Congo, Democratic Republic of the

The Democratic Republic of the Congo (DRC, formerly Zaire) is an African nation of almost 69 million people, with an astounding 46.9 percent aged 14 years or younger (the country's median age is 16.4 years). The population growth rate is 3.2 percent, with a rate of 43 births per 1,000 and a death rate of 11.9 per 1,000. Life expectancy at birth is 52.6 years for men and 56.2 for females; both are quite low by international standards due to death from infectious disease and warfare. The total fertility rate (the estimated number of children per mother) is 6.2, despite an infant mortality rate of 81.2 per 1,000 live births. The country includes over 200 African ethnic groups, with the Bantu in the majority; the population is 70 percent Christian, 10 percent Muslim, and the remainder other beliefs.

The DRC has a long history of political unrest and dictatorial rule, which prevented orderly economic development and impeded the established of even a basic system of health services delivery. It was first established as a Belgian colony and became an independent country in 1960, but in 1965 Joseph Mobutu (later Mobutu Sese Seko) seized power, which he maintained for over 30 years. The years 1996–2003 were marred by frequent civil warfare, in part sparked by unrest in neighboring Rwanda that spilled over the border: it is estimated that 5 million people died in the First and Second Congo Wars during these years. The continued internal warfare, along with wars in neighboring Rwanda, Burundi, and Uganda, produced many refugees and displaced persons: 2007 estimates are that the DRC harbors almost 200,000 refugees from neighboring countries and 1.4 million internally displaced persons.

Although the DRC is rich in natural resources (including cobalt ore, copper, diamonds, and tantalum), the continued warfare and political corruption mean that most of the population has yet to benefit from them. The per-capita Gross Domestic Product (GDP) in 2008 was $300, and the per-capita expenditure on health in the DRC was $4 in 2002, representing 4.1 percent of the total GDP. The government provides about 30 percent of spending on health, with external sources providing about 28 percent and private expenditures the remainder.

Women are a disadvantaged social class in the DRC due to a long history of discrimination, which has its basis in both tribal society and the colonial system. For instance, married women are required by law to have their husband's permission to take a job or open a bank account, and women have lower levels of education and are discriminated against. About 54 percent of women are literate, as compared to about 81 percent of men. Women also suffer disproportionately during the civil wars that are rampant in the DRC, often becoming victims of rape or kidnapping as sexual slaves. The DRC is on the Tier 2 Watch List of the U.S. Department of State for failures to monitor and combat human trafficking.