Preface

Having devoted much of my life to improving the health of women and children in sub-Saharan Africa, I am happy to see African governments enthusiastically embrace the agenda adopted by the 1994 International Conference on Population and Development (ICPD). The concept of total reproductive health speaks to Africans. We see not only a need for family planning to prevent the health risks of frequent childbearing, but also to reduce the high toll of illness and deaths associated with pregnancy and childbirth and to prevent the spread of sexually transmitted diseases (STDs), including HIV/AIDS. Yet despite a sea change from their earlier passivity, most governments in the region could do much more to improve reproductive health.

Although we Africans face enormous challenges in the area of reproductive and child health, I am optimistic that we are making headway. Infant and child death rates had declined steadily across the continent until economic problems and the AIDS epidemic recently slowed progress. Contraceptive use is increasing and birthrates are falling in several countries, although it is too early to see an impact yet on population growth. Botswana, Kenya, South Africa and Zimbabwe are leading the way, and I expect my own country, Ghana, to join their ranks soon.

Nevertheless, there are several areas where major changes are still needed.

As a physician, it is my view that reproductive health generally and family planning in particular have received too low a priority in Africa. Family planning remains overly medicalized, especially in light of the huge unmet need for services and the scarcity of doctors in rural areas. African governments need to relax restrictions on contraceptives that have a safe record of use elsewhere‹the pill over the counter is better than a risky abortion. Health care workers need to listen to people to learn the best ways to reach them with services.

Governments also cannot do it alone. Private groups were in the vanguard of reproductive health and early family planning efforts in Africa. Even though governments are now strengthening services at public sector health facilities, private groups still have a pioneering role to play in identifying creative new approaches. The challenge now is to mobilize different groups and harmonize their contributions.

The ICPD has made it possible for Africans to talk about previously taboo topics such as female genital mutilation and unsafe abortion. But our deep ambivalence about adolescent sexuality is causing us to fail our rapidly growing population of young people. These young people are Africa¹s future, and we need to make sure they get the information and services they need to protect themselves from AIDS and other STDs and early pregnancy. Over the long-term, efforts to help young people postpone pregnancy will also benefit society by increasing the span between generations and slowing population growth. The clock is ticking and time is of the essence if we are to avoid losing a generation.

I am struck that all these problems‹unwanted pregnancy, risky sexual behavior contributing to AIDS and other STDs, infant and child deaths, poor access to education‹are interrelated, as are their solutions. There is mutual synergy, for example, between educating girls and expanding reproductive health services. When mothers use family planning, their daughters are less likely to stay home from school to help care for younger siblings and help with housework. If teenage girls have access to good family life education and reproductive health services, they are less likely to get pregnant or get AIDS and drop out of school. When women are educated, they can more easily insist that their partners use condoms.

Finally, solutions to these problems require the sharing of experiences — both within Africa and with other regions. I am delighted to see the increase in South-to-South exchanges and partnerships, including within Africa. As a member of Population Action International's Board of Directors, I hope this report in its own small way can contribute to the sharing of African experiences.

Dr. Fred T. Sai