BRAZZAVILLE, Republic of Congo — As the Republic of Congo marked its 50th Anniversary of Independence today, it embarked on unprecedented steps to advance quickly in the areas of reproductive health and gender equity.
On the eve of the Congolese Independence Day, President Denis Sassou Nguesso announced that henceforth emergency obstetric care, including Caesarean sections, would be free. He also said he would submit to Parliament a bill calling for equal access for women to political, administrative and elective positions. Both are major step forward in this middle-income country that nevertheless has a high rate of maternal mortality (781 deaths per 100,000 live births, according to 2005 DHS estimates) and where despite some progress, women remain absent from most policy decisions.
These initiatives are part of a momentum building among African leaders to give priority to women's health issues, especially maternal, newborn and infant mortality. This was a major thrust of this year's African Union summit, and the theme has also been embraced by African first ladies. Throughout the continent, countries are taking ownership for the Campaign to Accelerate Reductions in Maternal Mortality (CARMMA), which has now been launched in 20 countries, and should be launched in the Republic of Congo later on this year. A strategic approach to the issue has formed around a coalition that includes government ministries, parliamentarians, the First Lady, civil society and the media, as well as UN agencies.
More than 800 maternal deaths each year
Maternal mortality in the Republic of Congo is far too high for a middle-income country, especially in a country where a majority of women deliver babies in health centres, noted UNFPA representative David Lawson. "The statistics are scary," he added in a recent interview. "More than 1000 women die in childbirth each year, 4000 children under the age of one month don't survive, and more than 68,000 children die before the age of five. Efforts by the Government and its partners to change the situation have been intensifying for some time, since the Maputo Declaration."
UNFPA is part of a nine-member panel, called the Observatory on Maternal and Newborn Mortality, aims to strengthen data collection and monitoring and to help coordinate information throughout the decision-making process. "Eventually we hope these strengthened information systems will contribute to bringing down the number of mother and child deaths," said Lawson.
The Observatory will collect, monitor and analyze data on maternal health, including maternal mortality. Although this data is already collected, it has not been done in a systematic way, he said, adding that UNFPA is working with the Government and WHO to strengthen the National Health Information system. The Observatory will specifically target maternal mortality and act as a central collector and disseminator of the latest and most accurate data. This effort can help the Government and development partners, identify effective strategies and give attention to those health centres or geographic areas in greatest need.
Reaching the hard-to-reach
Congo is highly urbanized with 85 per cent of the population concentrated around a few cities. Most women give birth in health centres. Focussing on major centres could have a large effect on maternal mortality rates. But it is equally important to address the needs of more isolated populations, Lawson noted. "As a UN agency we of course work throughout the country so we also support the Government in strengthening health centers in peri-urban and rural areas, often under-equipped due to their isolation. Sometimes they are completely cut off from urban areas, either because there is little infrastructure or because of nature. For instance Likouala Province in the North is covered with forest and can only be reached by river a few months a year or by air."
The Observatory will also help to track and treat women with obstetric fistula, Lawson noted. A 2009 initiative to treat women affected by fistula has been a success, but one that also revealed that the extent of the problem was more significant than was previously realized.
Lawson is anticipating rapid improvements in addressing maternal and child health if investments are forthcoming. "It's more important than ever to reinforce financial support, notably through the Maternal Health Trust Fund and the new mechanism created by the G8 in Canada. The Congo should be considered a priority country in spite of its economic status as a middle income country. This status actually hides that some 25 per cent of the population lives below the poverty line. Because of the country's environment, women delivering in health centres and heightened government action to reduce mortality, rapid results could be obtained here if the investments are forthcoming."