It’s 8:30am in Nkumbi and Patricia and I are on our way to the clinic. We pass the market and the school and exchange greetings with friendly faces who comment on our Restless Development t-shirts and curiously ask ‘Muleya kwisa?’ (Where are you going?). After twenty minutes of walking we arrive at the clinic and are welcomed by the nurse. Today we are giving a talk about Sexually Transmitted Infections (STIs) to the patients in the waiting area.
As we wait for more people to arrive we observe the comings and goings. Patricia is surprised to see so many young mothers present, but is equally happy to see a couple leaving the clinic who have just been for Voluntary Counselling and Testing (VCT) together. I am in awe as I see a woman, who gave birth a few hours ago, leaving the clinic alone with her new born swaddled in blankets. I wonder how far she will have to walk home, but the nurse is just happy that she gave birth at the clinic. She explains that many women give birth at home without trained birth attendants and this can lead to serious complications for the mother. I quietly draw comparisons in my mind between healthcare in Zambia and the UK.
Health is a Human Right
In accordance with The Universal Declaration of Human Rights, the World Health Organisation recognises that
“the enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being…”
– (WHO 2013)
However, stark global inequalities in healthcare exist, and the reality in Zambia remains that:
- 38 women die every month during pregnancy and childbirth, and unsafe abortions account for nearly 30 percent of all maternal deaths (UNDP 2013)
- In rural areas, where births to adolescent women are more common than in the country as a whole, only 44 per cent of recent births among women younger than 20 were delivered at a health facility (Anderson et al., 2013).
- Unmet need for contraception is high among married female adolescents aged 15–19 (22 percent), and even higher among sexually active adolescents who are not married (64 percent) (Anderson et al., 2013).
The impact of these statistics are felt mostly amongst the 67 percent of the rural population that are considered to be extremely poor (UNDP, 2013). The figures also reveal that young women are particularly at risk of unwanted pregnancies or experiencing complications during pregnancy and childbirth. Arguably, these issues are reflective of the lack of control and autonomy women have over their own Sexual and Reproductive Health Rights (SRHR) and access to health services
The barriers facing young women in accessing SRH services became increasingly noticeable, and through ‘The Girl Effect Campaign’, we were tasked with researching gaps existing in the provision of SRH services. Through the participation of in-school and out-of-school girls, and by speaking to community health professionals, the following were some key concerns raised by the girls at the conference in Lusaka:
- There is a reluctance to provide information about contraception to unmarried girls due to cultural and religious expectations. Girls are often not comfortable in receiving contraceptives because they fear being judged by the community.
- Early marriages correlate with the high instance of pregnancies amongst adolescent women.
- There is a lack of support and resources for the establishment of a youth friendly corner where young people can obtain family planning advice from trained peers.
- There is inadequate SRH information available in schools and in the community and young women are not empowered to make informed decisions about their SRH.
The barriers affecting access to SRH are complex and multiple, but the above tends to indicate that some barriers are linked to a combination of lack of resources and information, cultural norms, or gender inequality. Whilst this research was very useful, I also learnt a lot from having informal conversations with people in the community. During these conversations, something that struck me was how women recognise what their sexual and reproductive health rights are, in relation to universal expectations of human rights, but in reality they remain constrained in terms of the choices they make concerning their own health. This links to the low socio-economic status of women in a society dominated by patriarchal norms and values (LDHMT, TARSC, 2013), but also highlights how the narrative of Universal Human Rights often appears to be incompatible with the local cultural context.
Putting rights at the centre of a post-2015 framework
With access to SRH services being such a complex and culturally embedded issue, a solution for improving the situation is never going to be straightforward. The recent MDG report for Zambia does not provide much hope either for meeting the targets around gender equality and maternal healthcare by 2015 (UNDP 2013). Whilst the target-based approach to poverty reduction has its merits, the MDG agenda has failed to capture transformational change and unequal power relations remain unchallenged at the root.
A way forward for the post-2015 agenda is to focus upon a rights-based approach (RBA) (see Nelson 2007). However, there is a need to tread carefully because simply co-opting the language of human rights into the development agenda does not necessarily mean that unequal power relations within the international system will be addressed. Rights in the global South must be nurtured from the roots of local communities where citizens not only know what their rights are, but also have the power to participate in decision making, articulate demands and hold governments and civil society actors to account. In Zambia, only when people become empowered to exercise these rights and make informed decisions about their own healthcare will there be enough pressure to provide better access to SRH services.
The journey is still a long one, however during my time in Nkumbi I learnt that young Zambians are determined, and the work of Restless Development and other similar NGOs is enabling them to make noise, participate and have a voice.
- Anderson, R. Panchaud, C. Singh, S. & Watson, K. (2013) Demystifying Data: A Guide to Using Evidence to Improve Young People’s Sexual Health and Rights, Guttmacher Institute: New York.
- LDHMT, TARSC (2013) Women’s Health and Sexual and Reproductive Health in Zambia: A Review of Evidence, EQUINET, TARSC: Harare.
- Nelson, P.N. (2007) ‘Human Rights, the Millennium Development Goals, and the Future of Development Cooperation’, World Development, Vol. 25, no. 12, pp. 2041-2055.
- UNDP (2013) Millennium Development Goals Progress Report: Zambia, New Horizon Printing Press: Lusaka.
- World Health Organization (WHO) (2013) Health and Human Rights. Available at < http://www.who.int/hhr/en/> Accessed on 18/11/2013