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HEALTH-ANGOLA: The Dangerous Profession of Motherhood
By Karen Iley
LUANDA, Feb 28 (IPS) - 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
(END/2006)
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