Child Mortality In Angola: Understanding The Underlying Causes

Angola has one of the world's poorest healthcare systems, and its infant and child mortality rates are unacceptably high compared to other countries in the region. The country's recent war-filled history has strongly affected its inhabitants, and as a result, children's rights are not always respected. Angola's infant mortality rate refers to the number of infants who do not survive past their first year of life, and it was recorded at 45.7 deaths per 1,000 live births in 2022. This rate is influenced by a variety of factors, including social inequality, the legacy of war, limited access to healthcare, and inadequate nutrition.

Poor healthcare system

Angola's healthcare system is inadequate to meet the needs of its population. The system has not adapted to the growth of the population, the evolution of medicine and public health, the pace of technological innovation, or research and development.

The healthcare sector in Angola is made up of public and private service providers. Public hospitals serve almost 60% of the population, and while access is free, the quality of care is not perceived to be particularly good. Private clinics are expensive, so treatment abroad is sought by middle-to-upper-income families for complex medical interventions. Treatment at public institutions is of inconsistent quality and is provided with poor customer service.

Angola's healthcare system suffers from a shortage of medical professionals and skilled practitioners. There are an insufficient number of trained nurses and technical staff, and the few physicians are limited in their capacity to conduct outreach to the population, compounding the challenges related to delivering quality services.

The country's healthcare infrastructure is outdated and in need of replacement. The best hospitals and clinics are in Luanda, and most public and private healthcare assistance is delivered there. Other provinces and cities outside of Luanda lack modern facilities. In rural areas, citizens must travel significant distances to receive basic healthcare.

The quality of healthcare infrastructure in Angola is poor. There is a need for expanded healthcare infrastructure to provide more specialized treatments and procedures in fields such as cardiology, oncology, orthopedics, trauma, and burns. Many healthcare facilities are in a state of decay and lack basic sanitary conditions, including water and electricity. They run using alternative power and water sources like generators and water tanks and lack proper treatment plants for wastewater. Angola’s rural network requires significant expansion as remote geographical areas are not covered by roads, effectively excluding people from basic public services.

The government has outlined healthcare priorities in its 2012–2025 National Plan for Health Development (PNDS). These include rehabilitating and expanding public healthcare infrastructure and capacity, especially for rural and underserved urban populations, expanding healthcare professional training, and disease prevention. However, feedback from private sector healthcare companies suggests that an updated PNDS plan that spans a longer period would give product and service providers a clearer vision of potential market opportunities and better address the country's needs.

Lack of education

Angola's education sector is lacking in resources and has seen a decline in budget allocations. The Committee on the Elimination of Discrimination Against Women has raised concerns about the "shortage of qualified teachers, poor learning environments, and the suspension of new school construction". This has resulted in girls being forced to walk long distances to school and deprived them of adequate sanitary facilities.

The education programmes in Angola are also judged to be patriarchal and filled with sexist stereotypes about girls and women. Girls are underrepresented in traditionally male-dominated areas of education, such as technical and vocational education. This lack of education and gender inequality has led to a high rate of adolescent pregnancy, due to limited access to sexual and reproductive health services, including contraceptives.

The country's economic crisis, resulting from the drop in crude oil prices and the COVID-19 pandemic, has meant that the Angolan state has less money to invest in social programmes to improve the situation of children and ensure the respect of their rights. Public spending has been greatly reduced, which has impacted the quality of education and access to it.

The lack of education in Angola has also contributed to the issue of child labour and human trafficking. Children are victims of forced and hazardous labour, especially in the domestic work, mining, construction, and agricultural sectors. There is also a lack of awareness about the pathways to flee domestic violence, which further endangers children and prevents them from seeking help.

Gender inequality

Angola has made some progress in terms of gender equality, with 29.6% of parliamentary seats held by women as of February 2021. However, there are still significant challenges to achieving gender equality in the country.

Early Marriage and Adolescent Births

Firstly, early marriage and adolescent pregnancy are prevalent issues in Angola. According to statistics from 2020, 30.3% of women aged 20-24 were married or in a union before they turned 18. The adolescent birth rate has decreased since 2009 but remains high, with 163 births per 1,000 women aged 15-19 in 2014.

Gender-Based Violence

Secondly, gender-based violence is a serious problem in Angola. In 2018, 24.7% of women aged 15-49 reported experiencing physical and/or sexual violence by an intimate partner in the previous 12 months. Additionally, patriarchal norms and traditional practices, such as child marriage, dowry, polygamy, and female genital mutilation, remain entrenched in Angolan society. Despite legal reforms criminalizing female genital mutilation, impunity surrounding forced marriages persists, with a lack of information and investigations on the issue.

Sexual and Reproductive Health and Rights

Thirdly, women of reproductive age in Angola face barriers in accessing sexual and reproductive health services. In 2016, only 29.8% of women had their family planning needs met with modern methods. This lack of access contributes to the high adolescent pregnancy rate and can have negative consequences for maternal and child health.

Education and Employment

Finally, gender inequality in education and employment persists in Angola. Girls are underrepresented in male-dominated areas of education, such as technical and vocational training. Additionally, patriarchal values and sexist stereotypes are prevalent in educational programmes. In terms of employment, there are gaps in data on key labour market indicators, such as the gender pay gap, making it challenging to address inequalities effectively.

Overall, while Angola has shown some progress in gender equality, significant challenges remain. Addressing these issues is crucial to fulfilling the country's commitments to international agreements, such as CEDAW and the Sustainable Development Goals, and ensuring that Angolan women and girls can enjoy their full rights and achieve their potential.

Food insecurity

Angola is facing a severe food crisis, with 3.8 million people reported to have insufficient access to food in several provinces, including Cunene, Huíla, and Namibe. This number represents a 138% increase compared to 2020-2021, when 1.6 million people faced food insecurity. The southern provinces of Angola are experiencing their fifth consecutive year of drought conditions, with below-average rainfall deficits severely compromising agricultural yields and pastoral activities. This has resulted in poor harvests, depleted reserves, and the loss of livelihoods and livestock, all of which have severely impacted the country's food security.

The economic crisis that began in 2014, coupled with rising food prices and the COVID-19 pandemic, has further exacerbated the situation. The increase in food prices has made it difficult for vulnerable populations to meet their minimum food requirements, leading to the adoption of crisis or emergency coping strategies such as skipping meals, borrowing, reducing quantities, and consuming less preferred foods. Additionally, the Russia-Ukraine war has impacted regional food security, with wheat prices in Angola rising by 50% in March 2022.

The lack of access to safe water and sanitation in most rural communities in the south further exacerbates the problem. Water-borne diseases, resulting from the consumption of unsafe water, contribute to malnutrition and pose severe health risks, especially to children. An estimated 1.2 million people face water scarcity, and the drought conditions are expected to persist, with possible decreases in water resources in the southern provinces of over 50%.

The impact of food insecurity on child mortality in Angola is significant. In 2022, it was projected that 400,000 children would be acutely malnourished, with a prevalence of global acute malnutrition already above emergency thresholds (15%) in some provinces. However, the shortage of therapeutic feeding supplies due to supply chain disruptions has limited the ability to provide treatment. UNICEF targets 56,000 severely acutely malnourished children for treatment, but with current funding, only 11,000 can be assisted.

The situation is further complicated by inadequate dietary intake, poor feeding practices, and the high prevalence of water-borne diseases and infections due to limited access to safe water and sanitation. These factors contribute to the high rates of undernutrition in the country, with chronic undernutrition among children under five increasing from 29% in 2007 to 38% in 2015-2016. Undernutrition is a significant contributor to child deaths, accounting for 45% of them.

Unsafe living environments

Angola's recent history of civil war, poor governance, and the long-term effects of colonisation have resulted in unsafe living environments for children. The country's economic development has been limited by corruption and the presence of minefields, which threaten the lives of 29 million people across numerous provinces. In 2016, mines claimed the lives of 30 children.

Angola's extreme income inequality, with a gap between wealth in urban and rural areas, has resulted in unsafe living environments for children. Poverty is highest in rural areas, where 94% of the population is considered poor, compared to 29.9% in urban areas. This inequality is reflected in the disparity in access to electricity, with only 6% of people in rural areas having electricity, compared to 34% in urban areas.

The lack of investment in the health sector has also contributed to unsafe living conditions for children in Angola. Diarrhoeal diseases, malaria, neonatal disorders, and influenza are preventable causes of the country's low life expectancy and high infant mortality rate. Additionally, inadequate nutrition is a significant challenge, especially in rural areas, where there is a high rate of stunted growth in children under five.

The education sector in Angola also faces challenges, with a lack of resources and a decline in budget allocations. This has resulted in a shortage of qualified teachers, poor learning environments, and the suspension of new school construction. As a result, children in Angola do not have access to quality education, which can contribute to unsafe living environments.

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