SEXUAL AND REPRODUCTIVE

HEALTH FACT SHEET

WHO AFRICAN REGION

T he WHO Reproductive Health Strategy, endorsed by the

World Health Assembly in 2004 and guided by internationally
agreed human rights principles (1), specifies five core aspects of
KEY FACTS
sexual and reproductive health (SRH): “improving antenatal,
perinatal, postpartum and newborn care; providing high-
Maternal mortality ratio (MMR) in the
quality services for family planning, including infertility services;
African Region has declined from an
eliminating unsafe abortion; combating sexually transmitted
estimated 857 maternal deaths per 1000
infections including HIV, reproductive tract infections, cervical
live births in 2000 to 525 deaths per 1000
cancer and other gynaecological morbidities; and promoting
live births in 2017 (2). Despite this progress,
sexual health”. Additionally, the strategy highlights the
this is still far from the global target
importance of preventing and responding to violence against
of 140 maternal deaths per live births
women for improving reproductive health outcomes.
and progress remains unequal across
Achieving universal access to sexual and reproductive health countries. MMR ranges from 53 to 1,150
and rights (SRHR) is a key component to achieving Sustainable maternal deaths per 1000 live births in
Development Goals 3 and 5. Indicators to measure the progress Seychelles and South Sudan respectively.
towards this goal have shown that the African region, though
progressing based on interventions across the different The contraceptive prevalence rate,
countries, still lags behind the rest of the world and more effort modern methods, among married or
is needed to achieve the goal. in union women in Sub-Saharan Africa
increased from 14.7% in 2000 to 27.9% in
ADOLESCENT AND YOUTH SEXUAL AND 2019. However, only 52% of women in this
group have their need for family planning
REPRODUCTIVE HEALTH satisfied with modern methods (3).
Sub-Saharan Africa has the highest proportion (32%) of young
people aged 10 – 24 years (7). Policies which do not permit or Abortion can be provided legally upon
expressly guarantee youths and adolescents access to sexual request, with no justification requirement,
and reproductive health and rights can lead to unplanned up to a certain gestational limit in only 4
pregnancies, increase in STIs and HIV, and unsafe abortions. countries in the African region, Angola;
At age 18, 78% of all females in Liberia and 77% of all females Cabo Verde, Sao Tome & Principe and
in Congo had had first sexual intercourse. Similarly, 68% and South Africa. Consequently, most of the
66% of males in Congo and Angola respectively had had first abortions done in the countries where it
sexual intercourse (Figure 1). About 31% of females between is illegal are unsafe. It is estimated that
the ages of 20 and 24 in the African region were married prior 5.2% - 17.2% of maternal deaths annually
to age 18 (Figure 2). The top 5 countries in the region for early in Sub-Saharan Africa are due to abortions
marriage were Niger (76%), Central African Republic (68%), (4).
Chad (67%), Mali (54%), and South Sudan (52%). The African
region has the highest number of births to women aged 15-19 FGM remains a problem in the African
per 1000 women in that age group (99 births/1000 adolescent Region, particularly in the Western and
females) in comparison to other regions worldwide. The global Eastern sub-regions. Approximately 95%
rate is 44 births per 1000 adolescent females (8). Central African of females aged 15-49 years in Guinea
Republic (229/1000) had the highest adolescent birth rate than had undergone female genital mutilation
elsewhere in the region while Algeria (9/1000) had the lowest (FGM) in 2018 (5).
(Figure 3). Females who start childbearing at an early age are
at a higher risk of developing complications during pregnancy Approximately 25.7 million people are
as well as infant mortality. This has a negative socio-economic living with HIV in the African region and
impact on these females when compared to their peers who 1.1 million new infections were recorded
delay childbearing. With age of sexual debut, marriages, and in 2018. About 79% of pregnant women
childbearing starting quite early in the region, it is imperative to living with HIV received antiretrovirals for
address adolescent sexual and reproductive health and rights prevention of mother to child transmission
to forestall critical gaps. Comprehensive sexuality education for
of HIV in 2018 (6)
youths and adolescents will promote positive sexual behavior
and thus improve reproductive health.
Figure 1: First sexual intercourse by ages 15 and 18 among Figure 2: Percentage of women aged 20-24 married before age 18, African region,
individuals 25 - 49 years in the African region, 1994 – 2018 2010-2019
Data sources: Demographic and Health surveys (DHS) Data sources: DHS, MICS, and other nationally representative surveys

Figure 3: Adolescent birth rate by country, African region, 2007 – 2018

Data sources: DHS, MICS, and other nationally representative surveys;

FAMILY PLANNING
To prevent unwanted pregnancies and empower women and family planning (3). These women would like to stop or delay
adolescents in the region, women should be able access to childbearing but are not using any form of contraception and
family planning services. Family planning services include thus are more likely to have unplanned pregnancies or closely
counselling and provision of contraceptive methods. Modern spaced childbirth. Only about 28% of married or in union
methods of contraception include oral contraceptives, women (15 – 19yrs) in the region are using modern methods
implants, injectable contraceptives, intrauterine devices of family planning and 52% have their demand for family
(IUDs), condoms (male and female), emergency contraceptive planning satisfied by modern methods (Figure 4).
pills, lactational amenorrhea method, basal body temperature
method among others.

Approximately 17% of all women in Sub-Saharan Africa and

23% of married or in union women have an unmet need for

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 All women Maried or in union women
Contraceptive prevalence rate, any method 27.3 31.9

Contraceptive prevalence rate, modern methods 24.1 27.9

Demand satisfied for family planning, modern methods 54.7 51.8

Unmet need for family planning 16.7 22.5

Figure 4: Family planning indicators in the Sub-Saharan Africa, 2019 estimates

Data source: United Nations, Department of Economic and Social Affairs, Population Division (2020). Estimates and Projections of Family Planning Indicators
2020. New York: United Nations.

PREVENTING UNSAFE ABORTION/POST-ABORTION CARE

In 2017, there were an estimated 211 maternal deaths per
100,000 live births globally, with the African region having
the highest maternal mortality ratio (MMR) estimated at 525
maternal deaths per 100,000 live births (2). Between 2010
and 2017, the Average Annual Rate of Reduction (AARR) of
MMR was 2.3%. To reach the target of 70 by 2030, the African
region would need an AARR of 10.9% (Figure 5).

The major causes of maternal deaths are severe bleeding

(mostly after childbirth), high blood pressure during
pregnancy (pre-eclampsia and eclampsia), infections
(usually after childbirth), complications from delivery, and
unsafe abortion (4). It is estimated that 5.2% - 17.2% of
maternal deaths annually in Sub-Saharan Africa are due
to abortions (4). The laws concerning a woman’s right to
abortion are mostly restrictive in the African region and this Figure 5: Maternal mortality ratio (maternal deaths per 100 000 live births) in
promotes unsafe abortions which can result in maternal the African region 2000 – 2017 and projected estimates to 2030
Data sources: UN Maternal Mortality Estimation Inter-Agency Group
mortality. Safe abortions can be provided legally upon
request, with no justification requirement, up to a certain
gestational limit in Angola, Cabo Verde, Sao Tome & Principe,
South Africa. It is entirely prohibited in Senegal, Mauritania,
Madagascar, Guinea Bissau, Gabon, and Congo (Figure 6). In
the remaining 40 countries in the region, abortion is restricted
with legal permission only under certain circumstances. A
major challenge to understanding the severity of abortion
and post-abortion care in the African region is the dearth of
reliable data due to the stigma and fear attached to abortion
in countries where it is unlawful.

Post-abortion care is the management of complications

resulting from incomplete abortions or miscarriages. Health
facilities (public or private) that provide primary health care
services and higher levels are expected to have capacity for
post-abortion care. A study which looked at the capacity of
national health systems to provide post-abortion care in 7
African countries using signal functions revealed that less
than 10% of primary-level facilities had capability to provide
Figure 6: Legal status of abortion in the African region
basic post-abortion care in 5 (71%) of those countries (9). In
Data Source: WHO Global Abortion Policies Database (https://abortion-poli-
addition, less than 50% of referral facilities had capability to cies.srhr.org/)
provide comprehensive post-abortion care.

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HIV AND STIs
Sexually transmitted infections are infections that are to eliminating mother to child transmission of syphilis as one
transmissible mostly by sexual contact which includes vaginal, of the key targets of the Global Health Sector Strategy on STIs
oral, and anal sex. Transmission is also possible through blood (2016–2021) which is the reduction to ≤50 cases of congenital
products and tissue transfer. Some STIs like HIV and syphilis syphilis per 100 000 live births in 80% of countries. Syphilis in
can be transmitted from mother to child during pregnancy pregnancy can result in fetal and neonatal death. Syphilis can
and childbirth. STIs can lead to severe consequences such as be detected using a rapid test kit and there is effective
fetal and neonatal death, cervical cancer, increased HIV risk, antibiotic treatment for it. The median reported treatment
infertility among others. Many STIs have effective treatment rate among antenatal care (ANC) attendees in the African
and can be cured. The incurable STIs are caused by Human region who tested positive for syphilis was >95% in 2018.
Immunodeficiency Virus (HIV), Human Papilloma virus (HPV),
Herpes simplex virus (HSV), and Hepatitis B virus. Prevention
of STIs is through comprehensive sexuality education,
behavioral change, delayed sexual debut, promotion of
safer sex, interventions targeting key population such as sex
workers, STI and HIV pre- and post-test counselling (10).

The African region has the highest HIV burden globally with
25.7 million people living with HIV and 1.1 million new
infections in 2018 (11). It is also one of the leading causes of
death in the region (12). Efforts towards the prevention and
control of spread of the disease include access to HIV testing
and counselling, promotion of female and male condom use,
use of antiretroviral medicine (ARV), and elimination of
mother to child transmission of HIV (EMTCT). Approximately
79% of pregnant women living with HIV in the African region in
2018 received ARV in 2018 to reduce the risk of prevention
Figure 7: Global, and African sub-regional estimates of HIV prevalence and
mother to child transmission (PMTCT) of HIV (Figure 7). The people living with HIV receiving ART in 2018; median regional estimates of
coverage was higher in the East and Southern African sub- PMTCT coverage among pregnant women for HIV and syphilis in 2018
regions (92%) than in the West and Central African sub-regions Data source: UNAIDS, WHO 2018
(59%) (Figure 7). In addition, some countries have committed

CERVICAL CANCER
Cervical cancer is caused by the Human Papilloma virus lesions (15). This will aid early detection, when chances for
(HPV) and is the second most common cancer among cure are higher. The age requirement does not apply to HIV
women living in the undeveloped regions (13). The risk of positive women who are encouraged to go for screening as
HPV infection leading to cervical cancer is higher among soon as they know their status.
immunocompromised individuals.

HPV vaccines have been developed and approved for

use in preventing infection from the HPV types 16 and 18
responsible for about 70% of cervical cancer cases worldwide.
WHO recommends a 2-dose schedule of HPV vaccination
targeting young adolescent girls, aged 9-14 years old. The
recommendation is 3-doses for immunocompromised and/or
HIV-infected girls (14). As of December 2019, only 15 countries1
in the African region had instituted HPV vaccination as part of
the routine immunization system.

United Republic of Tanzania, Zimbabwe, Liberia, Malawi,

Zambia, Cote d’Ivoire Seychelles and Sao Tome & Principe
had HPV vaccination coverage >90% in 2018 (Fig 8). Figure 8: HPV vaccination coverage (recommended dose) in the African region
2018
Data source: WHO/UNICEF Joint Reporting form
WHO recommends that women 30 years and above undergo
screening for abnormal cervical cells and pre-cancerous

1 Botswana, Ethiopia, Mauritius, Rwanda, Sao Tome & Principe, Senegal, Seychelles, South Africa, Uganda, United Republic of Tanzania, Zimbabwe, Liberia, Malawi, Zambia, Cote
d’Ivoire

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Table 1: Women screened for cervical cancer by country in the African region, 2017 (countries that screened 10% or more)
Data source: WHO

SEXUAL AND GENDER-BASED VIOLENCE

Any harmful act, which includes physical, emotional or
psychological and sexual violence, and denial of resources or
access to services, that is perpetrated against one’s will and
is based on gender norms and unequal power relationships
is described as an act of sexual and gender-based violence
(SGBV) (16). Anyone can be a victim of SGBV, however, the
risk is higher in vulnerable population which includes girls,
adolescents, women, children, elderly people, and persons
with disability. SGBV includes rape, domestic violence, sexual
exploitation, trafficking, and female genital mutilation.

Approximately 37% of ever-partnered women above the age

of 15 in low and middle-income countries in the African region
had experienced physical and/or sexual violence by a current Figure 9: Percentage of ever partnered women (15-49 years) subjected to
physical and/or sexual violence by a current or former intimate partner in the
or former intimate partner in their lifetime (17). This last 12 months in the African region (Top 10 countries), 2010-2019
prevalence is higher than the global prevalence of 30% (17). Data source: DHS, MICS
Equatorial Guinea had the highest proportion of ever-
partnered women (15-49years) in the African region (44%)
that had been subjected to physical and/or sexual violence by
a current or former intimate partner in the 12 months prior to
the survey (Figure 9).

Figure 10: Prevalence of FGM in the African region among women aged 15-49, 2010-2018
Data Source: UNICEF data warehouse; DHS, MICS, and other nationally representative surveys
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Female genital mutilation (FGM) is a harmful practice that education, protection, and psychosocial support (16). It also
involves partial or total removal of the external female requires community engagement and support for victims.
genitalia or other injury to the female genital organs for non-
medical reasons. It has no benefits but can lead to health
WHO SUPPORT TO MEMBER STATES
risks and complications. FGM is linked to cultural and societal
norms. FGM is still a problem in the West and East African sub- WHO Regional Office for Africa (WHO/AFRO) develops
regions. About 95% of women and girls in Guinea had been guidelines, norms, and standards for sexual and reproductive
subjected to genital mutilation and this is the highest in the health and rights in different contexts. WHO/AFRO also
region (Figure 10) supports member states in adapting and developing national
guidelines as well as strengthening their capacity building to
As a complex problem, SGBV prevention and control requires
implement strategies to ensure universal coverage of SRHR.
a multi-sectoral approach from sectors such as health,

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