Huge leap, but Kenyan women have to wait longer to fully enjoy rights
Tomorrow marks the first day of the International Conference on Population and Development, held 25 years after the first ever such event that put women and girls at the centre of global and national development. Clifford Akumu highlights strides Kenya has made since then
The journey to safeguard the health and rights of women and girls and to promote their empowerment has been a precarious one, full of hits and misses.
That journey traces its way back, 25 years ago, at the International Conference on Population and Development meeting in Cairo, where 179 governments adopted what they termed as “ Visionary Programme of Actions.”
The document, contained a raft of measures, aimed at boosting the gender agenda. As ambitious as it came, it set out to change the world for women and girls.
Kenya was among the countries at the conference and subscribed to the ideals indicated on the day, but how far has it gone into implementing them?
Ending unmet need for family planning
Health experts agree family planning empowers women and girls to become educated and employed. It is also essential for reducing poverty and lowering the incidences of pregnancy related deaths.
With that at the back of their mind, the leaders recognised in 1994 the need to rally countries to “seek to provide universal access to a full range of safe and reliable family-planning methods.”
The United Nations Population Division (UNDP) estimates that 222 million women worldwide would like to prevent pregnancies, but are not using contraceptives. That is why, every year, 15 million girls give birth, 50 per cent of them in Africa.
Maricianah Onono, a research scientist at Kenya Medical Research Institute (KEMRI) highlights the important gains made on this promise.
In Kenya, notes the researcher, prevalence of modern contraceptives among married women is at 61 per cent in 2018, exceeding its 2020 target of 58 per cent and at 43.2 per cent among all women, according to data from the Ministry of Health, a great progress since 1994.
It is that progress that has led to the number being revised by the government to 66 per cent by 2030.
Indeed, access to voluntary family planning has grown since 1994. Available data indicate that in the least developed countries, modern contraceptive prevalence has more than doubled among women who are in a relationship and want from 15 per cent to 37 per cent.
She explains, “Contraceptives have been made accessible to women in most health facilities. In public hospitals they are offered at postnatal clinics for breastfeeding mothers, family planning and youth friendly clinics.”
However, reliable access to such services is still a far cry, she notes. In the country, women who want to avoid pregnancy are not using safe or effective family planning methods.
She points out lack of education about contraceptives in schools, some healthcare providers discouraging younger women from using long term contraceptives and shortage of contraceptives, as the major drawbacks in achieving the score card.
Prof Ruth Nduati, a paediatrician at the University of Nairobi thinks winning the war will need plugging the country’s fragmented healthcare system and investing heavily on adolescent health through trainings among others.
Reducing maternal deaths
The 1994 summit called for a reduction in maternal mortality by one half of the 1990 levels by the year 2000 and a further one half by 2015. However, between 1990 and 2015 for example, global maternal mortality fell by roughly 40 per cent, a significant decline.
Globally, the maternal mortality ratio (the number of deaths per 100,000 live births), now stands at 211, compared with 342 in 2000 according to World Health Organisation. It is still a far cry from the UN SDGs goal of no more than 70 deaths per 100,000 live births by 2030.
Good news is, about nine countries achieved this target of reducing maternal deaths by at least 75 per cent as per the commitment.
Professor John Alwar, a health expert, explains that majority of maternal deaths are preventable with proper antenatal care, skilled delivery at birth, post-partum care, and access to emergency obstetric care if complications arise.
Alwar notes that quality care is key, but adds that, “Not too many are able to access such.”
“The ever increasing rural urban migration and affordability of private health services coupled with expansion of National Health Insurance programmes like ‘Linda Mama’ has increased access to quality care” said Alwar.
He adds that a lot needs to be done especially on maternal mortality intervention funding and absorbing of qualified health workers to increase quality care. “As a country we are running far behind our GDP level in maternal mortality. This is primarily because health care in our rural communities has not brought emergency interventions for complications of pregnancy close enough to significant proportions of population.”
Alwar continues, “The persistent agitation to accept lay workers, yet many qualified health workers continue to be unemployed seriously undermines the possibility of increasing quality of maternal care. In maternal care use of lay community workers is pure tokenism, every mother should reach a facility with safe surgical delivery and blood transfusion within an hour of the onset of the complication.”
During a recent health stock take meeting in Nairobi, key stakeholders responsible for the health and wellbeing of children, adolescents and women made commitments to change the current worrying trends in maternal mortality by 2021.
They resolved to reduce the facility maternal deaths from 3,000 annually to 1,500 by 2021, reduce still births from 11,000 annually to less than 5,000 and improve skilled birth attendance from 65 per cent to 80 per cent by the same year.
Eliminating violence against women and girls
In 1994, leaders called for countries to “take full measures to eliminate all forms of exploitation, abuse, harassment and violence against women, adolescents and children”.
However, available data offers a stark reminder of how, globally, violence against women and girls remains an epidemic. A woman has one in three chance of experiencing physical or sexual violence in her lifetime, while an estimated 18 per cent of women have experienced physical, sexual or psychological violence at the hands of a partner in the past year alone.
Due to stigma and fear, survivors of violence often fail to report abuse, a situation that hampers the authenticity of data.
In Kenya, a recent study by UNAIDs titled ‘Shining Light On Gender-Based Violence In Kenya, found that 32 per cent of young women aged 18-24 years and 18 per cent of their male counterparts reported experiencing sexual violence before the age of 18.
Gender-based violence reduces the bargaining power to negotiate safer sex, stay on treatment or remain in school.
“Security-wise and legally, the country has seriously retrogressed. The cruel news of murder and maiming of girls and women and, especially in some cases that the perpetrators escape punishment attests to this,” noted Prof Alwar.
Ending harmful practices against women and girls
Twenty-five years ago, leaders called for urgent action to end child marriage and female genital mutilation (FGM).
Today, the rates of both harmful practices have fallen significantly, thanks to global efforts to raise awareness on the consequences of the practices on girls’ lives, bodies and future.
In 1994, about one in four girls were child brides. In 2019, the number is an estimated one in five. Whereas in countries with a high prevalence of FGM, the number has fallen from 49 per cent in 1994 to 31 per cent today. Kenya’s prevalence rate stands at 21 per cent, according to 2014 Kenya Demographic Health Survey.
Although the practice was banned in Kenya in 2011, it still continues, reportedly driven by older women. However, remarkable campaigns have seen significant reduction in the culturally related harmful practices against women and girls.
“Many women’s and girls’ rights have received lip-service on political platforms, but as we all know in the legislature not much has moved, thanks to a male dominated parliament that is not just insensitive, but also insincere to the rights of women,” says Alwar.
But the numbers could be swelling, albeit, from communities that have resorted to “secret harmful practices”.
Dr Natalia Kanem Under-Secretary-General and Executive Director of the United Nations Population Fund (UNFPA) notes achieving zero FGM is a reality. “It is time to guarantee the rights of women and girls. This is a fight that we must continue to wage and win,” she said at the Commonwealth Ministers meeting in Nairobi recently.
Advancing gender diversity
The Programme of Action urged governments to “accelerate women’s equal participation and equitable representation at all levels of the political process and public life”. Twenty-five years later, it is one of the actions that has registered tremendous strides.
At the global level, women and girls are heading countries, parastatals, ministries and corporate bodies. The world has embraced remarkable women leaders such as Ellen Johnson Sirleaf of Liberia, Michelle Bachelet of Chile, Dr Natalia Kanem of UNFPA and Dr Segenet Kelemu of Icipe.
What is not lost is that men still hold a majority of leadership positions, especially in the political arena. But still there are success stories for women in leadership. Today, less than a quarter of parliamentarians around the globe are women.
In Kenya too, the strides are being felt, but it is not enough. In 2017, after a long struggle, the number of women in the National Assembly rose to 76, members of county assembly stood at 96, with governors at three. However, the two-thirds gender rule still hangs over Kenya parliament thanks to a lack of political will.