While 2003, 2004 and early 2005 have seen improvements in economic growth levels and in governance, the challenges facing sub-Saharan Africa as it strives to meet its development objectives remain the most daunting facing any region in the world. These objectives include reaching the eight Millennium Development Goals (MDGs) for 2015 and the closely-related goals for 2015 set at the ICPD in 1994 and the ICPD+5 follow-up in 1999, including universal access to reproductive health services, gender equality and women's empowerment. This region, which is home to 34 of the world's 49 least developed countries, will continue to need the highest per capita levels of technical and financial support of any region, along with sustained political commitment by all stakeholders, if it is to make major progress towards meeting those goals by 2015.
Unfortunately, efforts to eradicate poverty, empower women, reduce child mortality and improve maternal health in the region continue to be severely undercut by the devastating AIDS pandemic and by massive human displacements in the wake of natural disasters, violent conflicts and debilitating political strife. In a region that is home to more than 60 per cent of the world's HIV-positive people, halting and reversing the spread of HIV, as well as addressing related issues of malaria and tuberculosis, must be among the highest priorities. Addressing the reproductive health needs of the millions of women and adolescents currently at risk for contracting the infection is critical to this effort. Two-thirds of those newly infected with HIV in the region are women. About 7 per cent of young women and 2.2 per cent of men aged 15-24 years in sub-Saharan Africa were living with HIV at the end of 2004.
Making motherhood safer is another urgent priority: women in the region face a 1 in 16 lifetime risk of dying from pregnancy-related causes, and millions will be disabled. The high rate of teen pregnancies creates additional risks for mothers and newborns. Lack of access to emergency obstetric care and low proportions of births attended by professionally trained personnel contribute to the continuing extraordinarily high rates of maternal mortality and morbidity. Additional priority must also be given to advocacy, targeting the poorest of the poor in urban slums and in difficult-to-reach areas, on-going efforts to stamp out harmful traditional practices and reducing gender-based violence, which is associated with poor pregnancy outcomes. Expanded efforts are also under way to treat women who have been disabled by obstetric fistula, a devastating injury of childbearing.
Sub-Saharan Africa 's population has grown faster than any region over the past thirty years, despite the millions of deaths from the AIDS pandemic. Between 1975 and 2005, the population more than doubled, rising from 335 to 751 million, and is currently growing at a rate of 2.2 per cent a year. The United Nations Population Division recently projected that sub-Saharan Africa 's population will reach about 1.1 billion by 2025. The region's youth bulge', the high proportion of young people, signals that the population momentum will probably continue for decades to come, even with AIDS reversing decades of gains in life expectancy. Indeed, in the countries most highly affected by HIV/AIDS, life expectancy continues to decline.
Although most African women want fewer children than in the past, contraceptive prevalence rates for modern methods in most of the region's 45 countries remains quite low, with some notable exceptions including Botswana, Cape Verde, Kenya, Mauritius, South Africa and Zimbabwe. The region's unmet need for family planning among married women is the highest in the world. UNFPA estimates that an additional $275 million a year is required to make up the gap in reproductive health commodity requirements.
Through the Network of African Women Ministers and Parliamentarians, as well as the Arab and African Parliamentarians in the Population and Development Sector, efforts continue to keep reproductive rights, population and gender issues high on the policy agenda. Almost all countries in the region now support reproductive health programmes, including family planning, and integrate population into their development programme. Yet, fully incorporating these issues and programmatic needs into national poverty reduction efforts remains a struggle. While progress continues to be made, in too many cases, population, reproductive health and gender issues are still not as firmly situated in broader policy dialogues as they should be.
In several countries, laws banning female genital mutilation/cutting and violence against women have been passed. Likewise, model legal frameworks promoting the right to reproductive health have been ratified in some countries.
Progress towards democracy in numerous countries in the region in the past decade has seen the growing participation of civil society organizations in policy dialogues and broader partnerships with government, including reproductive health service delivery to adolescents and the poor.
Efforts to build, expand and upgrade institutional capacity remains a key component of almost all UNFPA-supported country and regional programmes. A growing number of countries are beginning to develop or to expand youth-friendly health services, but coverage is still quite limited. Almost all countries have conducted at least one census and one demographic and health survey, indicative of an increasing commitment to data collection needed for planning, and particularly for monitoring progress towards attaining development goals.
As set forth in the recommendations contained in the March 2005 Report of the Commission for Africa, entitled Our Common Interest , African governments should meet their commitment to invest 15 per cent of their annual budgets to health, put in place strategies for the effective delivery of health services, and invest in training and retention of one million health workers by 2015. Governments must also prioritise sexual and reproductive health within their vision of health systems and integrate HIV/AIDS treatment and care into those systems. UNFPA should work closely with the African Union, the New Partnership for Africa 's Development (NEPAD) and the World Health Organization to ensure that a clear strategy for sexual and reproductive health is incorporated. The report also recommends that donors greatly increase their funding to support these strategies for the effective delivery of health services and provide the billions of additional dollars required annually between now and 2015.
The 2005 report of the UN Millennium Project, entitled Investing in Development , makes essentially the same recommendations, stating that such actions are required in order to enable a significant voluntary reduction in sub-Saharan Africa 's very high fertility rates and population growth rates, adding that this could happen in just a few years.
It is imperative that sub-Saharan Africa's governments, civil society and the donor community give priority attention to gender equality and women's empowerment and to the various matters required to scale up population and reproductive health, including family planning, and HIV/AIDS programmes between now and 2015 to ensure that poverty-reduction strategies and programmes gain and maintain momentum.
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