1. Journalist to Journalist Seminar: Reporting on Reproductive Health in East Africa Ayo Ajayi Population Council

2.  Some numbers ---demographic and RH  Maternal Mortality  Abortion  Contraception  STI  HIV  Harmful Traditional Practices  MDGs and CPA Outline

3. Some Numbers – mid 2005 Source: PRD 2005 World Population Data Sheet SSA E K T U ------------------------------  Population Size (millions) 752 77 34 37 27  Births per 1000 Population 41 41 38 42 47  Deaths per 1000 Population 17 16 15 18 15  Annual Rate of Natural Increase 2.4 2.5 2.2 2.4 3.2  Total Fertility Rate 5.6 5.9 4.9 5.7 6.9  Population Doubling Time (yrs) 29  Contraceptive Prevalence Rate 21 6 32 20 18  Infant deaths per 1000 births 94 100 77 120 88  % Urban 34 15 36 32 12  % 15-49 with HIV/AIDS 7.4 4.4 6.7 7.0 7.1  % living below $2 per day 75 78 58 73 97

4.  Measuring MM accurately is difficult  Use of process indicators for monitoring trends  Most widely used---skilled attendant at delivery  And Proportion of deliveries by Caesarian Section  Both indicators show increases between 1990-2000  Least change in sub-Saharan Africa – less than 25% Maternal Mortality

5. Births in 2000 and Births Attended by Skilled Personnel, 1995-2000 Births and Assisted Deliveries Worldwide Source: UNICEF End of Decade Databases—Delivery Care (www.childinfo.org/eddb/maternal/index.htm).

6. Lifetime Risks to Mothers Risk of Dying of Maternal Causes or of Losing a Newborn * Percent chance Source: Save the Children and Population Reference Bureau, Healthy Mothers and Healthy Newborns: The Vital Link (April 2002).

7. Skilled Care at Delivery and Maternal Deaths Regional Comparisons, 1995 Sub-Saharan Africa South Asia East Asia and Pacific Middle East and North Africa Latin America/ Caribbean North America Source: PRB, using data from Maternal Mortality in 1995: Estimates Developed by WHO, UNICEF, and UNFPA, 2001.

8. Causes of Maternal Deaths  Nearly three-quarters of maternal deaths are due to direct complications of pregnancy and childbirth, such as severe bleeding, infection, unsafe abortion, hypertensive disorders (eclampsia), and obstructed labor.  Women also die of indirect causes aggravated by pregnancy, such as malaria, diabetes, hepatitis, and anemia

9. Abortion Worldwide Abortions as a Share of Pregnancy Outcomes, Estimates for 1999 Note: The percentages are based on a 1996 UN projection of 210 million pregnancies for 1999. Source: Alan Guttmacher Institute, Sharing Responsibility: Women, Society, and Abortion Worldwide, 1999.

10. Contraceptive Methods, Sub-Saharan Africa Married Women 15 to 49 Using Contraception, 2004 Source: Population Reference Bureau, Family Planning Worldwide 2004 Data Sheet. Note: Percentage may exceed 100 due to rounding

11. Gap in Funding for Contraceptives and Condoms for AIDS Prevention Contraceptive Shortfall, Developing Countries US$811 Million US$154 Million US$739 Million US$1.8 Billion US$332 Million Source: UNFPA, Commodity Management Unit, unpublished data, November 2001.

12. Contraceptive Security  In the 1990s, donor funding for contraceptive supplies in less developed countries, including condoms, averaged 41 percent of the total supply costs  The number of contraceptive users is projected to increase more than 40 percent by 2015, due to both population growth and increased demand for family planning  Even if the donor share is maintained, the gap between donor funding and total needs will exceed US$1 billion by 2015

13. Sexually Transmitted Infections (STI’s)  STIs cause long term health complications  For instance, HPV and Cervical Cancer; STI’s and HIV  STIs are one of most preventable causes of LBW, stillbirths, congenital infections and post partum infections  Symptoms typically appear earlier in males  STIs are less likely to produce symptoms in women and therefore more difficult to diagnose until serious problems develop  Treatment seeking for STIs is a measure of knowledge of infections such as gonorrhea, syphilis, chlamydia*

14. Respondents With Symptoms Who Sought Treatment, by Sex Percent Awareness of STIs Note: The figure presents the percentage of respondents who reported symptoms suggestive of STIs in the last 12 months who sought care at a service provider with personnel trained in STI care. Source: ORC Macro, Demographic and Health Surveys.

15. HIV/AIDS  AIDS has reduced life expectancy significantly in several countries in Africa  In Botswana, for example, without accounting for the impact of AIDS, life expectancy would have been 74 years in 2010; however, with AIDS, life expectancy has dropped to 35 years in 2005  In Africa, HIV is spread predominantly through heterosexual activity; women account for more than half of the 30 million people living with HIV/AIDS.  In other regions, the proportion of people living with HIV/AIDS who are women drops to around one-third.

16. Growth of the AIDS Epidemic People With HIV/AIDS, Cumulative Regional Totals Millions *North America, Europe (except Eastern Europe), Japan, Australia, and New Zealand. **Eastern Europe, Central Asia, Middle East, and North Africa. Source: UNAIDS, “Twenty Years of HIV/AIDS: Fact Sheet,” 2002, and unpublished data.

17. HIV/AIDS Demographics, Africa/Rest of the world * Total does not equal 100 percent due to rounding. Source: UNAIDS, Report on the Global HIV/AIDS Epidemic, July 2002. Composition of the Infected Population, 2001

18. 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.

19. Early Marriage Source: DHS data, www.measuredhs.com

20. What do we know about married adolescent girls?  High levels of unprotected sex  Large age gaps with sexual partners  Are under pressure to become pregnant  Highly limited or even absent peer networks  Restricted social mobility/freedom of movement  Little access to modern media (TV, radio, newspapers)  Limited educational attainment and no schooling options Source: Haberland et.al 2003

21. Married Unmarried % Higher Kisumu 32.9% 22.3% 47.5% Ndola 27.3% 16.5% 65.5% Source: Glynn et al, AIDS 15(suppl 4), S51-60, 2001 Higher HIV prevalence among Married Adolescent Girls

22. Why might married adolescent girls be at risk of HIV?  Biological factors They have more frequent unprotected sex Their partners are more likely to be infected  Social factors Isolation Low status in new household

23. Proportion married among adolescent girls who had sex last week Source: Bruce and Clark, 2004.

24. Sexually active girls (15-19yrs old) who had unprotected sex last week Source: Bruce and Clark, 2004.

25. Likely married to an older partner Country% married by 18yrs Mean spousal age difference Ethiopia49.18.7 Kenya (1998)24.67.9 Uganda (1995)54.1n a Zambia42.16.7 Tanzania39.3n a DHS Data; Bruce & Clark, 2004

26. Older partners, likely infected Source: Bruce and Clark, 2004.

27. Social Isolation  Married adolescent girls are: More cut off from family and friends Less likely to watch TV or listen to the radio Less likely to be in school Less knowledgeable about HIV/AIDS May have limited access to RH services and info Often have no personal bargaining power, but are under control of husband and his family

28. Their situation is particularly vulnerable…  They are unable to benefit from common HIV prevention messages: Abstinence Reduce sexual frequency Reduce number of partners Use condoms Observe mutually monogamous relations with an uninfected partner

29. Their situation is particularly vulnerable…  They are unable to negotiate condom use, even when pregnancy is not desired  They are marginalized in RH programs including FP and ANC services

30. But it’s not just married adolescents who are vulnerable  Half of all new HIV infections occur in the 15-24 year- old age group  In some countries as many as 20% of girls aged 15- 19 are infected compared to 5% of boys the same age  HIV is more prevalent among older men  High transmission to young girls is likely from cross- generational and transactional sex  In many countries high rates of sexual violence

31. Other issues and controversies  Family Planning and Contraception  Emergency Contraception  Unsafe Abortion  Adolescent Sexuality

32. WHAT ROLE DOES THE MEDIA WANT TO PLAY?

33. Similarity of the MDG and CPA 1.MDG: Eradicate extreme poverty and hunger CPA: Aim at achieving poverty eradication 2.MDG: Achieve universal primary education CPA: Achieve universal access to quality education 3.MDG: Promote gender equality and empower women CPA: Countries should act to empower women and… eliminate inequalities between men and women 4.MDG: Eradicate child mortality CPA: Promote child health and survival

34. Similarity of the MDG and CPA 5.MDG: Improve maternal health CPA: Achieve a rapid and substantial reduction in maternal mortality ….including deaths and mortality from unsafe abortion 6.MDG: Combat HIV/AIDS, tuberculosis, malaria and other diseases CPA: Reduce the spread of HIV infection and minimize its impact.

35. Similarity of the MDG and CPA 7. MDG: Ensure environmental sustainability CPA: Reduce unsustainable consumption and production patterns as well as negative impacts of demographic factors on the environment. 8. MDG: Develop a global partnership for development CPA: Urge the international community to adopt favorable macro economic policies for promoting sustained economic growth