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Addressing the Challenge of Women's Health In Addressing the Challenge of Women’s Health in Africa Report of the Commission on Women’s Health in the African Region l l REGIONAL OFFICE FOR Africa Addressing the Challenge of Women’s Health in Africa Report of the Commission on Women’s Health in the African Region World Health REGIONAL OFFICE FOR Africa For centuries African women have been the mainstay of families and communities, often in the face of extreme adversity. Despite the level of their social status and their large share of the burden of disease and death, they continue to be peacemakers, life-givers, entrepreneurs and providers of care for children – the builders of Africa’s future. Addressing the Challenge of Women’s Health in Africa Report of the Commission on Women’s Health in the African Region World Health REGIONAL OFFICE FOR Africa AFRO Library Cataloguing-in-Publication Data Addressing the Challenge of Women’s Health in Africa Report of the Commission on Women’s Health in the African Region 1. Women’s Health 2. Women’s Health Services 3. Delivery of Health Care 4. Social Conditions 5. Social and Economic Development I. World Health Organization, Regional Office for Africa. ISBN: 978 929 023 1943 (NLM Classification: WA 309) © WHO Regional Office for Africa, 2012 Publications of the World Health Organization enjoy copyright protection in accordance with the provisions of Protocol 2 of the Universal Copyright Convention. All rights reserved. Copies of this publication may be obtained from the Library, WHO Regional Office for Africa, P.O. Box 6, Brazzaville, Republic of Congo (Tel: +47 241 39100; Fax: +47 241 39507; E-mail: [email protected]). Requests for permission to reproduce or translate this publication – whether for sale or for non-commercial distribution – should be sent to the same address. The designations employed and the presentation of the material in this publication do not imply the expression of any opinion whatsoever on the part of the World Health Organization concerning the legal status of any country, territory, city or area or of its authorities, or concerning the delimitation of its frontiers or boundaries. Dotted lines on maps represent approximate border lines for which there may not yet be full agreement. The mention of specific companies or of certain manufacturers’ products does not imply that they are endorsed or recommended by the World Health Organization in preference to others of a similar nature that are not mentioned. Errors and omissions excepted, the names of proprietary products are distinguished by initial capital letters. All reasonable precautions have been taken by the World Health Organization to verify the information contained in this publication. However, the published material is being distributed without warranty of any kind, either express or implied. The responsibility for the interpretation and use of the material lies with the reader. In no event shall the World Health Organization or its Regional Office for Africa be liable for damages arising from its use. Printed in the UK Contents Acknowledgements vi Members of the Commission vii The President’s Foreword ix The Regional Director’s Foreword xi Acronyms, Abbreviations and Definitions xiii Executive Summary xv Introduction 1 Chapter 1: Rethinking women’s health 3 Chapter 2: The health status of women in the African Region: from birth to the onset of sexual activity 12 Chapter 3: The health status of women in the African Region: the reproductive years 20 Chapter 4: The health status of women in the African Region: beyond the reproductive years 39 Chapter 5: The socioeconomic benefits of investing in women’s health 46 Chapter 6: Interventions to improve women’s health 60 Chapter 7: Conclusions and recommendations 79 Appendix: The methodology used to prepare this report 87 Appendix: Photography 90 v Acknowledgements The World Health Organization, Regional Office for Africa, wishes to express special thanks to H.E. Mrs. Ellen Johnson Sirleaf, the President of the Republic of Liberia, for her leadership in the work of the Commission. The World Health Organization also gratefully acknowledges the valuable contributions made by members of the Commission on Women’s Health in the WHO African Region. Internal reviewers of the report Dr. P. Olukoya, Dr. T. Nyagiro, Dr. S. Aboubaker, Dr. S. Abdool, Dr. E. Johansen, Dr. H. Bathija, Dr. H. Diallo, Dr. Chandra Mouli and Dr. E. Mason. External reviewers Dr. T. Chitepo, Prof. C.O. Airhihenbuwa, Dr. R. Loewenson, Prof. L.G. Olson and Prof. J.M. Kasonde. Members of WHO African Regional Working Group on Women’s Health Dr. T. Ketsela, Dr. A. Kosia, Dr. J. Kirigia, Dr. E. Asamoah-Odei, Dr. Patience Mensah, Dr. N. Bakyaita, Dr. D. Munodawafa, Dr. T. Nkurunziza, Dr. K. Mbaye and Dr. P. Mongi. WHO African Regional Office Staff who contributed at different stages of the development process of the report: Dr. I. Diop Touré, Dr. T. John, Dr. C. Ferreira-Borges, Dr. S. Da Gama-Nkomo, Dr. Phanuel Habimana, Dr. Kasonde Mwinga, Dr. Charles Sagoe-Moses, Mr. T. Ennison, Mrs. A. Amoi-Séminet, Mr. R. Fontes and Mr. M. Onana. The Writer of the Report: Mr. Gary Humphreys. Publication Consultants: The Global Library of Women’s Medicine and Mr. David Bloomer. The country level data and pictures could not have been obtained without the invaluable input of the WHO Country Representatives. vi Addressing the Challenge of Women’s Health in Africa Members of the Commission on Women’s Health in the African Region Honorary President H.E. Mrs. Ellen Johnson Sirleaf President of the Republic of Liberia Prof. Robert J.I. Leke – Cameroon Madam Marie-Elise Gbedo – Benin Consultant in Obstetrics and Gynaecology Magistrate, and President, Association of Women Lawyers of Benin Prof. Germano Mwabu – Kenya University of Nairobi Ms. Afoussatou Diarra – Mali Dr. Sylvia Deganus – Ghana Supreme Court Judge Ghana Health Service Prof. Christopher B-Lynch – UK Prof. Cheikh Ibrahima Niang – Senegal Milton Keynes Foundation Trust Hospital Institute of Environmental Sciences Cheikh Anta Diop University Prof. Stephen Munjanja – Zimbabwe Department of Obstetrics and Gynecology, Prof. Kodjo Evlo – Togo University of Zimbabawe University of Lome Prof. Pius Okong – Uganda Dr. Pascoal Mocumbi – Mozambique Nsamtya Hospital, Martyrs University Good Will Ambassador of Maternal Health for WHO Regional Office for Africa Dr. Soory Anthony Nnko – Tanzania Honorable Mr. Theo-Ben Gurirab – Namibia National Institute for Medical Research President of the Inter-Parliamentary Union (IPU) Dr. Ana Maria Van-Dúnem – Angola Adv. Bience Gawanas – African Union Faculty of Medicine, University Agostinho Neto Commissioner for Social Affairs Report of the Commission on Women’s Health in the African Region vii viii Addressing the Challenge of Women’s Health in Africa The President’s Foreword In my capacity as the Honorary President, I had the singular pleasing duty and honour of launching the Women’s Health Commission on April 14th 2010 in Monrovia, Liberia. In the context of Africa, paramount among the major roles and responsibilities of women is usually the lead role played by them in the development of health and welfare for their families, leading to the overall health and socioeconomic development of nations as well as families. Women face many challenges including a heavy burden of ill health which results in high morbidity and mortality rates among them; they are also subjected to many societal injustices and harmful sociocultural practices which further impact on their health and development. H.E. Mrs. Ellen Johnson Sirleaf The launching ceremony provided an opportunity for Africa and the rest of the world to reflect on the health of women, a reminder that the health of women in the Region is deplorable because every minute a woman dies in labour or suffers lifetime complications from pregnancy and delivery. I am hereby calling on all governments to reinforce their commitments and dedication to accelerating the reduction of maternal and newborn mortality as a fundamental right to life and development. We must also remember to actively involve women in all decisions related to their health and well-being. I have the utmost pleasure to introduce to everyone this Report of the Women’s Health Commission in the African Region, Addressing the Challenge of Women’s Health in Africa. The Report highlights the dire situation African women face throughout their lifetimes and gives recommendations for advancing the health of women in the Region. It would be most inappropriate were I to conclude without leaving you with these words: “a nation thrives when mothers survive; we must strive to keep them alive”. Though the task ahead may appear daunting, I encourage Africa to ensure that “No Woman Dies While Giving Life”. Let us all work assiduously together to reduce ill health, improve lifestyles and reduce deaths in the African Region. H.E. Mrs. Ellen Johnson Sirleaf President of the Republic of Liberia Report of the Commission on Women’s Health in the African Region ix x Addressing the Challenge of Women’s Health in Africa The Regional Director’s Foreword I am pleased to share with you this Report which draws on a wide range of facts to demonstrate that the role of women in society goes far beyond childbearing and which also makes the fundamental point that women have – first and foremost – a right to good health. The Report goes on to argue that Africa needs to invest more in women’s health, and, in particular, to give women the opportunity to unleash their potential for their own fulfilment and for the prosperity of their families and nations. The Report was produced by a multidisciplinary Commission on Women’s Health in the African Region established in Dr. Luis G. Sambo 2009 in response to a resolution adopted by the WHO Regional Committee for Africa at its 58th Session in Yaoundé, Cameroon, 1–5 September 2008.
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