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3.1. Issue Analysis
3. SEXUAL AND REPRODUCTIVE HEALTH RIGHTS, MATERNAL MORTALITY AND HIV/AIDS
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3.1. Issue Analysis
The past 10 years have seen modest gains with regard to women’s health on the African continent, with overall life expectancy among women increasing from 62.8 years in 2010 to 67.8 years in 2019. However, many facets of women’s health remain insufficiently addressed. Cardiovascular diseases, for example, are now the leading cause of death among women in Africa. The continent still has the highest rates of maternal mortality in the world and African women account for more than 75% of new female HIV/AIDS cases worldwide.1023
The Maputo Protocol enshrines women’s sexual and reproductive health (SRH) as a human right.1024 Article 14 guarantees “the right to health of women, including sexual and reproductive health” and, along with its corresponding General Comment No. 2, calls on States to recognise women’s rights to control their fertility; decide whether to have children, the number of children and the spacing of children; choose any method of contraception; self-protection and to be protected against sexually transmitted infections, including HIV/ AIDS; be informed on their health status and the health status of their partner, particularly if affected with sexually transmitted infections, including HIV/AIDS, in accordance with internationally recognised standards and best practices; and have family planning education.
Furthermore, under Article 14(2) of the Maputo Protocol, States Parties are committed to take appropriate measures to, among others, provide adequate, affordable and accessible health services to women, especially those in rural areas. They shall also protect the reproductive rights of women, authorising medical abortion in cases of sexual assault, rape and incest and where the pregnancy endangers the mothers’ mental and physical health or the life of the mother or foetus.
Goal 3 of the AWD aimed to improve women’s health, reduce maternal mortality and address the unequal burden of HIV/AIDS on women and girls in terms of infections, spread and increased workload, as well as unequal access to antiretrovirals (ARVs), good nutrition and formal medical services.1025
At the continental level, the AU and its Member States have developed frameworks addressing maternal health, SRH and HIV/ AIDS challenges across the continent. In response to the rising levels of maternal deaths, the AU launched the Campaign on Accelerated Reduction of Maternal, Newborn and Child Mortality in Africa (CARMMA).1026 Over the Decade, 51 countries (except for Egypt, Libya, Morocco and South Sudan) launched CARMMA nationally.1027 In 2014, as part of the CARMMA celebrations, the AU launched African Health Stats (AHS), a data visualisation tool to track and present data on key health concerns across the continent.1028 AHS is available online and aims to provide reliable data on the progress made by Heads of State and Governments in the implementation of the Continental Framework on SRHR. It uses 33 indicators for reproductive, maternal, newborn, child and adolescent health (RMNCAH), malaria, HIV/AIDS, tuberculosis and health financing.1029
In 2015, the AUC adopted the Revised Maputo Plan of Action for the operationalisation of the Continental Policy Framework on SRHR 2016–2030, which sets out a progressive framework for the achievement of universal access to SRHR services on the African continent.1030 The Revised Plan follows the Maputo Plan of Action 2006–2010, which committed States Parties to guarantee universal access to comprehensive SRH services in Africa by 2015. It also aligns with Agenda 2063, as well as the Common African Position to “end preventable maternal, new-born, child, and adolescent deaths, expand contraceptive use, reduce levels of unsafe abortion.”1031 Furthermore, it is progressive as it includes cost estimations in order to realise its objectives across 10 priority areas. These include investing in SRHR needs of adolescents, youth and other vulnerable and marginalised populations; instituting health legislation and policies for improved access to RMNCAH services; and increasing health financing and investments.
Taking stock of the slow progress on improvements to women’s health across Africa requires an examination of multiple factors: health financing, human resources for health, M&E, health research and health policies, as well as how health systems and women’s health are conceptualised, to name a few.
3.1.1. Health Financing
In 2017, 46 countries reported spending at least 15% of government expenditure on health, as set out by the Abuja Declaration. However, in more than half of these countries (n=25), the proportion of government expenditure on health stagnated or actually decreased between 2010 and 2017.1032 In 2019, a new health financing initiative was launched at the Africa Leadership Meeting: Investing in Health to help deliver increased, sustained and more impactful financing for health across Africa. The outcome of the meeting was a commitment of up to US$200 million from public and private sectors, as well as donor governments, to end epidemics and achieve universal health coverage.1033 There is no doubt that the COVID-19 pandemic will affect these pledges; however, it is precisely at this critical point that relentless commitment is required to ensure the current and future health and well-being of populations across the continent, particularly that of women and girls.
3.1.2. Health Workforce
Addressing health challenges requires a health workforce that is sufficiently resourced, staffed, trained and respected. Across Africa, there is an estimated shortfall of more than 1.5 million health workers, including nurses, midwives and doctors.1034 In the WHO Africa Region, this needs-based shortage of health care workers is actually forecast to worsen between 2013 and 2030.1035 To address this, in 2012 ministers of health in the WHO African region endorsed a Regional Road Map for Scaling Up the Health Workforce from 2012 to 2025. Although there has been some progress reported, with the number of countries with human resources for health strategic plans increasing from 20 to 34 between 2010 and 2015, further work is needed.1036 It is also important to note that women constitute the largest group within the health workforce; however, systemic gender inequalities exist.1037 For example, women are less likely to hold senior positions, more likely to be underpaid compared with their male counterparts and less likely to be in full-time employment.1038 Furthermore, women are frequently the primary carers of those who are unwell within families and communities, bearing the additional burden of unpaid care work.1039 These inequalities not only affect the delivery of services but ultimately also have impacts on the lives and health of women within the health workforce.
3.1.3. Health Information Systems and Health Data
There are major issues related to health data and health information systems in most countries across the continent, which poses a serious barrier to effective monitoring and evaluation of health programmes and policies.1040 For example, in 2015, just under 4% of African countries had fully functional systems for generating reliable cause-specific mortality data on a routine basis.1041 Without accurate and timely data, not just on health indicators but also in relation to determinants of health, health infrastructure and the health workforce, improving health systems across the continent will remain difficult. Furthermore, tackling gender inequalities within the health system will require more than robust health information systems and data sources. It will require data disaggregated by sex and other variables such as age, socioeconomic status and geographical location, to make it possible to examine the intersectional nature of inequalities. A report published in 2019 mapped gender data availability across 15 countries in sub-Saharan Africa.1042 This found that, of 105 gender-based indicators across a variety of domains, only 32% were produced with complete disaggregation at the national level.1043 The health domain, however, had the most sex-disaggregated indicators available compared with other domains, such as economic opportunities and political participation.
3.1.4. Research
Research capacity is critical to building a local evidence base to develop contextualised solutions to health care problems. Over the course of the AWD, research outputs from across the continent increased, with the majority of Africa’s scientific production coming from Algeria, Egypt, Kenya, Morocco, Nigeria, South Africa and Tunisia.1044 Despite improvements, though, it is still recognised that research capacity across Africa needs to be strengthened. Considering a gender lens, fewer women participate in academic research than men, and there are clear disparities in levels of responsibility.1045 Although steps are being taken to address these inequalities, many obstacles remain.
