General

New research partnership makes childbirth safer in Mozambique

Nazeem
Muhajarine , The Conversation, March 25, 2018

As the
world awakens to deep injustices for women globally, an ambitious project led by University
of Saskatchewan researchers in Mozambique
is striving to reset the
course — reducing maternal mortality and improving newborn health by empowering
women and girls.
In
Mozambique, gender-based violence, early marriage and early pregnancy
all play
a part in compromising the health of mothers and infants.
(Nazeem Muhajarine), Author
provided

Although
maternal deaths worldwide have decreased by 45 per cent since 1990, about 800 pregnant
women still die daily from largely preventable causes before, during and after
giving birth
.
Mozambique
has one of the highest maternal death rates in the world, estimated at
489 deaths per 100,000 live births in 2015
. One in five of these
maternal deaths occur in
women under age 20
.
The
neonatal mortality rate (deaths during the first 27 days of life) in the
country was 30 per 1,000
live births in 2011
— also one of the highest in the world.
A
gender-equality perspective
In
Mozambique, sexual, reproductive, maternal and infant health is challenged by a
range of factors that include gender-based violence, early marriage and early
pregnancy — all of them products of widespread gender inequality.
As the
government of Mozambique has identified in its National
Strategy to Prevent and Combat Early Marriage (2016-2019)
, education
about sexual and reproductive rights, and access to safe contraceptive methods
and safe abortion are all important tools in reducing barriers to women’s and
girls’ sexual, reproductive and maternal health.
However,
many more interventions that work in an integrated manner are also required.
In April
2017, we launched the Mozambique-Canada
Maternal Health Project
. This five-year project in Inhambane
province will improve access to health-care services for mothers, and work to
reduce maternal deaths and improve newborn health.
Community
engagement activities include mapping local resources and prioritizing topics
for education. (Don Kossick), Author provided
  

Funded by
Global
Affairs Canada
, this project takes a strong gender-equality
perspective in its work.
Working
in 20 communities within five districts, the project aims to support and
empower women within their families and communities. It will increase access to
health care services, increase management and leadership capacity in the health
care system and provide professional education for health practitioners.
The
project will also build infrastructure such as maternal clinics and waiting
homes, provide much-needed ambulances and medical equipment and increase the
use of research-based information in decision-making.
A village
to support safe childbirth
The
project partners with the provincial health directorate, Mozambique’s health
ministry, and two health training centres in Inhambane. It builds on more than
15 years of continuous partnership with Mozambican colleagues.
We also
partner with the NGO, Women and Law in Southern
Africa (WLSA)
, which has extensive experience with developing
knowledge and advocacy in issues related to gender, law and power. WLSA will
provide a gender-perspective to our work.
Our
community engagement activities are underway with community mapping to identify
local resources. Community leadership teams — or “núcleos” — that consist of
equal numbers of women leaders, prioritize topics for local,
participation-based education about maternal, reproductive and sexual health.
Researchers
and staff from Mozambique and Canada describe the ambitions of the five-year
Maternal Health Project.

 
These
teams are also prioritizing micro-enterprises to engage community members,
especially women, and improve their incomes.
The teams
participate in creating a formal and identifiable community-based network of
resources to support women in childbirth. These networks include madronas, or
midwives, and traditional healers, who exert influence in local communities.
It’s said
that it takes a village to raise a child. It also takes a village to support a
woman to have a safe childbirth.
Building
local support networks
For rural
women, reaching health services for deliveries without undue delay can be a
problem. They are often far from a clinic, and without means of transport.
Our
project will provide local ambulances. We will also provide maternal waiting
homes, which meet evidence-based standards for infrastructure and care, close
to the clinics.
Most
importantly, we will support local midwives to improve their ability to support
women in reaching health services without undue delay. We work with
community-based health workers to create an ongoing updated list of pregnant
women and plan support strategies in advance of delivery.
A village
near Balat, Inhambane, Mozambique. (Nazeem Muhajarine), Author provided
 

We are
providing education to health practitioners in clinics and hospitals about
improving care for deliveries and newborns, but also about reproductive and
sexual health issues. Some topics focus on technical skills and others on
improving attitudes towards rural women.
To
contribute to overall health system quality, we are working with the management
of the provincial health department to provide training on topics such as
leadership, conflict resolution and data collection and analysis. With the
health system managers, we are exploring the feasibility of using “near-miss”
methodology (an approach to preventing maternal death by preventing near-miss
cases) to improve practice.
The World
Health Organisation suggests that “a grand convergence” is within our reach,
that is, through
concerted efforts and well-placed resources we can eliminate gender-based
disparities
, of which maternal mortality is one.
To do so
would be a great achievement for gender equity and reflect a shared commitment
to a human rights framework for health.