title: Community perspectives on the determinants of maternal health in rural southern Mozambique: a qualitative study.
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.
authors.affiliation: Department of Medicine, University of British Columbia, 330 E. Columbia Street, New Westminister, BC, V3L 3LW, Canada. tfiroz@cfri.ca.
authors.forename: Tabassum
authors.initials: T
authors.lastname: Firoz
authors.affiliation: Department of Obstetrics and Gynaecology and the Child and Family Research Institute, University of British Columbia, 950 W 28th Ave, Vancouver, British Columbia, V5Z 4H4, Canada.
authors.forename: Marianne
authors.initials: M
authors.lastname: Vidler
authors.affiliation: Department of Geography, Simon Fraser University, Burnaby, British Columbia, V5A1S6, Canada.|Department of Surveying and Geomatics, Midlands State University, P Bag 9055, Gweru, Zimbabwe.
authors.forename: Prestige Tatenda
authors.initials: PT
authors.lastname: Makanga
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique.
authors.forename: Helena
authors.initials: H
authors.lastname: Boene
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique.
authors.forename: Rogério
authors.initials: R
authors.lastname: Chiaú
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique.
authors.forename: Esperança
authors.initials: E
authors.lastname: Sevene
authors.affiliation: Department of Obstetrics and Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
authors.forename: Laura A
authors.initials: LA
authors.lastname: Magee
authors.affiliation: Department of Obstetrics and Gynaecology, St George's, University of London, Cranmer Terrace, London, SW17 0RE, UK.
authors.forename: Peter
authors.initials: P
authors.lastname: von Dadelszen
authors.affiliation: Centro de Investigação em Saúde da Manhiça (CISM), Bairro Cambeve, Rua 12, Distrito da Manhiça, CP 1929, Manhiça, Mozambique.
authors.forename: Khátia
authors.initials: K
authors.lastname: Munguambe
mesh_terms: D003153:Community Health Services / Q000592:standards*; D003657:Decision Making; D061345:Early Medical Intervention; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D000068097:Maternal Health / Q000592:standards*; D008427:Maternal Health Services / Q000458:organization & administration / Q000592:standards*; D009073:Mozambique; D011225:Pre-Eclampsia / Q000517:prevention & control*; D011247:Pregnancy; D036301:Qualitative Research; D012424:Rural Population; D012959:Socioeconomic Factors
keywords: Determinants of health; Disparities; Equity; Maternal health; Poverty; Pregnancy