The Elephant in the Room: Cultural and Social Barriers Preventing Girls’ and Women’s Agency
Panellists Janet Mbugua, Dr Alaa Murabit,  Adriana Rubio, Goodness Ogeyi Odey and Mary-Ann Etiebet.

Millions of African girls are married before they turn 18, while others suffer female genital mutilation (FGM) and a multitude of preventable conditions, the closing plenary of the Africa Health Agenda International Conference (AHAIC) heard on Wednesday.

The plenary promised “bold and honest conversations” about the “backsliding on sexual and reproductive health and rights (SRHR)” on the continent, including scrutinising “social, economic, and cultural barriers driving the suppression of health rights”.

However, many of the panellists tiptoed around the prevailing religious and cultural conservatism despite an early appeal from the MC, Janet Mbugua, to address “the elephant in the room” – how to prevent the backsliding and ensure women and girls have “agency and power”.

Janet Mbugua

Mbugua runs the Inua Dada Foundation, a girls’ empowerment organisation, and spoke about a 16-year-old girl her foundation had assisted who “had never heard about sex or consent, but somehow ended up engaging in unsafe sex and becoming a teen mom”. 

“While there’s been so much progress, there’s equally been so much pushback. In fact, the more agency we have, the more it seems that our voices are silenced. We need to start having really tough conversations, really honest ones, and we need to push back against the pushback,” said Mbugua.

“Ultimately, if we don’t do that, we’re going to find ourselves here every so often asking ourselves: ‘Why are the rates of pregnancy on the rise? Why are we having adolescent girls compromised? Why the numbers are of HIV and AIDS on the rise?” said Mbugua.

Goodness Ogeyi Odey

Goodness Ogeyi Odey, Associate Editor at Wiley Journal, said that many young people did not understand consent, which was why “comprehensive sexuality education” was so important.

In Cross River State in Nigeria, where Odey comes from, many men assumed they could touch women in the market without consent, she said.

“That’s appalling. So we need to understand that, with sexual reproductive health and rights, consent is critical and young people have to understand and respect each other,” said Odey. 

“Many married couples say you can’t rape your wife because they don’t understand choice. They don’t understand consent. They don’t understand respect. They don’t understand bodily autonomy,” she said.

Odey added that many African countries had restrictive abortion laws yet they did not enable women and girls to get access to contraception or choices.

‘Bodily autonomy’

Natalia Kanem, UNFPA Executive Director

UNFPA Executive Director Natalia Kanem assured the plenary that her agency was “protecting sexual and reproductive health and rights in both development and humanitarian settings”. 

“We are helping young people to exercise their right to bodily autonomy, their body rights. We are helping young people to gain access to comprehensive sexuality education, so important to counter ignorance,” she added.

However, the obstacles are huge.

“Across Africa right now, 125 million women and girls alive today were married before their 18th birthday. Harmful practices like child marriage and certainly female genital mutilation violate the rights of the girl child,” she warned.

UNFPA is “countering harmful cultural norms and supporting the good norms, those that helped to end gender-based violence norms that call out harmful practices. This has to include promoting positive masculinities”, said Kanem.

Access to contraception

Mary-Ann Etiebet, head of MSD for Mothers

Mary-Ann Etiebet, head of MSD for Mothers, said that if women and girls had access to family planning, this could reduce the global maternal health burden by at least 30%.

“We need to ensure that every girl and woman has a fair and equal just chance to live life to their fullest capability and realise all of the opportunities in front of them,” said Etiebet, adding that this would never happen unless there was gender equity.

Dr Alaa Murabit, Director of Health at the Bill and Melinda Gates Foundation, agreed that access to contraception was the single most important SRHR intervention, and appealed for more money to be invested in SRH. 

“Women’s ability to control when and if they want to have children sets them on a completely different trajectory,” said Murabit.

Dr Alaa Murabit, Director of Health at the Bill and Melinda Gates Foundation

“We can’t talk about women’s health from menstruation to contraception to pregnancy to the entire lifecycle of a women’s health, without having tools that actually meet women where they are in communities where they are,” said Murabit.

“We’re talking about incredibly exciting things we have that can transform realities for women. We’re talking about contraception that women can take once every six months to ensure they have protection across the board. We’re talking about portable ultrasound that ensure that women who are pregnant have immediate reassurance and security,” she added.

“We’re talking about things we already have,” she said, remarking that not enough energy was being invested in these products _ or in urging policymakers to pass policies that ensure they can reach primary health care services.

“Let’s really rally around what we do have, let’s look at the resources we do have and talk about how we’re spending them and how we can spend them better.”

Adriana Rubio, General Manager of Roche Diagnostics, added that there were many innovations such as HPV tests, and other “homecare point-of-care testing” options and digital care to improve women’s lives.

“How do we remove regulatory barriers and make public policy embracing the value that innovation is bringing to allow us to realise the dream of universal healthcare?” Rubio asked.

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