Mozambique

OVERVIEW

Generally speaking, Mozambique is a country in transition. The majority of the country is poor, with a high fertility rate and infant mortality rate. Women tend to marry young, and child marriage and teen marriage is common. There are low rates of contraceptive use. The country struggles with issues related to gender inequality and a high rate of HIV infection. However, Mozambique is a young country, with over 60% of the population younger than 25 years old, and there are initiatives to improve sexual and reproductive health care. The rates of HIV infection and HIV-related deaths have gone down in recent years. Furthermore, the country has made significant strides to improve primary health care and reduce the infant mortality rate. For these reasons, it is perhaps most accurate to say that Mozambique faces significant challenges, as related to health care, but it has also seen growth since the 1990s. On a cultural and religious level, the country is also very diverse. The populace is a mix of many religions, including Roman Catholic, Muslim, Protestant, and other religions.

Contraception (Birth Control)

General Note: There are many types of contraceptives, also known as "birth control," including IUDs, oral contraceptives, patches, shots, and condoms, etc. If you would like to view a full list, click here.

Laws & Social Stigmas

In Mozambique, you can purchase condoms and birth control pills at pharmacies without a prescription. While you may technically need a prescription for birth control pills, this is not typically enforced, and birth control pills are available over-the-counter. However, for other forms of contraception, such as implants, injectables, and IUDs, you may need to directly visit a hospital or clinic to obtain them.

It is important to understand that many women in the country are poor, and they may not have the economic means to visit a pharmacy for contraception. It may be more common to visit a public facility or an NGO, such as DKT International, if they wish to obtain contraceptives.

Women in Mozambique tend to marry young and have many children. Among 20 to 24 years old, 48% of women (between the ages of 20 to 24) were married before reaching 18 years old. In addition, contraceptives are not commonly used, and women have a high fertility rate (5.02 children born/woman in 2018), making Mozambique the country with the 12th highest fertility rate in the world. According to a 2015 UN report, it was estimated that about 18% of women (who were married/in unions and between ages 15 to 49) were using any form of contraception in Mozambique. This is lower than the Eastern African average, where about 40% of women use any form of contraception, including traditional methods. Furthermore, about 28% of women have unmet family planning needs, which was a bit lower than the Eastern African average (about 24% of women had unmet family planning needs). The most common forms of contraception were contraceptive injectables (about 7% of women) and birth control pills (about 6%) of women. There were very low rates of usage for other forms of contraception, including condoms (about 2%), female sterilization (0.3%), the rhythm method (0.3%), withdrawal (0.3%), and IUDs (0.1%). There were practically no users of contraceptive implants or vaginal barrier methods.

What to Get & Where to Get It

• DKT International - Mozambique: This NGO offers a range of contraceptive and family planning services, including condoms, oral contraceptives (birth control pills), IUDs, contraceptive shots/injectables, and contraceptive implants. If you choose to get condoms from DKT International, they typically have three brands: Fiesta, Prudence (a brand represented by DKT), and Íntimo (a trademark brand of DKT Mozambique). Regarding birth control pills, they have Progestyn and Microlenyn 30+, which are both from their Íntimo brand. The injectable is called Enaf, and it's also from their Íntimo brand. If you choose to get contraceptive implants, they have Jadelle or Zarin, as of February 2019. You can check out their family planning FAQ page. They have 30 clinics and 4 mobile clinics in the Maputo, Sofala, Gaza and Inhambane provinces. Headquarters Phone (Maputo): +258 21 415 47; +258 84 305 27 85; Email: info@dktmozambique.org; Beira – +258 84 393 9925; Nampula – +258 84 393 9933

Costs

The cost of a Mirena IUD is 30 000 MZN (440$ USD equivalent) but the copper IUD is also available for about 10$ USD, as of 2017. Condoms (preservatives) are widely available in pharmacies and supermarket at a very low cost.

Emergency Contraception (Morning After Pill)

Important Notes: Emergency contraception may prevent pregnancy for three days (72 hours) and sometimes five days (120 hours) after unprotected sex. Take EC as soon as possible after unprotected sex to prevent pregnancy. If you don't have access to dedicated EC, oral contraceptives can be used as replacement EC, but remember the following: 1) Only some contraceptives work as EC 2) Different contraceptives require different dosages and time schedules to work as EC 3) You must only use the first 21 pills in 28-day packs and 4) They may be less effective than dedicated EC. For general information on emergency contraceptives, click here and here.

Laws & Social Stigmas

In Mozambique, emergency contraceptive pills (morning after pills) are available over-the-counter at pharmacies. You can also find them at public sector clinics and social marketing programs. No prescription is required.

Generally speaking, emergency contraceptive pills are accessible in pharmacies and clinics in Mozambique, particularly in larger cities. However, the knowledge of emergency contraceptives (i.e. what they are, how to use them, etc) may be low among the general populace. In 2014, it was estimated that about 15% of women (of reproductive age) in Mozambique had knowledge of emergency contraceptive options, and 0.9% had ever used emergency contraception. This showed growth in knowledge from 2011, when an estimated 10% of women (of reproductive age) in had knowledge of emergency contraceptive options, but it should be emphasized that education and knowledge of emergency contraceptive is still a concern. In 2015, a study conducted by DKT International found that, while emergency contraceptive pills were available in many pharmacies (i.e. 31 out of the 34 of the pharmacies that they surveyed carried the pill), many pharmacists or pharmacy employees held little knowledge of emergency contraception (such as the correct way to use it).

What to Get & Where to Get It

• You can find emergency contraceptive pills (morning after pills) available at many venues, including pharmacies, clinics and hospitals, social marketing programs, sexual violence programs, family planning programs, and SRH youth-friendly services. They are sold over-the-counter (no prescription required). Some brands you may find are Escinor 1.5, Postinor-2, Pregnon, and SEKURE.
• DKT International - Mozambique: This NGO offers emergency contraceptive options, including morning after pills and IUDs. They have 30 clinics and 4 mobile clinics in the Maputo, Sofala, Gaza and Inhambane provinces. Headquarters Phone (Maputo): +258 21 415 47; +258 84 305 27 85; Email: info@dktmozambique.org; Beira – +258 84 393 9925; Nampula – +258 84 393 9933
• Note: The longest-lasting EC is currently ellaOne. It lasts up to 5 days (120 hours) after unprotected sex. Check to see if your country carries ellaOne. If your country doesn't carry ellaOne, copper IUDs may also prevent pregnancy up to 5 days after unprotected sex. If none of these options are available, and it's been over 3 days since you had unprotected sex, you can still take EC, which may work up to 5 days. Note that EC pills are not 100% effective and should be taken as soon as possible.

Costs

• You can get the emergency contraceptive pill (Postinor-2) in public health facilities, free of charge.

• If you purchase emergency contraceptive pills at a private clinic or pharmacy, you can expect to pay around $1.20 - $3, as of 2015.

Sexually Transmitted Infections (STIs/STDs)

Important Notes - Learn about PEP and PrEP: If you think that you've been recently exposed to HIV (i.e. within 72 hours), seek out PEP (Post-Exposure Prophylaxis). It's a month-long treatment to prevent HIV infection after exposure, and it may be available in your city. Take PEP as soon as possible. For more information, click here. If you are at risk of HIV exposure, seek out PrEP (Pre-Exposure Prophylaxis). It's a daily oral pill that can prevent HIV infection before exposure. To learn more about PrEP, click here.

Laws & Social Stigmas

In Mozambique, there are no known travel or residency restrictions for people with HIV/AIDS. This means that you can enter the country, regardless of your HIV status, and you should not be deported if you test positive for HIV while you are in the country.

It is important to understand that Mozambique struggles with an HIV epidemic. As of 2018, about 13% of the population is infected with HIV, and women tend to have higher infection rates than men. In particular, adolescent girls experience higher infection rates than adolescent boys. Many HIV-positive people do not maintain their ART treatment, and Mozambique has a fragile health care system that suffers from insufficient funding, infrastructure, and resources. However, there is positive news related to HIV as well. The overall HIV infection rate decreased between 2000 and 2016, and the HIV-related death rate deceased between 2013 and 2016.

Testing Facilities

• Clínica de Sommerschield (diagnosis, testing, therapies): Rua Pereira do Logo 52, Maputo. Phone: +258 1 493 924 /5/6
• Centro de Saúde do Alto-Maé (voluntary counselling and testing), Maputo; Phone: +258 1 403 073

Support

• UNAIDS Mozambique
• Kindlimuka (Association of people with HIV/AIDS): Maputo. Phone: +258 1 422 651
• Tip from HIVTravel: "In Mozambique, treatment facilities for people with HIV/AIDS are limited to some private clinics in Maputo, the clinics "Sommerschield" and "Cruz Azul" for example. These clinics have the main combination therapies in stock and can import them from neighbouring South Africa. However, there is no appropriate laboratory equipment. People who live with HIV/AIDS should also be aware of their specific vulnerability caused by other infectious diseases that are common in Mozambique (like malaria, hepatitis, tuberculosis, cholera, meningitis, parasitosis etc.)."

Medications & Vaccines

Laws & Social Stigmas

Regarding HPV, the wide adoption of vaccination is important in all countries, particularly Mozambique. This is because women in sub-Saharan Africa have the highest rate of cervical cancer; it is the main cause of cancer for women in the region. Studies have shown that, when young women are informed about the health benefits of the HPV vaccine, the great majority of Mozambican women want the vaccine.

What to Get & Where to Get It

• You can find the HPV vaccine in Mozambique. There is also a nationwide vaccination pilot program, as of December 2018.
• There are demonstration projects for PrEP (pre-exposure prophylaxis) in Mozambique. They are meant to test the use of options in PrEP in real world settings, rather than in trial sites. For more information, you can contact PEPFAR, Médecins Sans Frontieres, ICAP at Columbia University, or BMGF through WHO. You can also check out this sheet on projects.

Menstruation

Note: In addition to pads and tampons, you can also use menstrual cups and menstrual underwear for your period. To learn more about menstrual cups, click here. To learn more about menstrual underwear, click here.

What to Get & Where to Get It

• One blogger in 2016 noted that it was hard to find tampons in Mozambique.

Gynecological Exams

What to Get & Where to Get It

You can see one of the best female gynaecologist in the country at clinic ICOR (Instituto Do Coracao). Tel. +258 214 1634 7 Address: 1111 Avenue Kenneth Kaunda in Summershield area. Ask for Dr. Elizabeth Mulhovo. She is available on Tuesdays and Thursdays and speaks English fluently. Although ICOR clinic reception staff speak english, you will struggle to make an appointment over the phone; it is best to go in person. This is one of the best private clinics in the country, specializing in cardiology, but you will be able to have any test, procedure, or surgery done there.

Costs

The cost of a gynaecological consultation at clinic ICOR is 1800 MZN (or 26$ USD equivalent). Credit card payment is available, as of 2017. The cost of a Mirena IUD is 30 000 MZN (440$ USD equivalent) but the copper IUD is also available for about 10$ USD, as of 2017.

Pregnancy

Laws & Social Stigmas

Mozambique has a maternal mortality rate of 489 deaths per 100,000 live births, as of 2015, making it the country with the 21st highest maternal mortality rate in the world. This rate is roughly similar to the maternal mortality rate of Lesotho, as of 2015.

Abortion

Important Note: There are two main types of abortions: medical (also known as the "abortion pill") and surgical (also known as "in-clinic"). For medical abortions, you take a pill to induce abortion. For surgical abortions, a procedure is performed to induce abortion. For general information about medical and surgical abortions, click here.

Laws & Social Stigmas

Since 2014, abortions have been legally available upon request in Mozambique. You can have an abortion within the first 12 weeks of pregnancy for any reason. You can have an abortion within 16 weeks in case of rape. For more information, click here.

What to Get & Where to Get It

• Rua Vila Namuali No 246, Bairro da Malhangalene, Maputo, Moçambique. forum@forumulher.org.mz; +25821414037/21414055; +25821414037

Advocacy & Counseling

What to Get & Where to Get It

• Maputo Police: Call 112, 119 or + 258 21 325031
• Maputo Fire Services: Call 198 or +258 21 322222
• Police (national): Call 10111
• Crimestop (national): Call 08600 10 111
• Ambulance (national): Call 10177
• ER24 (national): Call 084 124
• Fire Brigade (national): Call 998/999
• Life Line (national): Call 086 132 2322

List of Additional Resources

• Ministry of Health
• The Associação Moçambicana para Desenvolvimento da Família (AMODEFA): "The Associação Moçambicana para Desenvolvimento da Família (AMODEFA) was formed in 1989. Like most IPPF Member Associations, the organization’s initial focus was family planning, but over the years it has diversified to cover a wider range of sexual and reproductive health (SHR) requirements including emergency obstetrics care, antenatal and post-natal care, and services dedicated to the prevention, treatment and management of HIV and AIDS."
• Family Planning 2020 - Mozambique: "Mozambique became a FP2020 commitment maker in 2012. Mozambique strives to increase the use of modern contraceptive methods by adolescents in secondary schools across the country." Address: Av. M�rtires de Mueda, No. 596. Tel: (+258) 21 492 064/5
• Mozambique CARE: "Since 2007, CARE has focused its programming on women's issues, as CARE knows that empowering women results in whole families being rescued from the misfortune of poverty. Underlying all of CARE's work is a strong mission and organizational vision that seeks to serve individuals and families in the world's poorest communities."
• UN Women - Mozambique: Program goals include: "Women lead and participate in decision making at all levels; Women, especially the poorest and most excluded, are economically empowered and benefit from development; Women and girls live a life free from violence; To increase women’s leadership in peace, security and humanitarian response; National planning and budgeting processes promote stronger institutional accountability to gender equality commitments."
• Equaldex - Mozambique: Click here to learn about LGBTQ rights and laws in Mozambique.