Amidst wealth, dire reproductive health needs

Bridgit Adamou

Angola is the seventh wealthiest nation in Africa. It has oil—and lots of it. But maternal mortality is high and the total fertility rate is nearly seven children per woman, on par with some of the world's poorest countries.

It was late morning and we were driving on a busy dirt road on the outskirts of Luanda when our car suddenly stopped. I nonchalantly kept on talking to my colleague who was sitting next to me in the backseat of our pick-up when I noticed her attention had turned to the tanker truck stopped in front of us. By the side of the truck a young boy—about twelve or thirteen—had deftly opened a valve and was collecting the gas that was gushing out into his large bucket and splashing onto the ground.  Shocked, I asked if the driver of the truck should be alerted but was told that you can’t risk it since the boy—who at this point was looking right at us—might have a gun. I kept watching in disbelief as the boy struggled to carry his heavy bucket, which was still filling up even as the truck began moving away.

Mothers wait outside a clinicThis is Angola, a country that ended a 27-year civil war in 2002 and is working to rebuild its economy, government, and society amidst pervasive violence, corruption, and apathy. I recently spent two weeks in the capital, Luanda, providing support to my colleagues in the Pathfinder International/Angola office who are working with the government to improve reproductive health services. Although the image of the boy siphoning the gas is difficult—the images of the women in need are perhaps even more memorable.

At one clinic I visited, it was bustling with mothers, children, and pregnant women waiting to be seen by the nurse. Incredibly though, it had no water. The pump on the underground water tank was broken, so as temporary solution, the Ministry of Health had two water tanks installed. The Ministry paid for water to be delivered by truck, but the driver never showed up; he supposedly sold the water and pocketed the cash. There’s been no follow-up action, so the tanks have been bone dry for months. At another public health facility I visited, the motor on their water pump is also broken, as well as their two generators—but at least they don’t have a corrupt water truck driver and usually have water in their tanks.

The lack of government accountability and action didn’t surprise me, nor did the sight of women carrying heavy loads on their heads and babies on their back, school-aged children playing in the street in the middle of the day, mounds of trash smothering hillsides, and crowded, flimsy homes that look like they might fall apart in a strong wind; these images are all too familiar in sub-Saharan Africa. What’s incredible to me is that you see this despite the fact that Angola is the seventh wealthiest nation in Africa. For better or worse, Angola has oil—lots of it—and diamonds and gold and agriculture. In the short time since the war ended, Luanda has seen an explosion in the number of modern hi-rise buildings that have been built, the number of vehicles (many of them very expensive) on the road, and the number of businesses that have opened to cater to the foreign investors. 

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A young Angolan mother and her childBut as the wealthy get wealthier, the poor, who make up the majority of the population, are still poor.  The average life expectancy is just 43 years. Eight-six percent of the urban population lives in the slums. It wasn’t just my imagination that it seemed like a lot of women, including teenagers, were pregnant. Although birth control is available for free, the total fertility rate is nearly seven children per women, which is on par with some of the poorest countries in the world. There doesn’t seem to be much urgency on the part of the government to improve and promote family planning services even though the lifetime risk of maternal death is 1 in 12. Pathfinder and other organizations are filling in some of the gaps, one crack at a time, which seems encouraging on the one hand, but also quite daunting on the other—we have a lot to do.

Every morning on the drive from my hotel to the Pathfinder office I passed this one young mother in front of a store front selling pineapples and oranges. I noticed her because she had a toddler about the same age as my own child. The woman looked about seven or eight months pregnant and always appeared exhausted. The same thoughts ran through my head every time I saw her: Does she have other kids? Do they have enough to eat? How much is she earning every day selling fruit? How can she afford to live in this expensive city? Will her baby be healthy? Would I be in her shoes if I had been born here? Then our car turns the corner and she’s gone…until tomorrow. 

Women like her, and children like the boy siphoning the gas, can have different lives, but it takes commitment on the part of donors, governments, and organizations to support initiatives that change their lives—ensuring there is water in the health facility, family planning to lower maternal mortality and give women options for a different life, and support for youth to have other opportunities. I know the next time I travel to Luanda I may not see radically different images, but I hope that the road is at least paved for Angolan women to choose their family size, see their babies grow up to be healthy and safe, and enjoy life.

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