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WHO Director-General Roundtable with Women Leaderson Millennium Development Goal 5

AngolaCountry profileFor Demographic and Health Surveys, the years refer to when the Surveys were conducted. Estimates from the Surveys refer to three or five years before the Surveys.

Lead the fight for MDG 5

4. Causes of maternal deaths, 1997–2002A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to the pregnancy or its management but not from accidental or incidental causes. The most frequent causes of deaths in Africa (for 1997–2002) were haemorrhage (uncontrolled bleeding), infection (including HIV), hypertensive disorders (high blood pressure) and other causes. There are no country-specific data for Angola.

Angola and the world

5. Total fertilityThe total fertility is the average number of children that would be born to a woman over her lifetime. The total fertility rate can be separated into the births that were planned (wanted total fertility rate) and those that were unintended (unwanted total fertility rate).

Demographic and health data

1. Maternal mortality ratio: global, regional and country data, 2005

A maternal death is defined as the death of a woman while pregnant or within 42 days of termination of pregnancy from any cause related to the pregnancy or its management but not from accidental or incidental causes. The maternal mortality ratio is the number of maternal deaths per 100 000 live births per year. The ratio in Angola is 1400 per 100 000 live births versus an average of 900 per 100 000 live births in sub-Saharan Africa and an average of 400 per 100 000 live births globally.

2. Lifetime risk of maternal death (1 in N), 2005

The lifetime risk of maternal death is the estimated risk of an individual woman dying from pregnancy or childbirth during her adult lifetime based on maternal mortality and the fertility rate in the country. The lifetime risk of dying from pregnancy-related causes in Angola is 1 in 12, higher than the average of 1 in 22 for sub-Saharan Africa, and the global figure of 1 in 92.

Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Source: Khan KS et al. WHO analysis of causes of maternal death: a systematic review. Lancet, 2006, 367:1066–1074.

Source: Consultoria de Serviços e Pesquisas – COSEP Lda, Consultoria de Gestao e Adminstraçao em Saude – Consaude Lda [Angola] and Macro International Inc. Angola malaria indicator survey 2006–07. Calverton, MD, COSEP Lda and Macro International Inc., 2007.

3. Total population (in thousands)1 16 557 (2006) Lifetime risk of maternal death (1 in N)2 12 (2005) Total maternal deaths2 11 000 (2005)

Sources: 1World Health Organization 2008, World Health Statistics 2008 Geneva, Switzerland (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf). 2Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Source: Maternal mortality in 2005: estimates developed by WHO, UNICEF, UNFPA and the World Bank. Geneva, World Health Organization, 2007 (http://www.who.int/reproductive-health/publications/maternal_mortality_2005/index.html).

Other causes

30%

Anaemia

4%

Haemorrhage

34%

Abortion4%

Obstructed labour

4%

Hypertensive

disorders 9%

Sepsis or infections, including HIV 16%

Afr

ica

1 /1 2

1 /2 2

1 /9 21 /10 0

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3 /10 0

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7 /10 0

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Total births per woman

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1400

900

400

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200

400

600

800

1000

1200

1400

1600

Deaths per 100,000 live births

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9. Adolescent pregnancy rate by urban versus rural location 2006

The proportion of adolescent pregnancy is significantly greater in rural areas. Adolescent pregnancy rates can vary for many reasons, including cultural norms, socioeconomic deprivation, education, access to sexual health information and to contraceptive services and supplies.

According to a survey conducted in 2006, 72% of adolescent pregnancies occurred among adolescents living in rural areas.

8. Adolescent pregnancy 2006

Adolescent pregnancy is pregnancy in an adolescent girl (girls 10–19 years old). The adolescent pregnancy rate indicates the proportion of adolescent girls who become pregnant among all girls in the same age group in a given year.

According to a survey conducted in 2006, the percentage of girls who get pregnant increases with increasing age.

7. Perinatal and neonatal mortality rates, 2000Perinatal mortality refers to deaths of fetuses in the womb and of newborn babies early after delivery. It includes (1) the death of a fetus in the womb after 22 weeks of gestation and during childbirth and (2) the death of a live-born child within the first seven days of life. The perinatal mortality rate reflects the availability and quality of both maternal and newborn health care.

6. Proportions of births by urban versus rural location

In 2006, there were about 792 000 births, an increase from the 2005 estimates.1

The total number of births (in thousands): 774 (2005)2

Sources: 1Making Pregnancy Safer country profiles [online database]. Geneva, World Health Organization, in press (Department of Making Pregnancy Safer; http://www.who.int/making_pregnancy_safer/en).Demographic and Health Surveys [web site]. Calverton, MD, MEASURE DHS, Macro International Inc. (http://www.measuredhs.com/aboutsurveys/search/start.cfm).

2World population prospects: the 2006 revision. CD-ROM edition – extended dataset in Excel and ASCII formats. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (United Nations publications, ST/ESA/SER.A/266).

Sources: Perinatal mortality: monitoring and evaluation [online database]. Geneva, World Health Organization, 2006 (http://www.who.int/reproductive_indicators/countrydata)

Neonatal mortality. In: World health statistics 2008. Geneva, World Health Organization 2008 (http://www.who.int/whosis/whostat/ EN_WHS08_Full.pdf ).



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10. Adolescent pregnancy by subregion

Adolescent pregnancy rates tend to vary between different parts within countries. The rates can vary for many reasons including cultural norms, socioeconomic deprivation, education, access to sexual health information and contraceptive services and supplies. There are no country-specific data for Angola.

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2005 2006Year

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Perinatal mortality rate (2000)

Neonatal mortality rate (2000)

2.9 13.9

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28%

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Urban

Rural

Lead the fight for MDG

12. Family planning: prevalence of modern contraceptive use among women 15–49 years old, 2001

According to a survey conducted in 2001, the oral contraceptive pill was the most common modern method used, followed by the intrauterine contraceptive device (IUD).

16. Utilization of skilled birth attendants

A skilled birth attendant is an accredited health professional – such as a midwife, doctor or nurse – who has been educated and trained to proficiency in the skills needed to manage normal (uncomplicated) pregnancies, childbirth and the immediate postnatal period, and in the identification, management and referral of complications among women and newborns. All women should have access to skilled care during pregnancy and at delivery to ensure that complications are detected and managed. Many women continue to deliver without skilled attendants. For example, a Multiple Cluster Indicator Survey (MICS) conducted in 2001 showed that only 45% of live births were attended by a skilled attendant at delivery.

14. Contraceptive use by subregion 15. Antenatal careAntenatal care (ANC) visits include all visits made by pregnant women for reasons relating to pregnancy. According to a Multiple Indicator Cluster Survey (MICS) conducted in 2001, about 66% of women received ANC for that pregnancy from a skilled health provider.

13. Contraceptive use by urban versus rural location

Intervention coverage for mothers and newborns

11. Unmet need for family planning 2003 No dataThe unmet need for family planning is the proportion of all women that are at risk of pregnancy and who want to space or limit their childbearing, but are not using contraceptives.

Source: World contraceptive use 2007. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm).

Source: Countdown to 2015. Tracking progress in maternal, newborn & child survival: the 2008 report. New York, United Nations Children’s Fund, 2008 (http://www.countdown2015mnch.org/index.php?option=com_content&view=article&id=68&itemid=61).


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Source: World contraceptive use 2007. New York, United Nations Department of Economic and Social Affairs, Population Division, 2007 (http://www.un.org/esa/population/publications/contraceptive2007/contraceptive2007.htm

Contraceptive use also tends to vary between urban and rural areas within countries. The rates can vary for many reasons including cultural norms, socioeconomic deprivation, and education, access to sexual health information and contraceptive services and supplies. There are no country-specific data for Angola.

Contraceptive use also tends to vary between different parts within countries. The rates can vary for many reasons including cultural norms, socioeconomic deprivation, and education, access to sexual health information and contraceptive services and supplies. There are no country-specific data for Angola.

48%

9% 2%

30%

2% 2%

7%

SterilizationIUDPill

InjectablesVaginal barrierOther modernCondom

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Angola

17. Utilization of skilled birth attendants by wealth quintile

21. Caesarean section by subregion

19. Place of delivery 2006

Delivery in a health facility can reduce maternal and neonatal death and morbidity. According to a survey conducted in 2006 in Angola, 77.9% of women residing in rural areas who were pregnant gave birth at home. Most women who reside in urban areas gave birth in a health facility.

20. Caesarean section rates by urban versus rural location

18. Utilization of skilled birth attendants by subregion

22. Low birth weight, 1999–2006Babies weighing less than 2500 g at birth are considered to have low birth weight. According to data available for 1999-2006, of those babies who were weighed at birth, 12% were reported to weigh less than 2500 g (2.5 kg). Low-birth-weight babies often face severe short- and long-term health consequences and tend to have higher mortality and morbidity.


Source: World health statistics 2008. Geneva, World Health Organization 2008 (http://www.who.int/whosis/whostat/EN_WHS08_Full.pdf ).

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Whether a woman delivers with the assistance of a skilled attendant is highly influenced by how rich she is. In many developing countries, more women in the highest wealth quintile have a skilled attendant present at birth compared with women in the lowest wealth quintile. There are no country-specific data on skilled birth attendants by wealth quintile in Angola.

The percentage of women giving birth with the assistance of a skilled attendant also varies by subregions within countries. There are no country-specific data on skilled birth attendants by subregion for Angola.

Caesarean section is a surgical procedure in which incisions are made through a woman’s abdomen and womb to deliver her baby. It is performed whenever abnormal conditions complicate vaginal delivery, threatening the life and health of the mother and/or the baby. Low caesarean section rates could indicate an unmet need for access to adequate health system infrastructure, which needs to be met if maternal deaths are to be reduced. In developing countries the unmet need tends to be higher in rural than in urban areas. There are no country-specific data on C-sections in Angola.

Caesarean section rates vary in subregions within countries, depending on the availability of adequate health system infrastructure and human resources. There are no country-specific data for Angola.

70.2

1.8

27.8

0.2 21.7

0.1

77.9

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20 40 60 80

100

Urban

Rural

Public sectorhealth facility

Private sectorhealth facility

Home Other

% o

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Lead the fight for MDG

25. Equity – gap in coverage of four major interventions by wealth quintile

This graph illustrates the gap in coverage of four key interventions (family planning, maternal and newborn care, immunization and treatment of childhood illness) by wealth. The coverage gap reflects the difference between the goal of universal coverage of everyone in these four intervention areas and actual coverage. Where the gap is larger, it means that there is less adequate coverage. The opposite indicates better coverage. The graph indicates that, in the 2001 Multiple Cluster Indicator Survey (MICS), the coverage gap is highest for the poorest and is lowest for the richer members of society (wealthiest quintile). The gap in the survey in 2001 was 55%. Achieving equity requires improving coverage levels in the poorest quintiles.

24. Prevention of mother-to-child transmission of HIVThe percentage of pregnant mothers living with HIV and receiving antiretroviral drugs to prevent the transmission of HIV to their child increased by more than 10 percentage points between 2005 and 2006.

23. Anaemia in pregnancy by urban/rural locationAnaemia refers to abnormally low levels of haemoglobin (iron-containing oxygen proteins) in the blood. Severe anaemia is an important contributing factor to maternal deaths due to haemorrhage during childbirth. The percentage of women of reproductive age (15–49 years) with low haemoglobin levels (below 110 g/l) is higher in urban areas (56%) compared with rural areas.

Equity

Resources


Source: WHO database on national health policies, 2008.

The work of at least 23 health workers (doctors, nurses or midwives) per 10 000 population is estimated to be necessary to support the delivery of the basic interventions required to achieve the Millennium Development Goals related to health. Globally, 57 countries have been identified with critical shortages below this minimum. These countries have a severe crisis in human resources for health. Of these 57 countries, 36 are in sub-Saharan Africa. Angola, with about 14 health workers (as defined above) per 10 000 population, is one of the countries facing this crisis daily, with mothers and children lacking access to proper maternal and child care, HIV/TB and malaria care, and sexual and reproductive health information and services, including skilled birth attendants.

The shortage is exacerbated by staff losses due to migration (in search of a better life) of skilled staff to high-income countries, leaving behind already impoverished health services and systems.

Increasing the human resources around the world and establishing a balance between the services needed and the personnel available, and their distribution, are key elements of a well-functioning health system and critical requirements for achieving Millennium Development Goals.

26. Reproductive health Yes Maternal health Yes

27. Financial flow (per capita expenditure on health, in US dollars) 2007 38

28. Human resources

Policies




Source: WHO Global Atlas of the Health Workforce [online database]. Geneva, World Health Organization, 2008 (www.who.int/globalatlas/autologin/hrh_login.asp).

5

56% 44%

Urban

Rural

14

2005 20060

5

10

15

20

25

Per

cen

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Poorest 2nd 3rd 4th Wealthiest

%

20

0

40

60

80

100

Coverage gap (%)

2001MICS

55

1.6

25

Ratiopoorest/wealthiest

Differencepoorest-wealthiest (%)

Angola

29. Ratification of treaties and support of international consensus

For further information, contact:

Sources: Ratifications and reservations [web site]. Geneva, Office of the United Nations High Commissioner for Human Rights, 2008 (http://www2.ohchr.org/english/bodies/ratification/index.htm). Report of the Fourth World Conference on Women, Beijing, 4–15 September 1995. New York, United Nations, 1996 (http://www.un.org/womenwatch/confer/beijing/reports). Report of the International Conference on Population and Development, Cairo, 5–13 September 1994. New York, United Nations, 1994 (http://www.un.org/popin/icpd/conference/offeng/poa.html).

Source: World Bank indicators [online database]. Washington, DC, World Bank, 2008 (http://ddp-ext.worldbank.org/ext/ddpreports/ViewSharedReport?&CF=&REPORT_ID=9147&REQUEST_TYPE=VIEWADVANCED&HF=N/CPP&WSP=N).

Fixed-line and mobile phone subscribers (per 100 population) 14 (2006)

Internet users (per 100 population) 0.6 (2006)

Roads paved (% of total roads) 10 (2000)

Improved water source (% of population with access) 51 (2006)

Improved sanitation facilities (% of urban population with access) 79 (2006)

Convention on the Elimination of All Forms of Discrimination against Women Yes

Convention on the Rights of the Child Yes

International Covenant on Economic, Social and Cultural Rights Yes

International Conference on Population and Development Yes

Fourth World Conference on Women Yes

Child and Adolescent Health and DevelopmentTel: +41 22 791 3281E-mail: [email protected] site: www.who.int/child_adolescent_health/en

Reproductive Health and Research Tel: +41 22 791 3372E-mail: [email protected] site: www.who.int/reproductive-health

Making Pregnancy SaferTel: +41 22 791 3966E-mail: [email protected] site: www.who.int/making_pregnancy_safer/en

Immunization, Vaccines and BiologicalsTel: +41 22 791 4612E-mail: [email protected] site: www.who.int/immunization/en

Gender, Women and HealthTel: +41 22 791 2394E-mail: [email protected] site: www.who.int/gender

30. Other determinants of health: water, sanitation, communication and road networks

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