual and reproductive health and rights, goes primarily to advocacy through political dialogue at central level as well as to the health sector and preventive nutrition in the Tete and Gaza province.
  • In Mozambique, women have 5.3 children on average. In Denmark, the figure is 1.7.
  • Women in rural areas have more children than women in urban areas. In contrast, urban areas are harder hit by HIV/AIDS.
  • Besides birth complications, the high rate of maternal mortality is also due to physical debilitation related to, for example, HIV/AIDS, tuberculosis, malaria and lack of micro-nutrients.