SEATTLE – For 27 years—from the end of Portuguese colonial rule in 1975 until 2002—civil war plagued Angola. Over a quarter century of war left the nation severely depleted, with an estimated one million dead, 4.5 million internally displaced and 450,000 refugees having left the nation. At the end of the war, Angola’s infrastructure and government services were in ruins. The healthcare system was in shambles, and health outcomes were poor.
Algona has recovered considerably since the end of the civil war; today, according to UNICEF, Angola’s per capita GDP makes it a lower-middle income country. However, although the southern African nation has been peaceful and increasingly prosperous in the last decade and a half, the child and maternal mortality rates in Angola are still on par with those of the world’s poorest nations. As of 2018, nearly 20 percent of children die before their fifth birthday, and the maternal mortality rate is 610 deaths per 100,000 live births.
The U.N.’s Millennium Development Goals (MDG) Four and Five are to reduce child mortality and improve maternal health, respectively. MGD Four aims to reduce the under-five mortality rate by two-thirds between 1990 and 2015. MGD Five has two components: to reduce maternal mortality by two-thirds between 1990 and 2015 and to achieve universal access to reproductive healthcare by 2015.
To understand the progress Angola has made, there are two questions that must be asked. First, what progress has been made towards bettering child and maternal health in Angola? Second, what challenges does Angola still face?
Improvements Seen in Child and Maternal Mortality Rates
According to MGD Four, Angola was aiming to reduce its child mortality rate from its 1990 level of 226 (actually lower than what it was by the end of the war) to just 75 deaths per 1,000 live births. In 2015, Angola reported a child mortality rate of 157 deaths per 1,000 live births.
It is important to both recognize that Angola missed that target by a considerable margin and to acknowledge that the nation was at war for almost half of the 1990 to 2015 period defined by the MGDs. As such, the numbers look more promising when considering only the period of time after the civil war. Between 2002 and 2015, Angola reduced its child mortality rate by almost 50 percent, from 250 to 157 deaths per 1,000 live births.
Between its first recording in 1995 until the end of the civil war in 2002, the maternal mortality rate in Angola remained around 1,400 deaths per 100,000 live births. Its MGD target was to lower that number to just 350 deaths per 100,000 live births. Although not quite reaching that goal, Angola nonetheless made tremendous progress, recording a maternal mortality rate of 460 deaths per 100,000 live births, a reduction of 54 percent in 13 years.
It is important to note that the world overall did not meet MGD Four either. The U.N.’s MGD Report of 2015 states that, between 1990 and 2015, child mortality dropped 53 percent globally, an almost identical decrease to that seen in Angola.
Current Indicators of Child and Maternal Health in Angola
The WHO’s Atlas of African Health Statistics reported in 2017 that 81 percent of pregnant women had at least one prenatal care visit with a medical professional and that 61 percent had at least four. For Africa as a whole, those numbers are 80 and 52 percent respectively, meaning that Angola’s prenatal healthcare rate is slightly better than Africa as a whole. However, Angola’s numbers look less promising when compared to Europe and America. There, 92 and 94 percent of pregnant women, respectively, have four or more prenatal care visits with a health professional.
Furthermore, the WHO reports that 47 percent of births in Africa in 2015-2016 were attended by a skilled health professional. This is a huge increase from 1999, when skilled health professionals were present at just 23 percent of births in Angola. This is only slightly below the overall rate in Africa, where skilled professional attend 54 percent of births. At the same time, Africa as a whole and Angola more specifically are both far from reaching the U.N.’s Sustainable Development Goal of having 90 percent of all births attended by a skilled health professional by 2030.
Angola’s rather low rate of medical professionals attending births relates directly to its lack of trained health workers. In 2009, there were just two physicians and 17 nurses or midwives for every 10,000 people living in Angola.
Progress Continues: Current and Future Efforts
Child and maternal health in Angola have improved considerably since the end of the civil war, yet there is still much room for improvement. International organizations and the Angolan government are working together to continue bettering these health outcomes.
UNICEF has partnered with the Angolan government with the explicit goal to “reduce maternal and infant mortality and encourage authorities to ensure the necessary budget resources to improve health for women and children,” according to a U.N. News release. They are working together to achieve universal access to healthcare, specifically encouraging prenatal and child healthcare. Working with municipalities and local clinics, UNICEF hopes to improve access to quality healthcare and to ensure that clinics are equipped to help women with reproductive and prenatal care. The Angolan government has pledged to increase its spending on healthcare from 6.4 to 15 percent of the national budget.
The Angolan government is also working with USAID to train medical professionals and hopefully alleviate the health professional shortage in the country. Together, they are also sponsoring various health campaigns, most of which are aimed at promoting maternal, prenatal and childhood health. In 2014, USAID helped the government of Angola release a combination measles-polio-vitamin A immunization. The vaccine campaign was hugely successful; in one year, immunizations reached 7.7 million children, about 96 percent of the total population.
Angola is moving towards a better, healthier future for women and children. Increased spending and continued support from the Angolan government, as well as assistance from international organizations like UNICEF and USAID, should help health outcomes in Angola continue to improve.
– Abigail Dunn