Sexual reproductive health is dying for attention in Africa!

Francis Kokutse is a journalist based in Accra and writes for Associated Press (AP), University World News, as well as Science and Development.Net. He was a Staff Writer of African Concord and Africa Economic Digest in London, UK.

On a continent where researchers say, adolescent, sexual and reproductive health (ASRH) continue to be a major public health challenge, because Africa seems to be leading in child marriage, adolescent childbearing, HIV transmission and low coverage of modern contraceptives, one would expect the authorities to be doing everything possible to improve Sexual and Reproductive Health (SRH). Unfortunately, this has not been the case.

Perhaps, it is the complexity of the subject because SRH has come to mean different things to different people. In simple terms, it refers to all matters related to the reproductive system and its functions.

But it goes beyond that. Alexis Heaton, head of data and analytics, Shaping Equitable Market for Reproductive Health (SEMA),  defined SRH as including, “family planning, maternal health, prevention and treatment of sexually transmitted infections, matters related to fertility, safe abortion services, access to and information about contraceptive methods to enable individuals and couples to decide the timing and spacing of their children.”

Heaton said, advocating for the rights of individuals to make informed decisions about their reproductive health, free from discrimination, coercion, and violence are all part of it, adding that, its scope has been widened to encompass  matters related to adolescents’ health with special attention to the unique needs of adolescents, including information and services related to puberty, sexual development, and menstruation.

She said across Africa limited access to SRH products and services is driving high maternal and infant mortality rates. In fact, the continent  accounts for approximately one tenth of the world’s population and 20 percent of global births, and yet nearly half of the mothers who die during pregnancy and childbirth are from this region. Many infants also die due to inadequate prenatal and postnatal care.

In spite of the gloomy picture. Ghana is making some strides. In October, Ghana’s minister of health, Kwaku Agyeman Manu, told delegates at the Reproductive Health Supplies Coalition (RHSC) conference in Accra that, the country’s commitment to  reproductive health has  manifested in the evolvement of the Family Planning 2030 plan which is a comprehensive reproductive, maternal, newborn, child, and adolescent health, as well as a, nutrition strategy.

Manu said the government has also integrated family planning services into the National Health Insurance Scheme, adding that, between 2020 and 2022, the Ghana Health Service (GHS), and our strategic partners – United States Agency for International Aid (USAID), the United Nations Fund for Population Activities (UNFPA), Global Fund and the West Africa Health Organisation (WAHO)  have jointly provided about $14.4 million  worth of Family Planning Products.

“Beyond this, they have continuously accompanied us on this journey through technical assistance and mentoring to make sure women have access to a variety of family planning services. These collaborations, combined with our sustained commitment, have resulted in significant demographic shifts, notably a marked decline in births per woman. Total births per woman reduced from 6.4 in 1988 to 4.2 in the 2014  Ghana Demographic and Health Survey (GDHS) as well as reductions in household size 4.4 in 2010 to 3.6 in 2021 Population and Housing Census  (PHC),” he said.

With Ghana’s modest achievement, one would expect other African governments to make SRH, one of their top priorities to improve lives given the fact that approximately 810 women die every day from causes related to pregnancy, childbirth, and unsafe abortion.

Somehow, Africa seems to be placed in a tight corner and Heaton explained, the continent is burdened with  infectious diseases, and this has meant that policy makers have deprioritized the needed level of attention to SRH issues.

In terms of how Africa is doing, Heaton said, the state of  SRH in Africa varies across countries and regions, adding that, “over the last decade governments and partners have worked to increase access to lifesaving SRH services and products.”

This has contributed to 87 million more women and girls in low- and middle-income countries (LMICs) using a modern method of family planning compared to a decade ago. However, access remains out of reach for many. 218 million women in LMICs who want to avoid or delay pregnancy are still not using modern contraceptives.

It is for this reason, she said, that  SEMA has been working with countries to build healthy, equitable and resilient SRH markets that meet communities’ needs. They do this through the provision of quality, comprehensive and affordable sexual and reproductive health products and services to women and girls promoting a gender-equal world where more of them can stay in school and join the workforce for better livelihoods.

In some countries, what is hindering SRH is the fact that issues around it are considered taboo subjects. “Despite these challenges, there is an opportunity for advocates to work towards destigmatizing and prioritising SRH, fostering positive change and ensuring necessary funding for these vital services,” Heaton said.

Another problem that has become an albatross for Africa is the over-reliance on donor support to fund SRH activities. Heaton cautioned that funding from donors is unlikely to keep growing over the next decade and has shown signs of fragility.

Heaton said national financing is not growing fast enough to fill the gap and meet women and girls’ needs. “Addressing the issue of low funding for SRH services in Africa will require a multifaceted approach to address both the supply of and demand for products. This will need to include efforts to address cultural barriers and increase education and access to information,” she added.

To reduce the dependence on donors, Heaton  said countries need to develop more resilient and equitable financing approaches. This would include increased funding by country governments that focus on subsidising costs for populations based upon their ability to pay as well as promoting widespread, affordable availability via a robust and healthy private sector.

Furthermore, there is also the need to support longer-term planning and mechanisms to introduce new products, including necessary financing for health care worker training, guidance updates, and logistics systems to support product distribution.

Above all, there are also challenges that prevent women and girls from accessing SRH products and services. This includes limited access to health facilities, weak healthcare systems and services, societal stigma and discrimination, discontent with product options, limited access to information, certain cultural and religious beliefs, and economic barriers.

In fact, a recent study, ‘Hostilities faced by people on the frontlines of sexual and reproductive health and rights: a scoping review,’ published by the BMJ, Global Health echoed the attacks on frontline staff of SRH and said, though these frontline workers provide life-changing and life-saving services to millions of people every year, from accompanying the pregnant women, delivering babies and caring for the newborn, among others,  hostilities targeting them are committed the world over and yet, “remain largely underreported, underestimated and broadly invisible.”

“From ostracization and harassment in the workplace to verbal threats and physical violence, hostilities can extend even into their private lives. In other words, as SRH workers seek to fulfil the human rights of others, their own human rights are put at risk,” said the authors.

They pointed out that, the failure to acknowledge the scale and pattern of hostilities faced by frontline workers also means far too little action is taken in response: too little is done by employers to protect their workers from hostilities and to take appropriate and comprehensive action when they are subjected to hostilities.

In addition, they said, “too little is done by judicial and other due-process bodies to hold perpetrators of hostilities to account; and too little is done by the responsible State to meet their duties to tackle the wider social and political root causes of that antagonism. It leaves frontline SRH workers often ill-prepared for and insufficiently supported in the unsafe environments in which many of them must carry out their work.”

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