MDG 5 - Improve Maternal Health

1. IMPROVEMENT OF MATERNAL HEALTH: STATUS AND TRENDS

Maternal mortality has been gradually reducing from 1000 deaths per 100.000 live births in the beginning of the 90s to 408 deaths per 100.000 life births in 2003. The Implementation of the National Plan and Strategy for the Reduction of Maternal and New Born Mortality from the year 2000, led to considerable improvements in diagnosis in relation to the treatment of obstetric complications and consequently a greater access to quality health services. This increase access is also reflected in increases in the coverage of antenatal consultations, the number of controls per pregnancy, and family planning.

Intra-hospital maternal mortality represents an indicator of quality in relation to pregnancy and delivery health care. Routine records indicate that the intra-hospital Maternal Mortality Ratio per 100.000 live births has decreased from 234/100.000 live births in 1993 to 163/100.000 live births in 2007 although there was an increase to 185/100.000 in 2006. It is believed that this decrease reflects a significant increase in access to heath services (in terms of better means of communication and the expansion of emergency obstetric care), the fact that many pregnant women with obstetric complications who would otherwise die in the community are able to get to health centres, and finally the substantial improved in diagnosis, registration and notification of obstetric complications and institutional maternal deaths.

Despite the weak expansion of Basic Obstetric Care (COEBs) and Emergency Obstetric Care (COEmCs), the main causes responsible for intra-hospital maternal deaths in 2007 are still hemorrhagic bleeding, ante and post delivery, sepsis, pregnancy hypertension and uterine ruptures; with great deal of the cases of mortality closely related to late referrals of women to Health Centres.

Institutional deliveries have increased from 44.2% in 1997 to 47.7% in 2003 with a difference between urban and rural areas of 71.4% and 28.6% respectively. Records routinely collected for the Health Information System (Ministry of Health, MISAU 2007) show a rising trend in coverage for assisted deliveries per practitioner amounting 46.7% in 2004 and 53.8% in 2007. Comparing provinces, Maputo City, Niassa, Inhambane and Sofala show a coverage above national average.

Analysing IDS records on Child and Maternal Health inequality in Mozambique30 (January 2007), a number of factors have been identified as potential causes of obtaining or not the proper delivery care by a qualified practitioner. As shown in the diagram below, 4.61% of these factors are related to social and economical issues including household income (24%), education of woman (16%) and residence in rural areas (12%). Other important social and economical factors include frequency of access to information (5%) and women’s occupational tasks (4%). The quality in care, measured against the quality of antenatal care contributes to 23% of the inequality in obtaining care delivery by qualified personnel, whereas the remaining factors influencing relate to the use of maternal health services (16%) of which 12% have been classified as a perception of barriers to access, particularly in respect to long distances to health centres and the remaining 4% referred to quality of antenatal care.

Antenatal consultation coverage has increased from 71.4% to 84.5% according to surveys in 1997 and 2003 and Antenatal Consultation Coverage (CPN) with 4 or more control referrals, increased from 37.35 to 53.1% . Routine records from the National Health Services show 98% average coverage for CPN with at least 1 referral control in 2007.

In relation to Family Planning, the Total Contraception Rate of Prevalence has increased from 6% in 1997 to 17% in 2003, having in rural areas shown a 3% increase in 1997 to 12% in 2003, whereas in urban area it increased from 18% in 1997 to 29% in 2003, with a significant increase in the Provinces. The Rate of Contraception through Modern Methods was 14.2% in 2003 (IDS, 2003) and the level of unsatisfied demand for Family Planning Services is 53%, with 60% in rural areas and 41% in urban areas.

The target for 2015 is 34%. Routine records MISAU show an increase in Family Planning Programmes in 2007 with 12% new users.

2. MAIN CHALLENGES

• Insufficient Human Resources in number and quality to improve management of Programmes and Services at all levels and for the expansion of Complete and Basic Emergency Obstetric Care;
• More equitable distribution of existing qualified human resources;
• Availability and supply of goods and products for reproductive health including COEmB and COEmC;
• Constant quality improve on Sexual and Reproductive Health Services, including Family Planning;
• Increase the coverage relating to the Vertical Transmission Prevention Srvices and Malaria Preventive Treatment;
• Poor community involvement, and by men in particular, regarding reproductive health programmes and, especially, regarding family planning;
• Deffective system for information, monitoring and evaluation, as well as intra and inter-sector coordination.

3. SUPPORTIVE ENVIRNOMENT

Maternal Health has been a top priority for Government since 1977 with increased investment and significant progress on the main Reproductive Health Indicators. The launching of the Presidential Campaign for Maternal, New Born and Infant Health as well as the launching of a National Logbook for Accelerating Prevention of Maternal and Child Mortality, both express a strong commitment at the highest political level, between the Government and Development Partners in respect to Maternal, Infant and New Born Health. The effort of programmes to achieve the fifth MDG is measured on an annual basis through indicators as part of the Joint Evaluation Board (Governments and Partners) for the Health Sector Performance.

4. PRIORITIES FOR DEVELOPMENT ASSISTANCE

• Initial training for specific professionals in the area of Maternal Heath and their availability at district level (Child and Maternal Health Nurses, Surgery Technicians and Doctors);
• Training and continuous expansion of Emergency Obstetric Care and Essential Obstetric Care;
• Ensure quality of service through teaching supervisions;
• Intervention to strengthen community involvement;
• Strengthening of systems of information, monitoring and evaluation and inter and intra-sector coordination.

Source:2008 Mozambique Report on the Millennium Development Goals