Friday, November 21, 2014

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Quality, not Quantity: Reproductive Rights Examined

Family planning is felt in the long term, which makes it difficult to attract the attention of policy makers.
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Family Planning Sign, Rural Malawi

Introduction

Quality of life, not the number of inhabitants, deserves higher status on political agendas. Africa is vast, the well-being of its people is not determined by the amount of land it holds but by the quality of life it enjoys.  And from this perspective, the continent is lagging behind.

An African woman has on average over five children during her reproductive life.  Yet it is well-documented that women in the continent only want to have as many children as they can raise in a healthy environment. Almost a third of them would like to space their pregnancies or stop child bearing.  But they cannot do so because they have no access to family planning services. If African governments could provide basic family planning services to those who need them, it would result in better health for families and communities but also an improved quality of life and accelerated development for the countries.

Old struggles and the possibility of change

These facts are known. In spite of that, however, contraceptive use in the continent remains very low, less than a quarter of women of reproductive age use a family planning method. As a result fertility is high and in some cases abortion is used as a substitute for family planning.  Since abortion is illegal in most of the continent, women often resort to unsafe procedures that end up affecting their health for most of their lives. In many cases, these procedures are fatal.  Every year over four million unsafe abortions take place on the continent.

Family planning is a simple intervention that can be provided in a low or non-medical environment that is cost-effective and has high returns, not only in terms of better health outcomes but also rapid development and improved quality of life. In the last decade or so, a few African countries, mostly in the eastern part of the continent, have shown that rapid expansion of services is possible with dramatic results.

Reticence explained

If these are the facts and they are known, why is the continent so reticent about investing in family planning? Why is Africa behind from the rest of the world in addressing the reproductive rights of its people?

Most of the answers to these simple questions are undoubtedly rooted in the historical, cultural and religious background of the continent.  On the surface of it, however, there are two compelling reasons for this situation: complacency and crisis-management.

Our leaders have difficulty focusing on the rapidly growing population of the continent and its implication for employment creation, social services and economic growth. They adopt the simplistic reasoning that population growth is an asset for the country or conversely, that it is irrelevant to the economic development of their countries. They do not see that the extremely high level of youth unemployment in most urban centres in the continent is directly linked to the rapid growth of the population; they refuse to admit that overcrowded classrooms, congested health facilities and inadequate infrastructure are related to high fertility and low contraceptive use. 

The quasi-permanent state of crisis management we find ourselves in is another reason for neglecting this important issue. The continent is prone to all kinds of natural and man-made disasters.  HIV/AIDS is obviously the most dramatic of all, but it is far from being the only one. The continent is regularly confronted with all kinds of diseases and disasters: from malaria to meningitis, from flooding to drought and anything in between. Family planning, or lack of it, is not a crisis. Its impact is felt in the long term which makes it difficult to attract the attention of policy makers. 

In the last few years, African countries, through their continental or regional organisations, have passed important resolutions concerning maternal health, youth, gender and reproductive health. However, resolutions do not always translate into action. That is where the challenge lies for reproductive health advocates.

Almost two years ago, these same advocates, over 1200 of them, got together in Kampala to discuss how to overcome these challenges.  It was the largest gathering of the kind since the 1994 population conference in Cairo. Conference participants have reaffirmed their commitment to family planning and promised to drive this home in their respective national conferences.  And they did.  To date over half a dozen countries, including the continents’ giants such as Nigeria and Kenya, have organised conferences on family planning and re-positioned the issue in the national development discourse.  A second conference is planned in a few weeks’ time and, I am sure it will strengthen the enthusiasm and excitement created in Kampala.

Africa needs to manage its population growth if it hopes to achieve its development goals.  Recent economic growth in many countries are hopeful signs that things can and will change for the better. In order to benefit from these changes, however, it is important that fertility levels and, as a result, population growth are commensurate with our ability to provide the basic necessities of life to our people, especially those living in the margins of societies.

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Comments

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