On-Award small grant helps Mozambiquan scholar gain skills for reintegration

The On-Award Small Grants provide an opportunity for scholars to test how they can utilise their skills and knowledge gained through their scholarship in their home environment. It also provides an opportunity to create networks back home before scholars  return home and to start working on their Reintegration Action Plans. One such scholar small grantee is Dulce Osorio who is completing a Master of GlobalHealth/Infectious Diseases Intelligence at the University of New South Wales.

In 2024, Dulce received a small grant from Australia Awards Africa to understand the intersection between maternal health and disability inclusion in Mozambique. In Mozambique approximately 2.7% of the population are people with disabilities, nearly half of whom are women. Despite general health improving, specific groups including women and people with disabilities continue to experience significant disparities in health and poorer health outcomes.

Recognising that women with disabilities face substantial health and social inequalities, Dulce sought to evaluate current policies related to disability inclusion and accessibility to identify gaps and propose strategies to ensure more equitable service provision for all women, particularly those with disabilities.

Dulce’s grant project comprised of a desk-based review of policy and other documents on maternal health and disability inclusion in Mozambique, stakeholder consultations both online and in-person, and workshops with policymakers, healthcare providers, disability advocates and women with disabilities. With activities taking place during a period of instability in Mozambique, this multi-faceted approach to data collection was necessary to progress activities and gain different perspectives. Despite efforts to engage a multitude of stakeholders, protests caused disruptions to communications channels and an inability to access some regions in Mozambique, this resulted in a less diverse range of stakeholders being consulted, with 44% of those consulted being based in the capital city, Maputo and 17% being people with disability.

Stakeholder consultations found that 57% of respondents rated maternal health services as either unsatisfactory or very unsatisfactory and 63% of respondents further considered  that access to maternal health services are rarely equitable or not equitable at all for women with disabilities. Key challenges identified through these consultations included:

• Limited inclusivity for women with disabilities: Facilities lacked ramps, narrow passages, small examination rooms, non-adjustable examination tables and adapted bathrooms. Health professionals have insufficient training to meet the needs of women with disabilities leading to poor treatment and discriminatory practices. Limited or no provisions for sign language and a lack of alternative communication methods excluded women with disabilities from receiving adequate care.
• Deficiencies in services: A shortage of essential equipment and facilities impacts quality of care, along with overcrowding. People living in rural areas must travel long distances to access health facilities and unsafe road infrastructure can further limit access.
• Health provider attitudes: Assumptions that women with disabilities cannot or should not become mothers contributes to negative attitudes and discrimination from health providers. Some respondents reported that a lack of privacy, obstetric violence, and judgement of women with disabilities frequently occurs.
• Structural barriers: Many facilities are not equipped to provide dignified care leading to dissatisfaction among women with disabilities.
• Ongoing challenges: Despite efforts to improve services, gaps remain, especially in rural areas. Despite expanding services, respondents highlighted the need for improved training, infrastructure, and inclusivity to ensure equitable maternal health care for women with disability in rural areas.

According to Dulce, her grant: “Highlighted the importance of adaptability, inclusivity, and collaboration in addressing disability inclusion in maternal health.”

Having an opportunity to connect with stakeholders to start conversations about maternal health care was vital in understanding challenges and proposing solutions. Dulce’s research found that there is a need to continue to advocate for policy change and invest in capacity building to achieve sustainable improvements. Dulce’s findings from her grant are currently being prepared for publication in a scientific journal and she is interested in further strengthening her research skills.