Abstract
BackgroundMozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. Misoprostol can be administered by a traditional birth attendant or self-administered. The objective of this paper is to examine, through applying a human rights lens, the broader contextual, policy and institutional issues that have influenced and impacted the early implementation of misoprostol for the prevention of PPH. We explore the utility of rights-based framework to inform this particular program, with implications for sexual and reproductive health programs more broadly.MethodsA human rights, health and development framework was used to analyse the early expansion phase of the scale-up of Mozambique’s misoprostol program in two provinces. A policy document review was undertaken to contextualize the human rights, health and development setting in Mozambique. Qualitative primary data from a program evaluation of misoprostol for the prevention of PPH was then analysed using a human rights lens; these results are presented alongside three examples where rights are constrained.ResultsStructural and institutional challenges exacerbated gaps in the misoprostol program, and sexual and reproductive health more generally. While enshrined in the constitution and within health policy documents, human rights were not fully met and many individuals in the study were unaware of their rights. Lack of information about the purpose of misoprostol and how to access the medication contributed to power imbalances between the state, health care workers and beneficiaries. The accessibility of misoprostol was further limited due to dynamics of power and control.ConclusionsApplying a rights-based approach to the Mozambican misoprostol program is helpful in contextualising and informing the practical changes needed to improve access to misoprostol as an essential medicine, and in turn, preventing PPH. This study adds to the evidence of the interconnection between human rights, health and development and the importance of integrating the concepts to ensure women’s rights are prioritized within health service delivery.
Highlights
Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators
Applying a rights-based approach to the Mozambican misoprostol program is helpful in contextualising and informing the practical changes needed to improve access to misoprostol as an essential medicine, and in turn, preventing post-partum haemorrhage (PPH)
This study adds to the evidence of the interconnection between human rights, health and development and the importance of integrating the concepts to ensure women’s rights are prioritized within health service delivery
Summary
Mozambique has high maternal mortality which is compounded by limited human resources for health, weak access to health services, and poor development indicators. In 2011, the Mozambique Ministry of Health (MoH) approved the distribution of misoprostol for the prevention of post-partum haemorrhage (PPH) at home births where oxytocin is not available. The main causes were post-partum haemorrhage (PPH), sepsis, pre-eclampsia or eclampsia, complications arising at the time of birth and unsafe abortion. All of these causes are, to a large extent, preventable [1]. Oxytocin is widely used in health facilities across Mozambique but 30% of births take place without a skilled birth attendant (SBA) and many women give birth without uterotonic protection (IMASIDA, [6])
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