Analytical summary - Gender and women's health
Women’s health has come to the fore in the nation’s health agenda most recently due to concerns over maternal health. The maternal mortality ratio is on the increase (almost doubling between 1992 and 2007) and the nutrition and overall health of pregnant women appears to be impacting on the under‐five mortality rate in general, and newborn mortality in particular, which are not decreasing fast enough to meet MDG 4.
These trends occur in a context of increased delivery at health facilities, indicating challenges in the quality of services. At the same time, spending on maternal, child and adolescent health is declining and emergency obstetric care coverage is very low and inequitable. A 2005/06 EmOC Assessment Report found that only four out of 34 hospitals provided comprehensive EmOC. (MoHSS and Macro, August 2008)
The primary direct causes of maternal mortality in Namibia are severe eclampsia (33%), haemorrhage (25%) and obstructed or prolonged labour (25%). The most common direct obstetric complication treated in Namibia in 2006 was obstructed or prolonged labour (38%). According to the MoHSS, HIV/AIDS is the leading indirect cause of maternal mortality in health facilities, accounting for 37% of total mortality. Other causes include malaria, tuberculosis, meningitis and pneumonia. (MoHSS, 2010)
Efforts are being made to build capacity and skills of health workers to provide quality essential services to mothers during pregnancy and after delivery. The 2011-2015 Strategic Plan for Nutrition includes strategic priorities to improve maternal nutrition and contribute to improved maternal health. The National Strategic Framework on HIV/AIDS delineates additional relevant strategies to address issues related to HIV infection and unwanted pregnancies, abortion, etc. A Road Map for Accelerating the Reduction of Maternal and Neonatal Morbidity and Mortality (2010) was developed to guide Government and partners in achieving universal access to comprehensive quality maternal and neonatal health care, and accelerate progress towards achieving the health MDGs.
The overall welfare of women requires a multi-sectoral approach, and is largely coordinated by the Ministry of Gender Equality and Child Welfare. Namibia has made significant progress in the advancement of gender equality. Legal instruments supportive to the promotion of gender equality and women’s empowerment include among others, the Combating of Rape Act, Domestic Violence Act, Married Persons Equality Act, Affirmative Action (Employment) Act, Communal Land Reform Act, and Local Authority Act.
The recent National Gender Policy (2010-2020) and its Plan of Action (revised in 2011) include guidelines for multi-sector approaches to gender and reproductive health. A National Policy on HIV and AIDS was also adopted to address the special needs of vulnerable groups such as girls and women. By 2006, resources were put aside to roll out the Prevention of Mother-to-Child Transmission (PMTCT) programme to all the 13 regions of the country. Antiretroviral (ARV) treatment is now offered free of charge at all government hospitals and the majority of patients accessing this treatment are females. In 2010, the well-established PMTCT programme was already exceeding the target coverage of 75%. (Madam Penehupifo Pohamba, March 2010; MINISTRY OF GENDER EQUALITY, October 2007; MoHSS and UNAIDS, June 2011)
The Government has put policies in place and has mandated relevant stakeholders to address the issue of the girl-child. These include the Education Sector HIV and AIDS Policy, the National Policy on Orphans and Vulnerable Children and the National Gender Policy (1999) which contains specific recommendations for addressing issues of the girl child. A policy allowing teenage mothers to return to school has also been adopted. Despite these achievements, Namibia is experiencing challenges in implementing its policies and programmes. Factors such as gender-based violence, HIV and AIDS, negative cultural practices and poverty are still challenges that hamper the achievement of gender equality.
Other challenges are new and emerging issues at regional and global level, which have implications for the promotion of gender equality in Namibia. Such issues include globalisation and climate change, which have a disproportional impact on women and girls. (Madam Penehupifo Pohamba, March 2010; MINISTRY OF GENDER EQUALITY, October 2007)
In the health sector, adolescent girls are prioritised under the broader umbrella of adolescent health. The National Health Policy Framework 2010-2020 places emphasis on adolescent health due to the vulnerability of adolescents to HIV and STIs, unplanned pregnancies (19% of all pregnancies in Namibia are teenage pregnancies), unsafe abortion, substances and alcohol abuse, accidents as a consequence of risky behaviour, and mental health problems.
The policy document notes that “with increasing modernisation of Namibian society there is an increasing mismatch between the biological maturity and the socio-psychological role. Biological maturity happens before socio-psychological maturity and leaves a gap.” National Standards for Adolescent Friendly Health Services have been developed and youth-friendly-centres have been established but do not have a wide coverage yet.
A school health programme does exist with a policy document. However, both areas suffer from insufficient coverage, shortage of trained staff and routines for providing services as required. There are legal instruments meant to protect this age group, e.g. protection of minors, minimum age for buying alcohol and tobacco. Other sectors have important roles to play, which calls for intersectoral collaboration.
The policy framework proposes, among others, the creation of community awareness of the health needs of young people, in particular sexual and reproductive needs through media and other channels; increased access to protective means against pregnancy, STI and HIV; treatment of STIs and common ailments; and the provision of adolescent-friendly services based on evidence with adequately trained staff. (MoHSS, July 2010)
The MoHSS places is no specific focus on women beyond the reproductive years, although the NDHS does include statistics on women’s empowerment and demographic and health outcomes. Other areas of the survey that focus on women include family planning, adult and maternal mortality, maternal health, and nutrition of women and children.