Above, watch the full conversation on reproductive health in Zambia.
When a woman can control her fertility and determine the timing and spacing of her children she is more likely to be healthy, feed her family, attain her desired level of education, and be economically stable, according to Zambia’s first Minister of Gender and Child Development, Nkandu Luo. In mineral-rich Zambia, it is not a lack of resources that causes poverty, she said, but the prevalence of large unplanned families, which stretch resources.
On a global scale, 225 million women say they would like to control their fertility, but have an unmet need for contraception. If this need were addressed, economic growth and increased sustainability within families, communities, and countries would be within reach.
When asked about the greatest problem facing women in Zambia, Luo was quick to respond: poverty.
“If you [looked into] poverty, in a lot of African countries poverty has a female face,” Luo said during a recent dialogue at the Aspen Institute in Washington, DC. The Institute, the Global Leaders Council for Reproductive Health, Plan International USA, the Permanent Mission of Zambia to the UN, and the US Agency for International Development (USAID) presented the discussion to explore how to tackle issues facing women and girls in Zambia and globally.
Dr. Ariel Pablos-Mendez, assistant administrator of the global health bureau and coordinator for Maternal and Child Survival at USAID, also participated in the discussion. Both Pablos-Mendez and Luo are outspoken champions of reproductive health and rights for women and girls as a crucial step towards ending poverty and accelerating development.
Zambia has had steady progress in improving women’s access to reproductive health services. The average family size was 6.2 children per woman in 2007, and decreased to 5.3 in 2013-14. Between increased financing, task shifting, and the establishment of a Ministry of Gender in 2006, other health outcomes have shown encouraging results. Zambia’s maternal mortality ratio was 591 deaths per 100,000 live births in 2007; now it is down to 398. In 1992, 15 percent of women in the country used modern contraceptive methods; that percentage rose to 45 percent from 2013 to 2014.
Luo emphasized the need to invest in children — particularly girls — to continue this momentum. USAID is also launching the Youth Impact initiative to focus on the needs of youth in developing countries. In Zambia, as well as many other parts of the world, “[girls] have been socialized to be apologetic… and this has left us behind as a group,” Luo said. She sees girls’ empowerment through education and other interventions as a key step towards better holistic health. “We are looking at empowerment in its totality, because you cannot just have health, you have to have everything else that surrounds health.”
One of these initiatives, that has support from multiple ministries in the country, is a campaign to end child marriage in Zambia. Globally, 27 percent of girls are married before the age of 18, in most cases to older men and often without their consent. Ending the harmful practice of child marriage will address many other health and rights issues. “It’s like an octopus,” she described, “when a child gets married early and they are exposed to sex, they are [more] likely to suffer from cervical cancers, HIV infections, they will be out of school.” Luo is working with 10 ministries, including the Minister of Chiefs and Traditional Affairs, to raise awareness and end this practice in even the most remote areas of the country.
USAID is approaching the goal of maternal and child survival with a similar cross-agency initiative. Pablos-Mendez outlined the need for continued human resources, innovation in both technology and service delivery, and financing mechanisms. “We have to celebrate the great success… [and] have bold ideas, but make sure we organize our systems in the best way possible going forward,” he said.
Combined with optimism was a clear call for partnership, not only between the private and public sectors within countries, but also internationally. As Luo pointed out, “often [developing countries] are seen as recipients. We need to be partners.”
Valerie Moyer is reproductive health program coordinator at the Aspen Institute Global Health and Development Program.