Six of the countries of the East African Community – Burundi, Kenya, Rwanda, South Sudan, Uganda and Tanzania – recently concluded public hearings on a new sexual and reproductive health bill. Proponents of the bill argue that it will improve access to sexual and reproductive health which, in turn, will improve other public health and development indicators such as maternal mortality and HIV infection rates. But the bill has faced fierce opposition since it was first tabled in 2017. The Conversation Africa’s Ina Skosana spoke to researchers Anthony Ajayi and Nicholas Etyang to unpack what the bill covers and where the sticking points are
The Kenyan Medical Practitioners and Dentists Board has stopped the NGO Marie Stopes International from performing abortions in Kenya. Marie Stopes is a global organisation that provides contraception and safe abortion to women in urban and rural communities. Abortion is illegal in Kenya, unless a trained medical professional judges that there’s a need for emergency treatment, or that a woman’s life or health is in danger.
The Conversation Africa’s Moina Spooner spoke to Michael Mutua about the Marie Stopes ban and its implications.
How did the ban come about?
According to the Kenya Medical Practitioners and Dentists Board, they banned abortion services provided by Marie Stopes following complaints from the general public. The public claimed the organisation was running pro-choice media campaigns. These adverts specifically sought to provide women with a solution when faced with crisis pregnancies.
The adverts were also criticised by the Kenya Film Classification Board, which ordered Marie Stopes to pull them down for allegedly promoting abortion.
Family planning improves child survival and reduces maternal deaths. But the uptake of family planning in Africa is only 33%, nearly half the world average of 64%. The contraceptive prevalence rate in African countries is considerably low despite an increase in demand.
Niger has one of the highest fertility rates globally. Women of reproductive age have, on average, eight children. Niger has a maternal mortality ratio of 553 per 100,000 live births and an under-five mortality rate of 104 per 1000 live births. Mauritius has the lowest child mortality rate in Africa at 12 per 1,000 live births.
In Niger, 13% of children under five years die from various illnesses. The country is one of the top five that account for half of these deaths in the world.
The low provision of family planning across sub-Saharan Africa is cited as one of the main reasons for the region’s high maternal mortality rates. A lack of family planning leads to unintended pregnancies and often means that women deliver their babies with very low skilled assistance. This, in turn, pushes up the rate of newborn deaths.
Access to family planning services, particularly in developing countries, should be improved.
But Trump wants to go even further than his GOP predecessors by slashing spending on global health efforts funded through the United States Agency for International Development (USAID). Deeper family planning retrenchment would, however, put millions of lives at risk.
Throughout my visits to clinics in Africa I have seen the work of Marie Stopes International in South Africa, Tanzania, Ethiopia as well as Zambia. They provide a full range of quality reproductive health services for women. I have always been impressed by the comprehensive care they provide. Now, their work will be hampered because of an imposed policy of the new administration.
Yesterday morning President Trump signed an executive order to reinstate the Global Gag Rule, or Mexico City Policy, that prevents international NGOs that accept USAID (taxpayer) money from advocating for the legalization of abortions, provide abortions, mention the word, or even refer women to health practionioners that provide safe, legal abortions.
The Global Gag Rule was instated during the Reagan admininstration in 1984 and since then there has been a virtual seesaw effect between Republican and Democratic administrations regarding whether the Rule is reinstated or revoked. According to the WHO, 78,000 women die every year from unsafe abortions. Under Obama’s eight year administration, that number was reportedly decreased by more than half. Now, that President Trump has signed this executive order reinstating the Global Gag Rule, the fear among the global health community is that that number will rapidly skyrocket again.
Every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable – including obstructed and protracted labour and one of its side-effects, obstetric fistula.
An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother’s pelvis is too small or the baby is too large.
In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour.
South Africa has extremely high maternal mortality levels. This is true when compared with developed countries as well as other developing countries.
According to the World Health Organisation, for every 100,000 live births in the country in 2015, 138 women died due to pregnancy and childbirth complications. In Sweden, fewer than five women die for every 100,000 live births. In Brazil, the estimate is 44 women for every 100,000 live births.
People the world over come here every day looking for family planning information. Knowing that, I have decided to create a compendium post of sorts about everything I have learned and seen about family planning in my travels to and reporting from sub-Saharan Africa over the past few years.
I first learned about the critical importance of family planning when I covered the London Family Planning Summit a few years ago. Melinda Gates, along with key partners, called on governments and civil society to lay out a strategic plan to provide family planning services and contraceptives to 120 million underserved women in low-and middle-income countries. Currently there are 222 million women around the world who would like to space or delay their pregnancies.
Read the current Family Planning 2020 Progress Report with full commitments since the 2012 Summit. Undoubtedly there is a long way to go to reach the unmet need for modern contraceptives, but the initial commitments have been promising. $1.3 billion USD in funding for family planning was delivered in 2013 enabling 8.4 more women and girls to have access to modern contraceptives.
At the London Summit, I will remember the commitments read by country representatives. Dr. Tedros Adhanom Ghebreyeseus, former Minister of Health of Ethiopia, stood out. He said, “Inaction is no longer an option. It’s not what we promise today, but what we do when we get back home.”
Below are photos of family planning services and programs as well as modern contraceptives from Addis Ababa, Lusaka, Johannesburg and Dar es Salaam.
In an earlier piece today, How is Haiti Faring Five Years After the Earthquake, development and recovery effort data and details were rather pessimistic. The numbers bear out that while some overall development achievements have been met, there is still a long way to go to help Haiti fully recover. And, yet, there continues to be successes all over Haiti. Our partners are helping to make these successes happen.
SOS Children’s Villages
On January 10, 2015, SOS Children’s Villages opened its third village for orphaned children in Les Cayes, Haiti. 63 children will be provided a home. For over 30 years, SOS Children’s Villages has provided family-based care and education programs in Santo and Cap-Haïtien, Haiti. Immediately following the earthquake SOS Children’s Villages took in 400 orphaned children and fed 24,000 children every day.
“The biggest challenge for SOS Children’s Villages during the earthquake was to find a way to welcome these children because the village was too small,” said Celigny Darius, National Director of SOS Children’s Villages – Haiti. “We installed temporary houses to enable us to take them in.”
In addition to the opening of its third village, SOS Children’s Villages has invested in six schools to renew education on the island. And 3000 children receive support through their community centers.
In sub-Saharan Africa, 49 million women use traditional methods of family of no family planning methods at all. In Ethiopia, 39.1 percent of women use modern contraceptives up from 15 percent in 2005. The current low rate of contraceptive use in Ethiopia is a result of a combination of factors: cultural biases as well as a lack of trained health workers that can reach every woman … Continue reading Ethiopian Health Workers Receive Influx of Family Planning Training
2014 was a very good year! We partnered with leading NGOs and nonprofits to advance causes that mean the difference between life and death and quality living for the world’s poorest citizens. We traveled around the world to report on water and sanitation, newborns, maternal health, disaster relief, and health workers. We traveled domestically to report on some of our partners’ milestone seminars, conferences, and panels. But most importantly, we kept the momentum going to work collectively as mothers who use social media for good.
We very much look forward to 2015 and what it has in store. Here are our twelve highlight moments of 2014 – in no particular order.
By Ashley Judd, PSI Global Ambassador Virgila is more charismatic and animated than most actors I know. She’s a PSI-trained health worker on the outskirts of Port Au Prince, Haiti. And she’s passionate about her work. She goes door-to-door educating women about the benefits of reversible contraception like the IUD. Giving birth is dangerous business for Haiti’s poor, who suffer the highest maternal mortality rate … Continue reading Join Ashley Judd In Supporting Health Workers in Haiti
Photo: A premature baby is shown in the postnatal ward at Cama Hospital, a major hospital for women and children, in Mumbai, India. UN Photo/Mark Garten
Premature births are now the number one killer of babies globally. Of the 6.3 million children under five who died last year, 1.1 million of them died due to complications from premature births. Most of these deaths occured within the first month of life, according to new research published in The Lancet.
“This marks a turning of the tide, a transition from infections to neonatal conditions, especially those related to premature births, and this will require entirely different medical and public health approaches,” says Joy Lawn, M.D., Ph.D., of the London School of Hygiene & Tropical Medicine, a member of the research team and a long-term advisor to Save the Children. “The success we’ve seen in the ongoing fight against infectious diseases demonstrates that we can also be successful if we invest in prevention and care for preterm birth.”
Today is the the fourth World Prematurity Day, a global awareness campaign that focuses on the number of newborns that die every year and ways in which we can help those numbers decline. With heightened attention on premature births it is only a matter of time before global prematurity rates improve just as the overall child mortality statistics have improved steadily since 1990.
In Tanzania, orange has increasingly become the recognized color of family planning and reproductive health services. Population Services International’s orange Familia brand is quite common in most regions of this coastal country of 49 million. PSI, a global non-profit organization dedicated to improving the health of people in the developing world, has consistently and effectively branded everything in its nationwide Familia social franchise network since it began in 2009 with unforgettable orange and its semi-cursive Familia logo that bears a heart at the beginning of its name. All aspects of the Familia social franchise network from its clinics’ signage to the clothing of its health workers to its condom brand that claims in part 80% of Tanzania’s condom market and its health education booklets, all get PSI’s extensive branding treatment. The result: PSI Tanzania was able to serve 119,000 clients in 2013 through Familia via word of mouth and effective marketing.
Familia is PSI’s social franchise network of over 260 private sector clinics across 23 regions that primarily provides family planning, cervical cancer and maternal health services as well as health services for children under the age of five in urban and peri-urban community settings in Tanzania. Tanzania’s most remote areas are serviced by PSI outreach teams.
Salasala, Tanzania — It took over an hour in notoriously congested Dar es Salaam traffic and gingerly moving through winding, narrow, dirt roads to visit Blandina Mpacha. Mama Blandina, as her community affectionately calls her, is a PSIhealth worker who teaches women, men, and whole families about the importance of family planning. This isn’t something new to her. Mama Blandina has been a family planning health worker for over twenty years and has seen the slow-going, but eventual change in attitudes toward spacing births. In a country where women give birth to 5.29 babies on average, Mama Blandina is saving lives and giving women a chance to raise their families instead of living in a perpetual cycle of pregnancy.
Greeting us on her front porch where adult shoes and sandals laid strewn about, Mama Blandina first wanted to show us her chickens. It wasn’t just a few adult hens milling about and pecking around; no, it was a coop full of at least seventy growing chickens being raised for sale, for as much as Mama Blandina is a family planning health worker, she is also an entrepreneur and has been for much of her adult life. This is yet another sign of Mama Blandina’s resourcefulness, standing, and importance in a relatively poor community on the immediate outskirts of Dar es Salaam.
Blandina Mpacha first learned about being a family planning health worker on the only radio station in Tanzania at the time. Back then, she recalled between sips of coffee, only women who worked in offices used family planning methods. Now, for the most part, the stigma has fallen away.