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Maternal Health in Angola

Introduction

The World Health Organization lists the leading causes of maternal death as severe bleeding, infections, high blood pressure pregnancy, obstructed labor, and unsafe abortions. These problems contribute about 80% of all maternal mortalities worldwide with the vast majority occurring in developing countries. The other remaining factors that contribute to maternal death are malaria, anemia, and HIV/AIDS during pregnancy. The World Health Organization also states that the reasons why so many women die during childbirth usually are poverty, distance to care, lack of information, inadequate service, and cultural practice. All of these causes of maternal deaths and the corresponding reasons are too well known amoung Angolaian women. (who maternal mortality)

Angola is a relatively large African country that is located on the south west of Africa on the Atlantic coast. Angola shares boarders with The Democratic Republic of the Congo, Zambia, and Nambia. In the sub Saharan region of Africa where Angola is located poor maternal health is an ongoing problem in the early twenty first century along with other health problems. In Angola Maternal health is a very complicated issue.

Maternal Health Statistics

Angola represents one of the highest maternal death rates in the world(G H). Results vary but the estimated number of maternal mortality ratio (MMR) toward the end of the war was between 1281-1500 maternal deaths to 100,000 live births (CBS). This estimate was taken during the late 1990’s and throughout 2002 and represents the MMR situation at the end of the war. In 2008 the estimate decreased to around 610 deaths per 100,000 live births. In comparison Sweden is estimated to have a MMR of five deaths to 100,000 live births. (child info)

Angola has very few physicians to attend to its population. It is estimated that there are only about 0.08 physicians per 1000 people in Angola. (cia) Due to the length of the civil war nearly an entire generation missed out on the opportunity to receiving an education. This has led to a dramatic decrease of health workers and added to the poor maternal health problem. In responce to the shortage of health workers Cuban physicians are currently working in the country to improve health as well as to improve maternal health. (USAID) The maternal mortality rate of the country appears to be decreasing since the end of the civil war in 2002. However, it is still one of the highest in the world. On average women give birth 7.2 times. The infant mortality ratio is 154 deaths per 1000 live births. The mortality rate of children under five is 254 per 1000 live births. Finally the average life expectancy in Angola is 40 years. (USAID back). These figures are very high and show the need for improvement in maternal health.

Factors contributing to Maternal Health

In any given country the health of the people is affected by many different factors. [Health] factors can are as simple as daily life activities, as well as national and cultural realities. There are so many factors that affect the health of any given population and in particularly factors that affect maternal health that it is difficult to number them. Maternal health is closely related to social economic class, education, economics, topography, infectious diseases, and many other factors.

Diseases

Due to Angola’s location the climate is ideal for many tropical diseases that affect maternal health. Angola has a narrow coastal plain that rises into a high plateau in the interior. Rain forests are prevalent in the north and in the south the topography is mainly dry savanna (NG) [Malaria] and [shistosomiasis] are prevalent in the country. (CIA). These diseases and other such as [tuberculosis] and [HIV/Aids] further increase the complications and dangers faced by women during pregnancy. (GH) Location also plays a role negatively affecting maternal health, especially with the entrance of HIV/AIDS into the country. Throughout the seventies and eighties the civil war created an environment with elevated levels of internal migration. These migrants were more likely to behave in ways that increased HIV risk (HIV). However, due to the violence and political instability over the decades the number of people entering Angola from other countries decreased, causing fewer cases of HIV/AIDS to enter the country. This is evident in the HIV/AIDS rate in Angola in 2008 at only two percent compared favorably to neighboring [Zambia] which has an HIV/AIDS rate of thirteen percent (CIA). The location of Angola also makes the population susceptible to tropical diseases. [Malaria] alone is a huge factor of maternal health. In Angola malaria is very prevalent in the northern part of the country due to the climate and appears in the south but more seasonally. Unfortunately, the majority of the population lives in the northern areas. Malaria is a huge concern for maternal health contributing about 25% of the total maternal mortality alone (Africa Malaria). In 2009, [unicef], [NMCP], [who] and other organizations have partnered together in an effort to reduce the malaria burden (Africa Malaria).

Civil War

Of all the factors that negatively affect maternal health in Angola the civil war may have been the most severe. During the war as many as a million people were killed, 4.5 million people became internally displaced, and 450,000 fled the country as refugees (about angola). The 27 year long [Angolan Civil war] had devastating effects across the country. The civil war was fought between the two political parties “The Popular Movement for the Liberation of Angola and the National Union for the Total Liberation of Angola. The war began in 1975 and finally ended with the death of… in 2002 (CIA). The consequences of the war have been devastating throughout the country and had a particularly negative effect on women seeking prenatal care. The war damaged the country’s health infrastructure. Records in war torn areas were not kept during episodes of violence and many were lost due to the war. Vital statistics including death and birth certificates were not kept current and access to reliable healthcare was limited for citizens. For this reason data from this time period regarding maternal health is difficult to find. This harsh reality during the war was partially responsible for a cultural shift. (WBSC) The war has affected women in Angola attitudes regarding health care and child birth. Understandably, the war has made women more cautious and distrustful of government programs, including healthcare (seeking). The war has caused behavioral changes in women seeking health care. It is common for women today to not seek medical attention when in childbirth but to give birth to their children at home.

Health Care System

The Angolan government has not have much success in developing an effective health system. (usaid a) due to lack of infrastructure and rapid urbanization the government has been unable to promote programs that effectively address some of the basic needs of the people. health care specifically is not available for much of the country. (usaid about)

Unsafe Abortion

In Africa abortions are common. However, unsafe abortions are one of the leading causes of maternal death in the developing world. Recently, in Angola attention has been given to address the problem of unsafe abortions. Justice Minister Guilhermina Prata recently presented legislation that may help decrease the number of illegal abortions. In the region of sub-Sahara Africa it is believed that 40% of women who have an illegal and unsafe abortion die due to complications of the surgery. Information on unsafe abortions is difficult to obtain but due to the nature of the health care system and the prevalence of unofficial fees the number of illegal abortions is potentially much higher than reported. The debate regarding unsafe abortions in the country is relatively new and is highly affected by the cultural and religious atmosphere in the country.

Cultural aspects of maternal health

Maternal health in Angola is greatly influenced by the current culture. However, the culture today is a culmination of a society that has faced decades of war, urbanization, political uncertainty and a number of other issues. On the individual level women named four factors that highly influenced their decisions regarding child birth and natal care. The individuals perception of the quality of care, the process of labor, the significance of informal fees, and the women’s perception of being empowered (seeking). Perceptions of the quality of care vary greatly across the country. For many women care at a formal facility is so bad that they prefer to stay at home and have a home delivery. The process of labor is affected by strong traditions. Great admiration is given to grandparents who normally suggest home births with more traditional methods. However, due to more access to technology and the mixing of women in larger cities, a shift is taking place moving toward more advanced means of childbirth in formal hospitals. Dispite this shift of thinking from traditional to more modern child births other factors such as high informal fees, and individual women’s perception of being “curagous,” seem to bar women from seeking care in health facilities.

Poverty

One of the major problems with maternal health in Angola is the existence of wide spread poverty throughout the country. The poverty in the country is a result of long period of violence. The infrastructure was so badly damaged during the war that electricity is not reliable. Healthcare is also an enormous challenge in the country with as many as Poverty is associated with an elevated risk of all kinds of health problems and especially with maternal health. Currently in Angola 68% of the population lives below the poverty line living on only $1.70 a day. Of these 28% live in extreme poverty living on only seventy cents per day (about angola). Poverty discourages women from seeking health care during childbirth. It is common for women to give birth at home for free instead of going to hospital and be forced to pay “hidden fees” in order to receive care. (ad hoc) In Angola ad-hoc demands at clinics are common place (ad hoc) it is not uncommon for patients to arrive at a hospital or a clinic in need of care and be forced to wait until payment is made. The current economic state in the country had helped to create a culture with bribes being common. In many cases women chose to have their children at home instead of go to a hospital. This reality along with the negative level of confidence many women have of the clinicians results in higher numbers of MMR and IMR.

Policies to Reduce Maternal Health

International programs that improve maternal health are currently being developed and implemented in Angola. The government has implemented programs that train midwives providers in order to increase the number of births attended to by a credentialed clinician.

Malaria operational Plan

In 2008 president Obama announced the Global Health Initiative allocating funds to be used to decrease the number of women afflicted with malaria and increase maternal health (malaria). Angola was one of the first countries to receive aid and to have programs implemented to reduce the risk of malaria as well as increase the number of healthy pregnancies. (USAID malaria)