Inadequate health facilities failing Mozambique’s mothers

Macomia, Mozambique – Alda Lucas Balide is expecting her sixth child, but carrying this child to term will be different from past pregnancies. Unlike before, the 33-year-old has contracted maternal anaemia and malaria – a major cause of maternal mortality in southern Africa.

Her house was destroyed and her medication washed away by Cyclone Kenneth which made landfall in northern Mozambique on April 25, weeks after Cyclone Idai pounded the country’s central region killing over 600 people.

Balide is among an estimated 10,000 pregnant women in the coastal Cabo Delgado province affected by the fierce storm.

As with many poor pregnant women and new mothers in the country’s poorest region, Balide has to start from scratch preparing for the newborn, but starting over will be no easy feat.

“I have the food to give strength for the birth and I know I will make it, but I don’t know what I will give to this child,” she told Al Jazeera.

Balide’s due date is two months away, but Maria da Silva, the attending doctor at Macomia hospital, over 200km from the tourist town of Pemba, said her medical condition increased the risk of complications: going into premature labour or delivering a baby with a low birth weight.

Although Mozambique’s maternal mortality rate of 489 per 100,000 live births has significantly reduced, it is still among the highest in the world. The global maternal mortality rate stands at 216 deaths per 100,000 live births.

Malaria is endemic to the southern African nation and over 28,000 people have been infected as a consequence of the two cyclones that battered the impoverished nation of nearly 30 million. During pregnancy, anaemia is often a consequence of the deadly fever.

According to da Silva, Balide’s condition could mean she will need an assisted delivery at Macomia’s district hospital, but the labour ward is barely functional.

Health in crisis

The Macomia hospital has no electricity or piped water. The water system, cooking facilities, electronic equipment, and even beds were damaged during the heavy downpour.

Lousia Dorethea Jerafi feeds her baby as she waits for doctors [Tendai Marima/Al Jazeera]

The maternity ward is no longer functional after the roof was blown off and the infrastructure inside the unit was impaired by the cyclone. Across Cabo Delgado, 19 health facilities have been damaged by the Category 4 storm which killed at least 45 people.

More than 1.8 million people have struggled to recover from the damaging cyclones, but Mozambique’s mothers might be the most in need of help.

Mothers who need to have their babies weighed, immunised or measured, have to consult with doctors outdoors.

A temporary unit for gynaecological examinations and assisted procedures has been set up by the medical charity, Doctors Without Borders, known by its French initials MSF, but a better-equipped structure is urgently needed at this rural hospital where on average 120 women give birth each month.

Ingo Piegeler, the humanitarian co-ordinator of the UN Population Fund (UNFPA), told Al Jazeera the aid agency was preparing to provide temporary reproductive health centres in 20 sites across the affected areas in the northern Cabo Delgado and Nampula provinces.

The one-stop health unit is intended to enable women to consult with health workers on prenatal and ante-natal care as well as a range of other health issues.

Piegeler said the biggest challenge in the establishment of the temporary units was remoteness and inaccessibility in some areas of northern Mozambique.

“It’s quite an endeavour to bring everything from far away to here, particularly this location [Cabo Delgado province], but we are thankful to the government for providing us with the transportation for our supplies,” he said.

While UNFPA is optimistic the reproductive health centres will be set up very soon, in the meantime, many women still mill about Macomia hospital’s yard, waiting for nurses to check their baby’s health.

A mother in need

Among the crowds is Louisa Dorothea Jerafi, 26, who delivered baby Louisa in her home, just a week after the cyclone tore through the coastal district. After the rains shattered their house and swept away all their belongings, her husband built a makeshift shelter where they currently live with their four children.

Although two-week old Louisa is healthy, Jerafi worries about whether she’ll be able to produce enough milk as the baby grows. Their food was lost in the storm so they have received 50kg sacks of maize meal, distributed to most families in the rural town.

While Jerafi is grateful her family has something to eat, as a breastfeeding mother she needs more than just starch.

“I need more food, the cassava and maize we have is not enough, the nurses here say I must take more vegetables and fish, but we don’t have anything.

“I don’t know how I’ll look after this baby if I can’t eat and I don’t have anything for her. These two [cloth] wrappers and the clothes I’m wearing are all we have, the rest went with the water,” she said.

According to the World Health Organization (WHO), it is critical for lactating mothers to have energy and protein-rich foods during emergencies to ensure a baby is breastfed well.

“Breastfeeding is the best protection against diseases. Breastfed babies face much less risk of illness than babies who are not breastfed and, if they are sick, the duration of their illness is usually less,” Dr Nellia Mutisse, a specialist in child health with WHO Mozambique said in the organisation’s report.

‘What can I give her?’

Jerafi, like many in Cabo Delgado, a food insecure region, struggles with nutrition, but food is not the only post-cyclone struggle new mothers face.

Joaquina Alberto, another young mother, faces a similar challenge. Five days after the 19-year-old’s home was swept away by Cyclone Kenneth, Alberto gave birth in the small zinc shelter her husband, Joao Antonio, had built for the young family. With the help of a local midwife, she gave birth to a baby girl, Fermida.

“I prayed to God to help me deliver, I was scared for my baby because there were still floods around us when she was born, but I’m thankful she’s fine.

“Now my baby is growing well, but she has nothing, what can I give to her when I have nothing? I need so many things for her, I can’t imagine how we [me and my husband] will provide them,” she told Al Jazeera.

Piegeler said the UNFPA, along with its development partners and the government, would soon begin conducting needs assessments, as one of the key long-term aims of Mozambique’s post-cyclone recovery was to re-establish livelihoods.

“We have to work out how we can provide assistance through small grants or other income-generating activities especially for young women.

“We need to help them contribute in a sustainable and empowered manner that will help their communities to function again as they functioned prior to the disaster,” he said.

A pregnant woman walks past the labour unit at Macomia hospital in northern Mozambique [Tendai Marima/Al Jazeera]