EDITORIAL: Revamping the Reproductive Health Agenda in Africa After 2014

Friday Okonofua

Abstract

The International Conference on Population and Development (ICPD) which took place in Cairo in

19941 was particularly significant for sub-Saharan Africa as compared to the rest of the world.  Before then, previous population conferences had focused principally on the singular objective of reducing population growth through family planning as the solution to global development. Consequently, development assistance to Africa at the time largely targeted family planning, with less attention paid to other components of development.   It took the findings of research in the mid-1980s2 that documented the impact of social, economic and cultural factors on the high rate of mortality in the continent to convince the rest of the world that development goes far beyond numbers. Specifically, after years of intense debate, the world identified widespread poverty and the social exclusion and under-development of women as the root causes of the high fertility and high rates of mortality that characterize most parts of the developing world.  Women advocates argued that unless these are addressed, there will be little hope to reverse the parlous indicators of health (especially maternal health) that most countries face. Although ICPD was a global initiative, Africa’s situation presented a natural laboratory for global experimentation to test the hypothesis that focusing on women’s empowerment and improving economic fortunes will result in substantial decline in fertility and improve the social well-being of populations. 

September 5, 2014 will mark the 20th year that the ICPD began in Cairo. During the conference, member countries adopted a 20 year Plan of Action (POA) to deliver a more equal and sustainable global development.  The ICPD POA highlighted the relationship between gender inequality, poverty, poor health, poor educational attainment and sustainable economic growth.  Since the original POA was made, governments of member states have re-affirmed their commitments every five years. The key thematic areas addressed in the POA include:  poverty and inequality, women and girls, young people, reproductive health and rights, environmental sustainability, ageing, and urbanization and migration.

The past months have witnessed intense activities relating to ICPD+20 reviews aimed at identifying what has worked and not worked in various parts of the world, with the aim to generate a new sets of ideas for propelling global development in years to come.  It is within this context that the African Journal of Reproductive Health3, 4 a journal that was established in 1997 to document the processes, achievements and challenges in ICPD implementation in subSaharan Africa is issuing this comment.  No doubt, considerable progress has been made in the 7thematic areas of the ICPD in Africa over these 20 years. In particular, Africa has witnessed considerable economic growth, with evidence indicating that many countries in the continent have achieved some of the most rapid GDP growth in recent years.  Yet, World Bank data5 also show that despite this increasing prosperity, the region still has the highest proportion of persons living in abject poverty. It indicates that Africa is still faced with mounting inequality and marginalization, a key indicator for measuring the success of the ICPD.   

Sexual and reproductive health and rights (SRHR) being the cornerstone of the ICPD, the results of various programming efforts have been difficult to predict for much of Africa.  Although some indicators of SRHR have improved in most parts of the continent, Africa still remains the region with the worst indicators of sexuality and reproductive health in the world. Rates of maternal and child mortality, unsafe abortion, female genital cutting and HIV/AIDS are still disturbingly high in the continent, with little systemic pattern seen to 

indicate that further progress will be made in reducing the burden of disease anytime soon. This is in large part, due to the fact that much of the principles and ideas on which the success of ICPD was premised have not materialized in the continent.  High and rising rates of poverty, the continuing marginalization of women, denial of reproductive rights and cultural and religious hindrances still stand in the way of realization of the ICPD POA in Africa.  Additionally, there has been lack of political will and determinism by many African governments to implement the POA, with some of the affected countries not domesticating the most basic of the agreed principles.  By contrast, most ICPD-related SRHR programming in Africa have been donor-driven, with limited country-ownership and supervision.  It is increasingly evident that such programs will be unable to attain substantial scale and impact unless efforts are concentrated at prioritizing the programs as major agenda items owed and driven by the countries themselves.

Thus, the experiences of ICPD programming in Africa since 1994 can best be described or summarized as “work in progress”.  Although 20 years have gone, Africa is still at the threshold of transformation and social change in the field of sexual and reproductive health.  In our view, three critical interventions are now needed to accelerate the pace of development of the sexual and reproductive health and rights agenda in Africa, going forward.

The first is to ensure that countries not only sign the documents and affirm the decisions reached at ICPD+20, but that they actually take steps to domesticate the processes and to implement policies and actions that would ensure social cohesion and fast-track development in their countries.  Specific areas where government actions are needed are: addressing norms and harmful cultural/religious practices (e.g. forced early/child marriage) that prevent the full expression of sexual and reproductive health and rights by citizens, the integration of sexual and reproductive health into development frameworks through actual budgeting and disbursement of funds, and the promotion of economic justice through the elimination of poverty and social inequality for all citizens.  Indeed, we posit that country ownership should be the buzz word in any program that aims to sustain global development post-2014, rather than one that continues to promote dependency mentality for affected

African countries.  

The second intervention needed in Africa after ICPD+20 is to include the development and implementation of a purposeful and multi-pronged agenda for the development and social integration of young people.  Available data indicate that youth less than 30 years old constitute more than

60% of Africa’s population. Thus, youth development is not just a demographic necessity, but surely one of the priority interventions that can propel overall national development and eliminate social inequity in the continent.  Africa’s growing population can only become a demographic dividend rather than a liability, if African governments make the right kinds of investment through high quality education and health care for its young people which will result in immeasurable benefits in years to come. Although the ICPD POA made provisions for youth in its initial documents, it focused more on its immediate outcomes rather than its determinants.  More and more the intermediary and distal outcomes of youth development are becoming nightmares in Africa’s efforts to promote SRHR, and unless these are addressed, very little will progress will be made in the years that lie ahead. The third intervention needed for Africa’s SRHR development is genuine efforts made to empower women, to eliminate gender inequality and to mainstream women into developmental agenda of most affected countries.  ICPD POA made strong provisions for the empowerment of women and emphasized it as a key cornerstone for achieving informed decision-making and improved sexual and reproductive health outcomes.  Unfortunately, over the past 20 years although some gains have been made in the empowerment of women, this has not attained a scale that would see attendant improvement in SRHR indicators. By contrast, the continent continues to witness increased marginalization of women in social, economic and political spheres, with trends showing that the continent still lags behind the rest of the world in various gender parity indicators.  Going forward, we recommend that indicators of gender development be included in countries reporting frameworks, and that specific measures to hold governments accountable for performance in these indicators be clearly delineated.  

In conclusion, the ICPD POA provided great hopes that Africa would fast-track its human development through the implementation of a composite sets of policies based on human rights and the promotion of sexual rights and reproductive justice, the elimination of social and economic inequality, and the abandonment of harmful cultural norms and practices.  Our review indicates that progress has been slow, largely due to the poor integration of the values and principles of SRHR into development agenda in the continent.  Going forward, the prioritization of country ownership, especially those that foster the development of youth and the empowerment of women stands a greater chance of success.

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References

ICPD. Program of Action, Cairo, Egypt. September 2014.

Harrison K. 1985. Childbearing, health and social priorities: a survey of 22,774 consecutive hospital births in Zaria, northern Nigeria. BJOG 1985; 92 Supplement 5, 1-119.

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Rachel Snow and Okonofua FE. Launching the African Journal of Reproductive Health. Afr J of Reprod Health 1:1; 3 – 4, 1997.

World Bank. The state of the poor: where are the poor and where are they poorest? Poverty reduction & Equity. Accessed at: http://www.worldbank.org/content/dam/ worldbank.

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