Quality Antenatal Care in Mozambique

This week, FIGO hears from Dr Benjamim Mantigane from FIGO National Member Society Associação Moçambicana de Obstetras e Ginecologistas (AMOG), about maternal health in his country:

Right now, I am concerned about the quality of antenatal care in Mozambique. Antenatal care is essential to make sure women deliver their babies safely, and that those babies are healthy too. I can see that the women coming in have not received the WHO guideline number of eight antenatal care visits. It is a big, big challenge.

Here in Mozambique, we do not have as many gynecologists as we should. Some women do attend four antenatal visits, yet still, some come in with eclampsia. At the follow-up, she has developed high blood pressure. Often we wait to see, or we are unable to give the right prescription, and she develops preeclampsia. 

Many of the women are having antenatal visits with nurses. As the Associação Moçambicana de Obstetras e Ginecologistas (AMOG), we could help train the nurses in additional skills, training, and discuss the cases. Task sharing would be beneficial. We could start with being active in the training programmes of our nurses.

But, accessibility to the antenatal care is an issue; for many women, it is hard to get to clinics. If you go to the districts at the community level, many women have to travel on foot, very far to find quality care. A lack of transport keeps many women from accessing services. 

Government commitments

The government of Mozambique do understand that it is crucial to reduce our Maternal Mortality Ratio. In 2017 there were 3100 maternal deaths, with an MMR of 289 deaths per 100,000 live births, a decline from 798 per 100,000 live births in 2000. 

We now have many ministers and governors who are women. They are leading important causes in Mozambique. Our policies are always focused on maternal and child health. I believe that we are committed to this, and we have made excellent progress.

The new President says that he wants one hospital per district; this was included in his campaign paper. I believe he is committed to this. I hope that this will make it easier for women to access quality antenatal care. However, I could not say that the government is committed to addressing the quality of antenatal care in Mozambique. 

Avoiding unnecessary deaths

We could prevent so many unnecessary deaths in Mozambique if we addressed antenatal care.  I am working in a facility where the number one issue is women coming in with eclampsia and preeclampsia, one of the main causes of maternal death. 

At Central Hospital, the leading causes of maternal mortality is currently post-partum hemorrhage, followed by preeclampsia, and in the first quarter of 2019, preeclampsia was the leading cause. Many of the causes of hemorrhage, are due to premature discolourment of the placenta, an outcome of preeclampsia. Addressing this would be a good way to start.

I believe we have made excellent progress in Mozambique. If there was a strong commitment to increase the amount of antenatal cover, with a focus on quality, I think that we could achieve a lot more to reduce the needless deaths.