Access to safe, voluntary family planning is a human right. Family planning is central to gender equality and women’s empowerment, and it is a key factor in reducing poverty. Yet in developing regions, an estimated 218 million women who want to avoid pregnancy are not using safe and effective family planning methods, for reasons ranging from lack of access to information or services to lack of support from their partners or communities. This threatens their ability to build a better future for themselves, their families and their communities.
Early childbearing, high fertility rates and inadequate access to maternal health services are the main contributing factors in the high number of maternal deaths among young women in Africa. Girls aged 15-19 years are twice as likely to die during childbirth as women 20 years and above. Coupled with HIV, complications during pregnancy and childbirth are the leading cause of death for young women aged 15-19 years, with 26 per cent of all maternal deaths occurring among adolescents.
In the ESA region, adolescent fertility rates are either declining slightly or stagnant. However, ten countries have rates of more than 100 per 1000 live births.
Unsafe abortion because of unwanted pregnancy is also common among adolescents. It is an indicator of girls’ and women’s unmet need for contraception. In sub-Saharan Africa, extreme poverty, inadequate access to reproductive health information and services, and restrictive abortion laws cause many women to resort to clandestine abortion providers to avoid unintended pregnancy, resulting in about 3 per cent obtaining unsafe abortions each year. Unsafe abortion is a major contributor to maternal deaths, with 14 unsafe abortions performed for every 100 births in Africa.
Effective comprehensive sexuality education (CSE) enables young people to adopt positive sexual behaviours. These include delaying the age of sexual debut, reducing the frequency of sex and number of sexual partners, and increasing use of contraception, especially condoms.
The recent decline in HIV of more than 25 per cent in high burden African countries has been attributed to young people adopting protective behaviours as well as investments in programmes for young people.
In the East and Southern Africa region, large numbers of adolescents attend primary school but do not complete it, nor progress to high school. In addition, many drop out due to unwanted pregnancies.
Due to the goal of Universal Primary Education (UPE), many older adolescents are enrolling in primary education. However, in countries where age-appropriate CSE is not rolled out in the first years of primary education, many drop out before benefiting from the protective effects of CSE.
Notable progress has been made in reducing the maternal mortality ratio (MMR) in sub-Saharan Africa, which declined by 49 per cent over 23 years, from 990 deaths per 100,000 live births in 1990 to 510 per 100,000 in 2013. In the East and Southern African region, several countries have made progress towards MDG 5, in particular Rwanda, Ethiopia, Eritrea and Angola.
Despite this good news, much remains to be done. An estimated 64,000 women died in childbirth in East and Southern Africa in 2013. Moreover, the majority of countries are far from reaching the Millennium Development Goal 5 target to improve maternal health.
Countries heavily affected by HIV in East and Southern Africa have made little or no progress since 1990. Some ESA countries initially saw an increase in their MMR due to HIV & AIDS. However, this trend is now reversing in the context of increasing HIV testing and ART initiation for pregnant women.
Conflict and political instability also negatively affect the MMR in the region. South Sudan, for instance, initially reported an extremely high MMR rate but this is now reversing.
Although women who receive regular antenatal care are far more likely to give birth with a skilled health attendant and are better able to recognize the signs of complications before, during and after delivery, antenatal care coverage remains very low. In nearly half of all countries in the ESA region, more than 90 per cent of women make at least one antenatal visit.
However, in countries where maternal mortality presents the biggest challenge among women of reproductive age, such as Ethiopia, fewer than half of all women make even one antenatal visit. In many countries, the quality of care is poor and while the first antenatal check-up may be free, women must pay for subsequent visits.
Postnatal care coverage is not reported on by most countries in the region, particularly coverage for the 2-3 day postnatal visit. Where reported, the percentage is extremely low.
Bleeding during pregnancy or childbirth accounts for one quarter of all maternal deaths in East and Southern Africa. Many lives are also claimed by high blood pressure, obstructed labour, HIV, malaria, tuberculosis and infections. Other important risk factors include women marrying and having babies while still in their teens, short intervals between births, and high numbers of lifetime pregnancies.