Eldoret. – "Please all of you come get tested and vaccinated for free for HPV. I have seen too many women with stage 4 cervical cancer." This is offered by Dr. Hillary Mabeya, a speaker at the Federation of African Medical Student's Association FAMSA conference on "Working towards MDG 5: The present and future of reproductive health in sub-Saharan Africa".
The conference, which took place from Oct 8th – 10th in the Kenyan city of Eldoret, specifically addressed Millennium Development Goal (MDG) 5 , which is to improve maternal health by 2015 with the targets being the reduction of the maternal mortality by three quarters of maternal mortality ratio and achieving universal access to reproductive health. According to the worldwide MDG report of 2013, the highlight of MDG 5 was that most maternal deaths are preventable, but progress in this area is falling short and the goal will not be reached.
This is particularly unfortunate as most of women´s health concerns are preventable. Due to lack of awareness and lack of resources women in sub-Saharan Africa suffer almost twice as much illness from sexual and reproductive health causes than women in the rest of the world.
"Women should never feel as though they’re putting their health and lives at risk when they become pregnant, but the truth is maternal deaths still claim the lives of 800 women and girls every day." said Rebecca Brown from the Center for Reproductive Rights in the end of September, when the United Nations Human Rights Council unanimously passed its fifth resolution on preventable maternal deaths, urging all UN member states to take action at all levels to address the causes of maternal mortality with a human rights-based approach. However, according to the Centre for Reproductive Rights the resolution failed to acknowledge that such an approach must also ensure women’s sexual and reproductive rights.
The resolution calls for UN member states to address how discrimination against women has contributed to maternal mortality and to implement policies that address preventable maternal deaths and health complications, in accordance with the 2012 human rights guidelines from the Office of the High Commissioner for Human Rights.
Fistula for example is 100 percent preventable. It is not a health issue in the global North. Fistula is caused by obstructed labor and malpractice. Early marriage and teen pregnancies are contributing to the problem. Girls who become pregnant before the age of 15 in low- & middle-income countries are two times more at risk for maternal death and obstetric fistula. Prevention is the key to ending fistula. But only 58 percent of women in developing countries deliver with the assistance of a professional (a midwife or doctor) and only 40 per cent give birth in a hospital or health center. Fistula is not an issue in the global north. Consequently it is not very well researched, there are not enough doctors able to do the procedure and there are not enough resources.
The situation is slightly different in regard to HPV, which causes cancer. While the disease is well researched in the western world and there is even a vaccine, over 85% of the 275,000 deaths by cervical cancer each year, occur in developing countries. Women often lack access to cervical cancer screening and treatment. There is also little awareness about the virus.
The harmful practice of FGM is entirely based on cultural justifications. But culture changes and adapts. Therefore, advocacy and involvement of doctors is vital and stopping this custom said Mabeya.
The recently published report "Struggle for Maternal Health: Barriers to Antenatal Care in South Africa" by Amnesty International on maternal health in South Africa criticizes that a quarter of women dying during or after pregnancy could be saved if the state would provide adequate medical care. Discrimination and stigma in relation to HIV and long distances to hospitals prevent women from reaching out to doctors even though maternal care in South Africa is for free. "It is the governments job to ensure that women´s dignity and privacy are respected and health care is made accessible for women,” claimed Franziska Ulm-Düsterhöft from Amnesty International Germany.
The fact that women in the global South are most disadvantaged in regard to health care proves the overall disregard for their needs. They are discriminated against because they are women and because they are economically underprivileged. They are the last item on the list of priorities of most policy makers and doctors. Gender inequality within families, communities and societies contributes to the divide in equal access to medical care and in public health policies. The fact that value to women´s health is mainly given in regard to motherhood prevents an effective human rights approach to women´s health. The fact that MDG 5 is called "maternal health” instead of e.g. girls and women´s health is a major limitation to actual progress in health care for women and public health interventions.
The three examples of women´s health concerns given in this article show quite well how health problems, which are not directly linked to maternity, are rather neglected. Although they are "only” indirectly linked to reproduction, fistula being a consequence of birth complications, HPV being an STD and FGM potentially causing birth complications, all three conditions cause life-long suffering for women and prevent them from living a life in dignity.
Addressing women´s health issues goes beyond a women´s potential to give birth to a child. It is important to raise awareness, spread correct information and address discrimination and stigmatization of women seeking care regardless of pregnancy. Framing women´s health only in the context of family planning and population politics is a flawed approach. Women´s wellbeing and right to a life in dignity should be the agenda, and not just a potential side effect of development policies.
The Kenyan doctor Mabeya, who runs the Women´s Health Center Gynocare is working exactly on this issue. He fought against FGM in western Kenya, trained to be a fistula doctor and is now set out to tackle NPV. He wishes the success story of the fight against Malaria would be replicated for women´s reproductive health.
Maternal mortality and morbidity
- Amnesty International Report "Struggle for Maternal Health: Barriers to Antenatal Care in South Africa"
- Centre for Reproductive Rights: From Risk to Rights: Realizing States’ Obligations to Prevent and Address Maternal Mortality
- United Nations Secretary-General Report "Supporting Efforts to End Obstetric Fistula”, presented by UNFPA in New York on 13 October 2014
- Hamblin Fistula International
- Campaign to end fistula
- Fistula Foundation
- WHO Female Genital Mutilation Fact Sheet
- Desert Flower Foundation
- Equality Now Initiative against FGM
- WHO HPV Fact Sheet