Unmet Need and Fertility Decline: A Comparative Perspective on Prospects in Sub-Saharan Africa

Background:Rheumatological diseases are common in Sub-Saharan Africa [1] but specialist healthcare is limited and there are less than 150 rheumatologists currently serving 1 billion people in Sub-Saharan Africa [2]. Rheumatologists practising in the UK NHS are likely to be exposed to migrant patients. There is therefore, an unmet need for health care providers to understand the differences in rheumatology healthcare provision between Sub-Saharan Africa and the UK and the barriers which migrants face in their transition of rheumatology care.Objectives:To gain an understanding of the experiences of patients with rheumatological conditions, about their past healthcare in Sub-Saharan Africa and their transition of care to the UK.Methods:A qualitative study using semi-structured interviews was conducted. Participants were recruited from two rheumatology outpatient clinics in London. Thematic analysis was applied to identify key themes.Results:Seven participants were recruited. Five had rheumatoid arthritis, one had ankylosing spondylitis and one had undifferentiated inflammatory arthritis. Participants described the significant impact their rheumatological conditions had on their physical and emotional wellbeing, including their social and financial implications. Compared to the UK, rheumatology healthcare in Sub-Saharan Africa was characterised by higher costs, limited access to specialists, lack of investigations and treatments, the use of traditional medicines and poor communication by clinicians. Barriers to transition of rheumatology care to the UK were: poor understanding of rheumatological conditions by the public and primary care providers, lack of understanding of NHS entitlements by migrants, fear of data sharing with immigration services and delayed referral to specialist care. Patient, doctor and public education were identified by participants as important ways to improve access to healthcare.Conclusion:This study has described, for the first time, patients’ perspectives of rheumatology health care in Sub-Saharan Africa and the transition of their care to the UK. These initial findings allow healthcare providers in the UK to tailor management for this migrant population and suggests that migrants need more information about their NHS entitlements and specific explanations on what non-clinical data will be shared with immigration services. To increase access to appropriate care, a concerted effort by clinicians and public health authorities is necessary to raise awareness and provide better education to patients and migrant populations about rheumatological conditions.References:[1]G. Mody, “Rheumatology in Africa-challenges and opportunities,” Arthritis Res. Ther., vol. 19, no. 1, p. 49, 2017.[2]M. A. M. Elagib et al., “Sudan and Sweden Active Rheumatoid Arthritis in Central Africa: A Comparative Study Between,” J. Rheumatol. J. Rheumatol. January, vol. 43, no. 10, pp. 1777–1786, 2016.Acknowledgments:We are grateful to the patients involved in this study for their time and involvement.Disclosure of Interests:None declared

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Digital Connectivity in Sub-Saharan Africa: A Comparative Perspective

SSRN Electronic Journal ◽

10.2139/ssrn.3482294 ◽

2019 ◽

Author(s):

C. Emre Alper ◽

Michal Miktus

Keyword(s):

Sub Saharan Africa ◽

Comparative Perspective ◽

Sub Saharan

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Coloniality in Sub-Saharan Africa and the Americas

Journal of Developing Societies ◽

10.1177/0169796x19868317 ◽

2019 ◽

Vol 35 (3) ◽

pp. 367-390 ◽

Cited By ~ 1

Author(s):

Jurgen Poesche

Keyword(s):

Social Science ◽

Natural Science ◽

Status Quo ◽

Sub Saharan Africa ◽

Comparative Perspective ◽

State Sovereignty ◽

Minority Status ◽

Power Structures ◽

The Status ◽

Sub Saharan

The objective of this article is to contribute to the development of a common narrative on coloniality in Sub-Saharan Africa and the Americas. Since scholars tend to focus on either Sub-Saharan Africa or the Americas, a gap between these important regions has emerged in the literature on coloniality. This article seeks to bridge this gap by providing a comparative perspective on coloniality, and this hopefully will enhance Indigenous African nations’ and Indigenous American nations’ understanding of what needs to be done to overcome coloniality. The article explores three key theses. First, in spite of the differences in the extant societal power structures in the postcolonial African states and the former settler colonial states in the Americas, this article argues that the continued dynamics of coloniality are similar in Sub-Saharan Africa and the Americas. The minority status of Indigenous American nations throughout the Americas renders addressing coloniality more challenging than in Sub-Saharan Africa where Indigenous African nations are in the majority although they generally do not have effective sovereignty. Second, the extant societal power structures associated with both coloniality and occidental modernity have weaponized occidental jurisprudence, natural science and social science to defend and proliferate the status quo assisted by state sovereignty. Addressing coloniality effectively therefore requires a renaissance of Indigenous African and Indigenous American cosmovisions unaffected by modernity. Third, addressing coloniality in Sub-Saharan Africa and the Americas requires the recognition of the comprehensive and supreme sovereignty of the Indigenous African nations in all of Sub-Saharan Africa, and Indigenous American nations in all of the Americas.

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The Role of Public Population Institutions on Fertility Outcomes in Sub-Saharan Africa

Population Horizons ◽

10.1515/pophzn-2017-0002 ◽

2017 ◽

Vol 14 (1) ◽

pp. 1-8 ◽

Cited By ~ 3

Author(s):

John F. May

Keyword(s):

Fertility Decline ◽

Fertility Transition ◽

Economic Benefits ◽

Public Institutions ◽

Sub Saharan Africa ◽

Demographic Dividend ◽

The Public ◽

Population Policies ◽

Sub Saharan

Abstract The UN Population Division currently projects the population of Sub-Saharan Africa will reach 4 billion by the end of this century, unless we see a sharp decline in the region’s fertility rates. Although the region has embarked on its demographic transition, this process is occurring at a slower rate than in the rest of the developing world and seems to be stalling in several countries. The economic benefits that would follow from an acceleration of the fertility decline are now widely recognized but the SSA leadership is only slowly changing its attitude towards population issues. This paper’s discussion of SSA population growth focuses on fertility, and the identification of factors that may lead to fertility decline, with particular attention to the direct influence of public institutions. These are the public institutions dealing with family planning programs or those designed to prepare and implement population policies and/or monitor the demographic dividend. Reviewing the experience of these institutions in the SSA context allows us to suggest ways to strengthen them with the view of accelerating the fertility transition in the region, opening a demographic window of opportunity, and capturing a first demographic dividend.

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TRACKING CHANGES IN STATES OF CONTRACEPTIVE USE OVER TIME IN SUB-SAHARAN AFRICA THROUGH COHORT AND PERIOD ANALYSES

Journal of Biosocial Science ◽

10.1017/s0021932014000108 ◽

2014 ◽

Vol 47 (3) ◽

pp. 329-344 ◽

Cited By ~ 2

Author(s):

ELIZABETH LEAHY MADSEN ◽

BERNICE KUANG ◽

JOHN ROSS

Keyword(s):

Contraceptive Use ◽

Age Groups ◽

Unmet Need ◽

Sub Saharan Africa ◽

African Countries ◽

Younger Women ◽

Health Survey Data ◽

Sub Saharan ◽

Representative Samples ◽

Unmet Need For Contraception

SummaryIt is difficult to gauge the success of programmatic efforts to reduce unmet need for contraception without knowing whether individual women have had their need met and adopted contraception. However, the number of true longitudinal datasets tracking the transition of panels of individual women in and out of states of contraceptive use is limited. This study analyses changes in contraceptive use states using Demographic and Health Survey data for 22 sub-Saharan African countries. A cohort approach, tracking representative samples of five-year age groups longitudinally across surveys, as well as period-based techniques, are applied to indicate whether new users of contraception have been drawn from women who previously had no need and/or those who had unmet need for family planning. The results suggest that a greater proportion of increases in contraceptive use in recent years can be attributed to decreases in the percentage of women with no need, especially among younger women, than to decreases in the proportion with unmet need.

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On the pace of fertility decline in sub-Saharan Africa

Demographic Research ◽

10.4054/demres.2017.37.40 ◽

2017 ◽

Vol 37 ◽

pp. 1327-1338 ◽

Cited By ~ 11

Author(s):

David Shapiro ◽

Andrew Hinde

Keyword(s):

Fertility Decline ◽

Sub Saharan Africa ◽

Sub Saharan

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Francophone Africa at fifty

10.7228/manchester/9780719089305.001.0001 ◽

2013 ◽

Cited By ~ 7

Keyword(s):

West Africa ◽

Colonial Period ◽

Sub Saharan Africa ◽

Comparative Perspective ◽

Colonial Rule ◽

Francophone Africa ◽

French West Africa ◽

Post Colonial ◽

French Colonial ◽

Sub Saharan

2010 marked the 50th anniversary of the ‘Year of Africa’. All France’s colonies in sub-Saharan Africa gained their independence in that year. This book brings together leading scholars from across the globe to review ‘Francophone Africa at Fifty’. It examines continuities from the colonial to the post-colonial period and analyses the diverse and multi-faceted legacy of French colonial rule in sub-Saharan Africa. It also reviews the decolonization of French West Africa in comparative perspective and observes how independence is remembered and commemorated fifty years on.

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Socio-economic and demographic predictors of unmet need for contraception among young women in sub-Saharan Africa: evidence from cross-sectional surveys

Reproductive Health ◽

10.1186/s12978-020-01018-2 ◽

2020 ◽

Vol 17 (1) ◽

Author(s):

Bright Opoku Ahinkorah ◽

Edward Kwabena Ameyaw ◽

Abdul-Aziz Seidu

Keyword(s):

Young Women ◽

Formal Education ◽

Economic Status ◽

Unmet Need ◽

Wealth Quintile ◽

Sub Saharan Africa ◽

African Countries ◽

Socio Economic Status ◽

Sub Saharan ◽

Unmet Need For Contraception

Abstract Introduction Globally, sub-Saharan Africa (SSA) bears the highest proportion of women with unmet need for contraception as nearly 25% of women of reproductive age in the sub-region have unmet need for contraception. Unmet need for contraception is predominant among young women. We examined the association between socio-economic and demographic factors and unmet need for contraception among young women in SSA. Methods Data for this study obtained from current Demographic and Health Surveys (DHS) conducted between January 1, 2010 and December 31, 2018 in 30 sub-Saharan African countries. The sample size consisted of young women (aged 15–24), who were either married or cohabiting and had complete cases on all the variables of interest (N = 59,864). Both bivariate and multivariable binary logistic regression analyses were performed using STATA version 14.0. Results The overall prevalence of unmet need for contraception among young women was 26.90% [95% CI: 23.82–29.921], ranging from 11.30% [95% CI: 5.1–17.49] in Zimbabwe to 46.7% [95% CI: 36.92–56.48] in Comoros. Results on socio-economic status and unmet need for contraception showed that young women who had primary [aOR = 1.18; CI = 1.12–1.25, p < 0.001] and secondary/higher levels of formal education [aOR = 1.27; CI = 1.20–1.35, p < 0.001] had higher odds of unmet need for contraception compared to those with no formal education. With wealth status, young women in the richest wealth quintile had lower odds of unmet need for contraception compared with those in the poorest wealth quintile [aOR = 0.89; CI = 0.81–0.97, p < 0.01]. With the demographic factors, the odds of unmet need for contraception was lower among young women aged 20–24 [aOR = 0.74; CI = 0.70–0.77, p < 0.001], compared with 15–19 aged young women. Also, young women who were cohabiting had higher odds of unmet need for contraception compared to those who were married [aOR = 1.35; CI = 1.28–1.43, p < 0.001]. Conclusion Our study has demonstrated that unmet need for contraception is relatively high among young women in SSA and this is associated with socio-economic status. Age, marital status, parity, occupation, sex of household head, and access to mass media (newspaper) are also associated with unmet need for contraception. It is therefore, prudent that organisations such as UNICEF and UNFPA and the Bill & Melinda Gates Foundation who have implemented policies and programmes on contraception meant towards reducing unmet need for contraception among women take these factors into consideration when designing interventions in sub-Saharan African countries to address the problem of high unmet need for contraception among young women.

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