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.
