Six of the East African Community countries – Burundi, Kenya, Rwanda, South Sudan, Uganda and Tanzania – have recently concluded public hearings on a new draft law on sexual and reproductive health. Proponents of the bill argue that it will improve access to sexual and reproductive health which, in turn, will improve other public health and development indicators such as maternal mortality and HIV infection rates. HIV. But the bill has faced fierce opposition since it was first introduced in 2017. Conversation Africa’s Ina Skosana sat down with researchers Anthony Ajayi and Nicholas Etyang to unpack what the bill covers and where the friction points.
Is a regional response practical? Has it worked elsewhere?
Article 118 of the Treaty establishing the East African Community directs partner states to cooperate on health issues and develop policies for the region.
Regional responses can help accelerate progress, harmonize laws, and create a united front to address sexual and reproductive health issues. The development of regional frameworks is not new to the continent. Other examples include the South African Development Community Sexual and Reproductive Health Strategy 2019-2030, the South African Development Community Model Law on Gender Based Violence and the Model Law of the regional body on the eradication of child marriage and the protection of children already in marriage.
Regional frameworks help citizens hold their governments to account. And demand change. The East African region is pushing for integration on many fronts. These include immigration, trade and security policies. Remarkable progress has been made in the field of Trade and immigration. This could be repeated with health cooperation.
But passing regional laws is difficult. In the case of East Africa, seven countries are part of the East African Community. Getting everyone on board is a difficult task, especially when it comes to contentious issues such as sexual and reproductive care.
The first attempt to pass a Sexual and Reproductive Health Bill in East Africa was in 2017, with the 3rd Legislative Assembly. But many concerns raised by stakeholders. And the limited time for consultation before the end of their term meant the bill could not move forward.
The 4th Legislative Assembly began work on the bill in January 2020 and conducted a series of consultations with stakeholders. But the resistance continues.
Why is the invoice important?
The 2021 version of the bill is progressive legislation. It has enormous potential to address the sexual and reproductive health challenges of East Africans. Adolescent girls are disproportionately affected by sexual and reproductive health issues. The bill addresses these disparities in a substantial way.
In East Africa, complications from early pregnancy and childbirth are among the leading causes of death among older girls 15 to 19 years old. Young girls are also disproportionately exposed to new HIV infections and sexual violence. If passed, the bill will address teenage pregnancies and protect the right of young mothers to return to school.
Unsafe abortions are also among the leading causes of maternal death. These count for around 10% of maternal mortality. By expanding access to safe abortion, more lives would be saved. If passed, the bill will be a huge victory for the reproductive rights of women and girls in the region.
What’s in the bill?
The Sexual and Reproductive Health Bill sets out five ambitious goals. These are:
- protect and facilitate the realization of the sexual and reproductive health and rights of all people throughout their lives;
- promote and provide age-appropriate sexual and reproductive health information and services for all people, including adolescents and young people
- facilitate and promote the prevention of neonatal, infant, maternal mortality and morbidity from preventable causes;
- facilitate and promote the reduction and elimination of unsafe abortions, HIV and other sexually transmitted infections, early and unwanted pregnancies; and
- to prohibit and facilitate the elimination of harmful practices.
The bill has 29 articles covering a range of issues. These include the integration of sexual and reproductive health services into universal health coverage, sex education, continuation of education after pregnancy, menstrual health as well as family planning.
In addition, the bill includes provisions to protect the sexual and reproductive health and rights of persons with disabilities.
Section 16 provides for limited access to abortion on the grounds that, in the opinion of a health worker, the pregnancy may endanger the mental or physical health or life of the woman. In addition, in cases of sexual assault, rape and incest.
Article 17 protects the right of women and girls to postabortion care, regardless of the legality of the abortion. It also protects health workers from prosecution for providing postabortion care.
Article 21 recommends limiting the use of assisted reproductive technologies such as surrogacy to only those medically diagnosed as unable to have children. Further, it recommends that partner states grant special licenses to designated providers and protect surrogate mothers from exploitation.
Article 22 prohibits harmful cultural practices such as child marriage, forced sterilization and female genital mutilation.
Finally, the bill mandates partner states to develop and implement joint strategies for detecting, preventing, and reporting sexual and gender-based violence.
What is the delay in passing it?
The bill faced opposition in public hearings held June 27-30. Some oppose the bill entirely, while others want certain provisions removed.
Resistance comes mainly from religious and conservative groups, who argue that some provisions of the bill are part of the Western agenda and run counter to East African cultural values.
Three sections of the bill remain contentious despite revisions made after first reading and stakeholder consultations.
The first is the provision of comprehensive sex education for young people, which they oppose because they believe it will expose children to early sex. Some wonder why the government should be responsible for providing sex education to children rather than parents. They also oppose access to contraception for young people and argue that abstinence-only messages should be provided to young people. It is despite scientific evidence on the contrary.
A representative from Uganda’s Ministry of Education wants the word ‘full’ removed as it is inconsistent with nationally approved language.
Proponents of the bill argue that sex education is not just about sex, but encompasses information about menstrual health, decision-making, body awareness, social skills (family, respect and kindness), consent sexuality, healthy relationships, gender-based violence, HIV testing, and pregnancy.
The abortion provision meets with the most opposition. Opponents dispute the bill’s definition of abortion and argue that it does not reflect African values. They say that, if passed, the bill will make abortion services available on demand.
Partner States have ratified the Maputo Protocol, which permits the termination of pregnancy on the grounds set out in the bill. But opponents reject the provision that allows termination of pregnancy in cases of rape, incest and sexual assault. Burundian government stakeholders say the bill encourages immorality and the voluntary termination of pregnancy, contrary to divine principles, the national constitution and culture.
Finally, critics object to the section on surrogacy, saying it deviates from the order of creation and allows LGBT people to have children. A few Muslim leaders in Kenya and Tanzania reject the ban on child marriage and argue that once menstruation begins, regardless of age, a girl can be married.
Nicolas Okapu EtyangPolicy Officer, African Center for Population and Health Research
Anthony Idowu AjayiAssociate Researcher, African Center for Population and Health Research