Ethel Fiattor
2023 marks the twentieth anniversary of adopting the Protocol to the African Charter on Human and Peoples' Rights on Women's Rights in Africa (Maputo Protocol, 2005). This piece reflects on the Protocol's contributions to female reproductive health on the African continent. The Maputo Protocol mandates the right to health, including female reproductive health (Maputo Protocol, Art. 14). Yet the success rate in Africa is near to nothing in line with attaining the United Nations Sustainable Development Goals 2030 (SDGs G 3 T 3.7, 2023).
The process of childbirth is not autonomous to the woman, nor is it absolute or unrestricted. Failure in maternal mortality and morbidity is attributed to inadequate healthcare systems, teenage pregnancy, unsafe abortion, prolonged or obstructed labour, and high blood pressure, among other broader issues (United Nations, 2020). Maternal mortality and morbidity rates increased during the Covid-19 pandemic. Statistics also reveal that the continent is far from positive progress in attaining the SDGs on female reproductive health (United Nations, 2022). Extending the timeline for achieving the SDGs from 2030 to 2050 is crucial for successful implementation. As reported by the UN, twenty-seven countries in Africa would have achieved the target on maternal mortality with an SDGs push by 2050 compared to only nine countries by 2030 (United Nations, 2022). Due to COVID-19, the baseline is twenty-three countries achieving maternal mortality by 2050 (United Nations, 2022). With neonatal mortality, forty-seven countries would reach the target of at least as low as twelve per 1,000 live births under SDGs push to 2050 compared to nineteen countries under the SDGs in 2030. Due to the impact of COVID-19, only forty countries will achieve this target by 2050 (United Nations, 2022).
I do not overlook the efforts by the African Union (Africa CDC, 2023) and the continent to curb female reproductive issues and maternal mortality through various means, including disseminating information. However, the pervasive reception of information on sexual health among state parties is a hindrance (United Nations, 2022). In 2022, it was reported that 71 per cent of laws and regulations in Africa (excluding North Africa, which was 57 per cent) ensure maximum access to sexual and reproductive health care information and education, against the global average of 76 per cent (United Nations, 2022). Botswana has made commendable progress in the fight against sexual reproductive healthcare ( United Nations Botswana, 2022). AIDS-related deaths have declined from 5300 in 2017 to 5100 in 2020 based on disseminating information on protective measures (United Nations, Botswana, 2022). Lesotho has witnessed a rise in women between the ages of 15 to 49 making informed decisions on sexual relations, contraceptive use and reproductive healthcare, thanks to access to information efforts. (United Nations Lesotho, 2022).
While Ghana has made progress in reducing maternal mortality rates, dropping from 875 deaths in 2018 to 776 in 2020 despite challenges such as increased deliveries and a lower institutional maternal mortality ratio due to COVID-19, recent data since 2020 suggests a concerning trend. According to fertility, birth attendants, and GDP data, Ghana's maternal mortality rate has increased by 7.79 per cent from 2019, indicating a renewed urgency to address these issues as a pressing priority for achieving the 2030 SDG goal (Ghana Maternal Mortality Rate 2000-2023). Maternal mortality in Ghana is primarily caused by various factors such as haemorrhage, abortion, miscarriage, sepsis, obstructed labour, ectopic pregnancy, pre-eclampsia, and embolism (Benedict O. Asamoah and others., 2011). Access to safe, accessible medical care can significantly reduce maternal mortality and morbidity, with UNICEF estimating that 80 per cent of maternal deaths can be prevented in Ghana (Global Press Journal). As demonstrated by Sri Lanka and Turkey, the development of healthcare delivery for expectant mothers is crucial (World Bank Gender Action Plan). Proper education and channels for disseminating information can help reduce maternal mortality and morbidity illiteracy among women and girls, particularly in rural areas.
The significant role of women in Ghana and Africa's development cannot be overemphasised. Women are primarily defined as the traditional caregivers in most African societies. Frequent deaths of women during childbirth often lead to the loss of family care providers, resulting in improper child upbringing. Empowering women in education, employment, and financial services enhances economic development by providing access to suitable healthcare, improving dependents' lives, and promoting diversity for growth. Evidence shows that women's increased control over household resources, either through earnings or cash transfers, can boost countries' growth prospects by promoting children's spending on food and education, as shown in Brazil, China, India, South Africa, and the UK (World Bank Gender Action Plan).
After 20 years of the Maputo Protocol, statistics reveal the inadequacies in maternal mortality and female reproductive healthcare in line with the SDGs. The AU must integrate healthcare on the continent to provide profitable medical insurance schemes. Advocacy through regional and national conferences and rural education to disseminate information must spread widely (United Nations Populations Fund, 2010). Building capacity and mechanisms to monitor progress through partnerships with state parties and non-state parties must be redefined to implement article 14 of the Maputo Protocol effectively. A means of monitoring by deploying equipped healthcare personnel to deprived areas is central to achieving quality female reproductive healthcare (United Nations Populations Fund, 2010).
Women's political participation is crucial due to ill-representation and discrimination, particularly in African countries. Women's involvement in political decision-making is necessary as it aims to overcome ethnic and political divisions, promote socio-economic rights, and address reproductive health rights. State parties must adopt political involvement to legalise the consent of females to marriage and childbirth. Governments must address high fertility, use of contraceptives, pregnancy outcomes, train and equip health workers, establish special funds towards maternal mortality and involve private foundations through tax incentives (United Nations Populations Fund, 2010). AU members should maintain the flow of reproductive health commodities, especially to rural and deprived areas, consult localities, build female participatory processes, and advocate for equal universal health coverage and medical insurance for all citizens (United Nations Populations Fund, 2010). Governments must integrate sexual and reproductive health into poverty reduction policies and provide unique healthcare and incentives such as free antenatal care for pregnant women (United Nations Populations Fund, 2010).
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