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HEALTH: It Gets Worse in Africa

Sanjay Suri

LONDON, Aug 31 2004 (IPS) - The state of reproductive health is getting worse in several African countries, a new ‘report card’ prepared for a London meet reveals.

The report card ‘ICPD at Ten: Where Are We Now?’ was released Tuesday at the start of the three-day conference ‘Countdown 2015: Sexual and Reproductive Health and Rights for All’.

The conference has been called by non-governmental organisations to mark ten years since governments committed themselves in Cairo to reproductive health rights for all in 20 years time.

The report prepared by the independent groups Population Action International (PAI), Family Care International (FCI) and the International Planned Parenthood Federation (IPPF) finds that ”23 countries have made significant progress towards the health and reproductive rights goals of the 1994 International Conference on Population and Development (ICPD), but 17 countries have achieved little or nothing, or actually lost ground.”

More than 700 leaders, parliamentarians and activists in reproductive health and family planning from 109 countries have gathered at the Countdown 2015 global roundtable to assess progress made and progress needed to meet ICPD goals by the 2015 deadline.

The study intended as a centrepiece for discussions at the conference uses seven indicators to measure progress. These are: the female secondary school gross enrolment rate; the ratio of female secondary school gross enrolment rate to male secondary school gross enrolment rate; the percentage of births attended by skilled personnel; infant mortality rate (the rate of children dying before their first birthdays); contraceptive prevalence; the total unmet need for family planning; and adolescent fertility.

Developing countries found to have made little or no progress include Botswana, Namibia, Senegal and South Africa. Burkina Faso and Cameroon have lost ground since 1994. The countries making the most progress in the past decade are Tunisia, Bangladesh, Nepal, Peru, and the Philippines.

The report finds also that some of the developed countries including the United States, Portugal and Kuwait are doing poorly in this field.

The report card first ranks 133 countries (with a population of one million or more, 97 developing and 36 developed) on 13 indicators of reproductive health risk. The countries are divided into five categories, from highest-risk to lowest-risk. Countries that lacked data on five or more indicators were not ranked in the survey. These included Afghanistan, Denmark, Hong Kong, Ireland and Venezuela, among others.

The study lists several areas where there has been little or no progress. These include the following:

High proportions of teens are still giving birth. Since 1994, average fertility rates among both married and unmarried adolescents have remained practically constant.

Teen birthrates are highest in the Democratic Republic of the Congo, Angola, Liberia, Niger, Somalia, and Sierra Leone, where more than one in five girls aged 15 to 19 give birth each year.

Only marginal progress has been made worldwide in saving mothers from largely preventable deaths in complications of pregnancy and childbirth. Each year more than 525,000 women die from complications of pregnancy or delivery – almost all of them of in the developing world.

The past decade has seen a general liberalisation of abortion laws, yet one in every ten pregnancies still ends in unsafe abortion – about 19 million each year. A woman dies every seven minutes – nearly 70,000 each year – from unsafe abortion. In Africa, one in every 150 abortions leads to death, compared to one in every 85,000 procedures in the developed world.

Many clinics throughout the world have no contraceptives, safe motherhood kits, or other reproductive health essentials. The shortfall is acute and growing. Supply efforts suffer from lack of funding, poor coordination by donors and logistical complications. By 2015, the gap between the need for supplies, and the funding available for them, is expected to reach hundreds of millions of dollars.

But the study did find some areas where there has been progress:

The greatest increases in contraceptive use are in sub-Saharan Africa and Latin America. But millions of couples still want to space their children and cannot get access to contraception. Roughly 123 million couples (or one in six) in the developing world and former Soviet states have an unmet need for effective methods of contraception.

Worldwide, more boys attend secondary school than girls, but girls are catching up in many places. Significant progress has been made in all regions in raising the enrolment rates of girls in school, with a few countries seeing increases of more than 10 percent on average each year. Every year of education reduces the likelihood that a girl will bear a child in her teens or live in poverty.

Roughly 80 percent of countries have witnessed an increase in the share of parliamentary seats held by women. But women remain far underrepresented in these decision-making bodies.

In 2003, only 15 percent of national parliamentary seats were held by women. Women in northern and western Europe, along with Argentina, Costa Rica and Cuba enjoy the highest shares of seats, with rates of 30 to 45 percent. The United States, Britain and Japan trail the industrialised world with less than 18 percent.