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

84

67 66

39 37 35
32
26

10 11

Middle East/North Latin Sub-Saharan Africa East Asia/Pacific South Asia

Africa America/Caribbean

Births in millions Percent of births attended by skilled personnel

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

20

5 5

1 1

Africa Asia Latin America

Lifetime risk that a woman will die of maternal causes Lifetime risk that a woman will lose a newborn*

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 45 967

South Asia 59 430

East Asia 73 189

and Pacific

Middle East and 77 175

North Africa

Latin America/ 83 146

Caribbean
Percent of births assisted by skilled attendants
North America 97 9
Number of maternal deaths per 100,000 live births

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

Miscarriages
and Stillbirths
15%

Induced
Abortions Live Births
22% 63%

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

IUD
Condom
3%
8%
Other
Modern
Any Injectables 5%
20%
Method
Rhythm
No 27% 16%
Method Pill
73% 21%
Withdrawal
5%
Other
Female Traditional
Sterilization 11%
11%

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

2
US$1.8 Billion

1.5

1
US$811 Million
US$739 Million
0.5
US$332 Million
US$154 Million
0
2000 2005 2010 2015

Cost of supplies Expected donor funding Actual donor funding in 2000: 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

88
82 83
75

63 64
59
55

37
28 27
22

Cameroon Côte d'Ivoire Kenya 1998 Malawi 2000 Rwanda 2000 Uganda
1998 1998 2000/2001
Female Male

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

45

40

35

30

25

20

15

10

0
1981 1986 1991 1996 2001

Highly Industrialized* Sub-Saharan Africa South and East Asia

Latin America/Caribbean Eastern Europe, other**

*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

Children
Children
9%
3%

Men
38%

Women
30%

Men
Women
66%
53%

* 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

97 98 97
94
90 91

48

32
22
16

Egypt Eritrea Kenya Sudan Tanzania

Ages 20-24 Ages 45-49

Source: Special tabulations of Demographic and Health Survey data for 1989-2000 by Principia International,
Inc., and published data from ORC Macro.
Early Marriage

80
70
60
50
marr-15
40
marr-18
30
20
10
0
Ug Ken Ethp Tz
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

Married Unmarried % Higher

Kisumu 32.9% 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

100%
18.3 13
20.8 27.2
Unmarried
80%
Married

60%

40% 81.7 87
79.2 72.8

20%

0%
South & East West Africa LAC Asia &
Africa Middle East
(est.)

Source: Bruce and Clark, 2004.

Sexually active girls (15-19yrs old)
who had unprotected sex last week

70 60.8
59.8
60

50
41.4
Percentage

40 Married
30 Unmarried
16.4
20 13.2
11.1
10

0
South and East West Africa Latin America and
Africa Caribbean

Source: Bruce and Clark, 2004.

Likely married to an older partner

Country % married by Mean spousal

18yrs age difference
Ethiopia 49.1 8.7

Kenya (1998) 24.6 7.9

Uganda (1995) 54.1 na

Zambia 42.1 6.7

Tanzania 39.3 na

DHS Data; Bruce & Clark, 2004

Older partners, likely infected

50
43.2 Unmarried, Kisumu

38.2 Married, Kisumu

40
31.6 Unmarried, Ndola
30
30 Married, Ndola
22.6
16.8
20
15.8
11.5
10

0
HIV Prevalence HSV-2 Prevalence

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 the radio
 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 monogamous
relations 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
WHAT ROLE DOES THE MEDIA
WANT TO PLAY?
Similarity of the MDG and CPA
1. MDG: Eradicate extreme poverty and hunger
CPA: Aim at achieving poverty eradication

2. MDG: Achieve universal primary education

CPA: Achieve universal access to quality education

3. MDG: Promote gender equality and empower women

CPA: Countries should act to empower women and…
eliminate inequalities between men and women

4. MDG: Eradicate child mortality

CPA: Promote child health and survival
 Similarity of the MDG and CPA
5. MDG: Improve maternal health
CPA: Achieve a rapid and substantial reduction in maternal
mortality ….including deaths and mortality from unsafe
abortion

6. 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