Magazine article UN Chronicle

Reproductive Health in the African Region: What Has Been Done to Improve the Situation?

Magazine article UN Chronicle

Reproductive Health in the African Region: What Has Been Done to Improve the Situation?

Article excerpt

Africa accounts for about one tenth of the world's population and 20 per cent of global births; yet, nearly half of the mothers who die during pregnancy and childbirth are from this region. The World Health Organization (WHO) estimates that poor reproductive health accounts for up to 18 per cent of the global burden of disease, and 32 per cent of the total burden of disease for women of reproductive age. One of the underlying causes of this situation is the lack of access to key intervention for improving reproductive health, such as family planning. Despite well-known benefits of family planning, there are unmet needs: contraceptive use among married women in sub-Saharan Africa is very low, estimated at 13 per cent, and the total fertility rate is 5.5 children per woman. Consequently, the adult lifetime risk of maternal death is highest in Africa (1 in 26), while developed countries had the smallest lifetime risk (1 in 7,300).

Maternal mortality estimates for 2005 indicate that the decline between 1990 and 2005 in sub-Saharan Africa was on average less than 1 per cent a year and that to achieve Millennium Development Goal (MDG) 5--improve maternal health--a decrease of at least 5.5 per cent per year is needed. More than half of the estimated 536,000 maternal deaths worldwide occurred in sub-Saharan Africa, and 13 out of 14 countries with maternal mortality rates of at least 1,000 are in the region. (1) The main causes of death are severe bleeding (haemorrhage), infection (sepsis), eclampsia, obstructed labour and unsafe abortion (see Figure 1). However, an increasing number of mothers in the region die from indirect causes, such as HIV/AIDS, tuberculosis, malaria and anaemia.

Another important component of sexual and reproductive health that needs urgent action is the prevention and control of reproductive tract infections, particularly cervical cancer, which is the most common cancer among women, with a prevalence estimated at 20 per cent, and one of the leading causes of death among women. Although 80 per cent of these deaths can be prevented if diagnosed in time, 50 per cent of the cases are diagnosed too late.

Children in sub-Saharan Africa face the gravest challenges for survival. Africa accounts for 44 per cent of global under-five mortality. The main causes are neonatal complications, respiratory infections, malaria, diarrhoea and HIV/AIDS (see Figure 2). Malnutrition is associated with at least 50 per cent of child deaths. It has been estimated that out of the 60 countries worldwide, which contribute 94 per cent of child mortality, 37 are in the African region. While progress was made in improving the health of children aged one month to five years in the 1970s and 1980s, the health of neonates--newborns less than four weeks old--remains a neglected area of public health. Recent data show that neonates represent about 27 per cent of children who die before their fifth birthday and that 29 per cent of global neonatal deaths occur in Africa. Coverage of effective health and nutrition interventions and practices remains low, due to system-wide supply and demand obstacles. Although some progress has been made in child mortality reduction, it has slowed in recent years--the current rate is estimated at 170 per 1,000 live births. To achieve MDG 4--reduce child mortality--an 8.2 per cent average annual reduction rate of under-five mortality is needed in the African region.

Adolescents continue to be victims of sexually transmitted infection, HIV/AIDS, unwanted pregnancy and abortions as a result of unprotected sex. A large number of adolescents in the region are exposed to health-damaging habits, such as substance abuse and smoking, which continue on into adult life. In addition, the increasing trend of cardiovascular diseases and diabetes in adults is strongly associated with lack of proper nutrition and sedentary lifestyles during adolescence. Lack of adolescent-friendly health services and inadequate policy orientation to meet health needs are some of the priority problems that countries of the region are trying to address. …

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