Harmonizing Approaches to Women s Health in Africa Khama

Harmonizing Approaches to Women’s Health in Africa Khama Rogo MD Ph. D

Life Expectancy in Africa Botswana Uganda South-Africa Zambia Zimbabwe

Women’s Health: A broader developmental issue Women’s right to the enjoyment of highest standards of health throughout the life cycle …. is essential to leading productive and fulfilling life, and the right to control all aspects of their health is basic to their empowerment Ø economic rationale – poverty alleviation Ø health rationale – family and children Ø human rights rationale – choice and inequities

G 1: Poverty/Hunger G 5: Maternal Mortality G 2: Education G 6: HIV/AIDS Leader Worker Mother Care giver G 3: Gender G 4: Child Mortality Provider Wife G 7: Environment G 8: Partnerships

Responsibility Starts Early… Girl and Sibling

Responsibility starts early -Continues throughout life Ø Girl – caring for siblings, housework… pupil Ø Adolescent – cook, carrier of water and firewood; early marriage; early motherhood Ø Adult – providing for children, husband, in-laws, own family; worker, farmer, trader, leader, Ø Old age – widowed; family headship, community leadership

Demographically, Slightly more women than men Population Growth • 693 Million in 2002 • 1. 1 Billion by 2025 • 1. 7 Billion by 2050 Doubling of population in 20 years

Economic Rationale Dependency ratio 9: 1 Dependence on women higher

Heavy Burden on Women • Biological burden – pregnancy, delivery, lactation • Physical burden – the porter, long hours; long miles • Psychological burden - work/life balance; insecurity; cultural transition Heavy burden Vulnerability and ill health

Life – Cycle approach to Women’s Health 0 -9 years 45+ years 10 -19 years 15 -49 years

High Fertility Still Highly Valued Very little change in Africa in 40 years

Family Planning Low Contraceptive Prevalence Rate among Married Women (%) NO family planning, NO rest for womankind

National Contraceptive Prevalence Rates Most < 10% Only 4 > 30%

Unmet Need for Family Planning % 20 -35% unmet need

Higher premium on child, not mother X Mother and Child

High risk pregnancies are the African Woman’s fate Every minute, a woman dies in pregnancy • 1: 8 of girls born in Angola or Mozambique will die in pregnancy (risk is 1000 X higher than Western Europe) • For each maternal death 30 to 40 suffer lifelong debilitating injuries (e. g. incontinence of stool/urine) • Adolescents form up to 30% of maternity population.

What Kills African Women in Pregnancy? Pregnancies ……Too Early …Too Frequent …Too Late The 3 Delays I. Delay in the home Poor knowledge II. Delay in transportation to health facility III. Delay in accessing appropriate service at health facility

Maternal Deaths Wide sub-regional differences North Africa 460 Western Africa 1340 Eastern Africa Central Africa 1340 1020 Southern Africa 360 Deaths per 100, 000 births

ANC PAC Safe Delivery Basic Maternity Care Essential Obstetric Care Family Planning PILLARS OF SAFE MOTHERHOOD PRIMARY HEALTH CARE EQUITY FOR WOMEN

Child Mortality Under 5’s: Little Improvement in the 1990 s

Infant Deaths Two times higher mortality for Infants born at intervals less than two years < 2 years > 2 years

HIV Prevalence Rates M-F ratio is 1: 6 in adolescents

Under 5 Mortality, Maternal Mortality and Adult HIV Prevalence 2002 Over 15% 10% - 14. 9% 3% - 9. 9% 1% - 2. 9% Under 5 Mortality (per 1000) Maternal Mortality Ratio (per 100, 000) Over 150 130 -149 Less than 129 No African country is spared Over 1200 600 - 1199 Less than 600

Adolescents & Youth Education Health Recreation Employment Dreams Deferred • • Low school enrolment High early dropout Early child bearing Early marriage Harmful traditions High unemployment Drugs War and displacement

Age at Marriage: Selected Countries Median Age at First Marriage, Women 20 to 24 at Time of Survey Years Source: ORC Macro, Demographic and Health Surveys.

Unintended Births to African Teens Births to 15 -to-19 -Year-Olds Who Said Births Were Unintended Percent (%) Source: ORC Macro, Demographic and Health Surveys.

Teenage Childbearing by Education 15 -to-19 -Year-Olds Who Are Mothers or Are Pregnant With First Child Percent (%) Source: ORC Macro, Demographic and Health Surveys.

Female Genital Mutilation Practiced in 28 countries.

Female Genital Cutting, by Age Prevalence Among Younger and Older Women Percent (%) Source: Special tabulations of Demographic and Health Survey data for 1989 -2000 by Principia International, Inc. , and published data from ORC Macro.

Women’s Health in Africa: Confounding Factors • Low female education – lack of information • Lack of control of resources • Harmful cultures and traditions • Disempowering male attitudes • Poor governance/insecurity • Transitional societies • Inadequate health care/prevention

Emerging Issues • • • Increase in women headed households Needs of poor urban women Needs of professional women Conflict and displacement Gender based violence Migration of both males and females Multi-Sectoral Approaches

Improving Women’s Health: Opportunities • Changing societal orientations in Africa • The African Woman, ever innovative • African and international agreements/covenants: ICPD, WSSD, CEDAW • MDGs – Super Eight • NEPAD • AU and the peace dividends – Angola, Mozambique, Rwanda, Sierra Leone, DRC, Liberia, Sudan, Somalia

Investments: Where/How • Health Sector: Prevention & Access to services, Emerging issues • Economics: Micro-finance • Education: EFA plus • Governance: Security & Legislation • Socio-cultural: Male attitude Leadership - Information

Improving Other Areas of Investment • Water • Energy • Environment Community Participation – NGOs

Working at all levels Focus on Integration

Call for Effective Leadership 1. Stronger political commitment 2. Additional and better use of resources: intersectoral linkages 3. Seeing beyond vertical programs: commendable but not adequate 4. Intensive and outcome oriented professional action We can do more outside the health sector

Africa 2015 No Improvement to Women’s health…. “Invest in women’s health today and you will have a healthy nation…” “Educate a woman and you educate a nation…. ” Aggrey of Achimota …NO MDGs

Sector Specific MDG Targets u Goal 1: Reducing Malnutrition Targets: 50% reduction in hunger between 1990 and 2015 Goal 4: Child Mortality Targets: 2/3 reduction in child mortality between 1990 and 2015 u Goal 5: Maternal Mortality Target: ¾ reduction in maternal mortality between 1990 and 2015 Goal 6: Communicable Diseases Target: halt and reverse HIV/AIDS, malaria, other diseases by 2015

Accelerating health programs could save 20 m children in the next 10 yrs Tools for Community Approaches

"Will the legacy of our generation be more than a series of broken promises? " Nelson Mandela, 2001