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Nelson Mandela – responsible for the death of 95,000 babies?

Otto Kölbl

An in-depth analysis of the evolution of the infant mortality rate (IMR) in South Africa reveals a shocking reality: whereas the apartheid regime (until 1994) did not really excel in this field, the presidency of Nelson Mandela (1994 to 1999) saw a massive dying of new-born babies. Despite the efforts of his successor Thabo Mbeki, we can evaluate the number of babies who died because of Mandela's catastrophic policy at 95,000. Our media did not care at that time and still shroud this scandal in the veil of silence, which makes them also responsible.

Under the apartheid regime (until 1994), the country was already among the worst performing in this field: in a ranking of the countries according to their long term effort to reduce the infant mortality rate (IMR), the county ranked 129th out of 137 countries in 1990 (see our article The right to health – how can we hold the governments accountable?), but at least the government did something to improve the situation (the organization Child Mortality Estimate provides precise data since 1975; before this date, it is more difficult to get solid figures). Between 1980 and 1985, the reduction rate was 3.6% per year, between 1985 and 1990 3.4% per year. This value is above the international median of 3.1% resp. 2.8%.

From 1990 on, the decrease slows down and then stops. From 1994 on, when Nelson Mandela became president, the IMR starts to increase, going from 47.1‰ in 1993 to 53.3‰ in 1999 (end of Mandels's presidency). It increases more slowly to 54.9‰ in 2001, then it decreases to 43.1‰ in 2009.


Chart 1: Evolution of the infant mortality rate in South Africa, according to Child Mortality Estimate

Very few countries have experienced such a fast increase of IMR. In 1997-1998, it spiked in an increase of 2.8% per year. Most other countries which have seen a similar evolution have gone through a civil war or a total breakdown of the political regime, like for example Rwanda, Montenegro or some Baltic countries at the beginning of the 1990ies. All the other countries in the same case are in the same geographic area as South Africa: Swaziland (1994-2001, culminating in an increase of 1.9% per year in 1998), Botswana (1992-1998, maximum 5.6% per year) and more recently Mauritius (2005-2009). It looks as if Nelson Mandela's disastrous policy had become a regional trend.

The abstract figures of IMR in per thousand and their reduction or increase expressed in percent must not let us forget the reality of huge human suffering behind this reality. Another figure can help to illustrate this fact. Using the IMR figures for the 1990ies, we can calculate the number of babies which could have been saved with a reasonable effort.

The parting point is an average decrease or the IMR, calculated for all the countries on earth without ponderation according to the population. Then we calculate the difference between such a scenario of average decrease and the situation under Nelson Mandela.

Health workers often have to work under difficult conditions. Photo: WHO.

Health workers often have to work under difficult conditions. Photo: WHO.

Once the health system has been ruined by years of neglect, it is difficult to catch up the years lost. This is clearly proven by the fact that the decrease of the IMR can not go beyond a certain value, even if the government invests huge sums of money. In order to take this long term effect into account, we suppose that after the end of Mandela's presidency, his successor achieved a decrease rate double the average rate. Like this, we can calculate the number of babies who died as a consequence of the neglect of one precise government. For Nelson Mandela, we get the horrifying figure of 95,000 babies.

It is quite shocking to see that our media do not care at all about the babies born in South Africa. In fact, this issue, which is related to the access to health care in general, has got an influence far beyond the borders of the country; this is clearly shown by the problem of tuberculosis. If we order the countries of the world according to the incidence rate (the number of people who get infected out of 100,000 people each year), South Africa has got the second highest rate in the world, behind Swaziland. Both countries have experienced a huge increase of this rate between 2000 and 2008, of 50% for Swaziland and 65% for South Africa.

This disease will not only kill many people, the massive presence will also facilitate the appearance of resistance to antibiotics, which will make the treatment more difficult or even impossible in the future. If we consider the fact that South Africa in particular has got the necessary means to fight the spread of this disease, the negligence of the health system and the absence of measures to reign in tuberculosis since Nelson Mandela came to power is simply criminal.

With this article, I don't' want to imply that it would have been better if the apartheid regime had stayed in power. That regime was based on racism and had to disappear. However, Nelson Mandela's heroic fight against this shame of humanity can not justify a disastrous policy which cost the lives of 95,000 babies. Even if his successor Thabo Mbeki has managed to reduce the IMR, we have to wait until 2007 until this indicator goes below the value of 1993, the year before Mandela came to power. In 2009, in the ranking indicating the effort of each country to reduce the IMR in relation to the standard of living, South Africa ranked 149th out of 156.

South Africa is clearly among the worst violators of human rights in the field of medical care. The 2010 Soccer World Cup could have been an occasion to inform the world public opinion about the criminal negligence which its government shows for more than 15 years now, and to put some pressure on it so that something gets finally done; but nothing happened. If a regime jails a few dozen journalists or bloggers, we get a global outcry of the media. If a president has got the death of 95,000 babies on his conscience, he gets the Nobel Prize. What a wonderful world…


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