The continued poor sexual and reproductive health SRH outcomes in sub-Saharan Africa highlight the difficulties in reforming policies and laws, and implementing effective programmes.
This paper uses one international and two national case studies to reflect on the challenges, dilemmas and strategies used in operationalising sexual and reproductive health and rights SRHR in different African contexts. The second national case study examines the experiences with introducing the Sexual Offences Act in Kenya, and it is developed from organisational publications on the processes of enacting the Act and a review of media reports on the debates and passing of the Act.
Analysis of successes points to the strategies for tackling these challenges, which include forming and working through strategic coalitions, employing strategic framing of SRHR issues to counter opposition and gain support, collaborating with government, and employing strategic opportunism. The strategies identified show future pathways through which challenges to the realisation of SRHR in Africa can be tackled. More than 15 years after the radical shift in policy from a focus on population control to a focus on individual needs and rights initiated at the International Conference on Population and Development ICPDsexual and reproductive health and rights SRHR indicators remain poor in sub-Saharan Africa SSA.
Although some progress has been made in SSA in terms of developing reproductive health policies and
Sexual and reproductive health rights in africa laws to provide a framework for the implementation of SRHR programmes, SRHR still remain non-priority issues on the development agenda of many SSA countries due to limited political leadership and commitment to the realization of SRHR, and inadequate resource allocation [ 2 - 4 ].
Further, the lack of a universally recognised definition of SRHR at the international level [ 6 ] is another challenge for implementing national policies and programmes to realise these rights. As used in this paper, SRH refers to everything encompassed in both sexual health and reproductive health, as defined by the ICPD SRHR, on the other hand, is based on international human rights law and is about the right to SRH information, services and autonomy. However, SRH-related human rights are spread throughout various international Human Rights frameworks and are interpreted in a range of ways by different stakeholders.
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The lack of a universally recognised definition of SRHR at the international level [ 6 ] presents a challenge because SRHR covers a range of rights of varying levels of controversy, which can lead to confusion. SRHR, as used in this paper, is understood as the right for all, whether young or old, women, men or transgender, straight, gay, lesbian or bisexual, HIV positive or negative, to make choices regarding their own sexuality and reproduction, providing these respect the rights of others to bodily integrity [ 6 ].
This definition also includes the right to access information and services needed to support these choices and optimise health [ 6 ]. The controversies arise from "Sexual and reproductive health rights in africa" contradiction with certain cultural, religious and individual beliefs, norms and values.
Thus, efforts to change SRHR policy often receive strong opposition from certain political, religious and community leaders. As the contentiousness of certain SRHR issues persists compounded by the confusion between SRH and SRHR, these conditions continue to cause human rights violations, illness and even deaths, in addition to affecting other development indicators [ 2 ].
Using one international and two national case studies, this review paper reflects on the constraints, dilemmas and strategies used for getting controversial SRHR onto the policy agenda and influencing decision-making in different African contexts. The
Sexual and reproductive health rights in africa pool learning from these three case studies to highlight the strategies that different stakeholders can use to work their way around the opposition to contested and complex SRHR issues in different policy arenas.
The purpose of this paper is not just to share experiences and lessons, but also to contribute to the debate on challenges and opportunities for bringing controversial SRHR issues onto the agendas of government in SSA and influencing decision-making on these issues.
Literature on policy processes has shown that policy change is not simply a technocratic process based on rational analysis, but a profoundly political process that is complex, messy and power-laden [ 8 ].
Some studies have revealed the important role government policy actors can play in bringing about policy change [ 10 ], while others have emphasized the role of policy coalitions in policy change [ 11 ]. Still, others have argued for
Sexual and reproductive health rights in africa important role of ideas, framing, and use of policy narratives in bringing about policy change [ 1213 ].
The discussion of the case studies will explore their linkages with the international literature on agenda setting and policy change. This paper adopts a case study approach combined with a review of literature.
The case study approach is used because not much is known about the ways that different stakeholders negotiate the challenges and dilemmas in operationalising SRHR in SSA,
Sexual and reproductive health rights in africa the case study approach has been noted as being particularly appropriate for researching an area where few studies have been carried out [ 14 ].
The interviews in the two countries were purposively conducted to include stakeholders operating at different levels and with different interests and spheres of influence in relation to the operationalisation of the plan. Participants were identified at a regional level e. African Unionsub-regionally e.
This case is developed from a review of scientific papers and organisational publications that detail the processes involved in influencing the Act, and a qualitative interview with one of the experts involved in influencing the Act. The authors draw on their experiences and reflections to complement the data from other sources since all five authors have been involved either in conducting the studies reviewed in developing the case studies or have been extensively involved in SRHR research and influencing SRHR policy processes in African countries.
Why were these three cases selected? The international case study was selected because it examines the legal and policy environment as well as programme implementation for SRHR across SSA. The Ghana and Kenya cases feed into the international case study by providing examples of the legal and policy constraints and the legislating processes that bring about change on key SRHR issues.
It calls on African Union AU member states to enact policies, advocate for SRHR, build the capacity of health care providers and expand access to reproductive health services in partnership with civil society organisations, the private sector and development partners [ 15 ]. The Plan covers the period Inan evaluation of the implementation of the Maputo Plan of Action conducted by the African Population and Health Research Centre [ 4 ] found that although most countries have formulated SRH policies, they have not necessarily translated these into the provision of services.
Further, it found that the language of rights in SRH is still controversial in African countries and continues to undermine SRHR policy and programmes. In addition to these findings, the case study examines the experiences of actors in Botswana and Nigeria drawn from the larger qualitative data set gathered by the evaluation study combined with media reports on contentious SRHR issues in SSA.
These experiences are summarised here below. African countries have put in place reproductive health policies and even though some level of the human rights language has been incorporated into the policy documents, implementation remains problematic [ 4 ].
Stakeholders in Botswana and Nigeria felt that the rights approach to SRH was not supported by their governments. In-depth interview respondent, Botswana CSO. As a representative of a foundation in Nigeria noted, one of its main challenges was:.
In-depth interview respondent, donor foundation, Nigeria. These issues are aptly captured by a respondent from
Sexual and reproductive health rights in africa Botswana CSO, who observed that the country did not have:. Service providers are not allowed to supply commodities to prisoners and homosexuals are not recognized by the government. In most of sub-Saharan Africa, homosexuality is prohibited by law and is a punishable crime. Recent media reports on homosexuality around Africa have revealed both government and public opposition to the recognition of, and provision of services to, people in same sex relationships.
Media coverage revealed that members of the public in Kenya prevented a would-be first gay wedding from occurring when they stormed the house where the gay couple lived and forced the couple out moments before the wedding [ 16 ].
Sexual and reproductive health rights in africa Malawi, a gay couple was jailed for holding a wedding and only pardoned following an uproar from the international human rights community [ 18 ].
Uganda is in the process of legislating against pornography in the mass media, and sections of the proposed law seek to outlaw homosexuality [ 19 ]. The CSO respondent observed that:.
Similarly, a respondent from the Botswana National Youth Council noted that earlier programmes initiated by its members on adolescent SRHR were opposed by parents.
Respondents from an international development agency in Botswana noted that although Botswana had a policy on education and access to SRH for young people, the health system was still unfriendly and inaccessible as young people often felt judged when they sought SRH services.
Abortion remains illegal in most African countries and efforts to repeal the law in order to reverse this situation attract strong opposition and controversy. This is despite the fact that out of everyunsafe abortions in SSA result in death [ 20 ]. The opposition to the provision of abortion is grounded in cultural, religious and individual values. Even in countries where abortion laws are
Sexual and reproductive health rights in africa restrictive, access to abortion Sexual and reproductive health rights in africa is still a challenge because of the negative attitudes of healthcare providers.
These examples depict some of the difficulties in operationalising SRHR in many African countries, and the issue of rights is clearly still to be embraced by many governments. A donor representative in Nigeria summed it up as follows:. In-depth interview respondent, donor Foundation, Nigeria. To address the controversy, a National Coalition on Domestic Violence Legislation was formed by individuals and human rights organisations which organized from and carried out a nationwide consultation to win support for passage of the bill [ 22 ].
Parliamentary debates on the bill dragged on for years with several revisions of the bill.
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The study found that many sexual violence cases could not be prosecuted as victims did not receive the required medical examination due to the prohibitive costs of doing so. The study also established that some health facilities refused to treat survivors who had not been referred to them by the police. Those that were treated did not receive post-exposure prophylaxis from health facilities and were unable to access the few post-traumatic stress services available.
The findings of the study were disseminated widely through the mass media and through meetings with key stakeholders. This coincided with the debates in parliament on the Domestic Violence Bill inproviding an
Sexual and reproductive health rights in africa opportunity to influence parliamentarians with the INDEPTH findings and inform the bill so that it could adequately address the issues raised by the research.
Their dissemination approaches were informed by the understanding that parliamentarians were not easy to access and were also politically driven. They identified relevant parliamentarians those belonging to the Parliamentary Health, Constitutional and Legal,
Sexual and reproductive health rights in africa Gender Committees and also those that were sympathetic to SRH issues.
They worked with parliamentary clerks to identify and organise meetings with parliamentarians.
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They made short and focused presentations on the issues and what parliamentarians needed to do to address them. The presentations were made by credible and well-known researchers and legal advocates, who also availed themselves for follow-up.
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Following this dissemination, parliamentarians amended the bill to include a provision that mandates healthcare providers to provide free medical treatment to survivors of sexual abuse and domestic violence, pending a complaint to the police and the issuance of a report. The passing of the bill into an Act in has provided for sexual violence survivors in Ghana to receive free medical treatment whether or not they have reported a sexual violence case to the police.
Although the INDEPTH Network was not involved in the controversy that dogged the bill sinceit played a role in ensuring that the law waived the costs associated with obtaining medical services for survivors of domestic violence. This case study examines the experiences with introducing the Sexual Offences Act in Kenya.
InKenya enacted the Sexual Offences Act to provide a legal framework for
Sexual and reproductive health rights in africa with sexual offences and gender-based violence.
The Population Council Kenya office published a study that documented the processes that led to the enactment of the Act [ 24 ]. A draft bill to legislate against sexual violence was first developed by civil society groups and submitted to the Attorney General AGwho was expected to take ownership of the bill and present it in parliament for discussion.
He also provided legal draftspersons to advise the taskforce. The process of enacting the law witnessed polarised debates in parliament, with many male parliamentarians opposing the bill because they believed it contradicted norms and practices that are central aspects of Kenyan culture.
They noted that most traditionalist parliamentarians represented communities where discrimination against women was culturally entrenched and acceptable, and, as such, these parliamentarians argued that the legislation did not align with their culture.
For instance, the offence of unlawful advances was opposed and removed from the bill because the parliamentarians argued that such advances were merely components of sexuality and everyday courtship in the Kenyan society.
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Marital rape was also opposed and removed from the bill because male parliamentarians argued that there was no such thing as marital rape in African society as both men and women provide consent when making their wedding vows to allow all future sex within the marriage.
A male parliamentarian argued that:. Many people believe …this is not an African issue. Marriage creates sexual license to each party… that is the license they get by saying I do. The parliament debates resulted in several revisions of the bill and when it was
Sexual and reproductive health rights in africa passed in parliament, the bill had changed drastically. Given the enormous opposition to the law, a number of strategies were used to mobilize support from parliamentarians and members of the public, including organising meetings and workshops with opposing groups, media visibility of sexual violence incidents and framing of debates, public demonstrations by civil society, lobbying and advocacy, nationwide campaigns to educate the public on the bill, and forming and working through coalitions [ 24 ].
Statistics on the increase of rape cases and stories of rape survivors were used as part of these strategies to make the case for the law. The campaign was carried out by the parliamentarian who led the legislative process in parliament and the civil society organisations involved in the bill.
The actors employed different framings of sexual offences to gain support. For instance, they shifted the focus from sexual offences in general to sexual offences against minors and grandmothers.
Among the strategies employed to gain support, public demonstrations were noted to have had negative repercussions by increasing opposition to the bill [ 26 ]. Key lessons learned from the legislative process included: Drawing on the case studies, this section discusses the constraints, dilemmas, and
Sexual and reproductive health rights in africa used by different groups to try to operationalise SRHR in SSA.
Prohibitive laws in most African countries greatly hinder the operationalisation of SRH and rights. LLM/MPhil in Sexual & Reproductive Rights in Africa (SRRA)
Sexual and reproductive health rights in africa equip the learner with research skills in sexual and reproductive health and rights; to equip the. but how far are they relevant to the policy debate in eastern and southern Africa?
The gulf between legal human rights and the reality in a. Increasing Access to Sexual and Reproductive Health and Rights for Young Persons with Disabilities in East and Southern Africa.
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