A bold new policy approach to reproductive justice is taking shape in Pretoria and the rest of the continent should be paying close attention
By Lydia Zigomo
Regional Director, UNFPA East and Southern Africa
Every year, thousands of women across East and Southern Africa die from causes that are entirely preventable.
Despite existing solutions, systems meant to deliver them weren’t built with a justice lens. South Africa is shifting this narrative by pursuing a rights-based sexual and reproductive justice framework anchored in the Constitution by moving beyond service provision towards a comprehensive justice model.
In a recent side event of the fifty-ninth session of the Commission on Population and Development at the United Nations in New York, South Africa’s Deputy Minister Steve Mmpaseka Letsike took to the floor with a message that reframed the entire conversation: that sexual and reproductive health is beyond clinics and contraceptives but justice. Structures holding women and girls back such as inequality, poverty, exclusion cannot be addressed by health systems alone. What is needed is a whole-of-government commitment to Sexual and Reproductive Justice (SRJ), a framework that moves beyond legal rights to dismantle the conditions that prevent those rights from being real.
As East and Southern African countries continue to shape their policy foundations, this serves as a critical case study for future development. South Africa’s strategy is one of the most comprehensive of its kind on the continent. It links reproductive health to gender-based violence, to education and economic participation; treating these not as separate portfolios but as connected expressions of the same inequality. It demands coordination across government departments rather than siloing women’s health inside a single ministry. And it insists on accountability: whether services exist and how to reach the people who need them most.
This kind of systemic thinking is exactly what the region needs and what the data shows makes the difference.
For example, look at what has been achieved when political commitment connects with evidence-based implementation. In Ethiopia, the decision to deploy over 40,000 community health workers along with strategic investment in strengthening the health system and community empowerment contributed to dropping maternal mortality from 676 per 100,000 live births in 2011 down to 141 by 2025. This was a transformation that began with a government willing to follow the evidence wherever it led.
In Rwanda, performance data shaped a strategy that quadrupled the health workforce and achieved near-universal coverage for family planning and antenatal care. In Tanzania, real-time data dashboards gave district managers the visibility to act, and both maternal and child mortality fell steadily as a result.
Each of these countries built something South Africa’s SRJ framework makes explicit: the connective tissue between national policy and community-level reality. Data collected at clinic-level fed back into decisions made at the top. Community health workers were the backbone of delivery, and governments were willing to be held to measurable outcomes.
South Africa’s framework goes even further, asking not just whether services are available, but whether women can exercise their rights in practice. Whether a survivor of violence receives coordinated support across health, legal, and social systems. Whether a young woman in a rural province encounters a health worker who understands her full circumstances, not just her presenting symptoms.
This is the standard the region should be moving toward.
There are honest challenges ahead, and South Africa would be the first to name them. Digital exclusion remains a significant barrier, less than 30 per cent of the region’s population has reliable internet access, which means that technology-driven health solutions risk reaching only those already well-served. Data fragmentation across health systems leaves gaps that undermine even the best-designed policies. And the shift from a service delivery mindset to a justice framework requires sustained political will.
The architecture is there, and the political commitment, demonstrated at the highest levels in New York, is real. And the region has before it a model it can adapt, learn from, and build on. One shaped by an African government that understands its own context.
The conversation that began in Conference Room 7 at UN Headquarters does not end there. It must travel to Harare and Luanda, to Nairobi and Bunjumbura, to every health ministry in the region asking the same urgent question: how do we move from rights on paper to justice in practice?
South Africa has illustrated the way, and the region is inspired to walk it.
The South African government hosted a side event on the Roadmap to the Realisation of Sexual and Reproductive Justice at CPD59, UN Headquarters, New York, on 15 April 2026.
