Nyovani Madise Session III: Health, Mortality and Older Persons

UN Expert Group Meeting for Review of ICPD PoA and Review of the 2030 Agenda 1-2 November, New York Assignment

• Progress since ICPD in selected health areas • Future challenges • Knowledge gaps • Practical recommendations

We make research evidence matter in African-driven development Preamble

• Extreme poverty will be concentrated in the region • Urban poverty: Growth of large cities in Asia, Africa • Population growth mismatched with growth of healthcare and other services

We make research evidence matter in African-driven development Challenge 1: Child Survival Under-five mortality has fallen steadily between 1994- 2014, with reductions of 50% or more except in 200 Oceania

180

160 Latin America and the 140 Caribbean

120 Central Asia and Southern Asia

100 Eastern Asia and South-Eastern Asia -52% 80 Western Asia and Northern Africa 60 U5 deaths per 1000 live births -25% Sub-Saharan Africa 40 Oceania excluding Australia 20 and New Zealand -65% 0 1994 2004 2014 Rate of change for neonatal mortality has been lower in SS Africa and Oceania

• Rate of change 1990s to 2014: Eastern Asia and South-Eastern Asia - 65% Sub-Saharan Africa – 35% Oceania – 14%

We make research evidence matter in African-driven development Strong urban-rural differentials in under- five mortality still persist

140 Under-five mortality by region, 2000-2010 118 120 (Fink & Hill, 2013) 100 97

80 Rural Small urban Large urban 68 69 59 60 51 43 39 40 32 27 27 27 20

0 Latin America Middle East & North South & South-East Sub-Saharan Africa Africa Asia

We make research evidence matter in African-driven development Going forward, we need to pay more attention toGaps the urban poor.

• Interventions to reduce neonatal mortality  Address low-birth weight, Pre-conception and pregnancy nutrition, • Unfinished agenda to increase access to skilled birth attendants

• Urban-urban differentials – urban poor often neglected

We make research evidence matter in African-driven development If we improve healthcare and economic prospects, we can eliminate urban-urban and urban-rural differentials in child survival (Bocquier et al. 2011) Challenge 2: Reproductive Health and Family planning Sexual ad Reproductive Health and Rights Challenges are • Ownership of this agenda in LMIC • Culture, religion opposition • Lack of political commitment  Limited budget for SRHR • Dis-jointed policy landscape

We make research evidence matter in African-driven development Universal access to sexual and reproductive health care and family planning – neds financing, political will, and cultural shifts

Percentage demand satisfied by modern methods of contraception among young women by time period

60 53 44 43 33 34 20 11

Early 1990s 2010-16 Early 1990s 2010-16 Among sexually active unmarried Sub-Saharan Africa South and South-East women (2010-17) Asia 15-19 20-29 Total

66 51 38

South & South- Sub-Saharan Latin America & East Asia Africa Caribbean Africa’s youthful population  demand for SRHR services including family planning will increase. But benefit will outweigh costs.

We make research evidence matter in African-driven development On average, SS Africa’s fertility is still too high for accelerated development

Fertility rates: Africa 4.4; World 2.5.

If fertility declines at a slow pace, Africa will continue to have high ratio of young dependents to working age population Sustained fertility decline to replacement level is the best option for prolonged benefits of the demographic dividends.

We make research evidence matter in African-driven development Challenge 3: Harmful, unethical practices affecting gender equality and SRHR High rates of child marriages in LMIC

Percentage of women married by exact age - 18 years. SS Africa, 2011- 2017 90 80 76.9 70 60 50 40.4 40 30 20 7.8 10 0 Mali Chad Niger Benin Kenya Congo Gabon Liberia Angola Guinea Nigeria Zambia Senegal Burundi Lesotho Rwanda Ethiopia Namibia Tanzania Comoros Cameroon Zimbabwe Sierra Leone Cote d'Ivoire Congo Democratic…

We make research evidence matter in African-driven development Prevalence of child marriages in South and South-East Asia, 2010-2017

80 71 70

60 49 50 42 40 37 32 28 29 30 24 19 19 20 15 10

0

We make research evidence matter in African-driven development Child marriages – Latin America & Caribbean

45

40 38 37 35 34

30 26 25 24 22 20 16 15

10

5

0 Haiti Peru Colombia Guyana Guatemala Honduras Dominican Republic

We make research evidence matter in African-driven development Clear link between early childbearing and high achieved fertility in Africa

8.0

7.0

6.0

5.0

4.0 r=0.69 3.0

Total FertilityTotal Rate 2.0

1.0

0.0 0 50 100 150 200 250 Adolescent birth rate per 1000 women 15-19 years Other harmful cultural practices which should not be tolerated

Cultural practices • Children married off as repayment for loans • Early sexualization, initiation rites • Girls who get pregnant are forced to marry ©Greg Westfall/Flickr • Sexual violence against girls and women

We make research evidence matter in African-driven development HIV prevalence much higher in urban slums than other areas. Example, Kenya (2006-2008).

We make research evidence matter in African-driven development Chalenge 4: Maternal mortality

Maternal mortality ratios (maternal deaths per 100,000 live births), annual rate of change by regions, 1990-2015 1200 987 1000

800 2.4%

600 546

4.3% 391 3.0% 400 320 2.8% 187 200 110 135 67 0 Sub-Saharan Africa Southern Asia Latin America & Oceania Caribbean 1990 2015

We make research evidence matter in African-driven development Challenge 4: Maternal Health

“Achieving the SDG target of a global MMR below 70 will require reducing global MMR by an average of 7.5% each year between 2016 and 2030. This will require more than three times the 2.3% annual rate of reduction observed globally between 1990 and 2015.” Source: Trends in Maternal Mortality: 1990 to 2015 Estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division

We make research evidence matter in African-driven development Concluding remarks

• Political commitment to SRHR and family planning is donor dependent • Progress in SRHR least among adolescents and sexually unmarried • Growth or urban poverty erosion of gains in child survival, SRHR • Harmful practices still persist effects on gender equality and health • Breaking cultural and religious barriers

We make research evidence matter in African-driven development Thank you