What Can Be Done to Improve Women's Health in the African Region?

Tigest Ketsela
Lea Koyassoum-Doumta
Charles Sagoe-Moses
Djamila Cabral
Andrew Kosia

Division of Family and Reproductive Health
World Health Organization
Regional Office for Africa

Corresponding Author:
Andrew Kosia

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ABSTRACT

Women constitute a key link in the chain of development actions worldwide. For women to be able to fulfi ll their role in society, however, they need to be in a state of adequate physical, mental and social well-being. Unfortunately, the huge majority of African women are still unaware of their fundamental rights to health, education and life, and suff er from ill-health and sub-standard living condition.

Global leaders, including African ministers of health, have adopted a number of resolutions to improve women's health. However, the health situation of women in Africa continues to be poor, with 57% of women in the African Region lacking access to assistance by qualifi ed staff during childbirth, one out of twenty-six women being at risk of dying from birth-related complications, to mention a couple of signifi cant indicators.

Given that the issues of women's health are complex, this paper calls for multisectoral and concerted action involving the public and private sectors, nongovernmental organizations, communities and families. For this, it proposes that countries set up a multidisciplinary technical team composed of experts in health, gender and human rights to identify priority interventions for eff ective scaling up and resource mobilization for women's health at national level.

Among the ways forward proposed in the paper are scaling up women's health-related interventions; using the primary health care approach in line with the Ouagadougou Declaration to effectively deliver women's health interventions; strengthening the capacity of women, families and communities to prevent diseases; and empowering them economically to enable them to take appropriate decisions related to their health and sexuality.





RÉSUMÉ

Les femmes constituent un maillon essentiel dans la chaîne des actions de développement dans le monde. Pour que les femmes soient en mesure de remplir leur rôle dans la société, elles doivent être dans un état physique, mental et de bien-être social satisfaisant. Malheureusement, l'immense majorité des femmes africaines ignorent encore leurs droits fondamentaux à la santé, à l'éducation et à la vie et elles souff rent de mauvaise santé et de conditions de vie en dessous des normes.

Des dirigeants internationaux, dont les ministres africains de la santé, ont adopté un certain nombre de résolutions visant à améliorer la santé des femmes. Toutefois, en Afrique, les femmes continuent d'avoir une situation sanitaire médiocre. Pour ne citer que quelques indicateurs signifi catifs, 57% des femmes en région africaine n'ont pas accès à l'assistance d'un personnel qualifi é pendant l'accouchement et une femme sur vingt-six risque de mourir de complications liées à la naissance.

Étant donné que les problèmes de santé des femmes sont complexes, ce document fait appel à une action multisectorielle et concertée impliquant les secteurs public et privé, les organisations non gouvernementales, les communautés et les familles. Pour cela, il propose que les pays mettent en place une équipe technique pluridisciplinaire composée d'experts de la santé, des sexes et des droits de l'homme afi n d'identifi er les interventions prioritaires pour l'augmentation et la mobilisation effi cace des ressources pour la santé des femmes au niveau national.

Parmi les pistes proposées dans le document, on trouve l'augmentation des interventions en relation avec la santé des femmes utilisant la première approche des soins de santé en conformité avec la Déclaration de Ouagadougou pour fournir efficacement des interventions de santé aux femmes, en renforçant la capacités des femmes, des familles et des communautés pour prévenir les maladies et en leur donnant les moyens économiques pour leur permettre de prendre les décisions appropriées relatives à leur santé et leur sexualité.

SUMÁRIO

As mulheres constituem um elo fundamental na cadeia de acções de desenvolvimento a nível mundial. Para cumprir o seu papel na sociedade, no entanto, elas precisam de ter um estado adequado de bem-estar físico, mental e social. Infelizmente, a grande maioria das mulheres Africanas ainda não estão conscientes dos seus direitos fundamentais à saúde, educação e à vida, sofrendo de problemas de saúde e sub-condições de vida normal.

Líderes mundiais, incluindo os ministros da saúde Africanos adoptaram uma série de resoluções para melhorar a saúde das mulheres. No entanto, a situação de saúde da mulher em África é calamitosa, com 57% das mulheres na Região Africana sem acesso à assistência de pessoal qualifi cado durante o parto, 1 em cada 26 mulheres apresentando risco de morrer de complicações relacionadas com o parto, apenas para mencionar alguns indicadores.

Dado que as questões da saúde das mulheres são complexas, o documento pede uma acção multissectorial e concertada, envolvendo o sector público e privado, organizações não-governamentais, comunidades e famílias. Para isso, propõe que os países criem uma equipa técnica multidisciplinar composta por especialistas em saúde, género e direitos humanos para identificar as intervenções prioritárias para a intensificação e mobilização efi caz de recursos para a saúde das mulheres a nível nacional.

A necessidade de intensifi car as intervenções relacionadas com a saúde das mulheres; a utilização da abordagem de cuidados primários de saúde em consonância com a Declaração de Ouagadougou para efectivamente realizar intervenções de saúde das mulheres; reforçar a capacidade das mulheres, famílias e comunidades para prevenir doenças e fortalecimento económico das mulheres de forma a tomarem decisões apropriadas relativas à sua saúde e sexualidade são algumas das acções propostas no documento.


The ways forward include: scaling up women's health-related interventions; using the primary health care approach in line with the Ouagadougou Declaration to effectively deliver women's health interventions; strengthening the capacity of women, families and communities to prevent diseases; and empowering them economically to enable them to take appropriate decisions related to their health and sexuality.


By virtue of their multiple roles, women constitute a key link in the chain of development actions worldwide. Women not only account for over half of the population of countries in general, but they also invest their energy in families and communities, thus contributing to the wealth of nations.

Women need to be in a state of adequate physical, mental and social well-being to be able to carry out their numerous responsibilities. Against this background, during the United Nations Decade for Women (1975-1985) and at various international meetings on population and development(1). Member States of the United Nations agreed that women's health and their active participation in development actions were closely linked.

Unfortunately, the huge majority of African women are still unaware of their fundamental rights to health, education and life as part of the fundamental rights they gained several decades ago.(2,3) They continue to suffer from socio-cultural discrimination , harmful traditional practices such as female genital mutilation (FGM), gender-based violence, food taboos, forced marriages, and early and unwanted pregnancies, all of which are very harmful to their health.

These problems, coupled with the weakness of health systems, are at the root of the high maternal mortality in sub-Saharan Africa where 1 out of every 26 women is at risk of dying during childbirth compared with 1 woman out of every 7300 in industrialized countries. Furthermore, of the 14 countries worldwide where maternal mortality is above 1000 per 100 000 live births, 13 are in sub-Saharan Africa.

As maternal mortality is one of Africa's major health problems, countries and their development partners made a commitment at the Millennium Summit (2000) to reduce this mortality by three quarters between 1990 and 2015 (the fifth Millennium Development Goal - MDG 5). Although a 5.5% annual average reduction of maternal mortality was required in order to achieve MDG5, the actual annual reduction in sub-Saharan Africa between 1990 and 2005 was only 0.1%.(4)

African ministers of health have adopted a number of resolutions on women's health and their contribution to development, includinga road map to accelerate progress on MDG5.(5) In addition, the 2008 Ouagadougou Declaration on Primary Health Care and Health Systems in Africa focused on strengthening health systems to address maternal health, women's health and related issues using the primary health care approach.(6)

Challenges

The Women's Health Strategy for the African Region sets forth interventions based on the national women's health profile which defines the country's economic situation, the status of women in general and the status of women's health. Sixteen countries already have developed their national women's health profiles; however, very few have integrated women's health into their national health policies and programmes.(7)

The 2001 Regional Strategy on Adolescent Health has two main thrusts: prevention of teenage pregnancy and control of sexuallytransmitted infections and HIV/ AIDS. National strategies have been developed by a number of countries, but implementation remains a challenge.

The Road Map for accelerating the attainment of the Millennium Development Goals related to maternal and newborn health in Africa (MDG5) aims to provide women with assistance by qualified staff during childbirth and with access to quality emergency obstetric care. Although most of the countries of the Region already have their National Road Map, mobilization of resources for effective implementation has been difficult.

According to WHO estimates, 57% of women in the African Region lack access to assistance by qualified staff during childbirth.(4) The shortage of skilled birth attendants in health facilities, especially in rural areas, exposes women to preventable death.

The Child Survival Strategy for the African Region (2006) emphasizes the need to respect the rights of the child, including the girl-child.(8) However, the majority of girls are still subjected to discrimination, abuse and neglect. Addressing this problem remains a challenge in the Region.

Men are not adequately informed about the problems women face due to various social and cultural beliefs. The weak involvement of men in issues regarding girls, adolescents and women make it difficult to address women's health problems.

Despite international efforts to eliminate gender-based violence, including FGM, FGM has decreased in only 10 countries, owing to entrenched cultural and traditional beliefs. Addressing the problem of FGM in the remaining 17 countries has proved to be a major challenge.

The average life expectancy at birth in the African Region is 51 years for women. Case studies on motherhood-related disability in some countries show that disability of women is a huge but unaddressed problem. In addition, women traditionally give a lower priority to their own health compared with the health of other members of the family.(9)

Competing priorities, recurrent conflicts , poverty, and misunderstanding women's roles hamper the allocation of adequate resources to women's health. Issues of women's health are complex and require multisectoral and concerted action involving the public and private sectors, nongovernmental organizations, communities, families and individual women themselves.

The Way Forward

Women's health remains critical despite the commitments and efforts of Member States of the WHO African Region to improve the situation. There is a need to integrate women's health issues into existing programmes based on gender and human rights approaches. The following actions need to be addressed in the implementation of the Regional women's health strategy for effective impact on women's health.

It is important to strengthen existing multisectoral bodies to advocate for the implementation of international conventions and instruments related to women's health and development adopted by countries. These include the Millennium Development Goals and the Ouagadougou Declaration on Primary Health Care and Health Systems.

Countries will need to set up a multidisciplinary technical team composed of experts in health, gender and human rights to identify priority interventions for effective scaling up of, and resource mobilization for, women's health at the national level. The team should have clear terms of reference in order to assess and monitor trends in women's health.

Countries also need to scale up essential interventions related to women's health with special emphasis on rural areas. It is important to expand coverage of services, enhance the skills of health workers (skilled birth attendants) and social workers, and improve the existing facilities with particular emphasis on referral systems and availability of medicines in order to provide quality, timely and affordable care for women.

The primary health care approach should be used in line with the Ouagadougou Declaration to deliver women's health interventions. It is also essential to improve the utilization of services by women in general and by pregnant women in particular through active involvement of men and community participation. Men's involvement is important to address financial and geographical barriers to women's access to essential health services.

Strengthening the capacity of women, families and communities to prevent diseases by providing them with information on appropriate care and on the risk of diseases is crucial. Women should be economically empowered to access health services and to take appropriate decisions related to their health and sexuality.

A number of countries are making progress in the area of maternal and women's health. These countries need to be supported to document and share their best practices to stimulate other countries in the Region to emulate their examples.

Countries will also need to develop an integrated communication plan to increase understanding of the importance of women's roles and promote societal attitude change towards women. This plan should be comprehensive and interactive to address all the major obstacles to women's health. The relationship between the health of the mother and the well-being of the child should be reflected in this plan.

It is essential that internal and external funds are mobilized for effective implementation of essential women's health interventions, including by implementing the 2001 Abuja Declaration, in which African Heads of State committed themselves to allocate 15% of national budgets to the health sector. Various funding sources for women's health should be explored, including health insurance schemes and other community funding mechanisms, and allocate specific funds for the implementation of national Road Maps.

Strengthening partnerships with women's rights groups, including community-based organizations, nongovernmental organizations and women's associations, and integrating women's health issues into their agendas is also important. Collaboration between key stakeholders including development partners should be strengthened

ACKNOWLEDGEMENTS

We gratefully acknowledge the contributions of all those professionals at HQ, IST and WCO level for the review of the paper and at the country levels who are involved in data collection, processing and dissemination. Assessment of the women's health issues or monitoring its interventions would not have been possible without their crucial eff orts.

REFERENCES