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Firoz T, Vidler M, Makanga PT, Boene H, Chiaú R, Sevene E, Magee LA, von Dadelszen P, Munguambe K. Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study. Reprod Health 2016; 13:112. [PMID: 27719679 PMCID: PMC5056498 DOI: 10.1186/s12978-016-0217-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Background Mozambique has one of the highest rates of maternal mortality in sub-Saharan Africa. The main influences on maternal health encompass social, economic, political, environmental and cultural determinants of health. To effectively address maternal mortality in the post-2015 agenda, interventions need to consider the determinants of health so that their delivery is not limited to the health sector. The objective of this exploratory qualitative study was to identify key community groups’ perspectives on the perceived determinants of maternal health in rural areas of southern Mozambique. Methods Eleven focus group discussions were conducted with women of reproductive age, pregnant women, matrons, male partners, community leaders and health workers. Participants were recruited using sampling techniques of convenience and snow balling. Focus groups had an average of nine participants each. The heads of 12 administrative posts were also interviewed to understand the local context. Data were coded and analysed thematically using NVivo software. Results A broad range of political, economic, socio-cultural and environmental determinants of maternal health were identified by community representatives. It was perceived that the civil war has resulted in local unemployment and poverty that had a number of downstream effects including lack of funds for accessing medical care and transport, and influence on socio-cultural determinants, particularly gender relations that disadvantaged women. Socio-cultural determinants included intimate partner violence toward women, and strained relationships with in-laws and co-spouses. Social relationships were complex as there were both negative and positive impacts on maternal health. Environmental determinants included natural disasters and poor access to roads and transport exacerbated by the wet season and subsequent flooding. Conclusions In rural southern Mozambique, community perceptions of the determinants of maternal health included political, economic, socio-cultural and environmental factors. These determinants were closely linked with one another and highlight the importance of including the local history, context, culture and geography in the design of maternal health programs. Electronic supplementary material The online version of this article (doi:10.1186/s12978-016-0217-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tabassum Firoz
- Department of Medicine, University of British Columbia, 330 E. Columbia Street, New Westminister, BC, V3L 3LW, Canada.
| | - Marianne Vidler
- Department of Obstetrics and Gynaecology and the Child and Family Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia, V5Z 4H4, Canada
| | - Prestige Tatenda Makanga
- Department of Geography, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada.,Department of Surveying and Geomatics, Midlands State University, P Bag 9055, Gweru, Zimbabwe
| | - Helena Boene
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
| | - Rogério Chiaú
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
| | - Esperança Sevene
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
| | - Laura A Magee
- Department of Obstetrics and Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Peter von Dadelszen
- Department of Obstetrics and Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK
| | - Khátia Munguambe
- Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique
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ten Hoope-Bender P, de Bernis L, Campbell J, Downe S, Fauveau V, Fogstad H, Homer CSE, Kennedy HP, Matthews Z, McFadden A, Renfrew MJ, Van Lerberghe W. Improvement of maternal and newborn health through midwifery. Lancet 2014; 384:1226-35. [PMID: 24965818 DOI: 10.1016/s0140-6736(14)60930-2] [Citation(s) in RCA: 291] [Impact Index Per Article: 29.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In the concluding paper of this Series about midwifery, we look at the policy implications from the framework for quality maternal and newborn care, the potential effect of life-saving interventions that fall within the scope of practice of midwives, and the historic sequence of health system changes that made a reduction in maternal mortality possible in countries that have expanded their midwifery workforce. Achievement of better health outcomes for women and newborn infants is possible, but needs improvements in the quality of reproductive, maternal, and newborn care, alongside necessary increases in universal coverage. In this report, we propose three priority research areas and outline how national investment in midwives and in their work environment, education, regulation, and management can improve quality of care. Midwifery and midwives are crucial to the achievement of national and international goals and targets in reproductive, maternal, newborn, and child health; now and beyond 2015.
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Affiliation(s)
| | | | - James Campbell
- Instituto de Cooperación Social Integrare, Barcelona, Spain
| | - Soo Downe
- School of Health, University of Central Lancashire, Preston, UK
| | | | - Helga Fogstad
- Norwegian Agency for Development Cooperation, Oslo, Norway
| | | | | | | | - Alison McFadden
- Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
| | - Mary J Renfrew
- Mother and Infant Research Unit, School of Nursing and Midwifery, College of Medicine, Dentistry and Nursing, University of Dundee, Dundee, UK
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