Journalist to Journalist Seminar: Reporting on Reproductive Health in East Africa Ayo Ajayi Population Council
Outline Some numbers ---demographic and RH Maternal Mortality Abortion Contraception STI HIV Harmful Traditional Practices MDGs and CPA
Some Numbers – mid 2005 • SSA E K T U • ------------------------------ • Population Size (millions) 752 77 34 37 27 • Births per 1000 Population 41 41 38 42 47 • Deaths per 1000 Population 17 16 15 18 15 • Annual Rate of Natural Increase 2.4 2.5 2.2 2.4 3.2 • Total Fertility Rate 5.6 5.9 4.9 5.7 6.9 • Population Doubling Time (yrs) 29 • Contraceptive Prevalence Rate 21 6 32 20 18 • Infant deaths per 1000 births 94 100 77 120 88 • % Urban 34 15 36 32 12 • % 15-49 with HIV/AIDS 7.4 4.4 6.7 7.0 7.1 • % living below $2 per day 75 78 58 73 97 Source: PRD 2005 World Population Data Sheet
Maternal Mortality Measuring MM accurately is difficult Use of process indicators for monitoring trends Most widely used---skilled attendant at delivery And Proportion of deliveries by Caesarian Section Both indicators show increases between 1990-2000 Least change in sub-Saharan Africa – less than 25%
Births and Assisted Deliveries Worldwide Births in 2000 and Births Attended by Skilled Personnel, 1995-2000 Source: UNICEF End of Decade Databases—Delivery Care (www.childinfo.org/eddb/maternal/index.htm).
Risk of Dying of Maternal Causes or of Losing a Newborn* Percent chance Lifetime Risks to Mothers Source: Save the Children and Population Reference Bureau, Healthy Mothers and Healthy Newborns: The Vital Link (April 2002).
Skilled Care at Delivery and Maternal Deaths Regional Comparisons, 1995 Sub-Saharan Africa South Asia East Asia and Pacific Middle East and North Africa Latin America/ Caribbean North America Source: PRB, using data from Maternal Mortality in 1995: Estimates Developed by WHO, UNICEF, and UNFPA, 2001.
Causes of Maternal Deaths • Nearly three-quarters of maternal deaths are due to direct complications of pregnancy and childbirth, such as severe bleeding, infection, unsafe abortion, hypertensive disorders (eclampsia), and obstructed labor. • Women also die of indirect causes aggravated by pregnancy, such as malaria, diabetes, hepatitis, and anemia
Abortion Worldwide Abortions as a Share of Pregnancy Outcomes, Estimates for 1999 Note: The percentages are based on a 1996 UN projection of 210 million pregnancies for 1999. Source: Alan Guttmacher Institute, Sharing Responsibility: Women, Society, and Abortion Worldwide, 1999.
Contraceptive Methods, Sub-Saharan Africa Married Women 15 to 49 Using Contraception, 2004 Source: Population Reference Bureau, Family Planning Worldwide 2004 Data Sheet. Note: Percentage may exceed 100 due to rounding
Contraceptive Shortfall, Developing Countries Gap in Funding for Contraceptives and Condoms for AIDS Prevention US$1.8 Billion US$811 Million US$739 Million US$332 Million US$154 Million Source: UNFPA, Commodity Management Unit, unpublished data, November 2001.
Contraceptive Security • In the 1990s, donor funding for contraceptive supplies in less developed countries, including condoms, averaged 41 percent of the total supply costs • The number of contraceptive users is projected to increase more than 40 percent by 2015, due to both population growth and increased demand for family planning • Even if the donor share is maintained, the gap between donor funding and total needs will exceed US$1 billion by 2015
Sexually Transmitted Infections (STI’s) • STIs cause long term health complications • For instance, HPV and Cervical Cancer; STI’s and HIV • STIs are one of most preventable causes of LBW, stillbirths, congenital infections and post partum infections • Symptoms typically appear earlier in males • STIs are less likely to produce symptoms in women and therefore more difficult to diagnose until serious problems develop • Treatment seeking for STIs is a measure of knowledge of infections such as gonorrhea, syphilis, chlamydia*
Awareness of STIs Respondents With Symptoms Who Sought Treatment, by Sex Percent Note: The figure presents the percentage of respondents who reported symptoms suggestive of STIs in the last 12 months who sought care at a service provider with personnel trained in STI care. Source: ORC Macro, Demographic and Health Surveys.
HIV/AIDS • AIDS has reduced life expectancy significantly in several countries in Africa • In Botswana, for example, without accounting for the impact of AIDS, life expectancy would have been 74 years in 2010; however, with AIDS, life expectancy has dropped to 35 years in 2005 • In Africa, HIV is spread predominantly through heterosexual activity; women account for more than half of the 30 million people living with HIV/AIDS. • In other regions, the proportion of people living with HIV/AIDS who are women drops to around one-third.
Growth of the AIDS Epidemic People With HIV/AIDS, Cumulative Regional Totals Millions *North America, Europe (except Eastern Europe), Japan, Australia, and New Zealand. **Eastern Europe, Central Asia, Middle East, and North Africa. Source: UNAIDS, “Twenty Years of HIV/AIDS: Fact Sheet,” 2002, and unpublished data.
HIV/AIDS Demographics, Africa/Rest of the world Composition of the Infected Population, 2001 * Total does not equal 100 percent due to rounding. Source: UNAIDS, Report on the Global HIV/AIDS Epidemic, July 2002.
Female Genital Cutting, by Age Prevalence Among Younger and Older Women Percent Source: Special tabulations of Demographic and Health Survey data for 1989-2000 by Principia International, Inc., and published data from ORC Macro.
Early Marriage Source: DHS data, www.measuredhs.com
What do we know about married adolescent girls? • High levels of unprotected sex • Large age gaps with sexual partners • Are under pressure to become pregnant • Highly limited or even absent peer networks • Restricted social mobility/freedom of movement • Little access to modern media (TV, radio, newspapers) • Limited educational attainment and no schooling options Source: Haberland et.al 2003
Higher HIV prevalence among Married Adolescent Girls MarriedUnmarried% Higher Kisumu32.9% 22.3% 47.5% Ndola 27.3% 16.5% 65.5% Source: Glynn et al, AIDS 15(suppl 4), S51-60, 2001
Why might married adolescent girls be at risk of HIV? • Biological factors • They have more frequent unprotected sex • Their partners are more likely to be infected • Social factors • Isolation • Low status in new household
Proportion married among adolescent girls who had sex last week Source: Bruce and Clark, 2004.
Sexually active girls (15-19yrs old) who had unprotected sex last week Source: Bruce and Clark, 2004.
Likely married to an older partner DHS Data; Bruce & Clark, 2004
Older partners, likely infected Source: Bruce and Clark, 2004.
Social Isolation • Married adolescent girls are: • More cut off from family and friends • Less likely to watch TV or listen to theradio • Less likely to be in school • Less knowledgeable about HIV/AIDS • May have limited access to RH services and info • Often have no personal bargaining power, but are under control of husband and his family
Their situation is particularly vulnerable… • They are unable to benefit from common HIV prevention messages: • Abstinence • Reduce sexual frequency • Reduce number of partners • Use condoms • Observe mutually monogamousrelations with an uninfected partner
Their situation is particularly vulnerable… • They are unable to negotiate condom use,even when pregnancy is not desired • They are marginalized in RH programs including FP and ANC services
But it’s not just married adolescents who are vulnerable • Half of all new HIV infections occur in the 15-24 year-old age group • In some countries as many as 20% of girls aged 15-19 are infected compared to 5% of boys the same age • HIV is more prevalent among older men • High transmission to young girls is likely from cross-generational and transactional sex • In many countries high rates of sexual violence
Other issues and controversies • Family Planning and Contraception • Emergency Contraception • Unsafe Abortion • Adolescent Sexuality
Similarity of the MDG and CPA • MDG: Eradicate extreme poverty and hunger CPA: Aim at achieving poverty eradication • MDG: Achieve universal primary education CPA: Achieve universal access to quality education • MDG: Promote gender equality and empower women CPA: Countries should act to empower women and… eliminate inequalities between men and women • MDG: Eradicate child mortality CPA: Promote child health and survival
Similarity of the MDG and CPA • MDG: Improve maternal health CPA: Achieve a rapid and substantial reduction in maternal mortality ….including deaths and mortality from unsafe abortion • MDG: Combat HIV/AIDS, tuberculosis, malaria and other diseases CPA: Reduce the spread of HIV infection and minimize its impact.
Similarity of the MDG and CPA 7. MDG: Ensure environmental sustainability CPA: Reduce unsustainable consumption and production patterns as well as negative impacts of demographic factors on the environment. 8. MDG: Develop a global partnership for development CPA: Urge the international community to adopt favorable macro economic policies for promoting sustained economic growth