AWD Report 2020
3.3. Challenges and Gaps Despite North African countries having adopted legal, policy and institutional reforms, challenges, gaps and contestations remain. First, at the beginning of the AWD, some North African countries experienced protests and popular uprisings as part of the Arab Spring. Political instability and conflict impeded legal, policy and institutional reform on SRH, maternal health and HIV/AIDS. The uncertainty delayed or altogether stopped responses with regard to critical care and services and made accessing health a dangerous endeavour, especially for women and girls. A second gap concerns legislation on women’s reproductive health. Most countries in North Africa have constitutional provisions explicitly on SRH, maternal health or HIV/AIDS. Despite legislative reform during the Decade, however, many countries lack laws in this area. Moreover, existing laws are often inadequate and poorly implemented. Mauritania is a notable exception, as the only country in North Africa that has adopted a law specifically on reproductive health. It is also the only North African country that has laws on non-discrimination based on HIV and legislation that criminalises wilful transmission of HIV.1185 Of the seven North African countries, five did not launch CARMMA during the AWD. This may be explained in part by the political instability in some countries in the region. Third, during the Decade, only three countries adopted strategies to combat HIV/AIDS. Although prevalence of HIV/AIDS in North Africa is low compared with other African regions, it has increased. Women are disproportionately affected, and often lack access to and control over resources, care and treatment. Persons living with HIV/AIDS also face stigma and discrimination, with constitutional provisions on non-discrimination often ineffective. Groups such as sex workers and sexual minorities are particularly vulnerable. Firmly held views and norms, and laws criminalising these groups’ work and behaviour, often contribute to the stigma and prevent them from seeking care and treatment. In other cases, they may be denied care and treatment outright. Increased HIV prevalence may be linked to this persistent stigma and discrimination. A fourth gap concerns access to abortion and the upholding of the commitments made under the Maputo Protocol. During the AWD, there were almost legislative reforms on access to abortion in the region. In the majority of countries, the penal or criminal code contains provisions on abortion. Most commonly, these allow for abortion in cases of sexual assault, rape or incest, or when the pregnancy poses a threat to the life of the mother. Tunisia also permits abortion during the first three months of pregnancy. However, despite their having ratified the Maputo Protocol, Egypt and Mauritania prohibit abortion altogether, and it is punishable under the law. Existing legislation may also require permission in seeking safe abortion. Although prohibited under the Egyptian Penal Code, a doctor may perform an abortion under the physicians’ Code of Ethics to save a woman’s life provided that the doctor receives written approval from two other physicians.1186 It also requires the permission of the woman’s husband. Thus, access to safe abortion in the North African region remains restrictive for women and girls, and this endangers the lives of women and girls. Finally, across the region, access to SRH, maternal health and HIV/AIDS care and services is often limited, in particular for women and adolescents living in rural areas. Mauritania’s 2010–2012 Action Plan has substantially reduced the proportion of the population without easy access to a health structure, generally those living in poor rural, remote or landlocked areas.1187 However, the Plan does not specifically address the needs of women and girls; nor is it clear if it has been renewed. In some countries, access to such care and services requires women to obtain consent from their spouse. In Morocco, access to reproductive health services is limited to married couples, thus preventing adolescents from having control over this aspect.1188 Youth and adolescents often also have limited access to information. According to the sources consulted, only Egypt has taken steps to include family planning in the school curriculum. Lack of education on reproductive health, HIV/AIDS, maternal health and family planning denies adolescents the opportunity to make informed decisions about their health.
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