Sub-Saharan Africa at the Turning Point

By Conly, Shanti R. | The Humanist, July-August 1998 | Go to article overview

Sub-Saharan Africa at the Turning Point


Conly, Shanti R., The Humanist


Like most African women, she had to wait for her husband, who was away on business, to come home to give her permission and money to go to the family planning clinic. When she got there, the clinic staff explained she had to have a pregnancy test before they could give her a contraceptive. She could not bear the thought of another pregnancy: "I'm so afraid. My health cannot take it. If I'm pregnant, will they help me take it out?"

Across the continent, in a one-room hut in Uchiru village near Nairobi, Kenya, thirty-year-old "Sara" was scheduling an appointment for a tubal ligation. She and her husband have three children--ages twelve, six, and two--all planned with the help of birth control pills and an IUD. She wanted to give her children a decent life and an education, which is increasingly costly in Kenya. She did not want any more children and wanted a more permanent method of birth control--this in a region where, just five years earlier, experts had said voluntary sterilization would never be accepted. Her story is increasingly typical of younger African women, especially in Kenya, which has one of the oldest and most effective family planning programs in the region.

These two women are a study in contrasts. Born fifteen years and a generation apart, their different life patterns have been shaped in large part by their access to contraception: the older woman in Ghana has been worn down by frequent pregnancies and the burden of raising a large family; the younger Kenyan woman is taking charge of her life and shaping her family's future. They represent the dual challenge of rapid population growth and poor reproductive health confronting subSaharan Africa. Nowhere in the world is the situation further from the ideal.

The Challenges

With Kenya, South Africa, Botswana, and Zimbabwe leading the way, the countries of sub-Saharan Africa are at a critical turning point in their efforts to effect dramatic changes in government policies regarding family planning programs and fundamental shifts in people's attitudes toward childbearing.

Sub-Saharan Africa's population has doubled in just twenty-five years to 620 million--and is projected to double again in less than three decades, even after taking into account declining birthrates and rising deaths from AIDS. For more than twenty years, population growth of almost 3 percent a year has outpaced economic gains as well as increases in food production, leaving sub-Saharan Africans, on average, 22 percent poorer than in 1975. These farmers would have to increase production fivefold just to meet the region's basic food needs in the year 2050. Even sooner, by 2025, six out of ten Africans are projected to live in countries classified as water scarce, hampering food production and industrialization.

Women bear the greatest burden of frequent high-risk pregnancies, raising large families, and, increasingly, the AIDS epidemic. They also must perform household chores and most agricultural work. Together, these conditions have had devastating consequences for the health and well-being not only of African women but also their families:

* Just one in ten of the world's women live in sub-Saharan Africa, but the region accounts for 40 percent of all pregnancy-related deaths worldwide--215,000 deaths every year, or one every two and a half minutes. Childbearing is riskier in Africa than anywhere else--one woman dies for every 100 births--and most women have numerous pregnancies. Less than half of women receive any kind of skilled maternity care and half are anemic. During her lifetime, an African woman has a one in fifteen chance of dying from reasons related to pregnancy--odds over 200 times greater than those faced by women in the United States. The risks are somewhat lower in southern Africa, where incomes are higher than elsewhere in the region, access to health care is better, and women bear fewer children.

* Young women face heavy social pressure to marry and bear children early; more than half give birth by age twenty--a proportion that has remained substantially unchanged over the years. …

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