We must do so much more to support Africa’s most vulnerable women, children and adolescents, write Helen Clark, Board Chair of PMNCH and former Prime Minister of New Zealand, Winnie Byanyima, Executive Director of UNAIDS and Under-Secretary-General of the United Nations, and Githinji Gitahi, Group CEO of Amref Health Africa and Co-Chair of PMNCH Strategic Advocacy Committee.
At Kyangwali refugee settlement in Uganda, Furaha is surrounded by her six children and relieved to be alive. While giving birth prematurely to her youngest, she feared she would die, leaving her children as orphans. “It was a real problem, the way I delivered Salama, because I almost lost my life and she also almost lost her life”, she said.
Furaha and Salama received appropriate care from the right people at the right time. But countless others aren’t as fortunate. Even before COVID-19, there were many preventable deaths of women and children in Africa who were unable to benefit from the faster progress seen elsewhere in the world towards reaching the 2030 Sustainable Development Goals (SDGs). Sub-Saharan African (SSA) still accounts for more than two-thirds of maternal deaths worldwide, and it will take a further two decades for it to reach today’s global average for deaths of children under five.
Inequities are seen in other ways too. Although only 6% of the world’s population live in East and Southern Africa, the region accounts for over half of all people living with HIV. And throughout SSA, young women and girls are most at risk – representing 10% of the population but accounting for almost a quarter of new HIV infections.
COVID-19 is making a bad situation worse
The pandemic is exacerbating these inequities and creating new ones, reversing years of progress and compounding the feminization of poverty and vulnerability to violence. Emerging evidence from Eastern and Southern Africa shows that adolescent girls are experiencing increases in violence, child marriage, and teenage pregnancies, in part driven by school closures and disruptions to health services. Throughout Africa, COVID-19 has overburdened health systems and disrupted food systems, increasing malnourishment and malnutrition among children. Last year, both Liberia and Nigeria experienced big drops (35% and 13%, respectively) in children vaccinated against diseases such as measles and pneumonia. Schooling has been interrupted for most, undermining life chances.
COVID-19 has had a particular impact on HIV treatment and prevention. A World Health Organization survey across 112 countries, including in Africa, shows that almost half (49%) have experienced disruptions to HIV treatment and 46% to testing. Of 38 African countries surveyed, 40% also reported disruptions to sexual, reproductive, maternal, neonatal, child and adolescent health (SRMNCAH) and nutrition services and commodities. As a non-binary 18-year-old Ugandan told Rutgers, “Health centres, offices and business were closed and movement was restricted which made commodities like condoms, lubricants, and treatment for STIs inaccessible. Also, commodities were out of stock at open health centres because they were flooded due to high demand.”
Although people living with HIV are at risk of severe COVID-19, countries with the highest HIV prevalence have the lowest COVID-19 vaccination coverage. In SSA, home to 67% of people living with HIV, less than 3% had received at least one dose of a COVID-19 vaccine by July 2021.
The impact is massive. A single mother in South Africa told Amref Health Africa: “I am depressed because I don’t have a source of income. I almost committed suicide because I didn’t know who to turn to or what to do to put food on the table for my children.” An 18-year-old girl in South Africa added: “My mom is not working; some nights we go to sleep with no food, without eating the whole day. My mom ends up going to borrow money which she can’t pay back.” And a woman from Zambia explained: ‘’When you move around the streets you can see poverty roaming in our city.’’
Gender inequalities and violence have become more prevalent, robbing women and girls of fundamental human rights, including the right to education, health and economic opportunities. This increases their risk of HIV infection and blocks access to services.
Tragically, the most vulnerable were already at risk: refugees and displaced populations, urban poor, and those without access to basic socio-political protections and support systems. Of all such people throughout the world, around 12% live in Western and Central Africa and 19% in the East and Horn of Africa and the Great Lakes. During the pandemic, refugees in Ethiopia, Uganda, South Sudan, Kenya, Tanzania, Malawi, and Zambia received insufficient rations to meet their basic needs.
It’s clear that COVID-19 could reverse years of progress and investments into SRMNCAH, HIV, and other programmes, leaving a generation of vulnerable Africans, particularly women, children, and adolescents, even further behind.
Urgent action is needed
Despite these challenges, COVID-19 presents an opportunity for a more resilient, equitable, and just world. Last July, PMNCH issued a Call to Action to leaders to protect and prioritize the health and rights of women, children, and adolescents during the pandemic response and recovery.
The Call has seven key asks: protecting access to SRMNCAH services and supplies; improving gender equality and access to sexual and reproductive health and rights; improving quality care; supporting and protecting health workers, especially midwives; ensuring stronger social safety nets, especially for the most vulnerable and marginalised; clean water and sanitation; and prevention of violence.
We now urgently seek commitments from governments on these asks, especially pledges contributing to gender equality and support for the most vulnerable. Investing in women and girls will help restore human capital as the backbone of a resilient recovery. By driving more equitable and efficient policies, financing, and service-delivery we can save lives as countries recover from the pandemic and reinvest in essential health services.
COVID-19 has left African women, children, and adolescents further behind. We must reverse this disastrous trend