US aid agencies want to revitalise family planning in the Democratic Republic of Congo. This is certifiably insane.
Ever since it
gained independence in 1960, the Democratic Republic of Congo (DRC) has been in
chaos. By some statistics, the hinterland outside of the capital Kinshasa has
suffered through the worst war since World War II as rival armies of thugs,
warlords, or surrogates of hostile neighbours battle it out over our rich mineral
The DRC is rich in
people, too. It has a population of about 70 million and by the year 2050 it
will be one of the ten most populous countries in the world. Our total
fertility rate is 6.3, one of the highest in the world. Abortion is illegal
here, with some exceptions for the health of the mother.
health care is in a mess, especially for women, and it is actually getting
worse, year by year. The current maternal mortality rate (MMR) is estimated at 2,000
per 100,000 live births ; in 1990 it was 800. (The rate in Canada is 6 per
100,000 births.) Infant mortality in the first year is estimated at 92 per 1,000.
(In Canada, it is about 6 per 1,000.)
At the moment, however,
at least by the standards of the DRC, the country is relatively calm and the
thoughts of foreign aid donors have turned to improving health care. And the
band-aid they are offering is vigorous family planning programs.
Back in December,
the DRC’s First Lady, Marie Olive Lembe Kabila, opened a National Conference to
Reposition Family Planning in Kinshasa. It was attended by all the nabobs of
DRC’s health bureaucracy as well as USAID, the American aid agency, and UNFPA,
the United Nations Population Fund. "This is an issue that concerns us
all,” said Mme Kabila. “No one among us wants to lose a child, a loved one we
waited nine months for, and no man wants to see his wife left on the delivery
is investing US$8.4 million in family planning in the DRC. The US
Ambassador to the DRC, William Garvelink, told the conference that the unmet
need for family planning is more than 24 percent. Satisfying this unmet need
could avert over 18,000 maternal deaths and 850,000 child deaths.
I share the desolation of the First Lady, but this is almost
literally insane. No one can fail to weep at a stillborn child or the death of
a mother in childbirth. But it is absurd; it is criminally irresponsible, for
the United States and international aid agencies to argue that the solution to
the DRC’s calamitous maternal mortality is family planning.
The real solution is quality basic health care. Not conferences
about foreign aid. Not plans drawn up in air-conditioned offices in New York.
We need real health care. We need $8.4 million worth of penicillin, not $8.4
million worth of condoms.
A few years ago, the slogan was "Health for All by 2000".
Now it is the propaganda of "Millennium Development". We even have a
home-grown slogan, "the five yards of the president." This is all
pie-in-the-sky stuff. What the DRC needs is not a scaled-down version of the
American health care system, but an understanding of how to deliver primary
health care throughout the whole country, not just in Kinshasa and the
In the DRC, as in
most Third World countries, lack of medical care is the principal cause of
maternal mortality – and this is the case regardless of the legal status of
abortion or the level of family planning.
Here are a few of
the dismal statistics. The World Health Organisation says that medical problems
linked to maternity are the cause of 19 percent of deaths amongst women and
girls. Life expectancy was 42 years in 2002, when the mean for Africa was 51
years. Access to health services is less than 26 percent.
Throughout the country, especially in the
interior, basic health care and prenatal care is inadequate or nonexistent.
There are no midwives and clinics lack minimum conditions of hygiene. Even
major cities lack the infrastructure and equipment for emergency care. Where it
does exist, only a small minority can afford it. Doctors are poorly trained. Many
are not equipped to deal with emergencies in childbirth. In large public
hospitals there are excellent physicians, but sometimes they lack antibiotics
and sterile gloves.
Malaria is widespread. Eradicated diseases
such as trypanosomiasis, leprosy and plague have reappeared. HIV/AIDS affects
more than 4 percent of the population between the ages of 15 and 49. In the eastern
provinces where fighting is still going on, that figure rises to about 20
percent. According to recent estimates, 750,000 children have lost at least one
parent due to sickness. During the 1997-2005 war, 3.9 million of our people died.
Most of them succumbed to infectious diseases which they were too weak to
withstand because of malnutrition and the stresses of migration.
Although the DRC has an abundance of
natural resources, it is one of the poorest countries in the world, with vast disparities
in wealth. This is due mainly to the never-ending war which scourges the
country. In 2002 – the last year for which I have statistics -- 80 per cent of
the population were living below the poverty line of US$2 per day. Nearly 44% of women and about 22% of men had no income. Regional disparities are very strong. In the eastern
districts, people were living on $32 per year; in the southern districts, $138;
and in the capital Kinshasa, $323. Malnutrition affects between 30 and 50% of
women and children. In total, 16 million people live in conditions of
In these chaotic circumstances, how can the US ambassador seriously
propose family planning as a solution? He and his cronies in the aid agencies
are living in Never-Never Land.
I firmly believe that what the DRC needs to
turn around the appalling statistics on maternal deaths is good nutrition, basic
health care, good obstetric care during pregnancy, childbirth and postpartum. In
industrialized countries, birth-related deaths declined with the development of
better obstetric techniques and improvements in the overall health of women. In England and Wales, for example,
the maternal mortality rate dropped from more than 550 pregnancy-deaths per
100,000 births in 1931 to less than 50 in 1960, through the use of antibiotics,
blood transfusions and the management of hypertensive disorders during
According to the World Bank’s 2006 Development
Report, Malaysia and Sri Lanka have managed to reduce maternal mortality by
enabling access to midwives and nurses in rural areas and regularly supplying
provinces with medicines and medical equipment. Severe
bleeding contributes to 44 percent of maternal
deaths in Africa, deaths which could be prevented if doctors had access to
Rather revving up the engines of family
planning, foreign aid donors should think of ways to bring modern medicine and
better health care to the DRC. If they don’t, it will just confirm our
suspicions that family planning is merely a Trojan horse for legalizing abortion
in the DRC.
Gaston Asitaki is editor of the magazine Construire la famille in Kinshasa
and a lawyer.