Sexual and Reproductive Health Across Africa: Challenges and Opportunities
By Dr. Felix Bongomin and Dr. Ella August
While Sub-Saharan Africa has experienced impressive gains in economic growth in past decades, other aspects of the region’s development are lagging. Women in Sub-Saharan Africa face significant challenges, including high fertility rates, highly prevalent HIV infection rates, increased risk of maternal and infant mortality, and a substantial unmet need for contraception. Key population and health indicators reveal a confluence of population growth and lacking medical care, infrastructure, and policies to support the health and wellbeing of the population. Women and adolescents carry much of the burden as they experience critical gaps, particularly in the areas of sexual and reproductive health and rights (SRHR).
Family Planning and Contraceptive Services
While Africa comprises about one tenth of the world's population and contributes 20% of births worldwide, almost half of mothers who die during pregnancy and childbirth are African. These numbers are even more worrisome given that the Sub-Saharan African region has the highest proportion of residents aged 10 – 24 years and the highest number of births to females aged 15-19 years.
Females who give birth at a young age are more vulnerable to complications such as abortions, preterm labor, preeclampsia, and obstructed labor, as well as infant mortality. Such negative health outcomes put these females at a greater disparity economically compared to their counterparts who delay childbearing. Thus, it is critical to address sexual and reproductive health and rights from an early age to prevent a range of negative health and economic outcomes.
Child marriage and low use of modern contraceptives are key drivers of teenage pregnancy in Africa. Utilization of modern contraceptives remains less than 20% among key populations in most African countries. A recent systematic review showed that about 30% of adolescent females in Africa become pregnant. Meeting the needs for modern contraception has been estimated to be able prevent 6 million unintended pregnancies per year, averting 2.1 million unplanned births, 3.2 million abortions, and 5600 maternal deaths. Additional risk factors for teenage pregnancy include low education level and school drop out, poverty, and lack of parental guidance.
Importantly, more research is needed describing interventions to increase access to family planning and contraceptive services at the healthcare, policy, and individual patient level.
Comprehensive Abortion Care
Abortion is the leading cause of maternal morbidities and mortalities in Africa, yet it is preventable. There are moderately to highly restrictive laws on the legality of abortion in over 90% of the countries in Sub-Saharan Africa where women of reproductive age reside. Approximately three-quarters of abortions in Africa are not safe, and unsafe abortions can lead to death. Approximately 5.2% - 17.2% of maternal deaths annually in Sub-Saharan Africa are due to abortions. However, if all women’s contraceptive needs were fully met and all abortions were provided safely, abortion-related maternal deaths would be nearly eliminated.
A major barrier to providing comprehensive abortion care is a lack of clinician training, even in countries in which abortion is legal. Other barriers to abortion access include religious stigma, social stigma, as well as a lack of healthcare resources.
Low socioeconomic status and low levels of education have been associated with an increased risk of unsafe abortions in Africa. Women with fewer resources tend to seek inexpensive but unsafe abortions from untrained providers. These unsafe procedures often lead to sepsis, hemorrhage and uterine perforations.
Sexual and Reproductive Health and Rights (SRHR)
While countries across Sub-Saharan Africa have made progress in several SRHR priority areas including adolescent fertility rates, child marriage, and contraceptive uptake, more work is needed to ensure greater equity in enjoying these gains and to further address the pressing health and rights needs that persist.
In particular, two areas identified in the Sustainable Development Goals (SDG) are in critical need of research and application in the region. SDG 3 encompasses good health and wellbeing, highlighting a pressing need for more research and action in the areas of maternal and perinatal health, sexual dysfunctions and sexually transmitted infections, fertility care, sexual and reproductive health and rights in public health emergencies, and other issues relating to good health and wellbeing. SDG 5 focuses on gender equality, calling attention to gender-based violence, female genital mutilation, and other issues relating to sexual and reproductive health and rights. Of course, all of these concerns broadly require competent and respectful care delivery and policies that create funding and access.
Special Collection on Sexual and Reproductive Health Across Africa: Challenges and Opportunities
Much of the research in the area of SRHR describes the nature and impact of lack of access, adverse health and economic outcomes in women. These studies are badly needed to create evidence-based interventions and policies that improve the plight of women and girls in Sub-Saharan Africa. Additional research is needed to understand the connection of SRHR to the health, wellbeing, and economic plight of men, boys, and families. Other areas of particular interest are evaluations of systemic factors impacting care delivery and prevention.
We are guest-editing a Special Collection for Women’s Health and Therapeutic Advances in Reproductive Health, to bring together current knowledge and insights about SRHR across Sub-Saharan Africa and to identify the next steps for research in this field. Submissions are open until April 30th, 2024, and we welcome contributions and questions from interested authors.
About the Authors
