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In Sub-Saharan Africa, extreme poverty, lack of access to birth control, and restrictive abortion laws cause many women to resort to clandestine abortion providers to avoid unintended pregnancy, resulting in about 3% obtaining unsafe abortions each year. South Africa, Botswana, and Zimbabwe have successful family planning programs, but other central and southern African countries continue to encounter extreme difficulties in achieving higher contraceptive prevalence and lower fertility for a wide variety of compounding reasons. However, contraceptive use among women in Sub-Saharan Africa has risen from about 5% in 1991 to about 30% in 2006.

Finances

Providing the current level of contraceptive care in the developing world costs $4 billion yearly and saves $5.6 billion in maternal and newborn health service costs. The effects of fulfilling the current unmet need for modern contraceptive methods would create a huge impact. To fully cover all need for modern contraceptive methods would cost $8.1 billion per year.

Prevalence

Notes: Estimates are based on the most current data available between 1998 and 2007. These percentages refer to women who are married or in a union.Northern Africa: Algeria, Egypt, Libya, Morocco, Sudan, TunisiaWestern Africa: Benin, Burkina Faso, Cape Verde, Côte d'Ivoire, Gambia, Ghana, Guinea, Guinea-Bissau, Liberia, Mali, Mauritania, Niger, Nigeria, Senegal, Sierra Leone, Togo.Eastern Africa: Burundi, Comoros, Djibouti, Eritrea, Ethiopia, Kenya, Madagascar, Malawi, Mauritius, Mozambique, Rwanda, Somalia, Tanzania, Uganda, Zambia, Zimbabwe.Middle Africa: Angola, Cameroon, Central African Republic, Chad, Congo, Democratic Republic of Congo, Gabon, Sao Tome and PrincipeSouthern Africa: Botswana, Lesotho, Namibia, South Africa, Swaziland

An inequity in Africa exists when people are unfairly deprived of something they want or require to protect them from an unwanted or undesirable condition. In Africa, one in 26 women of reproductive age dies from a maternal cause due to lack of protection. The maternal mortality rate, which measures the death rate of women due to pregnancy and childbirth, is higher in Africa than on any other continent. In the year 2000 alone, there were approximately 830 deaths per 100,000 live births for the continent as a whole and an average of 920 for sub-Saharan Africa. Socioeconomic class constitutes an inequity in relation to mortality and morbidity. This economic gap between the rich and poor in the use of contraception has remained the same even though there has been general global improvements in socioeconomic status and the expansion of family planning services.The poor do not have the same access to life-saving and health-maintaining interventions as the rich, yet according to Martha Nussbaum everyone deserves the same access and opportunities.

The contraceptive use indicator called “unmet need” for contraception still remains high in Africa. This inequity is fueled by both a growing population, and a shortage of family planning services. In Africa, 53% of women of reproductive age have an unmet need for modern contraception. This phenomenon occurs because of limited access to contraception, cultural and religious opposition, poor quality of available services, gender based barriers, and spousal disapproval. In Eastern Africa specifically, the increase in unmet need is associated with socioeconomic variables, the family planning program environment and reproductive behavior models. In the 1980s and even into the 1990s, contraception and family planning were still associated with fears of eugenic ideology and population control which narrowed the scope of behavior-change communication and distribution of contraceptive devices. However in current years a new approach of promoting spousal discussion of contraception has been proposed as an effective policy strategy for narrowing the gender gap in partners' fertility intentions in developing countries. Discussion between spouses is expected to increase contraceptive use, because a sizable minority of women cite their husband's disapproval of contraception as the reason for nonuse, despite having never discussed family planning with their husband.

Methods

Birth control

In most African countries,a limited choice of contraceptive methods are offered making it difficult for couples to choose the method that best suits their reproductive needs. In fact, international program effort scores for 1994 showed that large proportions of people in most developing countries did not have ready access to a variety of contraceptive methods.Many African countries had low access scores on almost every method. In the 1999 ratings for 88 countries, only 65% of countries offered the pill to at least half their population, 54% offered the IUD, 42% offered female sterilization, 26% offered male sterilization and 73% offered the condom. Condom availability increased more sharply in Africa and Asia than any other developing country. This is important because low levels of condom use are cause for concern, particularly in the context of generalized epidemics found in Sub-Saharan Africa. The share of method mix for injectables rose from 2% to 8%, and climbed from 8% to 26% in Sub-Saharan Africa, while the share for condoms was 5–7%. The most uncommon method of contraception is women's reliance on male sterilization for contraception. This method's share of use remains below 3%. 6–20% of women in Sub-Saharan Africa used the injectable covertly, a practice that was more common in areas where contraceptive prevalence was low, particularly rural areas.

Effects

Tracking the change in contraception use of African women from 2008-1012

With the implementation of contraceptives and family planning, unintended pregnancies would decline by two-thirds, from 80 million to 26 million. There would be 26 million fewer abortions, including 16 million fewer unsafe procedures with the addition of 21 million fewer unplanned births. Seven million fewer miscarriages would occur, and a dramatic decrease of 1.1 million in infant deaths. Ensuring access to preferred contraceptive methods for women and couples is key to securing the well-being and autonomy of women, while supporting the health and development of communities. Family planning allows people to attain their desired number of children and determine the spacing of pregnancies. It is achieved through use of contraceptive methods and the treatment of infertility. Contraception is key to slowing unsustainable population growth and the resulting negative impacts on the economy, environment, and national and regional development efforts. The prevalence of contraceptive use has risen markedly over the decades. The latest United Nations review, using surveys that cover 85% of the developing world's population, shows that "almost all of the less developed countries with trend data experienced an increase in the level of contraceptive use". By region, the United Nations estimate is highest in northern Africa (42%) and Sub-Saharan Africa (14%). Increasing modern contraceptive method use requires community-wide, multifaceted interventions with the addition of education, life skills, and access to support. Interventions should aim to encourage positive perceptions of modern contraceptive methods and the dual role of condoms for contraception and STI prevention. Understanding the changes in contraceptive method mix is imperative to helping policymakers, and donor agencies meet the demand and estimate future needs in developing countries.

Society and Culture

Public Policy

The United Nations created the "Every Woman Every Child initiative" to asses the progress toward meeting women's contraceptive needs and modern family planning services. These initiatives have set their goals in terms of expected increases in the number of users of modern methods because this is a direct indicator that typically increases in response to interventions. In previous years, London began the London Summit on Family Planning in an effort to make modern contraceptive services accessible to an added 120 million women in the world's poorest 69 countries by the year 2020. A goal of this initiative is to reduce the number of women who have an "unmet need" for modern methods. The Summit wants to eradicate discrimination or coercion against girls who seek contraceptives.

Another initiative is the Millennium Development Goals which was established in 2000 by 193 United Nations member states and 23 international organizations. There are eight goals aimed at reducing inequality. Of the 8 goals, the fifth is improving maternal health. The maternal mortality ratio in developing regions is still 15 times higher than in the developed regions. The maternal health initiative calls for countries to reduce their maternal mortality rate by three quarters by 2015. Eritrea is one of the four African countries said to be on track to achieve Millennium Development Goals. This means attaining a rate of less than 350 deaths per 100,000 births.

Cultural Attitudes

In the traditional Northern Ghana society, payment of bridewealth in cows and sheep signifies the wife's obligation to bear children.This deeply ingrained expectation about a woman’s duty to reproduce creates apprehension in men that their wife or wives may be unfaithful if they used contraception. The possibility that women may act independently is regarded as a threat to the strong patriarchal tradition. Physical abuse and repraisals from the extended family pose substantial threats to women. Violence against women was considered justified by 51% of female and 43% of male respondents if the wife used a contraceptive method without the husband's knowledge. Women feared that their husband's disapproval of family planning could lead to withholding of affection or sex or even the dreaded divorce.

In the cities of Nairobi and Bungoma in Kenya, major barriers to contraceptive use included lack of agreement on contraceptive use and on reproductive intentions.There were also gaps in knowledge on contraceptive methods, fears from rumors, misconceptions about specific methods, perceived undesirable effects and availability and poor quality of services in the areas studied. About 33% of wives in Nairobi and 50% in Bungoma desired no more children however husbands desired about four or more children than wives wanted. Lack of couple agreement and communication were primary reasons for nonuse. Comparative to Ghana, the husband or man has the role of a decision maker.The husband has a greater desire for more children preferably sons because it predicts a level of economic security for him once he gets older.

In other Sub-Saharan African cultures, spousal discussion of sexual matters is discouraged. Friends of family and in-laws are used between partners in order for them to exchange ideas and issues pertaining to this matter. Couples in these cultures may use other forms of communication, such as specific music, wearing specific waist beads, acting a certain way and preparing of favorite meals, to convey unambiguous sex-related messages to each other. In the case of contraception, a man's use of a contraceptive may itself be a nonverbal indicator of approval. Therefore, discussion may improve knowledge of family planning attitudes only when it is more efficient than, or augments the effectiveness of, other forms of communication.

References

Category:Health in Africa Category:Birth control by country Category:Sub-Saharan Africa Category:Sexuality in Africa Category:Women's rights in Africa