Why Africa needs more investment in sexual, reproductive health

Former New Zealand Prime Minister Helen Clark was among the high-profile people at the recent International Conference on Population and Development (ICPD) in Nairobi where she represented the Partnership for Maternal, Newborn and Child Health (PMNCH), an alliance of more than 1,000 organisations backed by the World Health Organisation (WHO).

As the chairperson of the PMNCH board, Ms Clark has been particularly vocal in challenging world leaders and governments to prioritise sexual and reproductive health and rights of women, children and adolescents at the centre of policies such as universal health coverage.

She spoke to the Business Daily about the progress and challenges of this campaign, including PMNCH's stand at the Nairobi Summit.

WHAT WAS YOUR STAND ON SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS (SRHR) AT THE NAIROBI SUMMIT?

The Nairobi Summit took place at a time of critical importance for sexual and reproductive health and rights. Ideologically driven forces are seeking to roll back hard-won gains, to slash funding for essential services, and to remove references to these services and rights from international agreements. So, my stand on SRHR during the Nairobi Summit has been that we need to be bold. We have made progress since Cairo in 1994 — but that progress still falls short for many women and girls — and that can be a life and death matter.

IN FEBRUARY, THERE WAS A CALL TO ACTION ON SEXUAL AND REPRODUCTIVE HEALTH AND RIGHTS (SRHR), HOW WAS IT RECEIVED?

The response to the call to action has been very positive — over 300 organisations to date have signed on to it. But our work is far from done. In September, the UN General Assembly Political Declaration on UHC included some language on SRHR, but a group of countries disassociated themselves from that part of the text. So, clearly more dialogue is needed to make the case for SRHR in UHC in all countries. Our advocacy efforts also need to target Ministers of Finance and Heads of State to make the case for how SRHR contributes to healthy people and healthy economies.

WHAT IS THE STATE OF SRHR, ESPECIALLY IN SUB-SAHARAN AFRICA?

There has been progress on SRHR, but a lot remains to be done. Unfortunately, progress has been slower in Sub-Saharan Africa than elsewhere. For example, according to the latest UN figures, Sub-Saharan Africa accounts for roughly two thirds of maternal deaths worldwide, and rates in the region are decreasing at a slower pace than they are elsewhere.

The unmet need for contraception in the region also remains high. According to the Guttmacher-Lancet Commission, in 2017 214 million women of reproductive age in developing regions had an unmet need for modern contraception. Forty-two per cent of all women of reproductive age in developing regions were using modern contraceptive methods, ranging from as low as 22 per cent in Africa to 52 per cent in Latin America and the Caribbean.

When considering SRHR, we must also consider reproductive cancers. According to WHO, in Africa, 34 out of every 100,000 women are diagnosed with cervical cancer each year and 23 out of every 100, 000 women die from cervical cancer every year. Compare those figures with those in North America where seven out of every 100,000 women are diagnosed with cervical cancer each year and three out of every 100,000 women die of the disease each year. In Africa, most of the women with cervical cancer are diagnosed when the cancer is at an advanced stage which tragically is associated with poor outcomes. That is why the roll out of the human papilloma virus (HPV) vaccine is so important in preventing infection by common strains of HPV which cause cervical cancer. Just last month, Kenya joined an increasing number of African countries in introducing the HPV vaccine against cervical cancer into its routine immunisation schedule.

WHAT ARE SOME OF THE CHALLENGES IN ATTAINING UNIVERSAL HEALTH COVERAGE?

When we talk about UHC, we often talk about three dimensions — what services are included, who has access to them, and at what cost. So, we can frame the challenges around those three dimensions. Funding is always a challenge, but what is most important in that respect is political will. We need visionary leaders who put people at the centre of policy and who understand that investing in health –and prioritising the needs of women, children, and adolescents – is the soundest investment they can make.

WHAT ARE THE GAPS IN THE COVERAGE OF SRHR INTERVENTIONS ESPECIALLY IN DEVELOPING NATIONS? WHAT CAN BE DONE TO IMPROVE THE SITUATION?

Overall, progress has been uneven, and there are gaps across most, if not all, SRHR interventions in low- and middle-income countries. What can be done? Again, political leadership – at the highest level – which prioritises SRHR is essential. Increased investment in the quality and coverage of SRHR services is required. For low-income countries which rely heavily on official development assistance, donors need to step up their funding for these essential services in order to uphold the rights and dignity of women and young people.