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A Country in Constant Crisis: Maternal Health in the Central African Republic

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I'm delighted to see that the Huffington Post has launched a section devoted to maternal health called Global Motherhood.

Maternal health is one of the most pressing issues in developing countries, with hundreds of millions of women struggling on a daily basis to get access to rudimentary health care for themselves and their children.

One of the worst cases from my recent travels is the Central African Republic, a country that is little understood and rarely visited.

When I went there a few months ago I found a nation, and its people, on the edge of a precipice. Worse still, my impression is that if they fall, few will notice.

Despite coup after coup since gaining independence from France in 1960, and an ongoing problem with displaced rebels from Uganda's Lord's Resistance Army, the C.A.R.'s problems have garnered little media attention, in part because some of it's neighbors -- the Democratic Republic of Congo, Sudan and South Sudan -- have dominated the region's headlines.

But what we found in the Central African Republic deserves attention.

Health indicators are among the world's worst, with an average life expectancy of just 47.

One of the biggest problems we found for people seeking medical attention was user-fees.

Pregnant women, for example, are charged anywhere from a few dollars to over $100 dollars to give birth in hospital, depending on the complexity of the birth and medications required. Many families simply can't afford it.

"Women are dying for peanuts, you see, nothing really important," said the U.N. Population Fund's country representative, Therese Zeba. It could be for something as little as the cost of a phone call to a doctor, she says.

Not that there are many doctors. There are only six obstetricians in the C.A.R., and they're all in the capital, Bangui.

Women outside the capital often have to rely on a birth attendant with little or no formal training. Nearly half of those births take place at home in unsanitary conditions. If there are any complications, there's little hope.

Adrian Hopkins, an English doctor who worked for an NGO in Bossangoa for six years, told us that caesarian sections had a near 100 percent mortality rate for mother and child when he was there in the 1990s.

Since then, rebels and foreign armies have gutted the already-meager facilities and stolen anything they could carry away. And while Bossangoa has been relatively peaceful for the last few years, there's little money to replace the losses.

One answer, the government hopes, is to train more doctors and support staff. The problem is that they often have to go to neighboring countries for adequate training, and too many of them don't return.

Unless their numbers do increase, and working conditions improve, and health care is made free or affordable, there's little hope for the people who need it most.

David Lindsay is the managing editor of Global Health Frontline News. He and videographer Roger Herr traveled to the Central African Republic to cover stories on maternal health and river blindness. Visit GHFN's website for more reports about maternal and child health.