Kampala/Lusaka/Harare — Almost 30 years ago in 1994, the world witnessed a historic event as 179 nations convened on African soil, in Cairo, for the International Conference on Population and Development (ICPD).
In an unprecedented moment of collective action, Heads of State adopted a revolutionary Programme of Action and called for women's reproductive health and rights to take center stage in national and global development efforts.
This summer, in another first, the Women Deliver Conference had its annual meeting in Kigali, Rwanda. As the largest conference on gender equality in the world with 6,000 in-person delegates and a further 200,000 remote participants, the event was a welcome symbol of Africa's commitment to the rights of women and girls.
Despite this, it was frustrating to witness echoes of the global pushback currently plaguing the reproductive justice movement and how decades of progress on sexual and reproductive health and rights (SRHR) continue to face assault.
Speaking at the opening ceremony, the Hungarian President drew controversy for championing her 'pro-family' ideals in sharp contrast to the purpose that had united many of the delegates present.
President Katalin Novák, a key player in the movement opposing women's and girls' rights, notably access to safe and legal abortion, has publicly asserted that Hungarian women "should not compete with men" or expect to earn equal pay. She publicly envisioned her teenage daughter being empowered to choose a path of mothering a substantial number of children, "even 10 children if she chooses to".
As part of a 40-women delegation from the Women in Global Health network, we experienced the clash firsthand. Three decades since Cairo, and the struggle for women's and girls' rights continues, but as African health professionals and agents of change in the systems we deliver, so does our determination to sustain progress on the continent.
We have much to be proud of. In November 2021, Benin's Parliament voted to legalize abortion in most circumstances. The Democratic Republic of the Congo, the first country in Francophone Africa to do so, expanded access to abortion care, and endorsed guidelines to implement the directives of the African Protocol on the Rights of Women (the Maputo Protocol).
In July 2022, Sierra Leone took steps to modernize outdated abortion laws following decades of advocacy by the women's movement and government officials.
Despite these advances, women and adolescent girls in Africa continue to have some of the world's highest maternal death and morbidity rates. With low access to modern contraceptive methods and quality, safe and legal abortion, stalling progress means life and death for many women and girls.
The COVID-19 pandemic revealed the failure of many governments to integrate a gender-responsive approach in national health systems on SRHR. During the emergency response, SRHR services were not always deemed essential and sidelined, resulting in a surge of gender-based violence, unintended pregnancies and unsafe abortions.
Access to modern contraception and reproductive health, fundamental to determining whether and how many children to have, when and with whom, remains inaccessible for many adolescent girls and women. Quality, safe abortion care is a right. Restrictions on abortion do not eliminate abortion; they only eliminate safe abortions, resulting in women's deaths.
According to global estimates up to 10 million more girls will be at risk of becoming child brides in the next decade as a result of the COVID-19 pandemic.
Reports also indicate that though all women and girls globally face discrimination in laws, social norms and practices, women and girls in Africa bear the highest share of discrimination in terms of intra-household dynamics and caregiving roles, working environments including harmful practices such as domestic violence and female genital mutilation.
Women health workers are grossly underrepresented in health leadership and this is a key factor in the current push back on SRHR. Women comprise the majority of the health workforce, given they are 70 percent of the overall workforce globally and 90 percent of frontline staff, yet they occupy just 25 percent of leadership roles.
For lower- and middle-income regions such as Africa, the percentage of women in leadership is as low as five percent. As the majority of frontline health professionals, women health workers have a deeper understanding of the health needs of their communities including SRHR needs. This power imbalance at decision-making tables excludes their valuable experiences and expertise to shape policies and programs that adequately address the health needs of women and girls.
Compounding this, 70% of women in Africa are said to be excluded financially, with an estimated gap of $42 billion between men and women. Around six million women work unpaid and underpaid in core health systems roles, effectively subsidizing global health.
Health and care are essential employment sectors for women and have the potential to unlock gender transformative lessons for the rest of the economy by addressing systemic biases that hinder women's empowerment. Investing in the health workforce, the majority of whom are women, is a sound investment with potential gains for health systems, social change, and economic growth.
The role of women health workers delivering SRHR services in health systems cannot be overestimated. Women health workers typically counsel and support women and girls in accessing a range of modern contraceptives and in dealing with high-risk or unwanted pregnancy.
They brave violence and harassment from anti-rights protestors at quality, safe abortion facilities. They face online abuse and threats when expressing views in favor of SRHR, especially safe abortion.
As a platform, the Women Deliver Conference provided an opportunity for gender advocates and Civil Society Organizations to amplify efforts towards promoting a gender-responsive agenda among policy players and government leaders. While several countries have ratified human rights declarations over the years, not enough has been done to live up to the promise of making gender equality a reality.
Women's movements and their allies are pivotal for mobilizing the necessary political will needed to drive progress on SRHR. As members of Women in Global Health, a movement challenging power and privilege for gender equity in health, we are calling on political and global health leaders to establish the following:
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- 1. Gender responsive UHC that ensures all people have access to the services they need, when they need them including access to sexual and reproductive health and rights (SRHR) for women and girls.2. Gender Equal and diverse leadership in Global Health based on Gender Transformative Leadership. This offers equal opportunities for women to lead in health and contribute to shaping health systems and health policies that are gender responsive. This is critical if we are to achieve health for all.3. Gender equity in emergency preparedness and response. We are calling for continuation of essential health services, including SRHR, and the protection of health workers to be central in these political agreements.
Movements such as ours are pivotal in building allyship between health workers and national leaders in the delivery of SRHR while also safeguarding health outcomes for future generations. Across Africa, reducing health inequities and maternal mortalities is of paramount concern.
African countries have the opportunity to secure the foundation for just societies and health for all, what we need now is to hold firm against the global pushback on reproductive rights and deliver on the promises made to women and girls.
This article was authored by Members of the African Women in Global Health network:Dorothy Akongo, Research and Advocacy Manager, Busoga Health Forum and Coordinator, Uganda Chapter; Flata Mwale, Global Health Professional and Deputy Country Lead, Zambia Chapter; Vivian Mugarisi, Public Health Communications Specialist, Zimbabwe Chapter.
