Health officials with the UN Population Fund say African women may well experience more suffering than men because of health problems.
Although malaria and tuberculosis are leading causes of death on the continent, they strike men and women more or less equally. But the biology of women leaves them open to a number of illnesses that do not strike men. For example, 250,000 African women die in childbirth every year. Among the other top illnesses to strike women are HIV/AIDS and cervical cancer. All of these diseases, say health officials, are exacerbated by malnutrition.
Statistically, UN officials say the chances that a woman will die in childbirth in sub-Saharan Africa is 1 out 16, compared to 1 out of 2800 for women in the developed world. Behind the problem, they say, is the failure of adequate health care for women ? especially family planning and emergency obstetrics services.
Yves Bergevin is a senior advisor in reproductive health for the Africa Division of the UN Population Fund, UNFPA in New York. He says many women die during obstructed labor from hemorrhaging and convulsions, and from infections after unsafe abortions.
"We know what to do. We have experience from over 125 countries where this problem is being tackled extremely well and because we have so few conditions that lead to maternal mortality, we know what to do and the interventions are relatively low cost. We know how to deal with hemorrhaging at time of delivery, with infection and with convulsions. We know caesarian-sections will address obstructed labor and how to deliver strong family planning services. "
"The challenge we have is that complications that lead to death when you deliver a baby cannot be predicted ahead of time. So, you have to be ready to deal not only with a normal birth but with complications that might occur without predictability. So, health centers that do deliveries need to be equipped to offer basic emergency obstetrics and have a referral system to a district hospital that can perform essentially basic surgery for c-sections, with adequate anesthesia and a good blood bank in case you need a blood transfusion."
Bergevin says 75 countries have yet to make significant progress in reducing maternal mortality. Nearly half are in Africa.
Malawi is an example. A colleague of Bergevin in the UNFPA, Esperance Fundira, is based there. She describes the situation in the country:
"In Malawi, only two percent of health facilities can provide basic obstetric care. There is also a lack of skilled birth attendants: only 41 percent of births are assisted by skilled attendants in sub-Saharan Africa. In Malawi, it is not uncommon to hear stories of desperate pregnant women [whose deliveries] are being [done] by members of the cleaning staff in hospitals. There are no midwives, so whoever is there when the lady has to deliver tries to do something -- and usually the outcome?is death for both the mother and the baby."
The UNFPA officials say one common problem in countries with poor health care systems is fistula, or tears in the birth canal during obstructed labor. Feces and urine may leak through the openings, leading to pain and social ostracism because of the unpleasant odor. Officials say improved health care would allow quick access to midwives or health care professionals who could surgically remove the child before it damages the mother?s reproductive tract. Poor reproductive health services can also reduce the chances of obtaining a leading form of cancer in African women, cancer of the cervix. It is caused by the human Papilloma virus ? which is sexually transmitted.
Women in Africa are falling behind men in other health matters as well.
The UN health experts say young women are more likely today to be infected with the HIV virus, which causes AIDS. About a million women die of the disease every year in sub-Saharan Africa.
Fundira says much of it has to do with the weak social power of women in Africa ? which makes it difficult to negotiate having sex with a man: