20 February 2008
Maputo — 11 Mozambican women die every day due to complications arising during pregnancy and childbirth.
In a year, the death toll adds up to 3,840 women - for every 100,000 live births, 480 women die.
President Armando Guebuza read out these sombre figures on Wednesday morning, at a meeting with health workers to launch the Presidential Initiative for the Health of Mothers and Children, through which the government hopes to speed up a reduction in maternal and infant mortality, and to promote family health.
It is true that some other African countries have worse maternal mortality rates than Mozambique, and Guebuza mentioned the case of Mali, where 1,000 women die for every 100,000 live births.
Yet there is nothing inevitable about shockingly high death rates. In developed countries, death during childbirth is extremely rare. Guebuza cited Ireland, where there are now just two maternal deaths for every 100,000 live births,
"Of all health indicators, it is the maternal mortality rate that most reveals the gulf between developed and developing countries", remarked the President.
The main direct causes of maternal deaths in Mozambique are haemorrhages, uterine rupture, sepsis and eclampsia. It was on these complications that the greatest attention must be focused, urged Guebuza.
"The death of a mother is a tragedy in a family, and a great loss in the community, because she is the moral, social and economic support of the family and the community", declared Guebuza. Pregnancy and childbirth were not illnesses, and so maternal deaths "are one of the worst tragedies in any society, since they can almost always be avoided".
As for the infant mortality rate (deaths among children before their first birthday), Guebuza put it at 178 per 1,000 live births. Almost 30 per cent of these deaths (48 per 1,000 live births) took place in the first month of life. The main cause of this neonatal death rate, Guebuza noted, were premature births, low weight at birth (often caused by malnutrition of the mother), asphyxia, sepsis, congenital syphilis, and other illnesses inherited from the mother.
Guebuza told his audience he had not come with ready made answers, but was "here to listen to your ideas, to understand what you have to tell me about what needs to be done".
Responding to the President's appeal, health workers and students pointed out that the country still has an inadequate health network. There are simply not enough hospitals and health centres, particularly in the countryside. Matters are made worse by the absence of ambulances in most of the country, and the poor quality of the roads, making it difficult to transport pregnant women who have developed complications to the nearest hospital.
Problems in the electricity and water supply sometimes made it difficult to guarantee a safe and hygienic birth. The health service, they added, also suffers from a shortage of staff, and a lack of incentives for health workers.
Some district representatives called for the upgrading of health centres into rural hospitals, with operating theatres that could deal speedily with obstetric emergencies.
The health workers reaffirmed their willingness to help improve maternal and child health, but called for greater contribution from the community, in terms of a change of attitude towards pregnant women, mothers and children.
In response Guebuza recognised the difficult conditions facing health workers, and accepted that an improvement in their working conditions will lead to better care for mothers and their children.
The Presidential Initiative is directly related to two of the eight Millennium Development Goals, approved by world leaders at the United Nations Millennium Summit in 2000, Goal four is to reduce the rate of mortality among under fives by two thirds, and Goal five is to reduce the maternal mortality rate by three quarters by the year 2015.
A document from the Health Ministry notes that among the social factors contributing to maternal deaths, are the premature marriage of girls, and high levels of violence against women and children "practiced in the home, but tolerated by the community".
One aspect not mentioned in this document, but which certainly plays a significant role in maternal mortality, is back-street abortions. Clandestine abortions can lead to death via sepsis, haemorrage or uterine rupture. There is no such thing as a legal abortion in Mozambique, since the repressive clauses in the Portuguese colonial penal code, outlawing abortion under all circumstances, are still on the statute book. In practice, doctors do carry out abortions in hospitals - but nothing is said in public about this, and no right to abortion has yet been established.
Guebuza will continue his series of meetings on Thursday, discussing the issues with women's representatives in the morning, and with religious leaders in the afternoon.
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