The landscape of Sub Saharan Africa is a large and ever changing one. There are many many countries that make up this region, each with its own wonders and fair share of different problems as well. Although impossible to hit upon each and every issue facing the broad scope of women’s healthcare in Sub-Saharan Africa, there are common challenges that must be addressed for an overall fundamental rethinking of how to approach healthcare in terms of education, empowerment, access, and an understanding of the sociocultural determinants that shape the present and future of women’s healthcare. In general, some of the main healthcare challenges faced by women in this region are poverty, economic incapacity, and gender based violence, including female genital mutilation (Nwogwugwu, 2020).

 

The women in Sub-Saharan Africa are vulnerable to disease and death from different sources, accounting for more than half of deaths of women worldwide from nutritional deficiencies, maternal mortality and diseases like HIV/AIDS (NACA, 2016). Additionally, a major challenge standing in the way women’s health is an underinvestment in healthcare and healthcare policies. The majority of countries in Sub-Saharan Africa are unable to provide adequate access to quality healthcare, especially because most of the healthcare is urban-centered, leaving rural areas severely underserved.

 

A particular challenge that must be changed is the concept of out-of-pocket payment, which has led to an underuse of healthcare. This specifically signals out women because most women are financially dependent on the men in their lives, and their decisions affect a women’s access to healthcare services (Addressing the Challenge of Women’s Health in Africa, 2012). 

 

However, currently there is not enough government planning to change this system. Additionally, a major impediment to women’s health is sexual and gender based violence that has long term harmful physical effects.

 

An example of this is female genital mutilation, which is inflicted on more than 2 million girls, especially in the countries of Kenya, Nigeria, and Ethiopia. About 92 million females over the age of 10 are living with this pain daily, and among these more than 12 million between the ages of 10-14, a horrifying statistic of having to go through something so traumatic so young (Addressing the Challenge of Women’s Health in Africa, 2012). This mutilation is very harmful to health, and many women experience profuse bleeding along with higher risks for HIV infections and complications with childbirth. Along with mutilation comes sexual violence. Pernille Ironside, who is a child protection specialist working with UNICEF, has said that most girls returning from conflict zones in the region have experienced “extensive sexual violence,” and that the psychological trauma resulting leads to an increased risk of HIV/AIDS (Addressing the Challenge of Women’s Health in Africa, 2012).

 

Nigeria has one of the highest HIV rates in Sub Saharan Africa. There is a strong link between female poverty, sexual relationships, and HIV. About 70% of Nigerian women live below $1 a day with no education or economic empowerment (NACA, 2016). This combined with the fact that 500 Nigerian females have been abducted since 2009, often having to endure child marriages, forced labor, and forced sex which increases risk of HIV transmission. In Nigeria, the infection rate of young girls aged 15-24 is 3 times higher than that of males the same age.

 

Women face barriers in prevention and treatment, as well as social stigma and lack of status (NACA, 2016). In addition to the HIV epidemic and challenge of healthcare changes to gender based violence, Menstrual Poverty is a dire issue.

 

In Kenya, about 65% of women cannot afford to buy sanitary goods and often, girls are forced to have sex in exchange for hygeine products (Project, 2019). According to research done by UNICEF, 10% of young girls admitted to having sex with boda boda drivers in exchange for pads in western Kenya, while 54% have said that they have challenges getting these products. Andrew Trevett, Unicef Kenya chief of Water, Sanitation and Hygiene, has said that this practise is common due to poverty and lack of supply in rural areas, not to mention the heavy stigma around talking about menstrual health (Oppenheim, 2019). 

 

Agnes, who was a secondary student in Kuria West sub-county, has experienced this dark side of period poverty, “I was shy because I did not have sanitary pads,” she recounted. “On my way home I met a boda boda rider who was our close neighbour. He asked me why I was going home during class time. I could not tell him but instead stared at him. He looked at me and asked why I was tying a pullover around my waist. I kept quiet. He smiled at me and asked me whether I was on my period. I kept quiet…..He promised to give me 500 Kenyan shilling if I promised to have sexual intercourse with him first. I refused and ran away to tell people what had happened.” (Oppenheim, 2019). Other girls have not been so lucky. They are scared and often desperate, with 76% of females facing challenges in gaining access to water and sanitation facilities, and 1 in 10 girls missing school (Project, 2019).

 

This big healthcare hurdle leads directly into another challenge of the lack of access to reproductive healthcare across the region and specifically in Sudan. In areas of the Nuba Mountains in Southern Kordofan, Sudan, there is no access to contraception with the closest hospital being 2 hours away, the lack of emergency care exposes women to complicated pregnancies and a high rate of maternal deaths. The limited access for women and girls is also in part due to long ongoing armed-conflict between the Sudan government and the rebel SPLM/A-North. (Wheeler, 2017).There is restricted access for aid workers in this area, and various diplomats have not been able to provide access to these communities. Due to this, research by the UN has shown that in 2006, the maternal mortality rate in this region was 503 per 100,00 births, compared to the 91 per 100,00 births in neighbouring states (Wheeler, 2017). There are also no contraceptives available in this part of Sudan, and many women interviewed by Human Rights Watch did not even know what a condom is, leading to no control over fertility; and with little obstetric emergency care available from the government, this is a recipe for disaster.