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3.2. Laws, Policies, Strategies/National Action Plans A. REGIONAL ANALYSIS ........................................................................................................................................................................... 157
3.2. Laws, Policies, Strategies/National Action Plans
Over the Decade, several countries adopted constitutional reform that addresses health. The constitutions of Comoros, Rwanda, DR Congo and Côte d’Ivoire guarantee the right to health. In contrast, the constitutions of Algeria and Somalia provide a right to health care. The constitutions of Burundi, Kenya and Sudan include provisions relevant to SRH, maternal health and HIV/AIDS. Under Article 49.5 of the 2019 Constitution of Sudan, the State commits to providing free healthcare for motherhood, childhood and pregnant women.1046 Regarding SRH, the 2010 Constitution of Kenya prohibits abortion, unless “in the opinion of a trained health professional, there is need for emergency treatment or the life or health of the mother is in danger, or if permitted by any other written law” (Article 26).1047
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Many countries passed legislative reform that addresses SRHR, maternal health and HIV/AIDS during the AWD. Some sought to increase access to sexual and maternal health care for all persons, including marginalised groups, by implementing universal medical coverage. For instance, in 2016, the Rwandese government passed Law No. 21/2016, which reaffirms that all persons have equal, non-derogable rights to access reproductive health care services. In 2019, the Malian president declared that primary care for pregnant women (including childbirth) and family planning would be free.1048 In Togo, the 2011 Law on Health Care guarantees the widening of free health care to freelance workers and those in the informal sector, which is made up mostly of women.1049
In Gambia, the Women’s Act 2010 guarantees women’s rights to the enjoyment of SRHR, including medical abortion where the continued pregnancy endangers the lives of either the mother or the foetus. Where local medical facilities are not available, an appropriate referral is required. Furthermore, if women cannot afford the medical expenses involved, the government must bear the cost of the medical services (Section 30).1050 In Rwanda, political will regarding abortions is shifting, with President Paul Kagame agreeing to release 50 Rwandese women imprisoned for having abortions.1051 Rwanda’s abortion law has also been amended to provide exemptions to imprisonment for abortion in cases of “rape, forced marriage, incest, or instances where pregnancy poses a health risk.”1052 However, in Côte d’Ivoire, Article 426 of the Penal Code (2019) sentences every woman who procures or tries to procure an abortion to prison (from six months up to two years) and a fine ranging from FCFA 50,000 to FCFA 500,000 (approximately US$90–904 as of 4 July 2021).1053 The only exceptions are when abortion is needed to save a woman’s life, or in instances of rape (Article 427).
The majority of African countries have implemented policies that aim to improve access to SRH, maternal health and HIV/AIDS services and care. Several countries have made commitments to ensure resources and education to improve access to family planning for all. In its National Plan for Family Planning 2014–2018, Mali committed to addressing the unmet need for family planning and to achieving a contraceptive prevalence of 15% by 2018.1054 Niger’s Action Plan on Family Planning 2012–2020 aimed to increase the percentage of women using all methods of contraceptive to 50% by 2020.1055 In Sierra Leone, the government launched the Free Health Care Initiative in 2010, which provides universal access for the most vulnerable groups and targets pregnant women and lactating mothers. As a result of this policy, the country’s 2013 Demographic Health Survey reported an increase in the use of family planning among married women, from 7% to 16%.1056 In Benin, the National Strategy for the Safety of Reproductive Health Products 2011–2016 provides strategies to strengthen and sustain the supply of reproductive health products.1057 In Ghana, the National Reproductive Health Commodity Security Strategy 2011–2016 aims at ensuring that everyone can choose, obtain and use the quality of contraceptives and condoms (s)he needs for family planning and the prevention of sexually transmitted infections.1058
Other countries have adopted good practices in enhancing the availability and quality of sex education. The Roadmap on Sexual Education in Guinea aims to integrate the topic better within the curriculum to strengthen the capacity of agencies promoting sexual education and the development of services targeting adolescents, and to improve knowledge among communities.1059 Similar measures have been adopted in Cabo Verde, where special facilities have been established in selected health centres to ensure easy access, privacy and confidentiality of SRH services for adolescents.1060
States have also adopted policies to ensure better family planning services across their respective territories; as a result, in many countries contraceptive prevalence has increased. Examples include Benin and Ghana, described above. Tanzania has shown commitment to family planning by adopting a variety of national policies, including the Health Sector Strategic Plan IV 2015–2020 and the Five-Year Costed Implementation Plan for Family Planning 2018–2022, all of which focus on promoting family planning and access to reproductive services.1061
The majority of African countries have also adopted national HIV/AIDS strategies that include goals addressing the needs of women and girls. Some countries, such as Botswana, have adopted national strategies on women and HIV/AIDS. Many strategies align with the 90–90–90 HIV treatment targets (90% of people living with HIV know their HIV status, of whom 90% are on antiretroviral treatment and of whom 90% are virally suppressed) by 2020.1062 In an innovative move, the South Sudanese government, in partnership with UNAIDS, set up campaigns such as Right to Health to increase access to HIV/AIDS testing, treatment, counselling and information services for armed forces in the country. These services are tailored to the armed forces specifically because HIV infections occur more often within this group than among civilians in the country.1063
During the Decade, some countries also implemented institutional reform to reduce inequalities in access to health care and to increase awareness. In 2011, for instance, Gabon expanded its only social health insurance, National Health Insurance and Social Welfare (CNAMGS), to cover individuals in the public sector. In a progressive move, CNAMGS now covers all maternal health costs, providing comprehensive maternal health care, for various demographics, including the poor, and those in both the private and the public sectors. As access to health care, including maternal care, becomes more accessible, States must continue to maintain the corresponding costs of service provision. To increase awareness, in Burkina Faso, the departments of the ministry in charge of women’s affairs conducted sensitisation sessions on SRH, and in six regions have implemented trial modules on SRH in the school curriculum.1064
