Sexual Reproductive Health and Rights- Magnitude of the Challenges

This post comes at a time when the world is fighting a virus that has continually rippled through the world. Covid-19 emerged in November 2019 in Wuhan -China to become a defining global health crisis and the most immense challenge of 2020. More infections and deaths have come a daily normal; nothing has ever caused the world so much fear and apprehension regardless of the efforts to stay afloat. Just like the 1918 Spanish Influenza that infected over 500 million people resulting to 50 million deaths, the ruins and scars of Covid-19 will still hold the future in doom and gloom, experts warn. The new normalcy of social distancing holds the potential of devastating economic, social-cultural fall. Covid-19 has non-discriminatively taken away our life’s spices#StayHome#SocialDistance#Sanitize#MaskUp#WashYourHands may shield us from Covid-19. However, many families suffer from lack of basics while others became over night millionares. The prediction of when we can grab a loaf of bread and milk for breakfast from the nearest estate shop, or have have a break from try and error teachers to our little ones or care less if its day or night…just being us feels afar feels miles away. Speculations had it Jack Ma or Billionare Ratan encouraged the world over Covid-19 that ‘2020 is the year to survive, not make profits’. Anyway, moving to out topic, the impact of Covid-19 on sexual and reproductive health and rights cannot be underestimated.

Sexual and Reproductive Health and Rights-Integral and Sensitive Yet Controversial

On one hand, sexual and reproductive health is integral and sensitive, on the other, it is the most controversial of all international human rights issues. All the participating countries at the International Conference on Population and Development recognized sexual reproductive health as a fundamental right to people, couples, family as well as social and economic development for communities of all nations. Thus, the Conference focus shifted from family planning programmes placing women at the core of an approach that integrated reproduction, health, human rights and socioeconomic empowerment. 

Although the Millennium Development Goals don’t explicitly refer to sexual reproductive health, at least three of the eight Goals -3. Promote gender equality and empower women, 4.Reduce child mortality and 5. Improve maternal health relate to sexual and reproductive health. Concurrently, other international human rights instruments among them Convention on the Elimination of All Forms of Discrimination against Women, (CEDAW) and Universal Declaration of Human Rights, International Covenant on Economic, Social and Cultural Rights informs of the main principles behind shaping human rights, particularly, equality, non-discrimination, autonomy, integrity, dignity and individual well-being.

The Millennium Development Goals was successful and uneven because of inequalities. China is the most successful country in achieving Goal 1, followed by India for substantial progress in Goal 2, 4 and 8 the eighth Secretary-General of the United Nations.

Understanding the Magnitude- Feeling the Pinch

Women’s health has unique implications, but why and how? One, some of women’s health needs are specific and relate to their sexual and reproduction function. Two, women’s elaborative reproductive system is vulnerable to disease, prior to function or in the aftermath. Three, women suffer the same diseases of other body parts that can affect their sexual health. It’s worth noting the complexity at this point as disease patterns differ because of hormonal environment, lifestyle behavior and genetic composition, not to forget diseases of other body systems and their treatment poses risks to their reproductive systems or function. Fourth, women are social, subjecting them to social diseases that affect their social, mental and physical states. The impact of these is an incomplete state of physical, psychological and social well-being in all matters relating to the reproductive system. The magnitude is a clear link between women’s rights, struggle to health conceptions and social justice that eventually and negatively affect equity, participation, access and rights.

Maintaining sexual reproductive health for vulnerable women and girls as a human right feels like a sway, causing … in their physical, psychological and social well-being .

Latest reports by various organisations, health facilities, governments and other stakeholders paint a picture of a world that should stretch further to secure sexual and reproductive health and rights.With the prevalence of modern contraceptives, still 1.1 billion of the 1.9 billion women of reproductive age (15-49 years) worldwide cannot access family planning (World Health Organization). The magnitude of this affects other aspects of a women’s life such as education, economic participation, social relations, gender equality, maternal health and sexually transmitted diseases. Further, the disparity in contraceptive accessibility between the developed and developing countries is wide notwithstanding the general global improvement in more family planning services and socioeconomic status.

This inequality, which remain as an intractable obstacle has deprived poor women the right to protect themselves not only from unintended pregnancies but also other most threatening and unwanted situations. Inequality is also depictable in socioeconomic classes-mortality and morbidity rates are higher in Africa and Asia. Children born in the two continents as from 2015 have a 25 % possibility of celebrating their fifth birthday compared to those born in the 1960 (Department of Economic and Social Affairs of the United Nations).  Core to this improvement is a shift from predominantly infectious causes of death because of chronic and degenerative diseases. Public education and health have driven this transition in socioeconomic development and recognized as the most significant achievements. The Millennium Development Goal 4 committed to reduce child mortality by two-thirds between 1990 -2015. Recently, target 3.2 of the Sustainable Development Goals aims to reduce mortality deaths under five to than 25 deaths in 1000 births by 2030.  Although the improvement substantial these differences in mortality rate between and within countries require policies to redress inequalities in the living standards of children.

Maternal mortality is the death of woman while pregnant or within 42days after a pregnancy termination, irrespective of duration or site of pregnancy, from any cause related or aggravated by the pregnancy or it management but not from accidental or incidental causes ( World Health Organization). Maternal mortality is highly preventable. Unfortunately, each year women die of high blood pressure during pregnancy, haermorrage, postpartum depression and unsafe abortion. For instance, in 2017,810 women died of pregnancy related complications every day. Most of these deaths (94%) occurred in low socioeconomically disadvantaged regions.  Fragile States Index confirmed Democratic Republic of Congo, South Sudan, Central African Republic, Zimbabwe, Guinea, Somalia and Ethiopia as a “very high alert” with highest maternal mortality rates. Maternal mortality rate is also highest for adolescent girls under 15 years. Girls of age 10-19 years are more predisposed to unintended pregnancies and childbirth complications compared to 20-24 years (World Health Organization).

Neonatal and maternal care have remained low in marginalised regions across Africa. In Kenya, the ratio is approximately 342 per 100,000 deaths live births.

Women and girls pay a heavier price for humanitarian crisis, and so the explosion of Covid-19 has not spared them. For instance, in Kenya all learning institutions were shut down as a containment measure. The lock down took effect mid-March and by June, 152,000 school girls have gotten pregnant, with 40% increase each month. The worst hit is Machakos County with 4,000 pregnant girls (Government Managed Health Information Systems). A number of factors have contributed to this prevalence- restricted movements have made it accessing sexual and reproductive health services and information difficult, strain on healthcare systems that has deprioritized women and girl’s needs, the closure of schools has cut off girls from teachers leaving them in the hands of their unchaperoned parents risking the pleasures of peer pressure, poverty whereby girls engage in transactional sex, forced marriages, access to internet and social media- some communities still hold to the social norm and cultural practices that marriage, motherhood and childbearing are proof of femininity, existing challenges such as unfriendly youth reproductive health services, lack of sex education at home and school and while some parents trade their girls in exchange of material gains. The consequences of the current cases not forgetting the numbers are projected to increase. This is a glare to eroding the gains of the past years especially in education, health, economy and opportunities. Further, it is a manifestation of gender -based violence and gender disparies in Kenya.

“The pumpkin gives birth, the fence gets trouble.”~African Proverb

Aluta Continua…Keep up with more in the next post.