The Girl Child and Reproductive, Maternal, Newborn and Child Health

AFRICAN UNION UNION AFRICAINE

UNIÃO AFRICANA

Draft Policy Brief for the International Conference on Maternal, Newborn and Child Health (MNCH) in Africa. Johannesburg, South Africa, 1 – 3 August, 2013

Policy Brief

The Girl Child and Reproductive, Maternal, Newborn and Child Health

Background prematurely than boys. As a woman’s level of education is linked to delayed age of first sex, marriage and childbearing, as well as to focus on the health of the girl child is essential for reproductive, improved health outcomes for her own children, girls’ participation a A maternal, newborn, and child health efforts. Girls under in education has far-reaching, long-term health implications. the age of 15 are five times more likely than older women to die in childbirth. Infants are 60% more likely to die in their first year of life if their mothers are under 18. Among female adolescents, Challenges maternal conditions are responsible for 15% of all deaths. There have been a number of challenges to improving the health In Africa (excluding north Africa), women under the age of 20 of the girl child in Africa: have the least access to skilled birth attendance, highest rates of ƒƒ Youth-friendly reproductive health services often remain in pilot hospitalization due to unsafe abortion, and lowest access to form, or dependent on the participation of non-governmental reproductive and sexual health services. Of the 2.1 million partners. These services have not been consistently scaled up adolescents living with HIV (most of them in Africa), 62 per cent across the public sector. are adolescent girls. Maternal morbidity – including obstetric ƒƒSocial conditions, economic factors, and cultural beliefs fistula – is also higher amongst adolescents due to complications contribute strongly to the persistence of child marriage and from labor and delivery. young girls’ decision to become sexually active. These factors In many instances, child marriage exacerbates these statistics. In also influence the prevalence of coerced sexual relations. Africa (excluding north Africa), studies have shown that, among Changes to attitudes and behaviors are challenging to 15-19 year olds, those who are married are 75% more likely to implement, incentivise, sustain, and measure. have HIV than those who are unmarried. Two-thirds of those ƒƒHuman and financial resource constraints may prevent newly infected with HIV are girls. They are eight times more governments from effectively and consistently enforcing health likely to have HIV than their male counterparts. Only 15 per cent education and marriage policies. are using contraception. ƒƒGirls are often most vulnerable when living in areas with The adolescent girls are also more vulnerable to gender-based ongoing armed conflict, where health and education services violence and sexual exploitation. Globally, the lifetime prevalence do not reach. of intimate partner violence among ever-partnered women for ƒƒGirl child initiatives often require cross-ministerial coordination. girls age 15-19 is 29.4 per cent. In Africa, the proportion of Countries vary as to the degree to which different ministries women reporting intimate partner violence and/or non-partner are able to work efficiently and effectively with one another. sexual violence ranges regionally from 29.7 per cent (Southern) ƒƒGender equality is fundamental to attaining human rights, thus to 65.6 per (Central), the highest in the world. The prevalence of an approach that emphasizes accountability and seeks to sexual abuse before the age of 15 is also high in some areas; a assist participatory policy formulation is critical. The lack of a study in urban Namibia cited a prevalence rate of 21 per cent. human rights-based approach prevents promotion of mutually Health effects include sexually-transmitted infections, induced empowering relationships between boys and girls, both in the abortion, alcohol use, depression and suicide, injuries, and death public and private sphere. from homicide. In spite of efforts to eradicate female genital mutilation (FGM), the practice is still pervasive in many areas. Approximately 3.3 million girls are at risk of FGM each year. Strategies and Best Practices Nutritionally, girls are at risk of anemia and iron deficiency due Countries have initiatied a number of initiatives aimed at improving to menstruation. Girls are also more likely to leave school the health and welfare of the girl child. For example: a. The term ‘the girl child’ in this brief refers to girls between 5-19 years of age and, thus, includes adolescence in its definition.

Acknowledgements: This is an African Union Commission policy brief produced as part of a series in support of the International Conference on Maternal, Newborn & Child Health 2013. The following partners (listed in alphabetical order) have contributed to the development of this policy brief series; Countdown to 2015, Bill & Melinda Gates Foundation, Evidence 4 Action, Family Care International, Global Health Insights, Office of the United Nations High Commissioner for Human Rights, University College London Institute for Global Health, UNFPA, UNICEF, USAID, White Ribbon Alliance, WHO; through the Partnership for Maternal, Newborn & Child Health. Draft Policy Brief for the International Conference on Maternal, Newborn and Child Health (MNCH) in Africa. Johannesburg, South Africa, 1 – 3 August, 2013

ƒƒLegislation has raised the national minimum age of marriage of to provide counseling and services both within and outside of girls to 18 years, so as to protect against the physical and schools. For example, “Bancada Feminina” – discussion forums mental health consequences of child marriage and young for girls, adolescents, and young women – have been launched motherhood (e.g. Burundi, Lesotho, Namibia, Togo). to create opportunities to discuss reproductive health issues, ƒƒCivil registries have been established to better track the age of build self esteem, and link to mentors and positive role models. a woman at marriage and/or the age when she gives birth to a child (e.g. Malawi, South Africa, Togo). Key Opportunities ƒ National child or adolescent health policies and strategic plans ƒ Many countries and organizations have increased efforts to help provide guidance for both the public sector and its improve the health of the girl child: partners as to program development and implementation (e.g. Ghana, Kenya, Uganda, Zambia). ƒƒThe United Nations inaugurated the first International Day of the Girl Child on October 11, 2012. Global and national ƒ There is increased investment in and scale up of adolescent- ƒ advocates now have a focal day on which to highlight girl child friendly reproductive and sexual health services (e.g. Ethiopia, issues such as girls’ education, adolescent sexual and Ghana, Malawi, Mozambique, Namibia, Senegal, Tanzania, reproductive health, and child marriage. South Africa, Zambia, Zimbabwe). ƒƒMany African countries have signed key global and regional ƒ Outreach on girl child issues now targets community change ƒ charters on the rights and welfare of children, as well as on agents – both male and female - to support grassroots attitude women’s and human rights. These charters provide an and behavior change (e.g. Ethiopia, Senegal, Zambia). advocacy platform for policies and initiatives in support of the ƒƒHPV vaccination of 9-13 year old girls to prevent cervical health of the girl child. cancer in adulthood is an important entry point for delivery of ƒƒMany African countries have successfully legislated for an additional interventions. increase in the national age of marriage. A higher age of ƒƒThere is increasing investment in and promotion of girls’ marriage removes legal barriers to initiatives aimed at raising education, through outreach campaigns to parents, elimination of age of first sexual activity and creates a basis for enforcement. school fees, and re-entry policies to allow girls to return to school ƒƒGlobal and regional initiatives aimed at improving civil after delivering a child (e.g. Kenya, Liberia, Malawi, Zambia). registration have opened up policy windows and opportunities ƒƒVocational and literacy support is being provided to girls who for financing for countries wishing to create better systems of have left school early, including married girls and young mothers marriage and birth registration. (e.g. Ghana, Malawi). ƒƒA wide range of resources exist to assist countries in advocacy ƒƒCountries are approaching these issues from a multi-sectoral and planning. For example: perspective, bringing in stakeholders from Ministries of Health, ––Plan International’s Because I’m a Girl campaign provides Youth, Education, and Women (e.g. Mozambique). resources on a number of girl child topics, including school-based gender-based violence, urban and digital Figure 1: The Health of the Girl Child - A Multi-Faceted Approach space, and conflict. ––The Elders’ Girls Not Brides campaign is a global partnership that supports advocacy, legislation, incentivisation, and community mobilization towards the prevention of child marriage. ––National affiliates of the IPPF provide youth-friendly services and help train public sector workers in service delivery. ––Population Council has extensive research on adolescent reproductive and sexual health in Africa, and is a source of epidemiological and social data.

References 1. African Union. 2013. Documenting Good Practices in Maternal, Newborn and Child Case Study: Mozambique Health Interventions. Addis Ababa: AU. http://www.who.int/pmnch/media/events/2013/ camh6 _ mnch _ good _ practices2013.pdf In Mozambique, 41 per cent of girls 15-19 years have either already 2. IPPF. 2011. Girls Decide: Choices on Sex and Pregnancy. London: IPPF. given birth, or are pregnant, while 80 per cent are sexually active. 3. IWHC. 2008. Child Marriage: Girls 14 and Younger at Risk. June 2008. New York: IWHC. The maternal mortality ratio is presently 500 per 100,000 live 4. Nour N. 2006. Health Consequences of Child Marriage in Africa. Emerging Infectious Disease. 12(11):1644-1649. births, of which 8 per cent are girls, adolescents and young women 5. Plan International. 2012. The Status of the Girl Child in Africa. Woking, UK: Plan International. between the ages of 15-24 years. Girls, adolescents and young 6. Plan International. 2012. The State of the World’s Girls’: Learning for Life. Woking, UK: women are four times more likely to be infected with HIV than other Plan International. age/gender categories. Since 1999, the Government of Mozambique 7. PMNCH. 2012. Reaching Child Brides. Knowledge Summary 22. 8. Save the Children. 2012. Every Woman’s Right: How Family Planning Saves Children’s has been partnering with UNFPA and the family planning Lives. London: Save the Children. association, AMODEFA, to integrate adolescents into sexual and 9. UNFPA. 2013. Child Marriage. http://esaro.unfpa.org/public/cache/offonce/lang/en/ reproductive health policy, and create and extend youth-friendly pid/1234 Accessed July 6 2013. 10. WHO. 2013. Adolescent Health Epidemiology. http://www.who.int/maternal _ child _ adolescent health services. Using a cross-sectoral approach, the adolescent/epidemiology/adolescence/en/index.html Accessed July 6 2013. Ministries of Health, Youth and Sports, Women and Social Action, 11. WHO. 2013. Global and Regional Estimates of Violence Against Women. Geneva: WHO. and Education have partnered with technical agencies and NGOs http://apps.who.int/iris/bitstream/10665/85239/1/9789241564625 _ eng.pdf