(April 2000) The floods in southern Africa have turned world attention and resources to Mozambique. International donors have flown in emergency shipments of food, medical supplies, and search and rescue personnel to lessen human suffering and minimize the death toll — 500 confirmed and hundreds more expected.

A far deadlier but less obvious problem besetting the southeastern African country is maternal mortality. Maternal mortality, like the deaths from the floods, is difficult to measure; yet unlike a sudden natural disaster, the problem doesn’t make international news.

Mozambique’s ratio of maternal deaths to 100,000 live births — 1,500 — is among the world’s highest. With the country’s population of 19.6 million, the ratio translates into about 9,800 maternal deaths per year; roughly one in seven women die from pregnancy or childbirth complications. Often, the women who die leave behind other children, whose care may be jeopardized. In nearly every case, the deaths of women rob their families and societies of social support and productive workers.

Why is the toll so high? In fact, it could be higher. It’s difficult to measure maternal mortality because it requires accurate information about deaths of women ages 15 to 49. Few less-developed countries register births and deaths; fewer still record cause of death, which even in more-developed countries may elude health care workers if the women have tried to conceal or abort their pregnancies.

That is why the World Health Organization and UNICEF estimate maternal mortality rates and ratios for less-developed countries including Mozambique based on birth rates and the proportion of births that are assisted by a trained person. In the case of Mozambique, specialists use mathematical models to predict the proportion of all deaths of women of reproductive age that are maternal, and then apply this proportion to UN projections of adult female deaths.

There are three main reasons for Mozambique’s high maternal mortality:

  • Only 60 percent of the population has access to health services, which were destroyed during years of war and have not yet been rebuilt. Poor general health is common, prenatal visits are rare, and fewer than half of births are assisted by trained health workers.
  • Illegal abortions are common and very often result in maternal deaths. Although hospitals interpret abortion laws liberally and offer abortions for a fee, many women are too poor to pay and so go to unsafe practitioners.
  • Seventy-five percent of women are illiterate, and girls drop out of school early — sometimes marrying at age 10 or 11. Marrying young leads to early and risky childbearing; ignorance of family planning means little spacing between births.

These problems also help explain the country’s high infant mortality rate.

As of March 3, USAID’s total contribution to flood relief efforts amounted to $12.7 million. The agency’s fiscal year 2000 budget request for population and health programs in Mozambique totaled $14.5 million.


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Mozambique

Population: 19.6 million

GNP per capita, 1997: US$140

Total Fertility Rate: 5.6

Maternal Mortality Rate: 1,500 deaths per 100,000 live births

Infant Mortality Rate: 134 deaths per 1,000 live births

Source: PRB’s World Population Data Sheet, 1997 and 1999.