Anne Anyango is a 35-year-old mother to five children and a wife to her 40-year-old husband. Anne’s family resides in one of Kenya’s biggest slums – Kibera, in Nairobi – where access to basic needs can be a challenge.
Before Anne started using contraception, she was consumed by the myths and misconceptions peddled around by fellow women. “They told me that I would not get pregnant, I would grow fat and that I would be ‘cold’ in bed which would make my husband divorce me,” she disclosed.
She believed these myths for a long time. Her husband was not pro-family planning either, for he believed the side effects would break their marriage. But after Anne gave birth to five children in the space of eight years, she knew she needed to do something urgently to curb the pregnancies and births, for she did not have enough resources to support them. She also said her health was quickly deteriorating. “I became weak,” she said.
During one of her clinic visit days at Family Health Options Kenya, she spoke to a nurse about her fears regarding use of family planning. She was offered guidance and is now secretly using an IUD. “My husband has no idea that I am on family planning,” she said. She fears that if her husband knows about it, he might divorce her.
It has been two years now and Anne has experienced no side effects. “I am still the same,” she shrugged. She also said, however, that her husband wonders why she is no longer getting pregnant.
Anne’s situation reflects a true picture for millions of women across Africa today.
The recently launched State of African Women Report 2018 (SoAW) shows that the total fertility rate for the African Continent is the highest in the world, at an estimated 4.6 children per woman. The report indicates that 1 in 3 women use modern contraception and that about 1 in 5 women who are married have an unmet need for contraception.
The same report further states that adolescent pregnancy rates are highest in Sub-Saharan Africa, and it’s incidence is strongly related to child marriage. More than 1 in 4 girls in West Africa and Central Africa are pregnant before the age of 18 and 1 in 20 before turning 15.
These statistics indicate that Africa is still merely limping towards achieving its agenda regarding access and provision of sexual and reproductive health services to its people.
The Declaration on Human Rights states that every woman has control over her fertility, the number, timing/spacing of pregnancies and her method of contraception. In addition, it provides the right of women and girls to information and education on family planning and contraception, to non-discriminatory access to SRH services and to access abortion on specific grounds.
Although various Africa Union (AU) member states have made commitments to policy implementation frameworks, it is evident that challenges exist around domestication and implementation of human rights.
The reality is, national-level legislation often does not articulate women’s reproductive freedoms and rights. These issues are only reflected in policy or strategic frameworks. Very few countries realised the commitments expressed in the Abuja Declaration (2001) on health expenditures, which required Africa Union countries to allocate at least 15% of their annual budget to improve their health sectors.
Many girls and women in Africa living in rural areas and poorer communities face obstacles to their access to, and use of, SRH services. The challenges include: long distances to health facilities, unavailability of preferred contraceptive methods, absenteeism of family planning providers, high cost of managing side effects, desire for large family size, children dying under five-years-old, husbands forbidding women from using family planning and lack of community leaders’ involvement in family planning programs.
However, some countries have made initiatives to enhance access. These include allocation of budgets, integration of SRH services into primary health care and the provision of free services including contraceptive methods. Some countries have also introduced mobile clinics to enhance access to SRH services for rural women.
Comprehensive Sex Education
There have been policies and frameworks that place comprehensive sexuality education and information programs as key institutional obligations for states to implement in school curricula and out-of-school programmes. Some countries have adopted them well, while others are still facing challenges in doing so.
Similarly, adolescent access to SRH services is limited when countries lack youth-friendly services. Many young people shy away from discussing their sexuality around older people. Such services provide them with safe spaces to inquire freely about anything they want to know.
Legal guarantees for access to safe abortion as articulated in the Maputo protocol indicate that abortion can only take place when the life of the mother is threatened, when pregnancy poses a threat to the mental and/or physical health of the mother, in case of foetal impairment, or in case of sexual assault, rape or incest. Abortion is not allowed on any grounds not specified in the Maputo protocol.
Every year, an estimated 1.4 million unsafe abortions take place among girls aged 15-19 in Africa. Both married and unmarried adolescent girls are at high risk of being exposed to unsafe abortions. In most countries, guidelines regarding Safe Abortion Care and Post Abortion Care are missing. These are of critical importance to ensuring the quality of accessible safe abortion services.
Effects of the Global Gag Rule
Women in Africa are currently suffering from disruptions in reproductive health services, more unintended pregnancies, higher rates of maternal mortality, and an increase in unsafe abortions. Multiple studies have shown that the global gag rule has notdecreased rates of abortions overall, but has instead increased the number of unsafe abortions. NGOs are also suffering from significant funding shortages to provide comprehensive sexual and reproductive healthcare services.