Bringing lifesaving reproductive health care to remote Mozambique

CABO DELGADO, Mozambique – It was a hot day in Mozambique’s Chiúre District, and 23-year-old Constangelina Basílio, brought her young son, Magalhães, into the shade of a tree before telling her story. “We have a special bond,” she said, holding him close, “because we are survivors.”

Giving birth to Magalhães nearly cost Ms. Basílio her life, she told UNFPA. In her remote part of Cabo Delgado Province, women with labour complications have a long way to go for help.

“I recall all the suffering as if it happened yesterday,” she said. “It was around four o´clock… when I started feeling the pain. I managed to contact the community health activists to give me a ride by bicycle to the Mazeze primary health clinic.”

The ride to the clinic, along a poorly maintained road, took over two hours. When she finally arrived, she received bad news. “The moment I arrived, the nurse told me that she would be unable to assist my birth because I required a more specialized assistance,” she recalled.

Ms. Basílio was then transferred by ambulance to a clinic in Chiúre, an hour’s drive away. From there, she was transferred to a hospital in Pemba, the provincial capital. During the three-hour drive to Pemba, her water broke.

“That was the longest and most stressful trip in my life,” she said. “I kept wondering, what if the ambulance had not been available, and what if there were no community health activists to help me?

“When my water broke, I was worried. Luckily, I got to Pemba Hospital in time. I had a Caesarian section and Magalhães, my second child, was born.”

Taking action

Ms. Basílio and Magalhães survived, but many are not so lucky. According to the country’s 2011 demographic and health survey, the maternal mortality rate in Mozambique is 408 deaths per 100,000 live births, but in Cabo Delgado the rate stands at 822 per 100,000 live births. (According to official UN statistics, the country’s maternal mortality rate is slightly higher.) Cabo Delgado’s perinatal mortality is also the highest in the country.

Part of the reason is the poor availability of sexual and reproductive health care. Nationally, an estimated 55 per cent of pregnant women give birth in a health facility, but in Cabo Delgado, this number is only 36 per cent. The province also has the highest early pregnancy rate in the country, according to the 2011 survey.

A new four-year programme seeks to improve Cabo Delgado women’s access to sexual and reproductive health care, and to reduce the number of preventable maternal and infant deaths. Supported by the Korean International Cooperation Agency (KOICA), the programme will train community health workers and nurses, and provide much-needed equipment to health facilities. Community workers will also be trained to raise awareness of voluntary family planning options, which can save lives and improve the health and welfare of families.

The programme aims to reach more than 70 per cent of the province’s population. Both UNFPA and the World Health Organization will contribute technical assistance. The programme will be managed by UNFPA and implemented by the Ministry of Health and partner organizations.

The Government of the Republic of Korean has pledged $7.25 million in funding. “Korea in the 1960s was an undeveloped country, and we experienced similar problems,” said Heeseok Ko, the KOICA representative in Mozambique. “We decided to support this programme in order to help Mozambique improve its maternal health situation.”

Inspired to make a change

Ms. Basílio is also working to improve maternal health in Cabo Delgado. Inspired by her near-death experience with Magalhães, she has become a community health activist.

“I go around and tell women my age that it’s very important to seek assistance to deliver at the hospital to avoid complications,” she told UNFPA.

She also teaches women about the health benefits of family planning. “I also inform them to go to the clinic to receive information that will help them to delay and space pregnancy, and to access different contraception methods for free to better plan their families.”

– Amancio Vilankulos