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LUANDA, Feb 28, 2006, 2006 (IPS/GIN via COMTEX) -- 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 gray 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 by 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 (Uni o Nacional para a Independ^ncia 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 anemia 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.
The government claims to be very concerned about the health of its mothers, saying it 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 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 provisions 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 center 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 hemorrhaging.
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 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 $2.20) 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.
Copyright (c) 2006 IPS-Inter Press Service. All Rights Reserved.
(C) 2006 Inter Press Service. All Rights Reserved
