BORN TO DIE

Angola's health system was left in tatters by the 27-year civil conflict that ended in April 2002. Even after severao years of peace, medical institutions struggle to provide adequate treatment even for common illnesses. A study done last year by Partners for Health ReformPlus reported:

Angola’s health indicators are some of the worst in (Sub Sahara Africa)SSA. The infant mortality rate is 154 per 1,000 live births, and the under-5 mortality rate is 260 per 1,000 live births (Ministry of Planning [MOP] and UNICEF 2003). The total fertility rate is estimated to be 7.2 births per women, and average life expectancy is only 40 years. Malaria is reported to be the principal cause of mortality and morbidity in the country, with a total 3.25 million cases and 38,000 deaths due to malaria reported in 2003 (USAID 2005). A small number of diseases, namely malaria, acute diarrhoeal diseases, acute respiratory infections, measles, and neonatal tetanus, are directly responsible for 60 percent of child deaths, despite the fact that it is relatively easy to prevent or treat these problems at the level of the primary health care (PHC) services, and through better practices and care at household level (Ministry of Health [MOH] 2004b). Malnutrition is the main associated cause of mortality. The rate of maternal mortality was estimated to be between 900 and 1,300 maternal deaths per 100,000 live births, which is 12 times higher than in other developing countries (MOP and UNICEF 2003). Contraceptive
prevalence nationally is estimated to be only 6 percent among women age 15−49 who are married or in de facto unions (MOP and UNICEF 2003). Higher contraceptive prevalence (17 percent) was found in three municipalities in Luanda (Management Sciences for Health [MSH] and Consaúde 2002). These health indicators reflect a series of contributing factors such as lack of access to health services, water, means of excreta disposal, personal and food hygiene, food security, housing, household income, and health care knowledge and practices in communities and households.

The following comes to us from Inter Press Service (Johannesburg)


Health-Angola: The Dangerous Profession of Motherhood
By Karen Iley
Luanda

Walking into the Angolan capital's main maternity hospital, the first thing that hits any visitor is the stench: a nauseating combination of blood and excrement. After a short while, the stomach settles and the eyes adjust to the poor light in the Maternidade Lucrecia Paim; then, the true wretchedness of the grey walls and broken windows begins to sink in.

A heavily-pregnant woman wearing a tatty T-shirt full of holes is obviously in a lot of pain. Unable to find relief, she stumbles up and down the corridor, fretfully tying and untying her grubby sarong. She is wearing no underwear and as she leans, exhausted and moaning, against the wall, blood trickles down her legs and onto the floor.

No-one offers her assistance or a kind word. No-one mops up the blood. The scene is a telling illustration of how perilous child bearing in this Southern African country can be -- and of the difficulties Angola will have in meeting the fifth Millennium Development Goal (MDG) of reducing maternal mortality by three quarters, come 2015.

The United Nations Children's Fund estimates that for every 1,000 live births in Angola, 17 women die from pregnancy-related causes. Angolan women are thought to carry a one-in-seven risk of maternal death, higher than the one-in-16 risk for sub-Saharan Africa -- and much, much worse than the one-in-2,000 and one-in-3,000 risk in Europe and the United States.

To a large extent, these figures are a legacy of Angola's 27-year civil war between government and the Union for the Total Independence of Angola (União Nacional para a Independência Total de Angola -- UNITA).

While the country may now be enjoying its fourth year of peace, there is still a general lack of basic health facilities. Roads made impassable by potholes or landmines render the few services that do exist inaccessible to many in remote areas.

Pregnant women often go without basic antenatal care that includes advice on AIDS, nutrition, hygiene and the prevention of malaria -- a disease which leads to anaemia among pregnant women, and is a chief culprit in both maternal and infant mortality.

They also continue with established, but sometimes dangerous practices of plying their trade at the market or working in the fields right up until childbirth. When expectant mothers fear that something is amiss, they struggle to get to a health facility -- and often arrive too late.

"There is a lack of facilities, but the women also come seeking help at a very late stage," says Maryse Ducloux, assistant medical coordinator with the Belgian branch of Doctors without Borders, an international aid group.

Furthermore, many births take place in the absence of medical staff, meaning that complications which need not prove fatal often result in death.

"There is a long belief in traditional medicine and having babies at home, either on your own or with family members -- mothers, sisters, cousins -- to help. These beliefs are difficult to counteract," notes Ducloux.

"When the women reach the hospitals, the harsh reality is that there is often nothing we can do for them. They just come to die."

Then there is the sensitive issue of abortion, illegal in Angola except in instances where it is required to save a woman's life.

"There are no facilities for abortion, but it doesn't stop some women from trying at home using traditional medicine. They often arrive in our hospitals in a terrible state," says Ducloux.

High levels of fertility and precocious sexual activity mean the threat of complications, infection and death during childbirth is greatly increased.

Government claims to be very concerned about the health of its mothers, and wants to reduce the number of maternal deaths by a third, by 2008 -- something that would also mark substantial progress on MDG five. (In all, eight MDGs were adopted by global leaders at the U.N. Millennium Summit in New York six years ago -- this to address several of the main barriers to development, such as child and maternal mortality, environmental degradation and unfair global trade rules.)

But Angola faces an almost endless list of equally pressing needs, and with maternal health seen as a weaker cash-generator among donors than the fight against child mortality, there are fears that little will be done to make provision for expectant mothers.

Such a development would be especially grim in a country where many women lack access to education, and have few prospects apart from motherhood.

Angolan women have seven children on average. They also start having babies at an early age, with an estimated 70 percent giving birth to their first child while they are still teenagers.

Family planning information is scarce, and while medical practitioners in the field say women are willing to try contraception and birth spacing, the husbands and partners of these women often see this as an affront to their virility.

At Maternidade Lucrecia Paim, Teresa Miguel* is confronting the consequences of under-investment in maternal health.

Her family lives in Viana, a poor suburb just a few kilometers from the centre of Luanda; but her young daughter, pregnant with her second child at just 21 years old, arrived at the hospital too late -- and her baby girl was born dead.

Tears coursing down her cheeks, Miguel clasps her head in her hands and prays out loud for Lucia, who is still in the emergency ward, and still haemorrhaging.

The nurses have sent her out to buy drugs for Lucia, but in her distressed state she doesn't really know what to buy or where to go. Within a few minutes, she is back at the emergency room, empty-handed and panicky.

A young girl of about 16 years old looks on anxiously as she strokes her swollen belly.

"If you don't have the money to buy the drugs and the dressings, then you don't get the treatment," she explains, clutching a 200 kwanza note (about 2.2 dollars) in her hand.

Sadly, she, Lucia and even the bleeding woman roaming the hospital corridor can count themselves lucky. At least they live near the capital and have some access to basic antenatal and post-partum care. Most women in Angola's vast hinterland often have to manage on their own.

* Not her real name