REDUCING MATERNAL AND NEONATAL MORTALITY IN MOZAMBIQUE THE CHALLENGE IN THE NEW MILLENIUM

Economic Growth in Mozambique

Social Indicators access to health facilities30 % access to potable water20 % primary school attendance32 % secondary school attendance10 % Human Development Index 157 / 162 countries

Population: ~17 million MozambiqueMozambique

53% women 23% of these in reproductive age Total Fertility Rate -5.6 Contraceptive Prevalence Rate-5.4% SELECTED INDICATORS

Selected Maternal Mortality Ratios in Africa Source: UN 2001

Mother’s Index The Mother’s Index ranks Mozambique 79 out of 94 countries UNICEF/Pirozzi Source: State of the World’s Mothers 2001

Maternal Death WHO 1990 UNICEF/C-55-10/Watson “The death of a woman during pregnancy, delivery, or the six weeks following the birth of her baby”.

Risk of Maternal Mortality in Mozambique Lifetime Risk of Dying is 1 in 13

Maternal Mortality: a Small Part of a Larger Problem UNICEF/C-79-53/Goodsmith Maternal Mortality Poor Health and Disability

Risk of Death in the First Year of Life Perinatal Mortality: ~ 72 Infant Mortality: Source: Mozambique Demographic and Health Survey 1997; WHO Perinatal Mortality 1986

Perinatal Mortality Rate & Lifetime Risk of Maternal Mortality ALMOST THE SAME Risk of Maternal Mortality in Mozambique

Causes of Maternal Mortality Mozambique 1998 / 99 HIV / AIDS-10.6 Malaria-4.0% Anaemia-2.6%

Woman’s Low Status Jorge Moreiro Lack of access to and control of resources Limited access to education Lack of decision making power

1 Delay In Deciding to Seek Care Unacceptably high rate of illiteracy Ignorance about pregnancy related complications and lack of birth planning Harmful traditional beliefs and practices Within the family or community

2 Delay in reaching care

3 Delay in getting care at the health centre Lack of priority given to pregnant women Lack of qualified midwives, surgical technicians and gynaecologists / obstetricians Inadequate facilities

REDUCE … a Model on Maternal Health and Survival

Estimating the Consequences of Poor Maternal Health REDUCE MODEL Impact on survival and productivity ( ) Data on Maternal Health

Data Sources State of the World’s Mothers, 2001 Save the Children Revisao de Mortes Maternas am Mozambique 1998 / 99 Demographic and Health Survey (IDS 1997) Projeccoes anuais da populacao total Maternal Mortality in 1995, Estimates Developed by WHO, UNICEF, UNFPA The Global Burden of Disease, WHO Health Dimensions of Sex and Reproduction, WHO

Consequences of Maternal and Neonatal Mortality No new interventions maternal deaths

Consequences of Poor Maternal Health Survival consequences Disability consequences Economic consequences

Survival Consequences Loss of productive member of the family, community and society as a whole

Survival Consequences No new interventions > 1/2 million children will die

Disability Consequences Chronic anemia Incontinence Fistulae Chronic pelvic pain Emotional depression Maternal exhaustion 1.5 million women $ 600 million

Economic Consequences The loss of productivity, over the ten year period, due to maternal deaths, will be $ or meticais $ $

Maternal and Child health Policies and Programmes adopted Primary Health Care strategy establishment of Maternal and Child Health Section in MOH mid 1990s establishment of Adolescent and Youth Committee Development of Integrated National Programme

Lack of Impact Inadequate human resources in both quality and quantity Insufficient financial resources Poor programme management including monitoring and supervision Lack of access to services Poor quality of services Insufficient supplies, equipment and drugs Poor referral system

Commitment to reducing maternal and neonatal mortality Goal: 10 % by % by 2010

Reduction in Maternal Deaths

Key Interventions of the Strategy Improving quality of care Increasing access to emergency obstetric care in health facilities The strengthening of the referral system Strengthening community participation

Recommendations (1) Essential and emergency obstetric care at all health facilities The procurement and distribution of equipment, drugs, and supplies Pre-service and in-service training of reproductive health service providers Public and private transport services

Recommendations (2) The referral system, including linkages within and between communities and health facilities Capacity building for communities on the concepts of birth preparedness: - knowing danger signs - birth planning - organizing family resources

Recommendations (3) Availability and access to family planning, ante and post natal care, STI / HIV and AIDS services, including adolescents The provision of periodic presumptive treatment for malaria The provision of iron and folate during pregnancy and Vit A immediately after delivery

Key Message 12,700 women’s lives saved 223,000 disabilities averted 86,000 children’s lives saved $ 84 million in productivity gains

Estimated Costs & Productivity Gains Mozambique

Conclusion the right of Mozambiquan women to life and health benefits outweigh the costs thousands of lives of women and children saved large increase in women’s productivity and income generating capacity

Conditions Needed strong commitment to maternal survival and health by political leaders and decision makers clear focused national maternal survival and health strategy realistic, appropriate, and sufficient investment implementation framework with clearly defined supervision, monitoring and evaluation mechanisms.

The way forward lead the fight against maternal death and disability enable women to fully enjoy their rights fully contribute to the social, economic and political development of Mozambique

Thank You !