Journalist to Journalist Seminar: Reporting on Reproductive Health in East Africa Ayo Ajayi Population Council

 Some numbers ---demographic and RH  Maternal Mortality  Abortion  Contraception  STI  HIV  Harmful Traditional Practices  MDGs and CPA Outline

Some Numbers – mid 2005 Source: PRD 2005 World Population Data Sheet SSA E K T U  Population Size (millions)  Births per 1000 Population  Deaths per 1000 Population  Annual Rate of Natural Increase  Total Fertility Rate  Population Doubling Time (yrs) 29  Contraceptive Prevalence Rate  Infant deaths per 1000 births  % Urban  % with HIV/AIDS  % living below $2 per day

 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  Least change in sub-Saharan Africa – less than 25% Maternal Mortality

Births in 2000 and Births Attended by Skilled Personnel, Births and Assisted Deliveries Worldwide Source: UNICEF End of Decade Databases—Delivery Care (

Lifetime Risks to Mothers Risk of Dying of Maternal Causes or of Losing a Newborn * Percent chance 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 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

Gap in Funding for Contraceptives and Condoms for AIDS Prevention Contraceptive Shortfall, Developing Countries US$811 Million US$154 Million US$739 Million US$1.8 Billion US$332 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*

Respondents With Symptoms Who Sought Treatment, by Sex Percent Awareness of STIs 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 * Total does not equal 100 percent due to rounding. Source: UNAIDS, Report on the Global HIV/AIDS Epidemic, July Composition of the Infected Population, 2001

Female Genital Cutting, by Age Prevalence Among Younger and Older Women Percent Source: Special tabulations of Demographic and Health Survey data for by Principia International, Inc., and published data from ORC Macro.

Early Marriage Source: DHS data,

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

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 Higher HIV prevalence among Married Adolescent Girls

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 Country% married by 18yrs Mean spousal age difference Ethiopia Kenya (1998) Uganda (1995)54.1n a Zambia Tanzania39.3n a 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 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 year- old age group  In some countries as many as 20% of girls aged 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