Angola's Maternal Mortality Crisis: Understanding The Factors

Angola's maternal mortality rate is high due to a combination of factors, including the country's history, economic state, healthcare system, and prevalence of infectious diseases. The maternal mortality ratio is defined as the number of women who die from pregnancy-related causes while pregnant or within 42 days of pregnancy termination per 100,000 live births. In Angola, this ratio was estimated to be between 1,281 and 1,500 maternal deaths per 100,000 live births during the Civil War in the late 1990s and in 2002. While it has decreased since then, it still remains one of the highest in the world.

The leading causes of maternal death globally include severe bleeding, infections, high blood pressure during pregnancy, obstructed labor, and unsafe abortions, with 75% of maternal deaths occurring in developing countries. In Angola, additional factors such as malaria, anemia, and HIV/AIDS during pregnancy also contribute to maternal deaths. The World Health Organization (WHO) identifies poverty, long distances to care, lack of information, inadequate service, and cultural practices as common reasons for maternal deaths.

Furthermore, Angola's healthcare system is one of the poorest, with limited access to reliable healthcare services, especially in rural areas. The country also has a high level of adolescent fertility and low contraceptive use, increasing the risk of health complications during pregnancy and childbirth. Cultural beliefs and practices, such as negative stereotypes associated with abortions, further contribute to unsafe procedures and health risks for women.

To address these issues, the Angolan government has implemented programs to train midwife providers and improve maternal and child health. Non-governmental organizations are also playing a role in providing emergency obstetric care and addressing malnutrition among children. Despite these efforts, Angola continues to face challenges in reducing its high maternal mortality rate.

Poor healthcare system

Angola's healthcare system is considered one of the poorest in the world. The country's civil war, which lasted from 1975 to 2002, had a devastating impact on its healthcare infrastructure, personnel, and services. The war disrupted education, resulting in a dramatic decrease in health workers, and the healthcare system continues to feel the social effects of the conflict. The lack of educated medical personnel, administrators, and other essential positions in the governmental system has left the country struggling to provide adequate healthcare services.

Even before the war, Angola's healthcare system was facing challenges. The system has long been characterised by limited resources, poor infrastructure, and inadequate medical services. The situation was further exacerbated by the war, which resulted in the destruction of healthcare facilities, equipment, and medical supplies. The public healthcare system barely functioned during the conflict, and it continues to be severely underfunded and understaffed. As a result, both locals and expatriates often opt for private healthcare, which can be extremely expensive.

The consequences of the inadequate healthcare system are particularly dire for maternal health. Angola has one of the highest maternal death rates in the world, with an estimated maternal mortality ratio (MMR) of between 1,281 and 1,500 maternal deaths per 100,000 live births during the civil war. While there have been some improvements since the end of the war, with the MMR decreasing to around 610 deaths per 100,000 live births in 2008, maternal health remains a critical issue.

The lack of access to healthcare services, particularly in rural areas, contributes to the high maternal mortality rate. In rural Angola, citizens often have to travel significant distances to receive even basic primary healthcare. The limited availability of healthcare facilities and personnel makes it difficult for women to access essential prenatal care, increasing the risk of complications during pregnancy and childbirth.

The quality of care in formal healthcare facilities is also a concern. Due to the limited resources and inadequate infrastructure, hospitals and clinics may not be able to provide the necessary level of care or prescribed medications. This further discourages women from seeking medical attention during pregnancy and childbirth, opting instead for home births, which can be risky, especially in the event of complications.

The Angolan government has recognised the need to improve maternal health and has implemented various programs and initiatives. They are working to increase the number of trained healthcare providers, particularly midwives, and to improve access to education and healthcare services. However, progress has been slow, and Angola continues to face significant challenges in providing adequate healthcare to its citizens, particularly in rural areas.

Lack of education

The issue of lack of education is not just limited to mothers but also extends to healthcare providers. Angola's healthcare system is characterised by a lack of trained healthcare professionals, which contributes to the high maternal mortality rate. Insufficient training and education among healthcare providers can lead to inadequate care and increase the risk of maternal deaths during pregnancy, childbirth, and the postpartum period.

Additionally, limited access to education can hinder women's ability to make informed decisions about their health and well-being. Lack of education can result in lower health literacy, making it challenging for women to understand the importance of prenatal care, recognise warning signs during pregnancy, or seek timely medical assistance. This can further exacerbate the problem of high maternal mortality in Angola.

Moreover, the lack of education can perpetuate harmful cultural practices and beliefs that negatively impact maternal health. For instance, unsafe abortions are prevalent in Angola due to cultural taboos surrounding abortions, and women often seek unsafe procedures due to a lack of knowledge about the risks involved. Educating women about reproductive health, contraception, and safe abortion practices can help reduce maternal deaths associated with unsafe abortions.

To address the issue of lack of education, Angola's government and non-governmental organisations should focus on improving access to quality education for girls and women. This includes investing in educational infrastructure, training teachers, and developing curriculum that emphasises the importance of reproductive health and maternal care. Additionally, providing continuing education and training programs for healthcare professionals can help enhance their skills and knowledge, leading to improved maternal healthcare services.

Furthermore, public awareness campaigns and community education initiatives can play a vital role in empowering women to make informed decisions about their health. By addressing the lack of education through comprehensive and targeted interventions, Angola can significantly reduce its high maternal mortality rate and improve overall maternal health outcomes.

Poor infrastructure

Angola's maternal health system is in a poor state, with the country having one of the highest maternal death rates in the world. The country's infrastructure was devastated during the Angolan Civil War, which ended in 2002, and has been slow to rebuild. The war also caused large-scale internal migration, with citizens becoming refugees and migrating to avoid conflict. This has resulted in a lack of reliable healthcare access for citizens, with many women choosing to give birth at home instead of going to a hospital. The country's infrastructure was so badly damaged during the war that electricity is not reliable or accessible to many areas, especially areas of dense poverty. This has discouraged women from seeking healthcare during childbirth, as they are often forced to pay hidden or ad hoc fees in order to receive care. This has resulted in complications during childbirth, with women waiting too long to seek care and facing a higher risk of death.

The Angolan government has implemented programs to train midwife providers and increase the number of births attended by a credentialed clinician. They are also investing money into education and healthcare, using money generated from the country's large oil reserves. Free clinics are available to pregnant women and women with small children. However, the country's progress in improving maternal health has been slow, and Angola still has a long way to go to reach the United Nations' Sustainable Development Goal of having 90% of all births attended by a skilled health professional by 2030.

Poverty

Angola's maternal health is affected by many factors, including its history, economic state, and overall prevalence of infectious diseases. The country's Civil War devastated its healthcare system, infrastructure, and economy, and it has been slow to rebuild. As a result, Angola has one of the poorest healthcare systems in the world.

The World Health Organization (WHO) lists poverty as one of the main reasons why so many women die during childbirth worldwide. In addition, a study in South Korea found that women with lower income levels had a higher risk of maternal death within six weeks and one year after childbirth. The study also showed that not working was associated with a higher risk of maternal death, possibly due to increased income from working.

Furthermore, women in rural areas of Angola may face challenges in accessing healthcare due to transportation difficulties and the higher cost of equipment and supplies at hospitals in metropolitan areas. This can result in delays in receiving adequate care, increasing the risk of maternal death.

To address these issues, the Angolan government has implemented programs to train more midwife providers and is investing in education and healthcare. Non-governmental organizations are also playing a role in improving maternal health by providing emergency obstetric care and other services.

Cultural practices

Angola's maternal health is heavily influenced by culture. The country's culture is a product of a society that has faced decades of war, political uncertainty, and urbanisation, among other issues that have contributed to poor health.

On an individual level, women named four factors that heavily influenced their decisions regarding childbirth and prenatal care:

• Their perception of the quality of care
• The process of labour
• The significance of informal fees
• Their perception of being empowered to make their own decisions regarding childbirth

The perception of the quality of care varies greatly across Angola. For many women, the standard of care at a formal facility is so poor that they prefer to stay at home and opt for a home delivery. The process of labour is also affected by strong traditions, with grandparents often suggesting home births. However, due to increased access to technology and the mixing of women in larger cities, there is a shift towards more advanced means of childbirth in formal hospitals.

Despite this shift in thinking, other factors such as high informal fees and an individual woman's perception of being "courageous" seem to prevent women from seeking care in health facilities. Many women still view childbirth as an opportunity to showcase their physical strength.

Unsafe abortions are one of the leading causes of maternal death in developing countries, including Angola. Abortions are often considered taboo in many African countries, and women who get abortions are often associated with negative stereotypes due to cultural beliefs. These cultural issues force women to seek abortions in unsafe ways. It is believed that 40% of women who have an illegal abortion die due to complications from the surgery.

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