Africa, Development & Aid, Europe, Headlines, Health

HEALTH: All Uphill from Cairo into Africa

Sanjay Suri

LONDON, Aug 28 2004 (IPS) - A new push to reproductive health services planned at a London conference next week will have to work in Sierra Leone if anywhere.

More than 700 delegates will gather at the Countdown 2015 conference Aug. 31-Sep.2 to give new life to agreements reached at the International Conference on Population and Development (ICPD) ten years ago in Cairo. If these moves are going anywhere, things will have to get much better for those in a bad situation.

Sierra Leone, a small West African country on the Atlantic bordering Liberia and Guinea has the unhappy distinction of the highest maternal mortality rate in the world. ”That’s about 2,100 per 100,000 births,” Yvonne Harding who works with Marie Stopes International in the Sierra Leonean capital Freetown told IPS.

Marie Stopes is an international non-governmental organisation (NGO) providing reproductive health services in 37 countries.

”Infant mortality is 170 per 1,000 births, the fertility rate is 6.2 (the number of children women have on average) and the average life expectancy is just 34 years,” Harding said.

It was not always so bad. In 1990-91 maternal mortality was less than a quarter of what it is now. One reason for the collapse since then has been internal conflict which peaked into a civil war 1999-2002 between the government and the Revolutionary United Front which led to tens of thousands of deaths, and the displacement of about two million people – more than a third of the population.

”All infrastructure broke down, including health infrastructure,” Harding said. The services are still struggling to recover. Marie Stopes has set up seven centres to provide reproductive health services, five in the capital and two outside.

It is hard going. ”Family planning commodities are not readily available and we have to access condoms, pills, medicines and the like from outside,” Harding said. ”We cannot carry out abortions because they are illegal.” Abortions are legal only in South Africa and Cape Verde.

The requirements are more than the group can handle, Harding says. They need to provide the whole range of family planning services, treat sexually transmitted infections and provide information. Medicines need to be subsidised because most cannot pay. All this needs money.

”We have to make sure that funds are available for what governments committed themselves to in Cairo,” Harding said. ”The commitment cannot just be on paper, it has to be transformed into action.” The Cairo agreement and the London follow-up will mean little if nothing gets better for Sierra Leoneans.

But Sierra Leone is still only the worst of the bleak picture across Africa. ”Governments have reviewed the situation at a meeting in Dakar (Senegal), the UNFPA (United Nations Population Fund) has prepared a report on Africa, and the situation is not too good,” Josephine Mutingi who heads the Africa regional office of the International Planned Parenthood Federation (IPPF) from Nairobi told IPS.

”What is evident is that there is quite a bit of legislative policy, but in practice not much has changed,” Mutingi said. “In particular reproductive health services among the youth are being neglected, and that is a matter of concern because the youth are 44 percent of the African population.”

But difficulties remain also at the policy level because abortions are illegal in most countries. ”And maternal health is linked very closely to unsafe abortions,” Mutingi said. ”Women must be able to have the number of children they can support, have children when they want, and have the right to terminate pregnancy.”

In Sierra Leone and across much of Africa reproductive health services are at the heart of the state of the nation in both human and economic terms, Mutingi said. ”It is important that African leaders see the link between reproductive health and poverty. This conference can help to clarify the links between poverty, reproductive health and the millennium development goals.”

The London conference must focus on Africa because ”it is in greatest need of reproductive health services,” she said. The conference could bring hidden debates to the surface, Mutingi said. ”People in Africa are really quiet about the right to abortion. Governments know how serious the problem is, but very few are brave enough to tackle it.”