Why Africa must face facts on its reproductive health

Dr Angela Akol, a director at Ipas Africa Alliance

Dr Angela Akol, a director at Ipas Africa Alliance, during the interview at her office in Milimani, Nairobi, on Thursday.

Photo credit: Sila Kiplagat | Nation Media Group

Sex education, contraceptives and abortion have been a‘taboo’ topics in African communities for a long time until a push from health experts such as Dr Angela Akol, who insist that there is a need to bridge the knowledge gap surrounding the false narratives that have taken precedence over facts and statistics in sexual and reproductive health rights.

With over 20 years of experience directing health programmes in Africa, she explains why Africa’s health ecosystem still has a long way to go in prioritising sexual and reproductive health rights, especially for women and girls.

She is currently the Director of Ipas Africa Alliance, an international organisation that works to build sustainable abortion ecosystems.

What is the legality of abortion in Kenya?

Abortion is legal in certain circumstances. It is quite unfortunate that many women are forced to resort to crude and unsafe methods, which can lead to death.

Yet, it can be a safe minor surgical procedure or swallowing a couple of tablets to terminate the pregnancy. The pills are available in most hospitals.

The question of their illegality does not arise. What is important is increasing knowledge among the populace on how to seek information on how to get them safely.

Why is abortion still considered a taboo topic in African communities?

We are burdened by the legacy of norms, penal codes, laws and religious beliefs that came with the colonialists. There are provisions that we still recognise that even in their home countries are no longer prioritised.

That is our biggest challenge. Self-determination is what we failed to do. Culturally and traditionally, termination of pregnancy happens but we are very ready to override our traditional practices with imported beliefs.

We try to counter it through social norms programming and the creation of narratives around African women having bodily autonomy which means who can make decisions regarding a woman’s life including her reproductive life..

As a woman, have you felt that at one point somebody else had a say in what happens to your body?

I can say I am not a typical African woman. I recognise my privilege having grown up in an urban centre, having a very good education and being brought up by a single woman who was a very strong matriarch.

As a health practitioner, I have seen it so many times especially when women have to make decisions but must first consult. By the time they get consensus, it is too late to do what is right.

What are your thoughts about adolescents being given access to contraceptives?

I do not understand the controversy. From a medical standpoint, contraceptives are safe. An adolescent can use any of them safely.

From a social standpoint, we are a region that has a high teenage pregnancy rate. I think anyone who says they shouldn’t have access to them is saying it is okay for a teenager to have a child.

The global movement for gender equality, sexual and reproductive health rights and sexual minority rights is increasingly under attack from religious leaders, governments, politicians and online. What does this mean for African women and girls?

The impact is being seen as young girls get pregnant because of false information they believe. There are cases where girls conceived and they said that they were told that they could not conceive when they have sex for the first time.

It is a direct consequence of a restriction on comprehensive sexuality education. The norm that we say we should teach abstinence has failed. We have been at it for 10 years so let us look for alternatives.

Dr Angela Akol, a director at Ipas Africa Alliance

Dr Angela Akol, a director at Ipas Africa Alliance.

Photo credit: Sila Kiplagat | Nation Media Group

How has the democratic backsliding in the US following Roe Vs Wade affected the push for abortion rights in Africa?

18 months since the US Supreme Court overturned Roe Vs Wade, the impact is not as severe as I thought it would be.

When the ruling was made, we predicted there would be lots of confusion about our policy spaces given that the US government is the biggest funder of health services in this region.

There has been some confusion among health service providers about the legality of services which was also fueled by anti-rights groups who put out a narrative that even the US, has made abortion illegal.

In Africa, we use the Maputo protocol as an entry point for advancing women's rights.

You have extensive experience in the continent’s health ecosystem, what gives you hope to keep working? What worries you the most?

We continue because of the mission. Africa is a continent that unfortunately has the highest number of women who die from preventable causes.

That is what keeps me going. I am also a feminist at heart. What worries me is that the health ecosystem has several challenges. We do not include safe abortion care or contraception in the sexual and reproductive health discussions.

If Africa were a person, how would you describe its health - based on the state of its health facilities, and women’s and girls’ access to services?

I would say they are two-faced or have multiple personalities. Africa is not homogenous. Parts of Africa such as West Africa are significantly behind the rest of the continent.

Many of our health systems do not reach all the segments of the population they are meant to reach.

Africa is a youthful continent, with some referring to it as a democratic dividend. However, the latest statistics show this demographic group is leading in new HIV infections. As a public health expert, how should the continent handle this dividend?

Most of these new infections are among young girls. Data shows that the ratio between males and females recorded with new infections stands at 4:1. It is a female epidemic.

To address this, we must tease out the underlying statistics. It is young girls in rural areas who are not in school due to financial constraints. We also cannot ignore the issue of teenage sexuality. It is a reality.

What does the Ipas programme evidence tell us about SRHR in Africa? What are some of your biggest milestones?

There has been encouraging progress. In the last 20 years, a number of African countries have liberalised their abortion laws or made it legal.

Sometimes, it is not even up to the governments. As long as you put safe products in the markets, women vote with their feet.

What we need to do better is help women make more informed choices about their own sexual and reproductive health.