Sexual and Reproductive Health and Rights for All? At ICPD+30, Afrodescendent Women & Girls Still Bear Disproportionate Burdens

May 7

By Dilly Severin, Executive Director of the Universal Access Project, in conversation with Patricia Da Silva, PhD, Programme Adviser at the United Nations Population Fund (UNFPA), where she leads the People of African Descent initiative.

This year is a critical one for sexual and reproductive health, rights and justice. We mark 30 years since the International Conference on Population and Development (ICPD), a landmark moment when nearly the entire world agreed that sexual and reproductive rights are human rights and are essential to global development. We also recognize 30 years of the reproductive justice movement, started by Black women to center the human rights and bodily autonomy of women of color and other marginalized birthing people in their broader social, political and economic contexts.

Against this backdrop, and as Mother’s Day approaches, I'm reflecting on how the global community has supported mothers and birthing people in the movement for sexual and reproductive health. What have we accomplished and what goals remain to be realized? Most importantly, who has been left behind?

Certainly, we’ve made progress in these 30 years. But by too many markers, we still have a long road ahead of us in the pursuit of health and rights for all. This is especially evident when we look at the experiences of Afrodescendent women globally. No matter where they are in the world, Black women are bearing the burden of maternal morbidity and mortality.

This burden is so great, the United Nations Population Fund, or UNFPA (the UN agency dedicated to sexual and reproductive health and rights) has an initiative dedicated to People of African Descent. I spoke with Patricia Da Silva, PhD, Programme Advisor at UNFPA and leader of the initiative, on what the latest data says about sexual and reproductive health and rights for Afrodescendent women and girls, and what the path forward might look like to address such deep inequities:

It’s been 30 years since the adoption of the ICPD Programme of Action. UNFPA’s recent State of World Population report, Interwoven Lives, Threads of Hope, outlines achievements in advancing sexual and reproductive health, rights and justice since 1994; and it also showcases where progress is stagnating, or even reversing. Broadly speaking, what is the state of sexual and reproductive health and rights worldwide? What progress has been made, and what barriers and inequalities remain? As the report highlights: who has been left out, and why?

Patricia Da Silva: The report highlights how the role of racism, sexism and other forms of discrimination continue to play in blocking broad gains in sexual and reproductive health for women and girls. It brings into focus the serious barriers to health care, analyzed by wealth, education, rural or urban location, and ethnicity.

The findings show that serious problems accessing care have fallen more quickly for women who are more socioeconomically privileged and for those who belong to ethnic groups that already had fewer barriers to care to begin with. Many of these disparities are widening over time. So, what the report means is that in the last 30 years, we have largely succeeded in reaching those who were relatively easier to reach. Hidden in their shadows are those who have been left behind.

In many cases, disparities in health access are even greater within countries than between countries. This tells us we need a drastic shift in our approach and tactics to reach the most marginalized. The report also contains, for the first time, a snapshot of trends in women’s ability to exercise bodily autonomy. Out of 32 countries with trend data, 40% have seen women’s bodily autonomy diminish over time. Of course we need to continue to work to increase the number of countries that collect this data. While those who have been left behind vary depending on regions and countries, we know for example that:

Afrodescendent women across the Americas are more likely to die when giving birth than white women. In the United States, the rate is nearly three times higher than the national average.
An African woman who experiences pregnancy and childbirth complications is around 130 times more likely to die from them than a woman in Europe and Northern America.
Over half of all preventable maternal deaths are estimated to occur in countries with humanitarian crises and conflicts – that’s nearly 500 deaths per day.
Women from indigenous ethnic groups are more likely to die of causes related to pregnancy and childbirth.
Women with disabilities are up to 10 times more likely to experience gender-based violence than their peers without disabilities.
People of diverse sexual orientation and gender expression face rampant violence and steep barriers to care.

In terms of progress, the report also highlights that progress has been achieved, and can continue to be achieved with our collective effort. An analysis of countries’ voluntary national reviews shows policymakers are broadly willing to tackle inequalities and marginalization. And finally, we see signs that increased investment in sexual and reproductive health during the Millennium Development Goal era resulted in overall improvements in maternal health.

The report finds that there has been effectively zero reduction in maternal mortality since 2016, and in a number of countries, maternal mortality is actually rising. Afrodescendent women are disproportionately bearing this burden globally. Can you shed some light on this: what are the many intersecting factors driving this inequality? Do we see regional differences? What does the data – or lack of data – tell us?

Patricia: At UNFPA we are deeply committed to ensuring we leave no one behind, particularly those populations historically marginalized including Afrodescendent women and girls but also indigenous peoples and other groups, who way too often continue to face multiple and intersecting forms of discrimination.

When we look at the global numbers, what we are seeing is that, since 2016, in Europe and North America maternal mortality is up about 17% and in Latin America and the Caribbean, it is up 15%. Let's also not forget that 70% of the world's maternal deaths are still happening in sub-Saharan Africa. As mentioned above, disparities in health access are even greater within countries than between countries. This means that every society in the world needs to take action to address inequalities, which can be based on race, ethnicity, disability status, LGBTQIA+ identity, migration status and more. In fact, UNFPA’s analysis - Maternal Health of Women and girls of African Descent in the Americas - found that Afrodescendent women and girls in the Americas are disadvantaged before, during and after pregnancy.

Racism and sexism drive maternal health disparities and are a key barrier to achieving the highest attainable standard of maternal health. We found that where data is available, we see large discrepancies in maternal death rates. In the United States, Black women are nearly three times more likely to die than white women. In Suriname the rate is 2.5 times higher; and in Brazil and Colombia, 1.6 times higher.

The report also finds that higher income and education offer little protection: Maternal deaths among African American college graduates in the United States are 1.6 times higher than among white women with less than a high school diploma. In North America, Latin America and the Caribbean, maternal mortality rates are on the rise, and Afrodescendent women and girls are being hit the hardest.

We cannot fix what we cannot see, and unfortunately we still lack enough quality health data disaggregated by race and gender collected and analyzed. As a result, poor maternal and sexual and reproductive health outcomes for women and girls of African descent remain invisible in many countries of the Americas. So again, I want to emphasize the urgent need for more data disaggregated by gender, race and other important factors and this has been an important UNFPA contribution.

We cannot achieve the ICPD Programme of Action, or the promise of the reproductive justice movement, without closing the gap in maternal health for women and girls of African descent. UNFPA Executive Director Dr. Natalia Kanem emphasized that global collaboration is essential to progress: “There is only one way to achieve a future of dignity and rights for all: By working together.” What are some solutions the global community can rally around to support equity in maternal health care for Afrodescendent women and girls? What is the path forward for sexual and reproductive health, rights and justice for all?

Patricia: The UNFPA report offers specific recommendations that can play a significant role in bringing equity to the maternal health of women of African Descent. They include addressing the structural determinants of health faced by Afrodescendent women and girls, ensuring their representation in decision-making processes, increasing Afrodescendant representation in the health workforce, adopting equitable and culturally appropriate maternal health care approaches, and reforming medical education to eliminate biases and unscientific beliefs.

It is essential that the global community recognizes the challenges in maternal health for Afrodescendent women and girls as a critical justice and human rights issue requiring urgent, targeted attention. As our Executive Director, Dr. Natalia Kanem, has emphasized, global collaboration, but also global solidarity, and action are essential to address the challenges faced by Afrodescendent women and girls. So, we must work together and harness our collective efforts, including strengthening targeted resources, inclusive of financial resources, at the global level to bring impactful and lasting change and bridge the gap in maternal health for Afrodescendent women and girls. Let’s make improving maternal health and bridging the gap in preventable maternal death for Afrodescendent women a priority for us all in the global community.

Learn more about UNFPA’s work advancing equity and social justice for Afrodescendent people here.