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We need penicillin, not condoms, in central Africa
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 resources.
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.
Unsurprisingly, our 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 table.”
USAID 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 provincial capitals.
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 food insecurity.
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 pregnancy.
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 clean blood.
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.
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