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Note: This document is from the archive of the Africa Policy E-Journal, published
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Africa: Women's Health Documents
Africa: Women's Health Documents
Date distributed (ymd): 980511
Document reposted by APIC
+++++++++++++++++++++Document Profile+++++++++++++++++++++
Region: Continent-Wide
Issue Areas: +economy/development+ +gender/women+ Summary Contents:
This posting contains (1) a press release announcing a new study on family
planning in Africa from Population Action International and (2) excerpts
from last month's World Health Day announcement of an international initiative
aimed at reducing maternal mortality in Africa and other developing areas.
+++++++++++++++++end profile++++++++++++++++++++++++++++++
APIC Note to Readers: With the G8 Summit of leading developed countries
on May 15-17 in Birmingham, UK, the international Jubilee 2000 campaign
and other groups are focusing on presenting the case for cancellation of
unpayable debts. New links on this issue and the summit can be found at
http://www.jubilee2000uk.org,
http://www.newsunlimited.co.uk/debt/0,2759,18999,00.html
and http://www.africapolicy.org/action/debt.htm
AFRICA AT THE TURNING POINT:
DEVELOPMENT HINGES ON SUCCESS IN POPULATION, HEALTH
Study highlights rising demand for family planning as key to progress
May 3, 1998 -- Washington, DC
With Kenya, South Africa, Botswana and Zimbabwe leading the way, the
countries of sub-Saharan Africa are at a critical turning point in their
efforts to address the dual challenge of rapid population growth and poor
reproductive health, according to a new study from Population Action International
(PAI). The region's prospects for economic development largely depend on
the success--or failure--of governments in accelerating efforts to expand
family planning services and to combat deaths in pregnancy and childbirth
and from AIDS.
Sub-Saharan Africa's population has doubled in just 25 years to 620
million--and is projected to double again in less than three decades, even
after taking into account declining birthrates and rising deaths from AIDS.
For more than 20 years, population growth of almost 3 percent a year has
outpaced economic gains as well as increases in food production, leaving
Africans, on average, 22 percent poorer than in 1975.
"The development challenges facing sub-Saharan Africa are made
greater by rapid population growth and poor reproductive health,"
says C. Payne Lucas, President of Africare and a PAI Board member. "The
impact of other investments in the region will be undermined unless governments
move quickly to address these problems."
Fortunately, African governments are increasingly taking steps to address
these challenges. Today, two-thirds of countries in the region have active
family planning programs, up from just a handful in the early 1980s. This
dramatic change in government policy has been accompanied by a fundamental
shift in people's attitudes towards childbearing, according to the PAI
study, Africa's Population Challenge: Accelerating Progress in Reproductive
Health. Urbanization, the rising cost of education and other basic needs,
and the improved chances of survival for children are all affecting the
traditional preference for large families. The decline in birthrates--
limited a decade ago to a few countries in the region--is spreading steadily
across the continent, according to the study's authors, Shanti R. Conly
and James E. Rosen.
Use of family planning, although still low at 18 percent for the region
as a whole, has increased dramatically in some countries. Yet another 22
million married women--an additional 25 percent--indicate a desire to delay
or avoid another pregnancy, but are not using contraception. This "unmet
need" for family planning in Africa is higher than in any other region;
of 12 countries where such need exceeds 30 percent of married women, 11
are in sub-Saharan Africa.
Africa faces many other reproductive health challenges. Frequent childbearing,
high levels of maternal mortality, and an epidemic of sexually transmitted
diseases (STDs), including HIV/AIDS, all take their toll. With only ten
percent of the world's women, sub-Saharan Africa accounts for 40 percent
of all pregnancy-related deaths. During her lifetime, an African woman
has a 1 in 15 chance of dying in pregnancy or childbirth --odds over 200
times greater than those faced by women in the United States. About 22,000
African women die each year from unsafe abortion, reflecting both legal
restrictions on abortion and limited access to contraception. Meanwhile,
the AIDS epidemic has already killed more than 4 million Africans and an
estimated 21 million adults and children are infected with HIV/AIDS. Further
jeopardizing women's health is the traditional practice of female genital
mutilation which affects 110 million women in the region.
The task of addressing these and other social needs is doubly onerous
in countries--such as in sub-Saharan Africa--with rapidly growing populations.
Today, fewer than half of Africans have access to basic health care. The
proportion of children enrolled in primary school has actually fallen since
the 1980s. Women are disadvantaged in access to educational and economic
opportunities, and their low education and social status limit their influence
in family decisions and their ability to use contraception and health services.
The comprehensive PAI study provides examples of the substantial headway
some African governments are making in improving reproductive health in
the region--answering critics skeptical of development aid for Africa:
More countries now have outreach efforts at the local community level to
help improve acceptance for and access to family planning. In Kenya, a
leader in developing such programs, there are now 25 programs employing
about 17,000 outreach workers--women and men who take contraceptive services
directly to their clients. In communities served, nearly 60 percent of
men and women know a field worker. Voluntary sterilization for women--considered
even five years ago to be culturally unacceptable--is becoming more widely
available and is rapidly gaining popularity, although vasectomy has yet
to gain acceptance.Mass media campaigns are increasing knowledge of family
planning, as well as AIDS and other reproductive health issues. Radio programs
geared to young people in Kenya, Nigeria and Uganda transmit messages on
sexual responsibility and information on prevention of both pregnancy and
AIDS. Today, more than 20 countries are making subsidized, low-cost condoms
available through commercial sales outlets. Condom sales in sub-Saharan
Africa quadrupled between 1991 and 1995 to 166 million annually--one-quarter
of the worldwide total for so-called "social marketing" of condoms.
In Uganda, a vigorous AIDS prevention campaign has led to a decline in
HIV prevalence (rates of infection), showing that there is real potential
for bringing the AIDS epidemic under control, according to the report's
authors. Ghana, Kenya and Nigeria have introduced programs on a national
scale to improve emergency treatment of women suffering from complications
of unsafe abortion.
"Africa is a latecomer to the revolution in reproductive behavior
sweeping across the developing world, but is now poised for positive change
with respect to childbearing patterns and sexual health," says Shanti
R. Conly, PAI's director of policy analysis and co-author of the study.
"Meanwhile the needs are urgent; Africa must learn from successes
in and outside the region to accelerate improvements in reproductive health."
The PAI report highlights areas where progress to date is particularly
disappointing, including efforts to deal with the problem of teen pregnancy
and its serious consequences. More than 1 in 7 African adolescents give
birth each year--more than twice the average for other developing countries
and two and a half times the rate in the United States. Adolescents are
also at high risk of unsafe abortion and HIV infection, yet in most countries
the provision of sexual and reproductive health information and services
to young people remains highly controversial. Laws and policies often restrict
their access to such services. In Kenya, the Roman Catholic church has
vigorously opposed sexuality education in schools.
A second area where progress is lagging is the incorporation of AIDS
education into family planning and maternal health services. A study in
10 countries revealed that health staff discuss sexually transmitted diseases
with only one 1 in 10 family planning clients, and AIDS with just 1 in
14. Such services are often the only contact women have with the health
system and thus an important opportunity for educating women about protecting
themselves from HIV/AIDS.
Stressing the need for a partnership among governments in the region,
donor nations and the private sector, PAI calls on governments to further
expand basic health services in order to increase access to family planning
and other reproductive health services, and to build up their capacity
to deliver high quality reproductive health services. Governments also
need to reach out beyond health clinics to local communities, further strengthen
basic management systems--especially in the area of contraceptive supply--and
tap into the substantial expertise of both non-profit and for-profit private
organizations.
PAI further recommends that African governments:
- improve the quality of services by removing unnecessary obstacles to
contraceptive use and providing the broadest possible range of contraceptive
methods;
- break the taboo on providing services to unmarried adolescents, to
ensure they have the means to protect themselves from unwanted pregnancy,
AIDS and other STDs;
- expand campaigns aimed at increasing male involvement in both family
planning and prevention of STDs, especially AIDS;
- strengthen links between family planning and related health services
including, in particular, AIDS/STD prevention and post-abortion care;
- improve emergency care for women who experience complications during
delivery through community education, training of health staff and upgrading
of health facilities;
- intensify efforts to raise women's status by increasing school enrollment
among girls, removing legal and other barriers to women's economic participation,
and halting the practice of female genital mutilation.
Carrying out such an ambitious agenda will require enormous effort by
African governments, according to PAI, particularly with regard to financial
resources. Most countries in the region are extremely poor and current
funding falls far short of the estimated $2 billion needed in order to
meet family planning and other reproductive health needs. In 1990, African
governments spent only about $200 million of their own money for all preventive
health services, including family planning. The lack of resources in the
region highlights the need for continued assistance from the wealthy donor
nations. PAI recommends that donors increase support for family planning
and related health care from the current $500 million to at least $1 billion
by the year 2000.
Historically, the United States--the world's wealthiest country--has
led the way in assisting family planning and reproductive health programs
in Africa, providing some $127 million in 1996 for training, supplies and
other hands-on assistance. Other large-scale donors are the United Nations
Population Fund, Germany and Great Britain. But future prospects for population
assistance to Africa are uncertain because U.S. leadership on population
and reproductive health in the region is slipping, according to the PAI
study. Worldwide, U.S. funding for population programs is now 30 percent
lower than in 1995. In Africa, the U.S. Agency for International Development,
which administers population assistance, has closed nine country offices
since 1994 and reduced the number of population and health experts in the
field by more than one-third.
Africa's Population Challenge: Accelerating Progress in Reproductive
Health is the fourth in a PAI study series which began in 1992 with reports
on population and reproductive health programs in China and India. The
authors of the current study say their decision to focus on sub-Saharan
Africa, rather than any individual African country, reflects the urgency
of the challenges facing the region as a whole.
"With political and economic reforms now underway in many African
countries, governments are increasingly seeking to respond to the health
and education needs of their people," says Ms. Conly. "Given
the region's limited financial resources, however, there is no guarantee
that the progress highlighted in our report will continue. The donor community
must seize the opportunity to help Africa move out of poverty and towards
greater health and prosperity."
The report is available at
http://www.populationaction.org/programs/afpop/afpop_index.htm
For more information contact:
Sally Ethelston Population Action International Web: http://www.populationaction.org
E-mail: sae@popact.org
Tel: 202-659-1833, Ext. 133
1120 19th Street, NW # 550
Washington, DC 20036
United Nations Population Fund
United Nations Population Fund
220 East 42nd Street,
New York, NY 10017, USA
Tel. (212) 297-5020; fax (212) 557-6416 Web: http://www.unfpa.org
Contact: Hugh O'Haire
E-mail: ohaire@unfpa.org
Fax: (212) 557-6416
1998 'Year of Safe Motherhood'
UNFPA, Five Other International Agencies Seek to Slash Half Million
Annual Maternal Deaths
(full press release available at
http://www.unfpa.org/modules/intercenter/tables/index.htm)
NEW YORK, 6 April 1998--As nearly 600,000 women, primarily in developing
countries, die from childbirth-related illnesses and injuries, a vast majority
of which could be prevented with affordable measures, a consortium of United
Nations and international agencies, the Safe Motherhood Inter-Agency Group
(IAG), has launched a year-long awareness campaign and called on governments
and people worldwide to commit to implementing those measures.
The Year of Safe Motherhood website
(http://www.safemotherhood.org)
contains information and updates about relevant activities.
The Inter-Agency Group comprises the
United Nations Population Fund (UNFPA)
http://www.unfpa.org
the United Nations Children's Fund (UNICEF) http://www.unicef.org
the World Health Organization (WHO)
http://www.who.ch
the International Planned Parenthood Federation http://www.ippf.org,
and the
Population Council
http://www.popcouncil.org
Family Care International (http://www.familycareintl.org)
serves as the Group's secretariat.
Highlighting the year-long programme of activities was a major event
on World Health Day (7 April) at the World Bank headquarters in Washington,
D.C. ... (For further information on the World Health Day event, visit
the http://www.presspack.com Virtual
Press Office.) ...
The Inter-Agency Group will issue a call to action, which will include
the following:
- International aid agencies are urged to provide overseas assistance
to programmes that promote maternal care as an essential component of reproductive
health services.
- Governments of developing countries are urged to reduce maternal mortality
and morbidity by developing and implementing health, nutrition and education
programmes that promote the health of pregnant women and their infants.
- Corporations around the world are urged to encourage governments and
private organizations in host countries to provide funds and develop programmes
that foster safe motherhood, and to support safe motherhood among their
employees and customers.
- Women, men and families everywhere are urged to demand and seek quality
prenatal and obstetric care to ensure that no woman dies or suffers long-term
complications from childbirth.
In preparation for the "Year of Safe Motherhood," the Inter-Agency
Group and other experts held a conference in Colombo last October and approved
the results of 10 years of research on safe motherhood, which showed that
the following measures would drastically reduce maternal deaths:
- Routine care before, during and after childbirth;
- Emergency care for life-threatening obstetric complications;
- Services to prevent and manage the complications of unsafe abortions;
- Family planning to prevent unwanted pregnancies;
- Health education and services for adolescents; and
- Community education for women, their families and decision makers.
Maternal and newborn health services would cost an average of $3 per
person per year in developing countries; maternal health services alone
would cost as little as $2 per person, according to the Group. The measures
would curb maternal deaths, nearly three fourths of which are directly
related to severe bleeding (25 per cent), infection (15 per cent), unsafe
abortions (13 per cent), eclampsia (12 per cent), and obstructed labour
(8 per cent). Eight per cent of deaths are due to other direct causes such
as ectopic pregnancy, embolism and anaesthesia-related complications, while
the remaining 20 per cent are due to indirect causes such as anaemia, malaria
or heart disease.
Making motherhood safer requires more than good quality reproductive
health services; women must be empowered and their human rights -- including
their rights to good quality services and information during and after
pregnancy and childbirth -- guaranteed, according to the Group. ...
Related UNFPA web pages:
The State of World Population 1997--The Right to Choose: Reproductive
Rights and Reproductive Health. http://www.unfpa.org/swp/swpmain.htm
Rights for Sexual and Reproductive Health Chapter 2: http://www.unfpa.org/swp/1997/chapter2.htm
The Right to Choose: Reproductive Rights and Reproductive Health an
advocacy booklet based on The State of World Population 1997 report.
http://www.unfpa.org/modules/intercenter/reprights/theright.htm
Issues in Measuring and Monitoring Maternal Mortality: Implications
for Programmes Technical and Policy Paper No. 1, by Richard Leete.
May be ordered at: http://www.unfpa.org/publications/technical.htm#Reproductive Health
This material is being reposted for wider distribution by the Africa
Policy Information Center (APIC), the educational affiliate of the Washington
Office on Africa. APIC's primary objective is to widen the policy debate
in the United States around African issues and the U.S. role in Africa,
by concentrating on providing accessible policy-relevant information and
analysis usable by a wide range of groups individuals.
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