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Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk

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  • Chapman, Rachel R.

Abstract

Despite high infant and maternal mortality rates, many Mozambican women with access to prenatal services delay prenatal clinic consultations, limiting opportunity for prevention and treatment of preventable pregnancy complications. Ethnographic research, interviews with health providers and longitudinal pregnancy case studies with 83 women were conducted in Central Mozambique to examine pregnant women's underutilization of clinic-based prenatal services. The study found that pregnancy beliefs and prenatal practices reflect women's attempts to influence reproduction under conditions of vulnerability at multiple levels. Women reported high maternal reproductive morbidity, frequent pregnancy wastage, and immense pressure to bear children throughout their reproductive years. Reproductive vulnerability is intensified by poverty and an intense burden placed on poor, peri-urban women farmers for family subsistence and continuous fertility in a period of economic austerity, land shortages, and increasing social conflict and inequality. In this environment of economic insecurity exacerbated by congested living conditions, women report competing for scarce resources, including male support and income. This vulnerability heightens women's perceptions that they and their unborn infants will be targets of witchcraft or sorcery by jealous neighbors and kin. They respond by hiding pregnancy and delaying prenatal care. Within the context of women's perceived reproductive risks, delayed prenatal care can be seen as a strategy to protect pregnancy from purposeful human and spirit harm. Women mobilized limited resources to acquire prenatal care outside the formal clinic setting. It is concluded that provision of clinical prenatal services is insufficient to reduce reproductive risks for the most socially and economically marginal since it is their vulnerability that prevents women from using available services. Confidential maternity services and social safety nets for greater economic security are recommended.

Suggested Citation

  • Chapman, Rachel R., 2003. "Endangering safe motherhood in Mozambique: prenatal care as pregnancy risk," Social Science & Medicine, Elsevier, vol. 57(2), pages 355-374, July.
  • Handle: RePEc:eee:socmed:v:57:y:2003:i:2:p:355-374
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    Cited by:

    1. Siddiqui, Shayzal & Smith-Morris, Carolyn, 2022. "Professional competition amidst intractable maternal mortality: Midwifery in rural Pakistan during the COVID-19 pandemic," Social Science & Medicine, Elsevier, vol. 313(C).
    2. Christou, Aliki & Alam, Ashraful & Hofiani, Sayed Murtaza Sadat & Rasooly, Mohammad Hafiz & Mubasher, Adela & Rashidi, Mohammad Khakerah & Dibley, Michael J. & Raynes-Greenow, Camille, 2019. "How community and healthcare provider perceptions, practices and experiences influence reporting, disclosure and data collection on stillbirth: Findings of a qualitative study in Afghanistan," Social Science & Medicine, Elsevier, vol. 236(C), pages 1-1.
    3. Arps, Shahna, 2009. "Threats to safe motherhood in Honduran Miskito communities: Local perceptions of factors that contribute to maternal mortality," Social Science & Medicine, Elsevier, vol. 69(4), pages 579-586, August.
    4. Murray, Susan F. & Akoum, Mélanie S. & Storeng, Katerini T., 2012. "Capitals diminished, denied, mustered and deployed. A qualitative longitudinal study of women's four year trajectories after acute health crisis, Burkina Faso," Social Science & Medicine, Elsevier, vol. 75(12), pages 2455-2462.
    5. Berry, Nicole S., 2006. "Kaqchikel midwives, home births, and emergency obstetric referrals in Guatemala: Contextualizing the choice to stay at home," Social Science & Medicine, Elsevier, vol. 62(8), pages 1958-1969, April.
    6. Hackett, Kristy M. & Kazemi, Mina & Sellen, Daniel W., 2018. "Keeping secrets in the cloud: Mobile phones, data security and privacy within the context of pregnancy and childbirth in Tanzania," Social Science & Medicine, Elsevier, vol. 211(C), pages 190-197.
    7. Storeng, Katerini Tagmatarchi & Murray, Susan F. & Akoum, Mélanie S. & Ouattara, Fatoumata & Filippi, Véronique, 2010. "Beyond body counts: A qualitative study of lives and loss in Burkina Faso after 'near-miss' obstetric complications," Social Science & Medicine, Elsevier, vol. 71(10), pages 1749-1756, November.
    8. Pourette, Dolorès & Pierlovisi, Carole & Randriantsara, Ranjatiana & Rakotomanana, Elliot & Mattern, Chiarella, 2018. "Avoiding a "big" baby: Local perceptions and social responses toward childbirth-related complications in Menabe, Madagascar," Social Science & Medicine, Elsevier, vol. 218(C), pages 52-61.
    9. Mitchell, Ellen M.H. & Kwizera, Amata & Usta, Momade & Gebreselassie, Hailemichael, 2010. "Choosing early pregnancy termination methods in Urban Mozambique," Social Science & Medicine, Elsevier, vol. 71(1), pages 62-70, July.
    10. Valadez, Joseph J. & Hage, Jerald & Vargas, William, 2005. "Understanding the relationship of maternal health behavior change and intervention strategies in a Nicaraguan NGO network," Social Science & Medicine, Elsevier, vol. 61(6), pages 1356-1368, September.
    11. Ana Judith Blanco & Mark A. Micek & Lisa M. Frenkel & Pablo Montoya & Marina Karagianis & Laurinda Matunha & Wendy Johnson & Stephen Gloyd & James Pfeiffer, 2015. "Loss to Follow-Up Among HIV-Exposed Children in an HIV Clinic in Beira, Mozambique," SAGE Open, , vol. 5(3), pages 21582440155, July.

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