Windhoek Summit: An Interview with Dr. Margaret Agama on The Common African Position.

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Dr. Margaret Agama speaking at the Common African Position Meeting that was held in Windhoek, Namibia.

The Common African Position (CAP) meeting was held between 4-5th Sep 2019 in Windhoek, Namibia. The consultative meeting was initiated by Africa Union Commission (AUC) and International Planned Parenthood Federation (IPPF). It brought together civil society organizations within five regions in Africa.

I caught up with Dr. Margaret Agama-Anyetei, Head of Health, Nutrition and Population Division, Social Affairs Department Africa Union Commission (AUC) on the sidelines of the meeting to unpack what CAP is all about.

Here is the interview;

Lorna: Why are we having this conversation here today and why is it important?

Dr. Margaret Agama: The conversation is about developing a Common African position on population and development for the African continent. The reason why it is important is that even though there are a lot of agreed tools and commitments that Africa Union Member states have signed and ratified in view of advancing the population and development agenda on the continent, there are still key issues which countries and regions still grapple with. We are keen to hear from civil societies and member states on what they think the issues are and what solutions lie in addressing these issues.

The purpose of developing a common African Position is to identify the divergences, the similarities and commonalities in order for us to come to some sort of agreement as to how we would advance in addressing these issues and in order for Africa to speak with one voice when we negotiate our population and development issues at global fora.

Lorna: How does the AU plan to use the out document?

Dr. Margaret Agama: It is a wide continental consultation, we are beginning with the civil societies in Africa, we will consult governments and we shall consult particular countries like the island states because we know they have peculiar issues that are often drowned out when the continent assembles as a whole, we will consult with member states at a higher political level and inclusive of our negotiators in New York who often negotiate these issues on our behalf. Civil society’s voice is important in this conversation, and this is first of the many consultations that we will feed in the broader agenda.

Lorna; My young cousin living in the village, does this process involve her?

Dr. Margaret Agama; Yes, it has a lot to do with her, because as you have already heard from the conversation that took place today, rapid urbanization is a serious population dynamic issue. Whist at the same time, we know that majority of our young people live in rural areas, what is important and significant is that many services which they demand or need are not reaching them and are therefore migrating. Either they become victims of all the population negatives such as teenage pregnancies, school drop out et cetera, they don’t reach their full potential. Some migrate to the nearest urban centers or to other countries or in some cases to continents in search of meeting their full potential. We expect that civil societies groups who are more in touch with these communities bring their voices and concerns into the room.

We can have a plethora list of all the issues, but what are the key issues for particular countries within regions that are of concern out of the long list, and what solutions can be shared within countries and between countries as well as within regions.

Lorna: Any parting thoughts?

Dr. Margaret Agama: You have to remember that this process is guided by AU Agenda 2063, Aspirations One (1) and Six (6) which advocate for ‘a prosperous Africa based on inclusive growth and sustainable development, an Africa whose development is people-driven, relying on the potential offered by African people, especially its women and youth, and caring for children.

Lorna: Thank you so much for your time!

 

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Uganda Churches using the scripture to End FGM..

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Photo Courtesy

Uganda Joint Christian Council (UJCC), member churches (Catholic, Anglican and Orthodox) and the Inter-religious Council of Uganda are working to eradicate FGM through their religious leaders.

“Uganda has a rich legal and policy framework that promotes gender equity however, the implementation is poor. We prioritize to build capacity of religious leaders so that they can understand the legal framework and different referral points depending on the nature and magnitude of harm” Said Dinah Akallo, UJCC

Speaking in Nairobi during a recent convention that brought together inter-faith leaders and faith-based organizations from across Africa, Dinah Akallo, UJCC, said that a law passed in 2010 banning FGM in Uganda has helped to bring down the prevalence.

However, she admitted that some communities still continue to perform the rite, although they do so secretly. Anti-FGM crusaders refer to such communities as hotspots.

“Despite several interventions, FGM has remained remarkably persistent in some isolated communities in Uganda, with some communities crossing the border to perform it in nearby countries,” Dinah said.

The church expressed concern over the fact that the act is often performed on minors, and referred to it as a form of gender-based violence that infringes on the sexual and reproductive health and rights of women and girls, and undermines their dignity.

“We use the Bible as our biggest constitution to educate the masses on Gender Based Violence and FGM. God created us in his own image and likeness, besides the Bible does not mention anywhere about female circumcision.” Dinah Said.

According to UNFPA, nearly 200 million girls and women around the world have gone through the cut. The consequences are both physical and psychological and can last a lifetime.

Dinah said the council favors an approach that empowers the communities to decide for themselves to abandon the practice, as this will instill in them a sense of self-sufficiency.

She said, “Our church utilizes their structures in the affected regions to organize community dialogues with cultural leaders and educational forums for parents, so that the issue of FGM, GBV and HIV/AIDS is widely discussed and consensus is reached on locally acceptable solutions to address the problem”

She also said that uncircumcised married women facing stigma opt for this route in later years, because culture attaches significance to a woman mutilated.

“Culture attaches a lot of significance to a woman who is mutilated. An uncut woman has a lot of limitations for example, she cannot fetch water from the stream before other cut women for she is considered young, she cannot milk a cow for she is still a girl, she cannot enter the granary for she is considered unclean. A man married to an uncut woman is not allowed to sit in clan meetings. But again, most women are cut during child birth by midwives,” she said.

The UJCC is also running a project with the government to scale up gender and equity budgeting in local governments.

Some of the strategies UJCC use to eradicate FGM include capacity building for religious leaders, issuing press statements to hold the government to account, engaging with the media on talks shows, i.e. Radio talks shows that are religion based, and educate the masses on the existing laws that protect the victims.  UJCC also instituted gender-based violence monitors within the community to take note of GBV incidents and report to authorities.

The masses need to be educated on the existing laws as majority are still ignorant about them,” said Dinah.

The UNFPA notes that the global target of eliminating FGM by 2030 will only be achieved if efforts are intensified to address the problem.

Over the past three years, UJCC alongside the Church of Uganda and the Ministry of Gender has been staging an annual anti-FGM run during 16 Days of Activism to raise awareness about the dangers of circumcising girls in Kapchorwa District, where FGM is high.

UJCC is committed to improve the health and well-being of its people as part of God given mandate. This has been partly possible through training and capacity building of religious leaders, as the one offered by Faith to Action Network.

 

 

 

 

Malawi, Where HIV Testing and Treatment is Conducted Within Churches..

In Africa, stigma among members of the public remains a key barrier to seeking HIV testing and treatment services within communities they live in. However, the case is different in Malawi as churches have chosen to counter the situation by taking the services to congregants.

According to 2018 UNAIDS data, Malawi has one of the highest HIV prevalence in the world, with 9.6% of the teenage population aged 15-19 years old living with HIV. UNAIDS further estimated that one million Malawians were living with HIV in 2016 and 25,000 Malawians died from AIDs-related illness in the same year.

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Pastor Howard Kasiya at the faith leaders convention in Nairobi.

“Our people are dying due to lack of knowledge” Said Pastor Howard Kasiya, the National Coordinator of the Health Commission of the Evangelical Association of Malawi (EAM). Pastor Kasiya was speaking during an interview conducted on the sidelines of a recent inter-faith leaders’ training conducted by Faith to Action Network, in Nairobi, to build their capacity to influence changes in policy and social norms in the State of African Women Campaign.

EAM, a faith-based organization understands that health is a universal need. At the heart of evangelism, they run programs which mainstream interventions for the HIV scourge.

Roughly a third of all new HIV infections (12,500 out of 36,000) in Malawi in 2016 occurred among young people aged 15-14. Early sexual activity in Malawi is high with around 15% of young women and 18% of young men aged 15-14 reporting having sex before the age of 15 , (UNAIDS 2018).

Among their programs, EAM churches have teen clubs for young people and youth living with HIV. They meet twice weekly with support from a trained pastor. Teen clubs help answer various questions that young people have concerning issues of HIV infection and treatment.

Similarly, the adults within the churches and communities have HIV support groups for people living with HIV. These groups are also supported by a church leader.

For effectiveness, EAM has trained several religious leaders, of different ages, to become peer educators and counselors on issues of HIV AIDs and offer psychosocial support. The trained persons facilitate discussions within the groups.

In addition, the churches also offer nutrition services to the affected population.

“There has been an attitude change among boys and men who are often rigid at seeking HIV testing services. Many are now requesting for the services” Said Pastor Kasiya.

On days set aside for testing and counselling services, congregants turn out in good numbers. Pastors, deacons and church leaders often lead the congregants in taking up the services. Counselling and testing for HIV is offered by qualified service providers together with trained youth leaders and church leaders.

 “To deal with stigma associated with people going to public testing services, we decided to bring the services closer to them. Service providers come to our churches to conduct testing services. We make the exercise as comfortable as possible for all,” emphasized Pastor Kasiya.

Pastor Kasiya further noted that HIV prevalence has dropped in Malawi over the past few years, but they as a church cannot ignore the rising number of new infections among young people.

Besides HIV and AIDs, EAM also runs programs around Sexual and Reproductive Health, Family Planning, Maternal and child health, Sanitation and hygiene and nutrition.

“What is very important is that we present all these from a biblical perspective, with supportive scriptures from the bible, as an obligation to God” Concluded Pastor Kasiya.

Achieving this kind of commitment from faith leaders has not been easy. There has been constant training and capacity building of religious leaders, such as the one provided by Faith to Action Network with financial support from the European Union, to make faith actors effective amplifiers of the message that optimum health and wellness are a key part of God’s plan for humankind.

Culture, Illiteracy, Obstacles to Family Planning Uptake Among Refugees In Kakuma.

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Mrs. Diing Aten at the “ICPD What has changed conversation”

Uptake of family planning services among men and women living in Kakuma refugee camp and Kalobeyei communities is still low. Reasons for apathy vary; Social cultural beliefs, low education/literacy levels, religious beliefs -all lead to poor health seeking behavior.

“Our culture and traditions are the main reasons why women are wary of family planning services”, said Mrs. Diing Aten during the “ICPD what has changed” conversation event that was held last week in Kakuma.

At the event, women pointed their inability to make decisions in their homes which makes it difficult for them to decide how many children they would want to bear. Such gender inequalities generally place greater constraints on women’s access to Family planning programming.

For Instance, women from South Sudan have little say in their homes. As a matter of fact, they are not allowed to speak before men, or as Diing puts it, “We die with our problems”

However, Diing is happy to have an understanding husband who is warm to the need of spacing their children. At 35, Diing has four children. According to Diing, her age-mates have an average of 6-8 children.

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Diing speaking to three of her four children

Unsurprisingly, Diing is a community leader. She is also a member of the community health committee in Kakuma Refugee Camp. She has interacted with various family planning programmes supported by International Rescue Committee (IRC) and UNFPA Kenya.

She too is a family planning champion. “I use my position to reach out to my fellow women and men. I speak to them about the importance of family planning. I have individually convinced about 10 families. I will still reach out to more.” She assertively affirmed. Diing pointed out that besides culture, women fear using contraceptives for they fear that they might make them infertile.

John Mading prides in his big family of three wives and 13 children. He purports that during war, many men, women and children were killed thereby gravely affecting the South Sudan population. He considers having a big family as away of replacing the relatives he lost during war. “We are replacing our lost population” Said the 47-year-old South Sudanese Refugee who has been living in Kakuma for 27 years now.

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John Mading together with his last wife and some of his children

On his part, Mading maintains that he is fulfilling the theological command by God “Go ye fill the world” He quoted. Mading believes that children are from God and that men should obey Gods’ command.

In addition, he sighted that his culture despises men with less children, “Men with few children are seen to be weak. In fact, if two/three years go by without your wife getting pregnant, the community speaks ill of you.” Said Mading.

According to Mading, cultures such as wife inheritance among the South Sudanese are in place to ensure that widows bear more children which the late husband would have sired before he departed.

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John Madings’ second wife attending to her chores

However, Diing affirmed that awareness and educational programs are active within the refugee community, but the deep-rooted cultural beliefs are a big hindrance to uptake of family planning services.

John Wafula, Humanitarian Programme Specialist, UNFPA Kenya spoke of the above issues as priority matters that will be addressed at the upcoming ICPD+25 Conference, “ it was necessary for us (agencies) to have this conversation with our beneficiaries to illuminate what more can be done to accelerate the ICPD PoA” Said Mr. Wafula

“It is evident that more has to be done especially around the component of advancing gender equality. As the conversation unfolds, we must recognize that reproductive health, women empowerment and gender equality are the pathway to sustainable development” Concluded Mr. Wafula.

Twenty –five years ago in Cairo, Egypt, leaders drawn from 179 countries promised especially women and girls’ reduction in maternal deaths, elimination of violence and ending harmful cultural practices against women, ending unmet need for family planning, and advancing gender equality. This came to be known as the International Conference on Population and Development Programme of Action (ICPD PoA).

 

 

 

 

 

 

Improved Maternal & Newborn Care Has Saved Lives of Refugee Women In Kakuma

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Christine Acholi with her new-born baby at Kalobeyei Red-Cross Hospital

“It has been quite a safe delivery” Said Christine Acholi, a South Sudanese Refugee, as she admiringly looked at her 1-day old baby.

The 21-year-old mother who came to Kakuma in 2017 shared her delivery chronicles at a ward, at Kalobeyei Red Cross Hospital. As a second time mother, she compared her first birth experience to her second one; “My first birth was in 2017 when I had just come to the camp. It was at a clinic at this camp, but my delivery experience here is far much better compared to the other one” She noted

Christine’s statement is not far-fetched; The hospital that offers free maternity care to the refugee and host communities was unveiled back in 2017. On entering, there is a reception on the right and a consultation room on the adjacent left. Well-dressed charming nurses briskly whisk their way up and down the neat, wide corridor, symbolizing the volume of work at the facility.

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The front of Kalobeyei Red Cross Hospital

The facility has spacious admission and labor rooms, a spotless delivery room fitted with modern equipment, a nursery room tailored with incubators and a spacious ward area where new mothers and their babies are monitored before they are discharged.

“We are very happy about services here,” Said, a content father (Christine’s’ husband) who had just stopped by to check on the wife’s and child’s progress.

Anne Wangui, a nurse that has been working at the hospital for two years said that the hospital admits sick mothers, sick babies and pregnant mothers. It receives an average of 3-4 women a day and performs 90-100 safe deliveries every month.

Since she started working at the hospital, Anne notes that there is an increment in the uptake of delivery services; from 10% in 2018 to 20% in 2019; that more women from the refugee and host communities are accepting maternity care.

“When we started, admission was low, but now more women are coming to the facility,” She said.

“In the last two years, we have lost one woman, a South Sudanese national from the refugee community. She over bled and died before she arrived here. We were however able to save the baby. Had the mother arrived in good time, we would have saved her too” Said, a despaired Anne.

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A section of the maternity ward

Anne attributed the increment in hospital deliveries to efforts by Red-Cross Kenya, International Rescue Community and UNFPA Kenya. The agencies have safe motherhood promoters and community health workers who visit homes and monitor pregnancies and deliveries of women.

Anne also noted that technological advancement such as the introduction of the “balloon tamponade” has managed postpartum hemorrhage. As a mater of fact, the facility can manage all deliveries apart from Cesarean Sections. In such cases, patients are referred to other hospitals within the Sub-County of Turkana West.

In addition, 24-hour emergency services have encouraged women to deliver from hospitals. “With the uneven terrain and vastness of Kakuma and Kalobeyei, women had challenges accessing hospitals, but with the introduction of ambulances, women are picked and rushed here whenever they start laboring. The ambulances also rush referred patients to hospitals in case of emergencies” Said Anne.

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Anne Wangui, showing visitors around the Kalobeyei Red Cross Hospital

However, Anne endures both religious and cultural challenges from her patients. She noted that most of the patients are from strictly religious and cultural backgrounds. She gave a case of a Muslim woman who, during a blood transfusion, insisted that she could only receive blood from a fellow Muslim.

In yet another case, a patient claimed that her culture allowed her and her baby to bathe a week after delivery. A situation that poses a health risk to both the mother and the child.

She noted that some cultures do not allow women to make decisions. In cases like Cesarean section the women cannot accept the services without their spouses’ consent. In such scenarios, Anne must respect her patients’ decisions, regardless of the risks at hand.

Illiteracy, ignorance and language barrier are common challenges that Anne battles with daily.

The Kalobeyei Integrated Social Economic Development Plan (KISEDP 2018-2022  has suggested activities to improve the healthcare of both refugee and host communities.

The activities include: Scaling up of a strong healthcare financing mechanism for host communities through the transforming health for Universal Care project; Working with NHIF to ensure government and NGO facilities are accredited and start accessing funds provided in the Linda Mama programme; Staffing and equipping of facilities in line with NHIF requirements to accelerate accreditation; Advocating for a policy framework to facilitate the enrollment of refugees/asylum seekers in the National Hospital Insurance Fund; Increasing awareness among communities on need for enrolment for health insurance to avoid high spending on health; Piloting and advocating for mass enrolment of population from both host and refugees in the NHIF scheme.

 

Accelerating The Reproductive Health Promise For Kakuma Refugees

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Judith Kunyiha, Assistant Representative, UNFPA Kenya moderating the “What has changed” conversation in Kakuma.

“Before we delivered at home, now we deliver in hospitals ….”

A candid statement by Nyibol, a 34-year-old South Sudanese refugee who came to Kakuma Refugee Camp back in 2005.

“Years ago, women refused to go to hospitals since they preferred delivering at home.  As a result, some developed complications and bled to death while others lost their babies,” she continued.

Reflective in her facial expression, Nyibol confirmed improved uptake of antenatal and post- natal information and services by expectant women. “These days women attend antenatal and post-natal clinics as well as hospital delivery. Women previously feared being operated on if they went to deliver in hospital, which, according to our culture is a sign of weakness,” added Nyibol.

The community leader cited efforts by the International Rescue Committee (IRC) who use community health workers to visit homes and check on the progress of expectant women and new mothers. Introduction of emergency referral services such as ambulances has also helped in reduction of maternal deaths, according to Nyibol.

On community involvement in maternal health, Nyibol underscored the existence of a Community Health Committee that oversees the general health of women and children at the refugee camp. Again, these structures did not exist before.

Nyibol was speaking during a community conversation event held last week at the Kakuma Refugee Camp convened by the United Nations Population Fund (UNFPA Kenya) and partners to build momentum for the 25th anniversary of the ICPD slated for 12th -14th November 2019 in Nairobi.

Refugees from the Kakuma Refugee Camp and the Kalobeyei Integrated Settlement, and host community members from Turkana West Sub County thronged the venue of the meeting.

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A South Sudanese Refugee Woman sharing her experience around the “What has changed” conversation in Kakuma.

The interactive community conversation aimed at highlighting the successes and gaps in delivering quality sexual and reproductive health services and protection interventions to refugees and the host community.  As part of build-up activities ahead of the ICPD25 Nairobi Summit, the conversation explored progress towards attainment of the ICPD PoA commitments in humanitarian settings.

While there has been progress in all the areas, women and girls living in Kakuma and Kalobeyei still experience violence, including harmful practices such as forced and child marriage. The women and girls also face the unmet need for family planning which stands at 44%, according to UNHCR data.

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Priscilla Nyimal, Member, Youth Parliament Shares her experience as young woman around the “what has changed” conversation

“Where can one get help as an adolescent girl who needs information and services on reproductive health matters, including pregnancy?” asked an adolescent girl from Monreau Shapelle Secondary School in Kakuma. “Sometimes we require a person in whom we can confide personal reproductive health experiences, but this is difficult because lack of privacy, confidentiality, and stigmatization,” she lamented.

To address this need for safe spaces among adolescent girls and young women, agencies present at the conversation such as the Danish Refugee Council (DRC), IRC and UNHCR urged adolescents to use existing youth friendly centres where an array of youth focused services including life skills are provided. In their staunchly patriarchal societies, women and girls are overtly undermined. Or, as a South Sudanese woman explained, “Our culture prohibits us from making decisions without seeking permission from our spouses. I cannot use any family planning method unless my husband allows me”

It was evident that services are in place, but more educational and awareness programmes should be conducted across the communities.

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Harriet Awour, Women’s protection and Empowerment manager, Red Cross Kenya, responding to questions from the audience during the “What has changed” conversation in Kakuma.

The development partners committed to engage in concerted efforts to secure sexual and reproductive health rights and protection needs in keeping with the determination to accelerate realization of the ICPD Programme of Action.

Twenty –five years ago in Cairo, Egypt, leaders drawn from 179 countries promised especially women and girls’ reduction in maternal deaths, elimination of violence and ending harmful cultural practices against women, ending unmet need for family planning, and advancing gender equality. This came to be known as the International Conference on Population and Development Programme of Action (ICPD PoA).

Media urged to increase coverage of Reproductive Heath Issues affecting slum dwellers.

Urbanization is an inevitable trend. It takes place at different rates and in distinct places. According to UN Habitat , In developing countries, over 880 Million urban residents live in slum conditions. In Sub Saharan Africa, 59 percent of the urban population live in slums and by 2050, African urban dwellers are projected to increase to 1.2 Billion. Africa is not ready for this level of urban population explosion.

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Dr. Esiet Uwemedimo addressing journalists at the media interaction event in Nairobi.

“Residents of Africa’s urban informal settlement represent one population group that is increasingly left behind and at elevated risks for poor sexual and reproductive health and rights outcomes.

For instance, across Africa, unintended pregnancy is among the leading reasons that urban adolescents girls drop out of school. ” Said Dr. Uwemedimo Esiet, Director, Action Health Incorporated, Nigeria

Dr. Esiet spoke yesterday during a media interaction session and launch of the 9th African Conference on Sexual and Reproductive Health and Rights  (ACSRHR), at Sheraton Hotel Nairobi.

He urged journalists to increase reportage of sexual and reproductive health issues that affect women and girls living in urban informal settlements such as; unsafe abortions, maternal mortality and morbidity, sexual and gender based violence, sexually transmitted diseases and HIV/AIDs, unmet need for family planning, harmful traditional practices and early sexual debut, among others.

He further underscored the impact of these issues on the economic outcomes for Africa.

The draft Maputo Plan of Action 2016-2030 notes the need for investing in SRH needs of adolescents, by improving access to and uptake of quality information and services for youth, that also includes family planning through provision of quality integrated youth friendly services.

“We know, you have challenges that you grapple with while covering SRHR stories, reach out to us. We will gladly help you, wherever possible” Reassured Jane Godia, Acting Executive Director, African Gender and Media Initiative (GEM).

Indeed, journalists mentioned of challenges they face while covering SRHR stories including cultural restrictions, respondents fearing stigma, cost of production, sensitivity of some stories and restrictive laws especially on abortion.

Lack of access to sexual and reproductive health services result in unwanted pregnancies and unsafe abortions. Africa is the world region with the highest number of abortion related deaths. In 2014, at least 9% of maternal deaths in Africa were from unsafe abortion. In 2017, about 58 Million women of reproductive age recorded an unmet need for modern contraception.

Addressing the inequalities of women and girls in these informal settlements across Africa is key to achieving  the 2030 Sustainable Development Agenda and the AU Agenda 2063. As journalists, you have a significant role of bringing attention to these issues for governments and respective institutions to act”.  Concluded Godia

Africa’s population is the youngest and fastest growing in the world. Young people aged 10-24 years currently constitute about a third of the region’s population. The number of youth in the region is expected to grow as fertility rates remain high.

A growing proportion of the urban population are young people born and living in resource-constrained urban slums or who migrate to urban areas in search of opportunities. These urban youth live in an environment that offers limited education and employment opportunities, as well as inadequate housing, health, and social services. The result is an impoverished urban youth population with extremely high rates of unemployment and low educational attainment.

The future of Africa depends on its ability to harness the potential of its young people. Making the right investments in youth – particularly those in urban areas – can enable the region to experience substantial economic growth and sustainable national development for current and future generations (i.e. capitalizing on the Demographic
Dividend).

About the conference;

The 9th Conference on Sexual Health and Rights is a part of long term process of building and fostering regional dialogue/alliance on SRH that leads to concrete actions and enhances stake-holder capacity to influence policy and programming in favor of a sexually healthy conference.

The conference will be held on 12-14 February 2020, in Nairobi, Kenya under the theme ‘Advancing the Sexual and Reproductive Health and Rights of women and girls in urban informal settlements’