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					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




                                                                 9


             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

    5

    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

				
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