WOMEN'S HEALTHCARE OP-ED
Sexual and reproductive health rights in Africa still viewed through a patriarchal lens
In many places across Africa, sexual and reproductive health and rights are still overwhelmingly viewed through a male lens obscured by the influences of a patriarchal system that views women as incapable of making their own decisions.
In Africa, women are often considered the custodians and promoters of culture, while men are the enforcers. What is usually ignored, however, when celebrating the beauty and diversity of African culture is the role it plays in reinforcing inequality and denying women and girls their rights, be it the right to education and property ownership, or the right to gender-sensitive healthcare.
Few things have made this more evident than the continued existence of gaps in sexual and reproductive healthcare for African women and girls.
In many places across the continent, sexual and reproductive health and rights are still overwhelmingly viewed through a male lens obscured by the influences of a patriarchal system that views women as incapable of making their own decisions.
It is no wonder, then, that a woman can be revered for her role as homemaker, mother and caregiver, as she who brings forth and nurtures life, and in the same breath be admonished for wanting to have autonomy over her own body.
African girls and women live at high risk of unplanned pregnancy, preventable maternal death, unsafe abortion, HIV and other sexually transmitted infections (STIs), as well as harmful traditional practices such as female genital mutilation and cutting.
The lack of robust, inclusive, women-led frameworks that govern access to accurate, age-appropriate sexual and reproductive health information, quality health services and protection of sexual health and rights continues to put millions of girls and women at risk of never achieving their full potential.
In many African countries, the absence of such policies has left the well-being of half of the population largely at the mercy of a handful of men whose understanding of women’s health needs is, at best, learnt through medical school and partners’ experiences, and at worst, through hearsay – but never through lived experience.
We urgently need to invest in sexual and reproductive health for African women and girls in order to lift them as equal participants in our economies. There is a continued need for governments to craft and implement policies with the lived sexual and reproductive health needs of women and girls at their core.
An oft-repeated and terribly false assertion made during (male-dominated) debates on the sexual and reproductive health needs and rights of girls and women is that equipping adolescents with the information they need to abstain from early sexual activity, prevent STIs and avoid unwanted pregnancy goes against African culture and morals.
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In Africa – and indeed in many other conservative cultures – it is a commonly held belief that introducing sex education, furnishing pre-teens and teens with reproductive health information, providing easy access to contraception and legalising abortion, even under controlled circumstances, would erode the moral fabric of our society by “placing emphasis on sexual pleasure” and promoting promiscuity.
Opponents of efforts to democratise access to sexual and reproductive health information and care fail to acknowledge crucial facts. For example, sub-Saharan Africa has the highest prevalence of teenage pregnancy in the world, with pregnancy rates among adolescents (15 to 19 years) who have ever had sex ranging from 36.5% in Rwanda to 75.6% in Chad.
In Kenya, the maternal mortality ratio is 362 deaths per 100,000 live births – more than five times higher than the global target of 70 deaths per 100,000 live births as envisioned by Sustainable Development Goal 3 on Health and Well-being.
In Africa, one in five women of reproductive age have an unmet need for family planning, driven by socioeconomic inequalities that bar many uneducated, poor, rural girls and women from accessing modern contraceptives. According to Unaids, in sub-Saharan Africa, women and girls accounted for 63% of all new HIV infections in 2020, with young women bearing the brunt of the epidemic. Six in seven new HIV infections among girls between 15 and 19, while young women between 15 and 24 are twice as likely to be living with HIV than men.
Failure to acknowledge these statistics and accept that healthcare follows the trajectory of our needs as a society, is a great disservice not just to girls and women, but to entire communities.
Putting in place frameworks designed with the meaningful participation of women to govern access to quality sexual and reproductive healthcare and protecting the rights of all to access these essential services, shields girls AND boys, women AND men, therefore protecting our collective health and well-being and increasing our chances of living full, productive lives.
Matters of life and death
Efforts to safeguard our sexual and reproductive health should not be equated to the dilution of African culture; not when these are matters of life and death – and not only life, but the highest quality of life, which is a human right. Dialogue around sexual and reproductive health and rights should be approached objectively, soberly and with the interests of all – especially the most vulnerable among us – in mind. The outcomes of these discussions need not result in winners and losers because ultimately we all benefit from a healthy population.
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Africa’s universal health goals cannot be achieved if half the population’s health needs are ignored because of outdated cultural beliefs that do more harm than good. Protecting the rights of adolescent girls and women to make informed choices about their health, equipping them with the tools they need to prevent unwanted or unplanned pregnancies or limit childbirth, and involving boys and men in these efforts is as much about upholding human rights as it is about economic growth and development.
We must bridge the knowledge gap and address the misinformation and disinformation regarding efforts to protect these rights. Now is the time to work together for a future where women and girls everywhere have the freedom and ability to lead healthy lives, make their own informed decisions regarding their sexual and reproductive health, and participate as equals in society.
This is why Amref is pleased to host the East and southern Africa hub of the global family planning partnership, FP2030. By deepening this global movement’s presence and engagement in Africa, we can strengthen learning and collaboration between partners and provide an important structure for holding one another accountable for the commitments that governments, donors and organisations make to invest in family planning. With a greater presence in the region, FP2030 can also engage more deeply with “non-traditional” family planning partners, such as faith leaders.
Read more in Daily Maverick: “Sexuality education is not new or foreign to African culture”
Sustained reinforcement of the unequal power dynamics between men and women through our hesitance – and downright refusal – to truly protect the sexual and reproductive health and rights of Africa’s 320 million women and girls of reproductive age, is a disservice to us all.
Together, family planning champions can change this narrative and build a better future for women and girls that will strengthen African nations. DM
Dr Githinji Gitahi is Group CEO of Amref Health Africa, founded in 1957 as the Flying Doctors of East Africa, and now Africa’s largest health development international NGO. Dr Samukeliso Dube is Executive Director of FP2030, a global partnership centred solely on family planning.