Throughout my visits to clinics in Africa I have seen the work of Marie Stopes International in South Africa, Tanzania, Ethiopia as well as Zambia. They provide a full range of quality reproductive health services for women. I have always been impressed by the comprehensive care they provide. Now, their work will be hampered because of an imposed policy of the new administration.
Yesterday morning President Trump signed an executive order to reinstate the Global Gag Rule, or Mexico City Policy, that prevents international NGOs that accept USAID (taxpayer) money from advocating for the legalization of abortions, provide abortions, mention the word, or even refer women to health practionioners that provide safe, legal abortions.
The Global Gag Rule was instated during the Reagan admininstration in 1984 and since then there has been a virtual seesaw effect between Republican and Democratic administrations regarding whether the Rule is reinstated or revoked. According to the WHO, 78,000 women die every year from unsafe abortions. Under Obama’s eight year administration, that number was reportedly decreased by more than half. Now, that President Trump has signed this executive order reinstating the Global Gag Rule, the fear among the global health community is that that number will rapidly skyrocket again.
Every year just over 500,000 women die from complications in pregnancy and childbirth across the world. Another 20 million experience severe complications. But many of these complications are entirely avoidable – including obstructed and protracted labour and one of its side-effects, obstetric fistula.
An obstetric fistula is a hole in the birth canal between the vagina and the rectum or between the vagina and the bladder that is largely caused by obstructed and prolonged labour. This can occur when the mother’s pelvis is too small or the baby is too large.
In sub-Saharan Africa for every 100,000 deliveries there are about 124 women who suffer an obstetric fistula in a rural area. Obstetric fistulas predominantly happen when women do not have access to quality emergency obstetric-care services. Antenatal care could help to identify potential problems early but will not have an impact if there is no skilled surgeon to assist with the labour.
South Africa has extremely high maternal mortality levels. This is true when compared with developed countries as well as other developing countries.
According to the World Health Organisation, for every 100,000 live births in the country in 2015, 138 women died due to pregnancy and childbirth complications. In Sweden, fewer than five women die for every 100,000 live births. In Brazil, the estimate is 44 women for every 100,000 live births.
People the world over come here every day looking for family planning information. Knowing that, I have decided to create a compendium post of sorts about everything I have learned and seen about family planning in my travels to and reporting from sub-Saharan Africa over the past few years.
I first learned about the critical importance of family planning when I covered the London Family Planning Summit a few years ago. Melinda Gates, along with key partners, called on governments and civil society to lay out a strategic plan to provide family planning services and contraceptives to 120 million underserved women in low-and middle-income countries. Currently there are 222 million women around the world who would like to space or delay their pregnancies.
Read the current Family Planning 2020 Progress Report with full commitments since the 2012 Summit. Undoubtedly there is a long way to go to reach the unmet need for modern contraceptives, but the initial commitments have been promising. $1.3 billion USD in funding for family planning was delivered in 2013 enabling 8.4 more women and girls to have access to modern contraceptives.
At the London Summit, I will remember the commitments read by country representatives. Dr. Tedros Adhanom Ghebreyeseus, former Minister of Health of Ethiopia, stood out. He said, “Inaction is no longer an option. It’s not what we promise today, but what we do when we get back home.”
Below are photos of family planning services and programs as well as modern contraceptives from Addis Ababa, Lusaka, Johannesburg and Dar es Salaam.