For example, a study in Kenya found that three-fourths of family planning workers were unwilling to provide contraceptives to young women who had not given birth. In sub-Saharan Africa, only half of the population has easy access to health care. Africa has one-third as many nurses per capita as the rest of the world. 8 Limited budgets, problems imposed by the HIV epidemic, and few health care providers mean that improving reproductive health services is a challenge for most sub-Saharan African countries. In sub-Saharan Africa, as in other regions of the world, a culture of silence surrounds most reproductive health issues.
Many adults are uncomfortable talking about sexuality with their children.
Others lack accurate sexual health knowledge. 5 Many Africans feel unable to discuss sexuality across perceived barriers of gender and age differences. 3 Many Africans are also reluctant to provide sexually active adolescents with condoms. In several African countries, some people believe that men are biologically programmed to need sexual intercourse with more than one woman. Polygamy is a central, social institution that reinforces this belief.