Africa: Women's Health Documents, 5/11/98

Africa: Women's Health Documents, 5/11/98

Africa: Women's Health Documents
Date distributed (ymd): 980511
Document reposted by APIC

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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.

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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, and



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

For more information contact:
Sally Ethelston Population Action International
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

Contact: Hugh O'Haire
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

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.

TheYear of Safe Motherhood website ( contains information and updates about relevant activities.

The Inter-Agency Group comprises the

United Nations Population Fund (UNFPA)

theUnited Nations Children's Fund (UNICEF)

theWorld Health Organization (WHO)

theInternational Planned Parenthood Federation, and the

Population Council

Family Care International ( serves as the Group'ssecretariat.

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 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.

Rights for Sexual and Reproductive Health Chapter 2:

The Right to Choose: Reproductive Rights and Reproductive Health an advocacy booklet based on The State of World Population 1997 report.

Issues in Measuring and Monitoring Maternal Mortality: Implications for Programmes Technical and Policy Paper No. 1, by Richard Leete.


From: Message-Id: <> Date: Mon, 11 May 1998 21:47:22 -0500 Subject: Africa: Women's Health Documents

Editor: Ali B. Ali-Dinar

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