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Presented by Dr Sylvia Deganus Ghana

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1 Presented by Dr Sylvia Deganus Ghana
The Unfinished Business: Family planning & Maternal Health in a Context of Gender Inequality: Presented by Dr Sylvia Deganus Ghana

2 Presentation Outline Maternal Health and FP situation in Africa Today
Maternal Health and FP in the context of Gender Inequality Cost of Maternal ill-health and Death and FP, The way forward in addressing Africa’s “unfinished business” in SRH

Even though progress has been made (41% ) MMR in SSA still remains dismal 162,000 mothers die needlessly because of complications during pregnancy and childbirth. This figure represents a staggering 56% of the global total. Close to 1 million African children are left motherless In 2010, countries with highest maternal mortality were Chad (1,100), Somalia (1,000), Central African Republic, (890), Sierra Leone (890) and Burundi (800).[11] Lowest rates included Estonia at 2 per 100,000 and Singapore at 3 per 100,000

These medical causes of maternal deaths tell only part of the full story……. Deaths associated with HIV infection form a major proportion of indirect Causes of (other) Maternal deaths

Sub Saharan Africa has the highest fertility rates in the world, with a TFR averaging 5.5 (range

Contraceptive Prevalence, 2009 or Latest Available Data Source: (World Bank 2011) Modern Contraceptive Use In Ghana, Kenya, Malawi, Nigeria, Senegal, Tanzania, Uganada And Zambia, 1989–2006. Prata N Phil. Trans. R. Soc. B 2009 ;364 :

Birth rates in Africa are high in large part due to low use of family planning 29% of African women who are married or in union use contraception, compared with an average of 61% worldwide. 11 African countries have contraceptive prevalence rates of 10% or less, meaning that fewer than 1 in 10 women of childbearing age who are in union use family planning.

Factors contributing to Maternal Ill-health and Death in Sub-Saharan Africa Many factors prevent African women from seeking and receiving care before and during pregnancy and childbirth. These include: Poor Access to Quality health care services Ignorance/lack of information Distance to Facilities Socio-cultural practices Poverty GENDER POOR USE OF HEALTH CARE SERVICES & death

9 Gender Disparity In Africa is a Reality!
Gender inequalities are systematic and occur at the macro, societal and household levels. Compared to their male counterparts African girls and women are: Less educated Poorer In subordinate positions within the household context Economically dependent on men “Voiceless” in decision making at household, community and national levels More exposed to harmful traditional practices More exposed to unfavorable / harmful sexual and reproductive health practices.

In sub-Saharan Africa, more than half of girls—54 percent—do not complete even a primary school education ( Bruns et al. 2003). After primary school, girls’ participation plummets further—only 17 percent of girls in Africa are enrolled in secondary school (UNESCO 2003).

11 Gender in Marriage and Childbearing:
A woman’s identity in society is often associated with her capacity to give birth and the number of children she has. per cent of women (20-24 years old) in West and Central Africa were married or in union before they were 18 years old. In most of SSA Africa a woman’s has no control over her own sexuality or fertility Adolescent pregnancy and motherhood are exceptionally high in West and Central Africa

12 Women’s Low Economic Status
Women in SSA constitute 80% of the poor and account for most of the unpaid work. Women generally undertake unpaid domestic and agricultural chores that are not recorded in countries’ national accounts Women continue to care for children, the sick, and the old, gather fuel and water, and prepare food Women’s wages in the formal sectors of employment remain low due to their low level of education and skills.

13 Gender In-Equality in Leadership
In SSA failure of women to participate in decision making goes beyond the household level to a macro decision-making level. Gender disparity in SSA Governments promote expenditures that prioritize issues that do not directly benefit women and save them from needless deaths Indicators Total Male Female Participation in Parliament (%, 2007) 100.0 84.4 15.6 Participation in Government: Ministerial level (% 2005) 85.9 14.1 Participation in Government: Sub-ministerial level (% 2004) 93.1 6.9 Participation in Government : Administrators and managers (% 2004) 88.5 11.5 Participation in Labor Force (%, 2005) 59.0 41.0 Source: African Development Bank (2009), Gender, Poverty and Environmental Indicators on African Countries.

The young African girl and woman enters her reproductive years, in poorer health status and largely ignorant of SRH. She is exposed to harmful traditional practices e.g. FGM, early sexual activity and/or marriage. She has little control over her sexuality and fertility resulting unsafe sex and unplanned pregnancies with unfavorable consequences (e.g. STI/HIV, Unsafe Abortion). During pregnancy her lower social status often means she receives inadequate support and care at household level and from the health care system. When complications arise during pregnancy access to care is limited by her subordinate position, her lack of empowerment and economic dependency on her male partner. When consequences of poor Maternal health and SRH present (e.g. HIV, Fistula) she bears the blame, is neglected, divorced and further impoverished

RELATIONSHIP BETWEEN GENDER INEQUALITY INDEX (GII) AND MATERNAL MORTALITY GII, captures disparities between men and women across three dimensions (reproductive health, women empowerment and employment) Source: Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis: (Frank Chirowa1 Stephen Atwood1 Marc Van der Putte 2013)

16 Parity (PPP) and Maternal Mortality
Relationship between Total Health Expenditure (THE) in Purchasing Power Parity (PPP) and Maternal Mortality THE/PPP) captures preventative care, curative care, nutrition and reproductive health per person. Source: Gender inequality, health expenditure and maternal mortality in sub-Saharan Africa: A secondary data analysis: (Frank Chirowa1 Stephen Atwood1 Marc Van der Putte 2013

17 Can We Cost a Mother’s Health and Life?
In 2012, an estimated 162,000 women in Sub-Saharan Africa died from pregnancy- and birth-related causes; 62,000 of these women did not want to become pregnant in the first place. “A mother’s life is priceless…..” Cost of her death /ill-health extend beyond that quantified in measures, such as DALYs* or Dollars Effects of her ill-health and death impact on the well-being of her family, her society and nation affecting even generations unborn both economically and socially. Courtesy Kat Russell

MATERNAL IL-LHEALTH AND /OR DEATH COMMUNITY Productivity losses Loss of social cohesion Crime SHORT AND LONG TERM CONSEQUENCES WOMAN Physical Poor health Anemia VVF/Incontinence Uterine prolapse Dyspareunia Hypertension Psychological Depression Abuse CHILDREN Poor survival Low education Poor Growth and Development Risk of abuse Psychological challenges FAMILY AND HOUSEHOLD Social Loss of family structure Less social support Child care challenges Changes in relationships Violence and neglect Economic Increased poverty Productivity losses Adapted From:J Health Popul Nutr June; 30(2): 124–130

19 Economic Losses Due to Maternal Ill-Health and Death
Maternal health complications can have catastrophic effects on household expenditure. Poor households with maternal health complications spend 30 to 40 percent of their savings to cover expenses, compared to only 8 percent for the richest quintile . Maternal mortality has a negative effect on GDP. A single maternal death was found to reduce per capita GDP by US$ 0.36 per year. [Source:Kirigia JM et al, Afr J Health Sci. 2006; 13:86-95] Women make up 70 percent of Africa's labor force and produce 80 percent of food; therefore, maternal deaths and disabilities are a direct cost to the economy (Dr. Nomonde Xundu with the South African embassy).

20 Beyond 2014-The Way forward
A multi-sectorial approach is imperative to improve women’s health and reduce maternal deaths in Africa: Girl child /Women Education Access to quality Reproductive Health Care, (Maternal, FP) Protecting women’s rights and Economic empowerment Education Economic Prosperity Universal Access to SRH care Health & survival for women

21 1. Female Education Impacts on her Fertility
Women with more than seven years of education have on average fewer children in Africa than women with no education (Hobcraft 1993) Education will help achieve reproductive behavioural change in face of challenging socio-cultural, gender and economic circumstances

22 2. Universal Access (100%) to Sexual and Reproductive Health Care Is Necessary……….
All women must have access to SRH care including FP & skilled care during Pregnancy and childbirth “Gaps in access to care still exist” Prenatal care was 73.47% Births attended by skilled health attendant was 46.13%, Contraceptive prevalence (of women ages 15-49) was 21.83% World Bank Report For Sub-Saharan Africa in 2012

23 Universal Access To Sexual And Reproductive Health Care
The interventions that save women’s lives are known. What is needed is the commitment to make them a reality: Evidence-based interventions for major causes of maternal mortality Exist !

24 Family Planning Saves Lives !
Family planning is one of the most basic and essential healthcare services that can promote and ensure reproductive health. Fully meeting all need for modern contraceptive methods would prevent 48,000 of the 162,000 maternal deaths ---a 29% decline in maternal mortality. If all unmet need were fulfilled, the number of unintended pregnancies in the region would drop by 78%—from 19 million to four million—resulting in 8 million fewer unplanned births, 5 million fewer abortions and 2 million fewer miscarriages. Fulfilling unmet need of FP in SSA would also prevent 555,000 infant deaths—255,000 newborn deaths and 300,000 deaths among older infants—which would result in a 22% decline in infant mortality.

Source: (United Nations Population Division 2011) and (ORC Macro 2011)

26 Family Planning is Cost saving
Figure 2. Maternal and child health cost savings if Unmet needs for FP are met add up to $182 million for francophone West Africa, 2010–2020 Figure 1. Social sector savings are three times the costs of meeting unmet need for family planning in francophone West Africa, 2010–2020 Source: Policy Initiative/USAID Jan 2011

27 Women’ s Socio-economic Status Influence Their Use
of SRH Care Services Richer, educated and urban resident Ghanaian women benefit more from skilled deliveries…(MICS 2011)

28 3. When Empowered economically and socially , Women take charge of their own lives …..
The Rwanda Success Story: There are more women in Rwanda's parliament than any other country in the world. Laws have been passed so they can own land, and wives can legally keep their assets separate from their husbands Effective strategies and health and financing systems have been established that have improved women’s access to SRH care Rwanda has done what no other country has done to date – increased its contraceptive prevalence rate (CPR) more than 10-fold in less than a decade. Pictures are courtesy of Women’s health Report, WHO)

29 Beyond 2014…… Africa Must Focus on its Youth Today…………
The population of youth (15–24 years old) is expected to reach 200 million in SSA by 2015. Their ability to make healthy and informed decisions about sexuality, childbearing and birth spacing now will yield the desired high returns in the region well beyond 2014. The 3 strategic approaches of Education, improving access to SRH care (including maternity care, Family Planning, Abortion Care) and Social/ Economic programs must focus on this generation.

30 If we dream it…it is possible!
Of the 10 countries that were reported to have achieved MDG5 in 20101, at least five were in sub-Saharan Africa. These include Equatorial Guinea that achieved an impressive 81% reduction, Egypt, Eritrea, Cape Verde, and Rwanda.

“The woman is the heart of the house, so if your heart is working well the whole body I think is also to benefit,“. (Dr. Jean Damascene Ntawukuriryayo, a parliamentarian for the Social Democratic Party, RWANDA).

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