Dr Munyaradzi Murwira
Women and girls in developing countries face multiple challenges in accessing affordable, quality and comprehensive sexual reproductive health and rights (SRH&R) services. This article explores three key issues that affect women and girls sexual reproductive health outcomes, morbidity and mortality. The “Treble Tragedy” in women’s health, particularly in the developing world are – Unmet Need for Family Planning – Unwanted Pregnancy – Unsafe Abortion.
The Primary Health Care (PHC) concept coupled with the Universal Health Coverage (UHC) approach are opportunities to ensure universal access to SRH&R services for women and girls. UHC means that all individuals and communities receive the full spectrum of essential and quality health services including an explicit commitment to provide sexual and reproductive health services to all. International commitment to address the “Treble Tragedy” is supported by the WHO/UNFPA call to action for attaining UHC through integrated SRH&R and HIV/AIDS interventions. The UHC agenda provides an important opportunity for equitable health coverage, which meets the needs of the rights of all, and in particular, the marginalized and vulnerable populations.
Efforts to address the “Treble Tragedy” in Zimbabwe are articulated by the SRH&R goals within the National Health Strategy 2021-2025. These goals are to; Increase the Modern Contraceptive Prevalence Rate from 67% in 2015 to 80% by 2025; Reduce the Adolescent Birth Rate from 108 per 1,000 women in 2019 to 93 per 1,000 by 2025; Reduce Maternal Mortality Ratio from 462 in 2019 to 240 per 100 000 live births by 2025; and Achieve Universal Access to Reproductive Health by 2025.
Unmet Need for Family Planning
Unmet need for family planning (FP) is the proportion of women who would want to use contraception but are not able to do so due to various reasons. Improving access to SRH&R including FP will greatly reduce the unmet need for FP. Focus for FP programmes should be young people and marginalized communities. The current national FP strategy 2022-2026 aims to; Reduce unintended pregnancies among women of reproductive age (reduce unmet need of FP from 10% to 7% by 2026. In Zimbabwe 10% of currently married women have an unmet need for family planning. Unmet need is higher in the rural (11%) than in urban (9%). Unmet need in higher in women with low socio-economic status and is significantly higher in sexually active unmarried young women (40% in unmarried sexually active 15-19 year and 17% in unmarried sexually active 20-24 years respectively). There is also disparity in unmet need based on geographic location, with unmet need being highest in southern provinces (Matabeleland South 16%, Masvingo 15% and Matabeland North 13%).
Unwanted & Unintended Pregnancies
In Zimbabwe, upto 40% of pregnancies are unintended or unplanned; and 1 in 4 of those unintended pregnancies end in abortion. A hospital based study in Harare by Mbizvo et al showed that 41% of pregnancies were unplanned and that younger women below 19 years and older women over 35 years were more likely to have unplanned pregnancy. Some factors associated with unplanned pregnancies included, unemployment, being single, divorced/separated/widowed, and women with low income. Having unwanted pregnancy is linked to social and psychological effects and sexual gender based violence among women and girls. Improving access to FP and reducing the unmet need will go a long way in averting unwanted and unintended pregnancies in Zimbabwe.
In Zimbabwe almost 25 percent of unintended pregnancies end in abortion. It is estimated that more than 65,000 induced abortions occur in Zimbabwe annually. Due to restrictive abortion policies and limited knowledge, most of these abortions were clandestine and potentially unsafe, and mostly performed outside the formal health system. As a result, too many women are still dying from unsafe abortion, with the survivors faced with stigma and discrimination. Through the Population Reference Bureau project on – “Breaking the Silence: Expanding Access to Safe Abortion in Zimbabwe” there have been efforts to use media to describe the problem of unsafe abortion, its health and financial costs, challenges posed by the law, and steps that decision makers can take to remedy the situation in Zimbabwe.
Integration of Sexual Reproductive Health and Rights (SRH&R), Maternal & Child Health (MCH) and HIV/AIDS programmes offers a platform to enhance universal access to sexual reproductive health services for women and girls in Zimbabwe. Focused FP programming is required to reduce unmet need in margianlised and vulnerable communities. Risk factors for unwanted pregnancy form a pattern similar to those for maternal mortality, thus, unwanted pregnancy is a major indicator of the presence of factors known to increase the risk of maternal death. Health policies should address factors contributing to unwanted pregnancy, its prevention and mitigation in order to prevent reproductive morbidity and mortality due to unsafe abortions. The Ministry of Health & Child Care should consistently review relevant policy guidelines in line with current best practices for better access to comprehensive SRH&R services including safe abortion care.
Dr M Murwira is a Public Health Expert with special interest in Sexual Reproductive Health, and Population & Development.