MOZAMBIQUE: Making childbirth safer

ESPUNGABERA, 22 May 2009 (PlusNews) - During its first five years of operation, between 2002 and 2007, the health centre in Mude, in the Mussorize district of Manica Province, central Mozambique, assisted in only one birth.

"Men are unaware of the importance of safe childbirth," said Otília Rabissone, a nurse specialising in maternal and child health. “This lack of awareness, when combined with jealousy, leads them to prohibit their wives from receiving care from a male nurse.”

A reluctance to give birth in hospitals, and the long distances that must often be travelled to reach them, have been major obstacles in efforts to ensure safe deliveries and the prevention of mother-to-child transmission (PMTCT) of HIV.

HIV prevalence in Manica Province is 19 percent, compared to the national average of 16 percent, but the instruments used by traditional midwives are rarely sterilised, and most are unaware of the measures that must be taken when an HIV-positive woman gives birth.

Getting women to use health services

Extensive information on the importance of safe childbirth and a number of changes in the health care system have gradually increased the number of women in Mussorize district giving birth at health centres.

"When the childbirths began to be assisted by women [rather than male nurses] more people came to health centres to have their babies, and we began to register at least three births per day," said Rabissone.

A number of changes were also made to get around local customs, for example that women be assisted by an older female relative to please the ancestors. Today, health services in Mussorize encourage women about to give birth to bring their female relative with them to the maternity ward.

"The mothers' waiting houses [hostels where women can stay for several days and receive medical attention until labour begins] are a reliable alternative for women who live far from the health centre," said Carlos Selemane, head district doctor in Mussorize.

Tackling barriers to PMTCT

Justina*, 29, gave birth to her first three children at home and all suffered severely from measles. "This time I came [to the health centre], because I can get medical assistance, but mainly because we're at the end of the farming season and there's not much work to be done," she said. "That's why my husband let me come."

The low social position and educational level of women, especially in rural areas, complicates the implementation of PMTCT programmes, as does the level of stigma associated with HIV infection.

Justina's husband, for example, advised her not to take an HIV test during a pre-natal check-up, fearing that the news would spread if the result was positive. "I had no choice, and I refused to take the test," she said. Many women are prohibited by their partners from even going to the health centre.

Data from the District Health and Social Action Services in Mussorize show that by December 2008, PMTCT services were offered in nine of the district's health centres. HIV tests were offered to roughly 8,000 pregnant women, 87 percent of whom accepted, but only 14.5 percent of the 358 who were positive received treatment to prevent transmission.

According to the World Health Organisation, an HIV-positive pregnant woman without access to PMTCT services runs a 30 percent risk of passing the virus to her baby. A single dose of the antiretroviral drug, nevirapine, given to the mother during labour, and to the newborn child, reduces the risk to 13 percent.

A Health Ministry survey found that knowledge about this risk was still low, in particular among poor women with no formal education in rural areas, where over 70 percent of the population lives.

The UN Children's Fund (UNICEF) supports a community awareness campaign in which groups of women share information on HIV and PMTCT, with explanatory posters to reduce prejudice and increase the participation of men. Local leaders are also encouraged to talk about health, including PMTCT, in neighbourhood meetings.

The Manica Provincial Health Department is training traditional midwives to reduce the risk of mother-to-child HIV transmission, and 22 of them in Mussorize district are being taught to sterilise cutting tools and counsel pregnant women on feeding practices.

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Theme (s): Gender Issues, HIV/AIDS (PlusNews), Prevention - PlusNews,

[This report does not necessarily reflect the views of the United Nations]