Accelerating Africa’s promise in SRHR

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wenty-five years ago, 179 countries met in Cairo, Egypt for the International Conference on Population and Development (ICPD).

A major change from previous population and development conferences was the move away from a primary focus on demographic targets to the broader relationship between population and development, emphasising that “increasing social, economic and political equality, including a comprehensive definition of sexual and reproductive health and rights… remains the basis for individual well-being, lower population growth, sustained economic growth and sustainable development”.

ICPD signalled the global commitment to sexual and reproductive health and rights (SRHR). ICPD also called for an end to gender-based violence and harmful traditional practices, including female genital mutilation. Regionally, African countries have made further commitments to the ICPD agenda through the Maputo Plan of Action (2007-2030) and the Addis Ababa Declaration on Population and Development in 2013. Sustainable Development Goals (SDGs) reinforce the commitments to ICPD.

Since its launch, there has been tremendous progress on the broader agenda of the ICPD Plan of Action. Countries have developed and implemented policies on SRHR, enabling millions to access SRHR services. According to Unicef estimates, under-five mortality in Africa declined by 52 percent over a 20-year period between 1994 and 2014, while data from national demographic and health surveys (DHS) suggest that the transition to lower fertility is underway, with the average number of births that African women have now around 4.4, down from around 6 in the 1990s.

Notwithstanding these achievements, the progress on SRHR in Africa has been very uneven. In particular, trends in the desired number of children and actual achieved fertility are very uneven across the continent and between socio-economic sub-groups. In Malawi, child marriages remain an issue though progress is being made. Child marriages provide some explanations for the persistently high fertility in Africa such as low female education, household poverty, and culture. There needs to be renewed focus on the quality of care and solutions to women’s fear of side effects, in order to prevent pre-mature discontinuation of modern contraceptives in Malawi and sub-Saharan Africa at large.

Another area which needs renewed focus is adolescent sexual and reproductive health and rights (ASRHR). Twenty-five years after Cairo, we are still having controversial debates on Comprehensive Sexuality Education (CSE) for the youth and vulnerable groups such as adolescent mothers and the need to develop interventions tailored to their needs.

Why are African countries still struggling with implementing commitments to SRHR? Across the continent, SRHR has been an uncomfortable topic in the policymaking spheres as leaders grapple with making good on commitments that they have made at a global level, against the reality of strong opposition at home from religious and traditional leaders. Furthermore, most African governments do not assign sufficient funds for SRHR, leaving development partners to fund most of the budgets. SRHR policies reflect the tensions surrounding this topic: policy documents often give mixed messages, use contradictory language, and can be very ambiguous. There is also limited use of evidence on what works or doesn’t work to aid decision-making in this space. As a result, some SRHR interventions are implemented without strong underpinning evidence; furthermore, scaling-up is done without knowing how the added component will affect the health system’s effectiveness overall. 

There is a renewed need for researchers, decision-makers, and practitioners to refocus the role of evidence in addressing SRHR in Africa.  We must not wait another 25 years to finish the ICPD agenda. We urge African decision-makers, researchers, and development partners to act now on the evidence to ensure that the continent achieves the ICPD goals of zero unmet need for family planning; zero preventable maternal deaths; and zero gender-based violence and harmful practices against women, girls and youth.

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