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Acknowledgement


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Literature Review

The literature review included available data from reliable sources to look at the state of sexual and reproductive health and rights (SRHR), with focus on maternal, infant and child health, and in the overall framework of health, population and development for Africa. Data from other continents were also utilized for comparison. The review looked at the level of performance by Member States, and identified gaps that need to be addressed to achieve the MDGs by 2015. It is noteworthy that there are considerable inter- and intra-country variations. (The full list of the 53 AU Member States indicating those that responded is annexed to the Report as Annex A.)




Factors Affecting SRHR in Africa



A wide range of factors have a negative impact on the sexual and reproductive health and rights of Africans. They range from socio-demographic, including rapid population growth and a young population, to socio-economic, reflected in the region’s pervasive poverty. Weak health systems, gender inequalities and others serve to compound the problem. These and other factors are summarized in the following sections.



Demographically and economically, Africa – especially South of the Sahara – is characterized by rapid population growth, high maternal mortality and morbidity, a young population, pervasive poverty and food insecurity.

Socio-Demographic Factors

In 2008, Africa’s population was estimated to be 987 million, with an average annual population growth rate of 2.3 per cent from 2005 to 2010 (UNECA et al., 2009). During the 1990–2000 decade, the continent’s population increased from 622.4 million to 795.7 million, an addition of 173.3 million (28.4 per cent) in ten years. According to the projections, Africa’s total population will more than double in the next four decades, increasing to nearly 2 billion by 2050. The challenge is that population growth rate is not in tandem with socio-economic development, but is, instead, associated with increasing poverty and hunger in Africa.


The report of the 15-year review of the implementation of the ICPD in Africa 1994–2009 (ICPD+15, UNECA et al., 2009) indicates that life expectancy at birth in Africa has, in general, shown a slow but steady increase from 39 years in the 1950–1955 period to 54 years in 2005–2010. Northern African countries have a higher average life expectancy, rising from 43 years to 68 years. In Eastern and Southern Africa, however, where the impact of AIDS-related mortality has been most severe, the average life expectancy rose to 61 years during 1990–1995, but subsequently declined to 51.6 years from 2005 to 2010. This represents a significant reversal of gains in health, including reproductive health.
Another challenge is that the population of most African countries continues to be young. The most recent estimates show that children under age 15 constitute 41.2 per cent of the population. Children and youth aged 30 and below constitute over 70 per cent of the continent’s total population (UN World Population Prospects – 2008 Revision). This has impact on SRHR including high fertility rates, high rates of teenage pregnancies, a tendency to have large but poor and under-nourished families, and high rates of new HIV infections including mother to child transmission (MTCT).

Socio-Economic Factors

Compared with other regions of the world, Africa suffers disproportionately from poverty and deprivation (UNECA et al., 2009). Worldwide, about 20 per cent of the population survives on less than US$1 a day; the African average is twice that. Nearly half the population of Africa lives in extreme poverty and one-third in hunger. About one-sixth of Africa’s children die before the age of five – the same as a decade ago. In the continent’s previously war-torn countries, the levels of poverty and hunger have stagnated and even worsened in some.



Despite promises, net official development assistance flows to the least developed countries generally remain far lower than pledged.
Food security in Africa is worse than it was in 1970. The proportion of the population that is malnourished has remained within the 33–35 per cent range in sub-Saharan Africa, with over 70 per cent of the food insecure population in the continent living in rural areas. Poverty reduces access to adequate and balanced nutrition, an important factor for improving maternal and child health and survival. Physical and intellectual stunting related to prolonged malnutrition is irreversible. Such a picture is not conducive to health and development.
It will also be recalled that developed countries committed to providing 0.7 per cent of their GNP to developing countries, of which between 0.15 and 0.2 was to be allocated to the least developed countries (LDCs). Despite the promises, net official development assistance (ODA) flows to these countries generally remain far lower than expected. Consequently, the social sector in general and the health sector in particular receive limited support, whereas all MDGs hinge on social development. This situation has a negative impact on maternal and child health in Africa.

Weak Health Systems

Inadequate or non-functioning describes the poor health systems in most African countries, an indication of the low priority given to the wellbeing of people and to the fundamental right to health. Health facilities are ill-equipped and basic supplies often unavailable. Staffing is generally inadequate, salaries are low and working hours are long, all of which contribute to low staff morale, which in turn affects the quality of services. Service providers usually do not have adequate training, and are not well versed in issues of SRHR. Furthermore, they are unable to provide specialized and skilled services. The few skilled medical personnel are often concentrated in urban areas or attracted to better working conditions outside the continent, further aggravating the health of women and children in Africa.


Moreover, the services that are available tend to neglect or overlook the special needs of adolescents and youths – this despite their large proportion of the populations. In addition, distances between referral points are long and the roads are often bad and frequently impassable, with poor and expensive transportation resulting in under-utilization of the available health services.
According to the UNFPA Arab State Regional Office Northern African Member States have made significant but variable improvements in maternal and child health. These improvements are reflected in the reductions in infant and child mortality to about 20 or fewer deaths per 1,000 live births between 1990 and 2008. Maternal, infant and child mortality remain high by international standards, however, but these indicators drop quickly when mothers have access to medical care and emergency obstetric and newborn services during childbirth. Some countries, for example, dramatically lowered a woman’s lifetime risk of dying from pregnancy or childbirth during the 1990s and some even earlier, and are now considered successful models. The decline was managed through the adoption of a comprehensive and coordinated approach to improving the health of expectant mothers. This followed the analysis of the specific factors contributing to poor maternal health in communities and effective steps to address those causes. Many countries are also seeking to increase theuse of contraception to help bolster child and maternal health as well as lower fertility and slow population growth.
In much of Africa, annual health expenditure is less than US$30 per person, far below the minimum ‘survival kit’ for essential health. While local health financing has generally increased over the years, it has mainly been supported by external funding. Only about ten AU Member States attained the 15 per cent target pledged by African leaders in 2001, and just a few others have reached 10% and above. According to World Bank statistics, 41 per cent of people in sub-Saharan Africa live on less than US$1 per day, although a small percentage lives on much higher amounts, comparable to developed countries. This situation cannot ensure family and community health and development.

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