Induced abortion: A cross-sectional study on knowledge of and attitudes toward the new abortion law in Maputo and Quelimane cities, Mozambique

BMC Women's Health, Volume 20, No. 1, Year 2020

Interpretation

Background: Maternal mortality, of which 6.7% is attributable to abortion complications, remains high in Mozambique. The objective of this paper is to assess the level of induced abortion at the community, as well as to assess awareness of and attitudes towards the new abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities. Methods: A cross-sectional household survey among women aged 15-49 years in Maputo and Quelimane cities was conducted using a multi-stage clustered sampling design. Data on sociodemographic characteristics, maternal outcomes, contraceptive use, knowledge and attitudes towards the new abortion law were collected. Bivariate and multiple logistic regression analysis using the complex samples procedure in SPSS were applied. Results: A total of 1657 women (827 Maputo and 830 Quelimane) were interviewed between August 2016 and February 2017. The mean age was 27 years; 45.7% were married and 75.5% had ever been pregnant. 9.2% of the women reported having had an induced abortion, of which 20.0% (17) had unsafe abortion. Of the respondents, 28.8% knew the new legal status of abortion. 17% thought that the legalization of abortion was beneficial to women’s health. Having ever been pregnant, being unmarried, student, Muslim, as well as residing in Maputo were associated with higher odds of having knowledge of the new abortion law. Conclusion: Reports of abortion appear to be low compared to other studies from Sub-Saharan African countries. Furthermore, respondents demonstrated limited knowledge of the abortion law. Social factors such as education status, religion, residence in a large city as well as pregnancy history were associated with having knowledge of the abortion law. Only a small percentage of women perceived abortion as beneficial to women’s health. There is a need for widespread sensitization about the new law and its benefits. This paper used data from a cross-sectional survey of women of reproductive age conducted in Maputo (2016) and Quelimane (2017) cities. It uses data from 1657 women (827 in Maputo and 830 in Quelimane) taken from the main household survey conducted among women of reproductive age with the objective of understanding sexual and reproductive health. The eligibility criteria for the survey were: being a woman aged 15–49; being a resident of the study site and being a member of the selected household. Women were excluded if they did not give written consent for adult women and parental/caregiver informed consent and informed assent for women under the age of 18 and if there were no conditions for the interview to be conducted in privacy. These two Mozambican cities were selected as study sites mainly because they present different social systems of family organization in Mozambique (patrilineal in Maputo vs matrilineal in Quelimane). Maputo is the capital of Mozambique, and it is located in the South of the country. The total population at the 2017 census was 1,080,356 inhabitants of which 51.7% were women. About 56.0% of women were aged 15–49 years. Of this total, 41.3% were aged between 15 and 24 years old [18]. In Quelimane, the capital of the central province of Zambézia, the total population in 2017 was 347,907 inhabitants, of which 51.9% were women. About half (50.1%) of women were in the reproductive age (15–49 years), and 46.8% of those were aged 15–24 years [18]. Additionally, the national report from Direcção Nacional de Planificação of the Ministry of Health, indicated that the health facilities in Quelimane (696) and Maputo city (2629) attracted a high number of women in Gynecology Urgency, seeking post-abortion services in 2014 [19] compared to other cities located in the same region of Mozambique. Regarding availability and access to health facilities, Maputo has 39 health facilities, of which 5 are of the level II, and 2 are of level IV. Quelimane has 12 health facilities, of which 1 is of level III, and 1 is of level IV. The remaining health facilities in both Maputo (25) and Quelimane (10) are of level I [20]. Level I and II health facilities can only offer primary care services, while health facilities of levels III and IV also offer specialized care [20]. At the moment of data collection, safe induced abortion was offered in health facilities of levels II and IV in Maputo. There was no information about safe abortion services in Quelimane. Data on household wealth, maternal and infant mortality per city are scarce in Mozambique. Existing statistics are usually presented by area of residence (urban vs rural) and province. Thus, the flowing characteristics described are those of the provinces where the studied areas are located. The average of household expenditure per month during the period 2014/15 was 25.912,00 MZN (767.54 USD) in Maputo, while in Zambézia, where Quelimane is located, the average of expenditure per month was 3.749,00 MZN (111.04 USD [21]. Regarding reproductive health, data captured through 2011 DHS showed that in Maputo the level of infant mortality was 61 per 1000 live birth [5]; while maternal mortality was estimated in 362 per 100,000 live birth [22]. For Zambézia, this was respectively 95 per 1000 live births [5] and 508 per 100,000 births [22]. These characteristics reflect the underlying socio-economic differences between the two study sites. The sample size was calculated to include a representative sample of the population. The sample size was adjusted to the cluster design effect and added 5% of contingency rate to cover cases of non-response. The 50% of prevalence was used taking into account that the survey was to collect data about different sexual and reproductive health indicators such as health-seeking behaviour, gender violence, pregnancy, and induced abortion, hence resulting in the maximum sample size. A four-stage clustered sampling procedure was used to sequentially select the neighbourhoods, Enumeration Areas (EA), households and women. EA corresponds to the primary geographic unit defined for sampling in all statistics, such as census, demographic health survey, among others, developed by the National Institute of Statistics [23]. As there were a large number of neighbourhoods and limited financial resources, we used population size and socio-economic status to limit the number of neighbourhoods from which to select. All neighbourhoods with a large population (> 6000 for Quelimane and > 10,500 for Maputo) and a high proportion of the population (= > 0.56) living below the median poverty level were selected. These neighborhoods are densely populated, with difficult access, especially access to information, which is important on issues of health. The subsequent stage consisted of randomly selecting 14 households in each selected EA. This stage was followed by selecting one eligible woman for the interview in each of the selected households. For households with only one eligible woman, she was automatically selected. In households with more than one woman, the names of eligible women were listed. For a detailed description of the sampling strategy, see Additional file 1. Data were collected from August 2016 to January 2017. Data were collected using a questionnaire that was administered to participants in Portuguese by trained research assistants. The questionnaire was adapted from WHO questionnaires [24–26], and the 2011 Mozambican DHS [5]. Before its implementation, the questionnaire was pre-tested with 50 women of reproductive age in Quelimane and Maputo. The following paragraphs present the concepts used in this study and their operationalization. The main outcomes for this study were induced abortion; knowledge of the new status of abortion law, and attitude regarding the availability of abortion services at the health facility. Pregnancy outcomes refer to the way in which pregnancies ended (new-born baby, spontaneous abortion or induced abortion). Spontaneous abortion or miscarriage as a spontaneous expulsion of the fetus due to natural causes before 28 weeks of gestation. Induced abortion (up to 28 weeks of gestation) [13] was defined as using any method to expel the fetus from the womb. The pregnancy outcome was capture through the questions: Have you ever been pregnant? Subsequently, we asked how many times they have been pregnant? For each pregnancy, we asked how it ended? The interviewers were trained to understand if the way pregnancy ended was forced by women, such as the use of any medicine or had been helped, or if abortion was due to natural causes, such as illness. The reasons for pregnancy termination (induced abortion) were measured by an open-ended question that asked about the main reasons to terminate the pregnancy. The answers to this question were analyzed and grouped into 2 categories (personal and interpersonal). The intention to terminate a pregnancy refers to women who had considered an abortion while they were pregnant but did not go through with it. Knowledge and Attitudes towards the new legal status of abortion law were measured through the questions: “Is induced abortion legal in Mozambique?” and “Is the legal permission of abortion at health facility beneficial for women?” (yes, no, and do not know). Socio-demographic characteristics included age in years, marital status divided into two categories, married (formal or traditional union or cohabiting) vs unmarried (not in union, divorced or widow), religion (Catholic, Muslim, Protestant and “Other religion”); education level (no formal education, primary, secondary, tertiary); occupation (unemployed, employed and students). Knowledge of family planning and contraceptive methods was measured through the proportion of women who have ever heard about any modern contraceptive methods and the number of contraceptive methods known. The use of contraceptive methods was measured by the proportion of women reporting having ever used contraceptives. These were measured using Yes/No questions. To allow for comparability with other studies and to ensure that the results reflect the whole target population, data were weighted based on women of reproductive age in the study area. Univariate analyses consisted of descriptive statistics such as means, frequencies, or proportions. This was followed by bivariate and multiple logistic regression analyses. All processes of data analyses either univariate, bivariate, or multiple logistic regression were performed taking into account the study design, using the complex sample procedure in SPSS version 23. First, a comparative description of participants was made, followed by bivariate analysis, to understand the association (test of independence) between the dependent and independent variables. The results were summarized in cross tables. The age was presented as mean with standard deviation (SD), while the remaining, categorical variables were presented as proportions. Multiple logistic regression analysis was applied to identify factors that explain the variability of knowledge and attitudes toward the new legal status of abortion. The covariates used in this regression to predict knowledge of and perceived benefits of abortion permission at the health facility, were: age, marital status, level of education, religion, city of residence, occupation, use of contraceptives, and experience on pregnancy. In the explanation of the perceived benefits of abortion permission at the health facility, we also added knowledge about the new abortion law as an independent variable. These variables are common in this kind of analysis, see, for example, Geleto et al. [27], Awoyemi et al. [28], Bitew et al. [29], Adinma et al. [30], Morroni et al. [31], Tedrow et al. [32]. All variables were entered at once in the model. No selection of variables was done. The proportion of abortion among women was calculated based on, at least, one episode [33] reported by the participant.

AI Digest

Study Justification:

– Maternal mortality in Mozambique is high, with a significant portion attributed to abortion complications.
– This study aims to assess the level of induced abortion and awareness of the new abortion law among women of reproductive age in Maputo and Quelimane cities.
– Understanding the knowledge and attitudes towards the new abortion law is crucial for improving reproductive health outcomes and reducing maternal mortality.

Study Highlights:

– A total of 1657 women were interviewed between August 2016 and February 2017.
– 9.2% of the women reported having had an induced abortion, with 20.0% of those being unsafe abortions.
– Only 28.8% of the respondents knew the new legal status of abortion.
– Factors associated with higher odds of having knowledge of the new abortion law included being unmarried, a student, Muslim, and residing in Maputo.
– Limited knowledge of the abortion law and a small percentage of women perceiving abortion as beneficial to women’s health were observed.

Study Recommendations:

– Widespread sensitization about the new abortion law and its benefits is needed.
– Efforts should be made to improve knowledge and awareness of reproductive health rights and services.
– Targeted interventions should focus on educating women, especially those who are unmarried, students, and residing in areas with limited access to information.

Key Role Players:

– Ministry of Health: Responsible for implementing and coordinating reproductive health programs and policies.
– Non-governmental organizations (NGOs): Involved in advocacy, education, and service delivery related to reproductive health.
– Community leaders and religious leaders: Play a crucial role in disseminating information and addressing cultural and religious beliefs.
– Health professionals: Provide accurate information and services related to reproductive health.

Cost Items for Planning Recommendations:

– Development and distribution of educational materials: Includes the cost of designing and printing brochures, posters, and other materials.
– Training programs for health professionals: Budget for organizing workshops and training sessions to improve knowledge and skills related to reproductive health.
– Awareness campaigns: Allocate funds for organizing community events, radio programs, and other activities to raise awareness about reproductive health rights and services.
– Monitoring and evaluation: Set aside resources for monitoring the implementation and impact of the recommendations, including data collection and analysis.
Please note that the provided cost items are general suggestions and may vary depending on the specific context and resources available.

Strength of Evidence

The strength of evidence for this abstract is 7 out of 10.
The evidence in the abstract is based on a cross-sectional household survey conducted in Maputo and Quelimane cities in Mozambique. The study collected data from 1657 women and used multiple logistic regression analysis. The findings provide insights into the level of induced abortion, knowledge of the new abortion law, and attitudes towards it among women of reproductive age in suburban areas. However, the abstract does not mention the specific sampling methodology used, and there is limited information on the representativeness of the sample. To improve the evidence, the abstract could include more details on the sampling strategy, such as the sampling frame, sampling units, and response rate. Additionally, providing information on the generalizability of the findings to the larger population would enhance the strength of the evidence.

Abstract

This paper used data from a cross-sectional survey of women of reproductive age conducted in Maputo (2016) and Quelimane (2017) cities. It uses data from 1657 women (827 in Maputo and 830 in Quelimane) taken from the main household survey conducted among women of reproductive age with the objective of understanding sexual and reproductive health. The eligibility criteria for the survey were: being a woman aged 15–49; being a resident of the study site and being a member of the selected household. Women were excluded if they did not give written consent for adult women and parental/caregiver informed consent and informed assent for women under the age of 18 and if there were no conditions for the interview to be conducted in privacy. These two Mozambican cities were selected as study sites mainly because they present different social systems of family organization in Mozambique (patrilineal in Maputo vs matrilineal in Quelimane). Maputo is the capital of Mozambique, and it is located in the South of the country. The total population at the 2017 census was 1,080,356 inhabitants of which 51.7% were women. About 56.0% of women were aged 15–49 years. Of this total, 41.3% were aged between 15 and 24 years old [18]. In Quelimane, the capital of the central province of Zambézia, the total population in 2017 was 347,907 inhabitants, of which 51.9% were women. About half (50.1%) of women were in the reproductive age (15–49 years), and 46.8% of those were aged 15–24 years [18]. Additionally, the national report from Direcção Nacional de Planificação of the Ministry of Health, indicated that the health facilities in Quelimane (696) and Maputo city (2629) attracted a high number of women in Gynecology Urgency, seeking post-abortion services in 2014 [19] compared to other cities located in the same region of Mozambique. Regarding availability and access to health facilities, Maputo has 39 health facilities, of which 5 are of the level II, and 2 are of level IV. Quelimane has 12 health facilities, of which 1 is of level III, and 1 is of level IV. The remaining health facilities in both Maputo (25) and Quelimane (10) are of level I [20]. Level I and II health facilities can only offer primary care services, while health facilities of levels III and IV also offer specialized care [20]. At the moment of data collection, safe induced abortion was offered in health facilities of levels II and IV in Maputo. There was no information about safe abortion services in Quelimane. Data on household wealth, maternal and infant mortality per city are scarce in Mozambique. Existing statistics are usually presented by area of residence (urban vs rural) and province. Thus, the flowing characteristics described are those of the provinces where the studied areas are located. The average of household expenditure per month during the period 2014/15 was 25.912,00 MZN (767.54 USD) in Maputo, while in Zambézia, where Quelimane is located, the average of expenditure per month was 3.749,00 MZN (111.04 USD [21]. Regarding reproductive health, data captured through 2011 DHS showed that in Maputo the level of infant mortality was 61 per 1000 live birth [5]; while maternal mortality was estimated in 362 per 100,000 live birth [22]. For Zambézia, this was respectively 95 per 1000 live births [5] and 508 per 100,000 births [22]. These characteristics reflect the underlying socio-economic differences between the two study sites. The sample size was calculated to include a representative sample of the population. The sample size was adjusted to the cluster design effect and added 5% of contingency rate to cover cases of non-response. The 50% of prevalence was used taking into account that the survey was to collect data about different sexual and reproductive health indicators such as health-seeking behaviour, gender violence, pregnancy, and induced abortion, hence resulting in the maximum sample size. A four-stage clustered sampling procedure was used to sequentially select the neighbourhoods, Enumeration Areas (EA), households and women. EA corresponds to the primary geographic unit defined for sampling in all statistics, such as census, demographic health survey, among others, developed by the National Institute of Statistics [23]. As there were a large number of neighbourhoods and limited financial resources, we used population size and socio-economic status to limit the number of neighbourhoods from which to select. All neighbourhoods with a large population (> 6000 for Quelimane and > 10,500 for Maputo) and a high proportion of the population (= > 0.56) living below the median poverty level were selected. These neighborhoods are densely populated, with difficult access, especially access to information, which is important on issues of health. The subsequent stage consisted of randomly selecting 14 households in each selected EA. This stage was followed by selecting one eligible woman for the interview in each of the selected households. For households with only one eligible woman, she was automatically selected. In households with more than one woman, the names of eligible women were listed. For a detailed description of the sampling strategy, see Additional file 1. Data were collected from August 2016 to January 2017. Data were collected using a questionnaire that was administered to participants in Portuguese by trained research assistants. The questionnaire was adapted from WHO questionnaires [24–26], and the 2011 Mozambican DHS [5]. Before its implementation, the questionnaire was pre-tested with 50 women of reproductive age in Quelimane and Maputo. The following paragraphs present the concepts used in this study and their operationalization. The main outcomes for this study were induced abortion; knowledge of the new status of abortion law, and attitude regarding the availability of abortion services at the health facility. Pregnancy outcomes refer to the way in which pregnancies ended (new-born baby, spontaneous abortion or induced abortion). Spontaneous abortion or miscarriage as a spontaneous expulsion of the fetus due to natural causes before 28 weeks of gestation. Induced abortion (up to 28 weeks of gestation) [13] was defined as using any method to expel the fetus from the womb. The pregnancy outcome was capture through the questions: Have you ever been pregnant? Subsequently, we asked how many times they have been pregnant? For each pregnancy, we asked how it ended? The interviewers were trained to understand if the way pregnancy ended was forced by women, such as the use of any medicine or had been helped, or if abortion was due to natural causes, such as illness. The reasons for pregnancy termination (induced abortion) were measured by an open-ended question that asked about the main reasons to terminate the pregnancy. The answers to this question were analyzed and grouped into 2 categories (personal and interpersonal). The intention to terminate a pregnancy refers to women who had considered an abortion while they were pregnant but did not go through with it. Knowledge and Attitudes towards the new legal status of abortion law were measured through the questions: “Is induced abortion legal in Mozambique?” and “Is the legal permission of abortion at health facility beneficial for women?” (yes, no, and do not know). Socio-demographic characteristics included age in years, marital status divided into two categories, married (formal or traditional union or cohabiting) vs unmarried (not in union, divorced or widow), religion (Catholic, Muslim, Protestant and “Other religion”); education level (no formal education, primary, secondary, tertiary); occupation (unemployed, employed and students). Knowledge of family planning and contraceptive methods was measured through the proportion of women who have ever heard about any modern contraceptive methods and the number of contraceptive methods known. The use of contraceptive methods was measured by the proportion of women reporting having ever used contraceptives. These were measured using Yes/No questions. To allow for comparability with other studies and to ensure that the results reflect the whole target population, data were weighted based on women of reproductive age in the study area. Univariate analyses consisted of descriptive statistics such as means, frequencies, or proportions. This was followed by bivariate and multiple logistic regression analyses. All processes of data analyses either univariate, bivariate, or multiple logistic regression were performed taking into account the study design, using the complex sample procedure in SPSS version 23. First, a comparative description of participants was made, followed by bivariate analysis, to understand the association (test of independence) between the dependent and independent variables. The results were summarized in cross tables. The age was presented as mean with standard deviation (SD), while the remaining, categorical variables were presented as proportions. Multiple logistic regression analysis was applied to identify factors that explain the variability of knowledge and attitudes toward the new legal status of abortion. The covariates used in this regression to predict knowledge of and perceived benefits of abortion permission at the health facility, were: age, marital status, level of education, religion, city of residence, occupation, use of contraceptives, and experience on pregnancy. In the explanation of the perceived benefits of abortion permission at the health facility, we also added knowledge about the new abortion law as an independent variable. These variables are common in this kind of analysis, see, for example, Geleto et al. [27], Awoyemi et al. [28], Bitew et al. [29], Adinma et al. [30], Morroni et al. [31], Tedrow et al. [32]. All variables were entered at once in the model. No selection of variables was done. The proportion of abortion among women was calculated based on, at least, one episode [33] reported by the participant.

Materials

https://efashare.b-cdn.net/materials/d637af532ca08c7784866cfcc9b73ab4a4d8c641f7e2ddb2354c2e8f7375b24b/12905_2020_988_MOESM1_ESM.docx

Innovations

Based on the provided information, here are some potential innovations that could be recommended to improve access to maternal health:

1. Increase awareness and education: Develop comprehensive awareness campaigns to inform women of reproductive age about the new abortion law in Mozambique. This could include targeted messaging through various channels such as radio, television, social media, and community outreach programs.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of health facilities, particularly in areas with limited resources. This could involve increasing the number of health facilities, ensuring they are adequately staffed, and providing necessary equipment and supplies for safe abortion services.

3. Training and capacity building: Provide training and capacity building programs for healthcare providers on safe abortion procedures and post-abortion care. This would help ensure that healthcare providers have the necessary skills and knowledge to provide safe and quality care to women seeking abortion services.

4. Community engagement and involvement: Engage with community leaders, religious leaders, and other influential stakeholders to promote understanding and acceptance of the new abortion law. This could involve organizing community dialogues, workshops, and sensitization programs to address misconceptions and reduce stigma surrounding abortion.

5. Integration of reproductive health services: Integrate reproductive health services, including safe abortion services, into existing healthcare systems. This would ensure that women have access to comprehensive reproductive healthcare, including contraception, family planning, and post-abortion care.

6. Research and data collection: Conduct further research and data collection to better understand the barriers and challenges women face in accessing safe abortion services. This information can help inform evidence-based policies and interventions to improve access to maternal health.

It is important to note that these recommendations are based on the specific context of Mozambique and the findings of the study mentioned. Implementing these innovations would require collaboration between government agencies, healthcare providers, NGOs, and other stakeholders to ensure their effectiveness and sustainability.

AI Innovations Description

Based on the description provided, the recommendation to improve access to maternal health would be to focus on widespread sensitization and education about the new abortion law and its benefits. The study found that there was limited knowledge of the abortion law among women of reproductive age in suburban areas of Maputo and Quelimane cities in Mozambique. Only 28.8% of the respondents knew the new legal status of abortion, and only 17% thought that the legalization of abortion was beneficial to women’s health.

To address this issue, it is important to implement comprehensive awareness campaigns and educational programs that provide accurate information about the new abortion law and its benefits. These campaigns should target women of reproductive age, as well as the broader community, including healthcare providers, religious leaders, and community leaders. The goal is to increase knowledge and understanding of the law, dispel misconceptions, and promote positive attitudes towards abortion as a safe and legal option for women’s reproductive health.

Additionally, efforts should be made to improve access to safe abortion services in health facilities, particularly in areas with limited availability. This may involve training healthcare providers on safe abortion procedures and ensuring that health facilities have the necessary resources and equipment to provide these services. It is also important to address any social and cultural barriers that may prevent women from seeking abortion services, such as stigma and discrimination.

By increasing knowledge and understanding of the new abortion law and improving access to safe abortion services, it is hoped that maternal health outcomes will improve, and the incidence of unsafe abortions and maternal mortality related to abortion complications will decrease.

AI Innovations Methodology

Based on the provided description, here are some potential recommendations to improve access to maternal health:

1. Increase awareness and education: Implement comprehensive awareness campaigns to educate women and communities about maternal health, including the new abortion law. This can be done through various channels such as community health workers, radio programs, and social media.

2. Strengthen healthcare infrastructure: Improve the availability and accessibility of healthcare facilities, particularly in areas with limited resources. This includes increasing the number of health facilities, ensuring they are adequately staffed, and providing necessary equipment and supplies for safe abortions.

3. Training and capacity building: Provide training and capacity building programs for healthcare providers to ensure they have the necessary skills and knowledge to provide safe and legal abortion services. This can include training on counseling, post-abortion care, and the use of medical abortion methods.

4. Address social and cultural barriers: Address social and cultural barriers that prevent women from accessing maternal health services, such as stigma and discrimination. This can be done through community engagement and sensitization programs that promote understanding and acceptance of women’s reproductive rights.

To simulate the impact of these recommendations on improving access to maternal health, a methodology could include the following steps:

1. Define indicators: Identify specific indicators that can measure the impact of the recommendations, such as the percentage of women with knowledge of the new abortion law, the number of safe abortions performed, or the reduction in maternal mortality rate.

2. Collect baseline data: Gather baseline data on the selected indicators before implementing the recommendations. This can be done through surveys, interviews, or existing data sources.

3. Implement interventions: Implement the recommended interventions, such as awareness campaigns, infrastructure improvements, training programs, and community engagement activities.

4. Monitor and evaluate: Continuously monitor and evaluate the impact of the interventions on the selected indicators. This can involve collecting data at regular intervals, analyzing the data, and comparing it to the baseline data.

5. Analyze and interpret results: Analyze the data collected to assess the impact of the interventions on improving access to maternal health. This can involve statistical analysis, such as comparing pre- and post-intervention data, and interpreting the results in relation to the defined indicators.

6. Adjust and refine interventions: Based on the results and analysis, make adjustments and refinements to the interventions as needed to further improve access to maternal health.

By following this methodology, it is possible to simulate the impact of the recommendations on improving access to maternal health and make informed decisions for future interventions.

Authors & Co-Authors

Statistics:

Citations: 1

Authors: 7

Identifiers:

DOI: 10.1186/s12905-020-00988-6

Research Areas:

Community Interventions, Health System and Policy, Maternal Access, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health, Social Determinants

Study Countries:

Mozambique

Study Design:

Cross Sectional Study, Grounded Theory

Study Approach:

Quantitative

Participants Gender:

Female