Family planning improves child survival and reduces maternal deaths. But the uptake of family planning in Africa is only 33%, nearly half the world average of 64%. The contraceptive prevalence rate in African countries is considerably low despite an increase in demand.
Niger has one of the highest fertility rates globally. Women of reproductive age have, on average, eight children. Niger has a maternal mortality ratio of 553 per 100,000 live births and an under-five mortality rate of 104 per 1000 live births. Mauritius has the lowest child mortality rate in Africa at 12 per 1,000 live births.
In Niger, 13% of children under five years die from various illnesses. The country is one of the top five that account for half of these deaths in the world.
The low provision of family planning across sub-Saharan Africa is cited as one of the main reasons for the region’s high maternal mortality rates. A lack of family planning leads to unintended pregnancies and often means that women deliver their babies with very low skilled assistance. This, in turn, pushes up the rate of newborn deaths.
Access to family planning services, particularly in developing countries, should be improved.
But Trump wants to go even further than his GOP predecessors by slashing spending on global health efforts funded through the United States Agency for International Development (USAID). Deeper family planning retrenchment would, however, put millions of lives at risk.
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.