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http://www.thestar.com/News/World/article/840806

 

CONGO - MATERNAL & INFANT MORTALITY

 

July 28, 2010

Rosie DiManno

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Mother Pamela and baby, not yet named, pose in Democratic Republic of Congo, where four women die every hour from complications of pregnancy.

 

The Congo is a difficult place to be born, or borne. Dangerous for the baby, dangerous for the mother and dangerous for the first five years of life — a dismal mortality rate shared with many nations in sub-Saharan Africa.

 

But few countries on Earth are worse to be pregnant in. Every hour of every day, four females in the Democratic Republic of Congo die from complications of pregnancy and labour, according to statistics from the United Nations Population Fund. For every woman who dies giving birth, between 20 and 30 suffer serious health problems such as obstetric fistula.

The infant mortality rate is 81.21 for every 1,000 live births, a figure that has actually gone up by 2 per cent since 2008, while maternal and infant deaths have otherwise dropped globally.

“Women continue to die as they are giving life,” fretted Congo’s first lady, Marie Olive Kabile, recently, as her husband, President Joseph Kabila, committed the government to improving maternal health by earmarking more funds for prenatal and obstetric care.

Six million dollars — that’s what has been allocated in the Congo’s budget to finance the entire health sector, while at least $60 million is urgently required.

“We are still waiting,” Marie Jeanne Mpembe, director of planning for Safe Maternity, a health ministry agency, told the Star Tuesday, in reference to whatever increased funds will eventually come down the pike for maternal health care.

A distant rumour, adds Mpembe, is the $5 billion package for boosting maternal and child health in poor countries — the Muskoka Initiative — pledged at the recent G8 summit in Canada, one-fifth of it to be ponied up by Ottawa in new funds over the next five years. (A further $2.3 billion in contributions has been promised from six non-G8 nations and the Gates Foundation.)

“I know only what I’ve read on the Internet,” says Mpembe. “Here at the ministry, nobody has said there will be more money coming from international donors or how much.”

From her small and understaffed office, Mpembe feels overwhelmed by the health issues facing her country’s women and the babies they are producing — way too many babies, starting at way too young an age for young mothers and spaced way too close together.

Half of Congo’s 35 million women give birth by age 19 and have an average of 6.2 children during their fertile years. They start too soon and continue too long. Only an estimated 6 per cent of Congolese use contraception. Added into that mix, of course, are catastrophic rape figures driven by the continuing conflict in the eastern part of the country.

One survey undertaken last year revealed that half the 2009 births — 3 million in all — were unwanted babies. It’s unknown how many newborns, the progeny of sexual violence, are killed at birth.

There are few options for reluctant mothers looking to dispossess themselves of babies. Often turned out from their homes, both mothers and children must beg for alms on the street. Infanticide, a terrible crime, can be understood only from the perspective of women with nowhere to turn beyond overburdened humanitarian agencies.

“The central problem is poverty,” explains Mpembe. “We don’t have enough facilities, we don’t have enough health workers, we don’t have enough medical equipment, doctors or drugs.”

Maternal health care has for too long been at the bottom of issues to be addressed in the Congo, as in other developing nations. Childbirth is considered a natural and private event, something that occurs in the home rather than a matter worthy of medical attention. This is a view also advocated by out-of-hospital birthing proponents in the West, who claim that midwives are sufficient for the purpose.

Which may be true — certainly trained midwives are capable — but pregnant women in the First World can be rushed to hospital if labour difficulties arise, and those identified as at risk receive close obstetric care through regular office visits.

That kind of attention for expectant women simply doesn’t exist in the Congo.

“It costs about $20 (U.S.) to give birth in a hospital here,” says Mpembe, herself a mother of five, all born in the hospital. “That’s a lot of money for an ordinary family. And that’s just if nothing goes wrong and the mother can go home right away.”

Most Congolese women never see a doctor during their pregnancy and show up at the hospital only to give birth.

And those hospitals are not well-equipped.

Some lack such basic items as surgical gloves and masks and clean water. Hygiene is difficult to maintain, so ward infections spread easily. More sophisticated medical equipment, such as incubators for preemies, is sparse on the ground. Blood for transfusions is rarely available.

“Doctors run around looking for blood from family members and, in the meantime, women die.”

While childbirth may be a completely natural and normal process, the bodies of 13-year-old girls were never intended to deliver babies.

“Most of our first-time mothers are adolescents — 13, 14, 15 years old,’’ says Mpembe. “Many parents prefer to marry them off early, to get them out of the house so they won’t have to be responsible anymore.”

Daughters are a drain, too often not worth educating, not worth keeping around as they grow older, unless they can contribute to the family’s income — valued for whatever bridal price they can attract, a formality traditional throughout Africa and Asia.

Then they start to breed — children having children, pubescent girls wracked by labour and infants dead out of the womb.





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