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MOZAMBIQUE: Building Awareness to Reduce Maternal Mortality

Jessie Boylan

COBUE, Mozambique, Sep 17 2009 (IPS) - In the Niassa province of northwest Mozambique, one doctor has been working with local communities to overcome the delays responsible for three-quarters of maternal deaths each year.

Dr Peg Cumberland, a slim, energetic English woman, has worked in Mozambique for over 13 years. She came to the Niassa region in 2004 when she heard that the community was asking for assistance.

Since then she has trained around 400 local people in remote health care. Of that number, only eight are paid staff. The rest are volunteers.

"For the first two years, I didn’t have a house. I just had my backpack and was travelling on foot through the communities, staying in people's homes and spending a lot of time talking with the traditional leaders.

"I set out to establish what people wanted to see happening and how we could work together, but I made it clear that, one, I cannot provide drugs, that we’d have to get them from the government, and two, that I cannot pay people."

More than half a million women die in pregnancy and childbirth every year around the world, a number which has decreased by less than one percent each year since 1990. About 99 percent of these women live in developing countries, and over half in sub-Saharan Africa.

Arguably one of the most ambitious Millennium Development Goals (MDGs) – and the one seeing the least progress – Maternal Health aims to reduce maternal mortality by three-quarters by 2015.

This requires a 5.5 percent reduction in maternal mortalities each year, which would be easily reachable if all births were attended to by skilled health workers, trained midwives, nurses or doctors. Yet currently, only 59 percent of births are professionally attended to in the developing world.

Poor, rural women are at the greatest risk. With long distances between home and a health-care facility, most women who experience complications during childbirth die before reaching help.

Cumberland and her team work with 43 communities along 143 km of the lakeshore, and up in the mountains about three or four hours walk from the lake. "Most of the communities can only be reached by foot or by boat. Some of them in the south can occasionally be reached by car," said Cumberland.

Training

In the only training hall in the small town of Cobue in northwest Mozambique, a group of around 25 people have walked for up to two days to attend Cumberland’s training sessions on remote health care education and services.

"Before the project started," says Pedro Engalamau, a volunteer attending the training session, "people were walking for many kilometres, sometimes for up to three days, but now, because of the outposts (remote health care facilities run mostly by volunteers), people don’t have to walk so far."

Since Cumberland started training traditional midwives and volunteers in the communities in how to identify problems early and refer women to the outposts or clinics, there has been a significant drop in maternal deaths in the region.

"For statistics on maternal mortality you need a huge amount of data to determine the drop. And we don't have that, so I don't think we could show statistically that it has dropped. But anecdotally from what the communities say, there has been a big reduction, and we’ve had no maternal deaths this year so far," says Cumberland.

Causes of maternal mortality

In the past, lack of education in remote areas meant that most people referred to traditional healers for assistance.

"Before the project started, people were dying," said Jordan Baltazarsambau, a volunteer in Cumberland's project. "They were dying and they didn’t know why."

Baltazarsambau's own sister-in-law died. "The first time she gave birth she had to have a caesarean section, and the second time she got pregnant she wasn't sure if she'd need to go to hospital, so she went to the traditional healer who said she would be fine.

"But when it was time for the delivery, there were tremendous problems and she died. Now, the midwives would know to refer a case like that."

According to one traditional belief, a slow birth is caused by the woman being in conflict with someone in the community, and for her labour to progress, that person needs to come and rinse their mouth out with water and then spit the water onto the woman’s abdomen, enabling the child to come out.

"So what really needs to happen is we need to contact the person and they need to come here and do the ritual in the clinic, so we can embrace tradition while administering proper obstetric care," said Cumberland.

The lowly status of women and the lack of women's rights is another cause of maternal mortality in the developing world, although Cumberland doesn't see this as the main concern.

"Education is a big issue, but really it's access to reasonable health services that's needed. We also need quite a high level of health service, to give caesarean sections and transfusions, but I think we're quite a long way from having those facilities in the area. So a lot depends on improving basic infrastructure," she said.

The closest hospital in which these services are available is on Likoma Island. "It is difficult to get a transfer to the island. It can take two or three days of travelling. And it's no quicker in a canoe rowing across," said Cumberland.

"Women are slow getting a transfer to Likoma Island, not because they're being blocked by men, but because they're being blocked by the older women "on the basis of traditional beliefs."

Success story

However, despite the limited access to resources, a dispersed population and minimal funding in the region, projects like Cumberland's should be seen as a success story. She and her team are at least making inroads, not only in reducing maternal mortality in Mozambique, but in tackling the scourge of HIV/AIDS and malaria in the area.

Projects like this, along with ongoing and improved government developments in infrastructure and resources, could eventually ensure that most births are attended to by a skilled health-worker, making the Maternal Health Millennium Development Goal that much more reachable.