Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study.
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.
['Firoz|Tabassum|T|', 'Vidler|Marianne|M|', 'Makanga|Prestige Tatenda|PT|', 'Boene|Helena|H|', 'Chiaú|Rogério|R|', 'Sevene|Esperança|E|', 'Magee|Laura A|LA|', 'von Dadelszen|Peter|P|', 'Munguambe|Khátia|K|', '|||']
D003153:Community Health Services D003657:Decision Making D061345:Early Medical Intervention D005240:Feasibility Studies D005260:Female D006801:Humans D008297:Male D000068097:Maternal Health D008427:Maternal Health Services D009073:Mozambique D011225:Pre-Eclampsia D011247:Pregnancy D036301:Qualitative Research D012424:Rural Population D012959:Socioeconomic Factors
Maternal health Determinants of health Poverty Disparities Equity Pregnancy