Focus on poverty and maternal mortality

Two-month old Justine had an ominous start to his short life. His aunt, Fatima Antomane, delivered Justine in the early hours of the morning. She used a paraffin lamp to light up the dark hut and a razor blade to cut his umbilical cord. "Nothing went wrong. My sister gave birth quickly and soon she was cooking and cleaning again," said Antomane in the local language, Mocua. But something did go very wrong for Justine's mother, 23-year-old Awage Federico. A few days after the birth, the family were rushing her to a rural hospital in the northern province of Cabo Delgado. They propped the sick mother on a bike as they ran beside her for the one-hour journey. "When she arrived, the mother was in very bad shape," said the nurse, Filomena Benjamin. "She was suffering from anaemia and a post partum infection. She was still bleeding heavily and the blood smelt badly. They delayed bringing her to the hospital." Federico was given antibiotics and a blood transfusion. But two days later the young mother died, leaving behind baby Justine and two other children, Gito aged three and Latifa aged five. The manner in which Federico died is not uncommon in Mozambique, where about 22 women die every day from pregnancy and childbirth related causes. Mozambique's maternal mortality rate stands at an estimated 1,500 out of 100,000 live births, one of the highest rates in the world. In this southern African country, myths, lack of education and trained medical staff, poorly equipped health facilities with no maternity wards, unreliable or no communication and transport, make giving birth a high risk event. Family members often delay making the journey to the hospital due to misguided beliefs. Complications in pregnancy, such as sepsis (infections), haemorrhage and uterine rupture, are in some areas believed to be the woman's fault. "If a woman has bad habits during her pregnancy, then she will have a complicated birth," said Elena Feta, an elderly traditional birth attendant working in Federico's district. Asked for examples of bad habits, she explained that, "the woman probably had sex with another man during the pregnancy". Confirming the widespread misconception that complications are a result of "infidelity" during pregnancy, a young vibrant, health director of Montepuez, Dr Auzenda Domingos, picked lack of education as the biggest problem she is up against. Even when the families do decide to bring the expectant or new mother to the hospital, finding an ambulance is a feat. In Cabo Delgado, home to 1.3 million people, only one ambulance at the most is available for each of the 16 districts, with some communities 100-km away from the nearest maternity ward. Three districts do not even have one ambulance. When the vehicle is available, making contact with a health facility is another hurdle. Of the three rural hospitals and 84 health units, only four have a telephone, explained Celso Varinde, the provincial director of health in Cabo Delgado province. Some communities do not even have access to radio communication. UN agencies have recently increased their support to the government to reduce these alarming maternal mortality rates. For example, the Dutch National Committee for the UN Children's Fund (UNICEF) has pledged US $950,000 to combat maternal mortality over a three-year period in Cabo Delgado, the province with the highest rate of maternal deaths and the highest numbers of home deliveries. A recent study conducted by the US Agency for International Aid, the UN Population Fund and UNICEF, showed that about 72 percent of women aged 24 years or below gave birth at home compared to the national average of 45 percent. The Dutch funds will be used to hire a medical doctor to assist with the programme in the province. The programme will train more health workers, educate young people in reproductive health, including the prevention of sexually transmitted diseases and HIV/AIDS, and equip maternity wards and build more waiting houses for expectant mothers. UNICEF has already supported the setting up of five waiting houses near hospitals in the province, where expectant mothers can come with their families during the last week of the pregnancy so that any complications can be dealt with in time. "These are very important," Carolina Siu, a UNICEF health officer told IRIN this week. "The women are beginning to use these facilities. We also plan to provide health education for the expectant mothers and their families while they wait." In addition, UNICEF has provided eight radios and four ambulances to the most remote health facilities in Cabo Delgado, and plans are underway to introduce bicycle-ambulances, which have been used effectively in other developing countries. The bicycle-ambulances would be able to accommodate the person pedalling and the expectant mother. However, there is a long haul ahead until stories like Justine's are uncommon in Mozambique. Not only has he lost his mother, but he has been separated from his brother and sister and his own chances for a healthy life are slim. The three children have been shared among their aunts. Justine stays with Christina Antomane, who had walked 30 km to bring Justine to see the family and to the hospital. She had remembered to take his yellow health card, but it showed Justine had not yet been vaccinated. He was also suffering from untreated conjunctivitis. For some reason, she could not explain, Antomane had not taken him to her local health centre. Antomane, herself a young mother, who does not know her age and has never been to school, has two other small children of her own. She cradled Justine tenderly as she enticed a grubby teat of a bottle containing formula milk back into his mouth after he had thrown it on the sandy earth outside her sister's wattle and daub hut.