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Lack of Access to Reproductive Health Care a Leading Cause of Suffering Among African Women

Health officials with the UN Population Fund say African women may well experience more suffering than men because of health problems.

Although malaria and tuberculosis are leading causes of death on the continent, they strike men and women more or less equally. But the biology of women leaves them open to a number of illnesses that do not strike men. For example, 250,000 African women die in childbirth every year. Among the other top illnesses to strike women are HIV/AIDS and cervical cancer. All of these diseases, say health officials, are exacerbated by malnutrition.

Statistically, UN officials say the chances that a woman will die in childbirth in sub-Saharan Africa is 1 out 16, compared to 1 out of 2800 for women in the developed world. Behind the problem, they say, is the failure of adequate health care for women – especially family planning and emergency obstetrics services.

Yves Bergevin is a senior advisor in reproductive health for the Africa Division of the UN Population Fund, UNFPA in New York. He says many women die during obstructed labor from hemorrhaging and convulsions, and from infections after unsafe abortions.

"We know what to do. We have experience from over 125 countries where this problem is being tackled extremely well and because we have so few conditions that lead to maternal mortality, we know what to do and the interventions are relatively low cost. We know how to deal with hemorrhaging at time of delivery, with infection and with convulsions. We know caesarian-sections will address obstructed labor and how to deliver strong family planning services. "

"The challenge we have is that complications that lead to death when you deliver a baby cannot be predicted ahead of time. So, you have to be ready to deal not only with a normal birth but with complications that might occur without predictability. So, health centers that do deliveries need to be equipped to offer basic emergency obstetrics and have a referral system to a district hospital that can perform essentially basic surgery for c-sections, with adequate anesthesia and a good blood bank in case you need a blood transfusion."

Bergevin says 75 countries have yet to make significant progress in reducing maternal mortality. Nearly half are in Africa.

Malawi is an example. A colleague of Bergevin in the UNFPA, Esperance Fundira, is based there. She describes the situation in the country:

"In Malawi, only two percent of health facilities can provide basic obstetric care. There is also a lack of skilled birth attendants: only 41 percent of births are assisted by skilled attendants in sub-Saharan Africa. In Malawi, it is not uncommon to hear stories of desperate pregnant women [whose deliveries] are being [done] by members of the cleaning staff in hospitals. There are no midwives, so whoever is there when the lady has to deliver tries to do something -- and usually the outcome…is death for both the mother and the baby."

The UNFPA officials say one common problem in countries with poor health care systems is fistula, or tears in the birth canal during obstructed labor. Feces and urine may leak through the openings, leading to pain and social ostracism because of the unpleasant odor. Officials say improved health care would allow quick access to midwives or health care professionals who could surgically remove the child before it damages the mother’s reproductive tract. Poor reproductive health services can also reduce the chances of obtaining a leading form of cancer in African women, cancer of the cervix. It is caused by the human Papilloma virus – which is sexually transmitted.

Women in Africa are falling behind men in other health matters as well.

The UN health experts say young women are more likely today to be infected with the HIV virus, which causes AIDS. About a million women die of the disease every year in sub-Saharan Africa.

Fundira says much of it has to do with the weak social power of women in Africa – which makes it difficult to negotiate having sex with a man:

"In Malawi, a recent study showed that 49 percent of women have had some kind of violence from their intimate partner…The decision makers [in society] are men. Women’s subordinate roles are underpinned by cultural norms and beliefs depriving them of the power to make decisions regarding sexual matters and to negotiate safer sex. They are also exposed to sexual violence outside the home while fetching water, firewood and doing farm work. Schoolgirls are pressured to succumb to sexual advances of men to pay for schoolbooks and to meet personal expenses. [Some men believe having sex with an uninfected young girl will cure them of the disease]. I see in papers here that a woman that refuses sex with someone HIV positive sometimes gets (beaten or) killed. "

Fundira says Malawi’s Ministry for Gender has developed a program to educate women and young girls about HIV and about violence against women. It’s also working to empower women by educating them on their property and inheritance rights. UNFPA officials also recommend the use of the A-B-C campaign of abstinence, being faithful to one’s partner, and condoms as means of curbing the chances of infection.

They also recommend a stronger cooperation among AIDS prevention and treatment campaigns with reproductive health efforts. They say scaling up prevention and treatment programs would be more efficient if the already existing reproductive health networks were used.

Women are more likely than men to suffer malnutrition, which makes it more difficult for them to fight off illness.

"In many cultures the men eat first, then the children and [finally] the women. So that women are likely to want their children to have more food and they are left with the scraps. That is a risk of malnutrition, then you can get anemia from menstruation every month and then multiple pregnancies and deliveries, so the risk of anemia in women is much higher than in men, compounded by malnutrition. Many millions of African women are chronically anemic which puts them at risk of death if they get a hemorrhage at time of delivery. "

Bergevin says in sub-Saharan Africa, the health of a woman is not only important to the development of the economy, but to the family. He says the death of a mother is likely to be more devastating to the survival of the family than the death of a man:

"Say you are an 18 month old child and your mother has died giving birth to your sister…You are very vulnerable, you were probably still breast fed and eating simple foods that children of a year or two of age eat. But the supplement of breast milk is not there; so, the likelihood of malnourishment is increased dramatically. Malnutrition is responsible for over half of deaths of children in Africa. The death of the mother is critical for the survival of the ones she leaves behind, especially the ones below the age of three. "

At the World Summit last year, national leaders pledged to reduce maternal mortality by 75 percent by 2015, to meet one of the UN’s Millennium Development Goals. They also pledged to ensure universal access to reproductive health.

Countries of the 53-member African Union have also committed themselves to drawing up national road maps for maternal and newborn health to ensure that every woman has a safe delivery and that her baby is healthy.

The WHO estimates the effort will cost about half a billion dollars in 2006, and three billion in 2015 in Africa.