WOMEN’s decision-making and choices in relation to reproductive health, including engaging in sexual activity and condom use, are essential for good reproductive health and well-being.
Gender inequality has robbed women of their Sexual, Reproductive Rights (SRH) and their ability to control their sexual reproductive options as they continue to experience obstacles of when and if they wish to start a family and negotiate for safer sex.
Getting sexual partners to talk to one another about their reproductive rights is evidently an important step towards having a healthy relationship.
To date, gender inequality in reproductive health in Africa still remains a challenge in both married and unmarried partners as decision making continues to be determined by male partners.
If campaigns on reproductive health are to be effective, we need to recognise existing cultural patterns of decision-making.
The female dominated structure of most family planning, fertility, HIV/AIDS and safe motherhood programmes have seen most men shun them despite calls by different stakeholders calling men to get involved.
In adolescents, at household and community level, it is specifically targeted by harmful practices to children through early marriage with female genital mutilation FGM) in some regions.
Studies show young people aged 15 to 19, who represent 20.3 per cent of the African population, are at risk of early and unwanted pregnancy which has led to unsafe abortion, Sexually Transmitted Diseases (STDs) and dropping out of school.
For instance, Eastern Province in Zambia has one of the highest rates of early marriages affecting the young girls who become mothers while they are still girls.
This poses a risk to their sexual and reproductive health as they get repeated pregnancies and go through child birth before they are physically ready.
In addition, they are also at high risk of unsafe sex as they have less control over deciding on their sexual and reproductive matters.
The risk is intensified by unsafe sex of intimate partners and sexual violence.
Sexual and reproductive health may refer to individuals being able to freely make decisions about their sexual activity; that is, choose when, where, and with whom to indulge in sexual activities.
A family planning and antenatal health service provider in one of the local clinics in Ndola said the response of men participating in reproductive health programmes is still low and more campaigns were needed to encourage them to participate.
The nurse, who could not disclose her name, said the role of a man during a partner’s pregnancy is to offer financial, emotional and physical support and be present during antenatal clinics.
She said since most women are economically dependent on men, their nutritional status, especially during pregnancy, also depends heavily on their partners.
Because of that, most of their sexual decisions are determined by their partners.
‘‘Women’s ability to make decisions regarding their reproductive health has important outcomes for their health and also their well being,” the nurse said.
She said empowering women to take charge of their reproductive health should focus particularly on those with low educational background and those coming from vulnerable back grounds.
“Imagine a pregnant woman found HIV positive during her first trimester of pregnancy and coming back for their next visit without their partner compounded with a negative message from home. So these women and young girls have to be put on antiretroviral medicines without the consent of their partner and they continue to have sexual relations without any protection throughout their pregnancy and also after birth,” she said.
The nurse said attending to women coming from an educational back ground is different as some women have chances of negotiating for safer sex and increasingly take active decisions on matters affecting their reproductive health.
The health worker said the reality of the cultural barriers that saw men take decisions on family size, when to have a baby and choice of spacing and using protection even when they know their status still, has some influence in some couples.
She said from her experience with counseling women in clinics, male partners were primary decision makers regarding marital sexual activity.
Further research indicates that men make up slightly less than half of the adults living with HIV across the world.
Men account for nearly 60 per cent of the AIDS related deaths.
However, the story on infertility is different for women because the pressure from society puts the blame on infertility on the women and leaves out the men.
Infertility is a reproductive health problem affecting many couples and despite community awareness on the causes of infertility which shows that both women and men can be victims, women still endure the worst of the blame.
Because the blame is lamped on women, it is compounded with male partners not willing to seek medical attention together with their partners for fear of being found with the problem of inability to bear children.
This practice of inequality in decision making in reproductive health matters has taken away the joint responsibility of the husband and wife attending to the problem, living it all on the woman.
Merck Foundation Africa, through its programme ‘Merck more than a Mother’, working with African first ladies in raising community awareness, believes that the media plays a significant role.

The foundation, through its CEO senator Dr Rasha Kelej says the important role that media plays to influence our society to create a cultural shift with the aim to break the stigma around infertility in general and infertile women in particular.
The foundation, through its activities, raises awareness of male infertility and infertility prevention through the ‘Merck Foundation More Than a Father’ campaign.
The foundation also raises awareness in other social issues affecting African communities which also have a negative bearing on reproductive health of women.
These include programmes such as supporting girl education, women empowerment, ending child marriage, ending FGM, and or stopping Gender Based Violence (GBV) at all levels in different countries.
Similarly, despite major strides in increasing access to reproductive and sexual health services through family planning over the past few decade and supply methods prioritised, women still lack the power to make decisions about their own bodies, including when to become pregnant.”
Given the inequalities in reproductive health on women and girl, and its effects on their health there is need to address the patriarchal perception of decision making with and an inclusion of men participation in all reproductive health programmes.
Further, when women are empowered in SRH decision making, they are more likely to negotiate safer sex and have higher HIV related knowledge and make an informed decision about the health of their children through routine child health and immunisation programms.
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