Welcome to Sati - Sourcing Africa to Invest

👋🏾 Marge and Ona here…

We’re both Ugandan 🇺🇬

And through our work at Benue Capital, we’re on a mission to support Uganda’s tech ecosystem and invest in extraordinary founders across Sub-Saharan Africa.

We write Sati to uncover Africa’s history of tech and private investment to understand the present and predict the future.

Join us; let’s see where this ride takes us 🚌

This is the kick-off of our 3-part series on FemTech in Africa.

We’re excited about this one!

Why?

Because we’re highlighting an industry that hasn’t received much coverage.

Returning to today’s topic…

The inspiration for this piece stems from a conversation with a FemTech founder who has built a solution for African women prone to and fighting cancer.

Our research uncovered the following:

In Part 1 of this series, we want you to walk away understanding:

• Section 1: Why women are pivotal to improving Africa’s economy

• Section 2: The unique health-related challenges African women face that hamper their ability to contribute to economic development

In Part 2, we will share:

• Section 3: Non-tech and FemTech solutions tackling these challenges

• Section 4: Whitespace for founders to build

Let’s dive in.

Section 1: Women are pivotal to improving Africa’s economy

Women’s health is the foundation for social and economic development for two reasons

1. Women represent ~50% of the continent’s human resources but contribute to only 33% of GDP. If more countries focused on advancing women’s health and equality, by 2025 the continent could add $316 billion or 10% to GDP.

2. Women bear life. The better the health of African children, the more productive the continent's workforce and the more fruitful the future economy. However, a child’s health depends on their mother’s health, starting before conception.

Section 2: African women face disproportionately more health-related challenges than women in the rest of the world

Let’s walk through the health-related challenges African women face versus women in other parts of the world by examining:

1. Menstrual Health

2. Fertility and Adolescent Pregnancy

3. Sexually Transmitted Infections

4. Maternal Health

Menstrual Health

For women and girls across Africa, menstruation often brings more than biological changes. It introduces cultural, financial, and social challenges.

The Cost of Menstruation

In certain cultures, a girl is seen as a potential bride and/or sexual partner at the onset of ovulation, exposing her to the risks of early sex, childbearing, and related health complications.

Beyond these risks, many women and girls cannot afford to purchase sanitary products or manage their periods with dignity.

A BBC study across 11 African countries found that women earning minimum wage spend between 3–13% of their monthly income on two packs of sanitary towels, the average requirement.

Even the cheapest available products are unaffordable.

Among surveyed countries, Ghana had the least affordable menstrual products.

With a monthly minimum wage of ~$26, 76% of urban workers earn just enough to scrape by.

One woman recounted how she could previously purchase sanitary pads for 4.88 Ghanaian cedis ($0.45) per pack.

But, when the government imposed higher taxes on sanitary products, prices surged to 20 cedis ($1.84) per pack, placing them well above her means.

Why taxation on feminine hygiene products matters

Taxation drives up the cost of products.

Unfortunately, many governments tax feminine hygiene products as highly as luxury items instead of consumer goods.

Kenya set a precedent with a bold policy shift.

In 2004, it became the first country to remove taxes on period products. In 2016, it went even further, scrapping taxes on raw materials used to manufacture sanitary pads.

As a result, Kenya now has the most affordable menstrual products in Africa, costing just 50 Kenyan shillings ($0.35) per pack.

The impact of period poverty on African women

Period poverty forces many women into difficult and unsafe situations.

Some report exchanging sex for funds to purchase pads, while others resort to alternatives like chicken feathers, mud, newspapers, or reusable materials like old clothes and pieces of blankets.

The lack of proper sanitation facilities in schools and public places further complicates menstrual hygiene management.

Girls frequently miss school during their periods, disrupting their education and increasing the likelihood of dropping out. Early school dropout often leads to early marriage and childbearing, limiting economic opportunities and trapping women in cycles of poverty.

In workplaces, inadequate sanitary facilities reduce productivity, resulting in wage loss and additional barriers to career advancement.

Fertility and Adolescent Pregnancy

Published texts, talks, and podcasts often harp on Africa’s rapidly growing population. It is expected to nearly double by 2050 to 2.5B, making it home to 1 in 3 youth (aged 15-35) globally.

The only way these statistics can be achieved is through high birth rates.

While birth rates in Sub-Saharan Africa have declined over time, they remain significantly higher than in other regions.

Additionally, adolescent pregnancy is most prevalent in Sub-Saharan Africa.

The risks of adolescent pregnancy

Adolescent pregnancy poses public health risks, including higher maternal mortality, low birth weight, and severe neonatal complications.

It can also adversely affect mental, physical, and social well-being, and remains a leading cause of death amongst adolescent girls globally.

Moreover, like period poverty, adolescent pregnancy creates barriers to education, employment, and financial independence.

Factors contributing to high rates of adolescent pregnancy

These factors vary by country but can be broken down into three major buckets:

1. Rate of child marriage

2. Poverty rate

3. Years of schooling

1. Child marriage contributes to adolescent pregnancy

   

   Girls subjected to child marriage typically come from backgrounds with limited education and reside in impoverished, rural areas.

   In some cases, families marry off their daughters to secure dowries.

   Once married, they face familial or spousal pressure to start families or demonstrate reproductive potential, resulting in early pregnancies.

2. There’s a link between poverty and adolescent pregnancy

   

   NIH studies also reveal that poverty drives some girls into coerced sexual relationships with older men to meet basic financial needs.

   Other research found that some girls may intentionally become pregnant to access government support grants targeted at teenage mothers.

3. Lower levels of education are associated with adolescent pregnancy

   

   Adolescents with higher levels of education are more likely to delay sexual activity and marriage. They tend to be more informed about their rights, reproductive health, and the importance of timing marriage and childbirth.

Sexually Transmitted Infections (STIs), HIV, and Cancer

Sub-Saharan Africa records the world's highest STI rates, with women disproportionately affected.

Over 30 bacteria, viruses, and parasites can be transmitted sexually, with some also passed from mother to child during pregnancy, childbirth, or breastfeeding.

8 pathogens are linked to the majority of STI cases:

• 4 are curable: syphilis, gonorrhea, chlamydia, and trichomoniasis.

• 4 are incurable: hepatitis B, herpes simplex virus (HSV), HIV, and human papillomavirus (HPV).

The African woman’s experience with STIs is characterized by late diagnosis and treatment. When untreated, curable infections can lead to infertility, cancer, and other complications, as well as increased vulnerability to HIV.

Below, we take a closer look at HIV and cervical cancer, two diseases that take a huge toll on African women.

HIV

In the 1990s and early 2000s, HIV/AIDS had risen to become the leading cause of death in Africa.

The rollout of antiretroviral (ARV) treatment in 1987 marked a breakthrough and has saved millions of lives in the developing world

But this progress was hard-fought. The first ARV drug was the most expensive drug in history, costing a patient $10,000/year.

In 1988, at the International AIDS Conference in Stockholm, debates arose about how to make treatment accessible in developing countries. It was considered far too expensive for resource-limited settings.

Still, the focus on prevention over treatment continued, leaving many without life-saving treatment.

Change began in 2001 when an Indian generics manufacturer offered ARVs for less than $1/day. Since 2003, international funding has supported the widespread distribution of ARVs, with over 80% sourced from Indian generics.

The dramatic price drop to $50 per patient per year has saved millions of lives.

Yet, women continue to bear the brunt of the epidemic

Women and girls (ages 15+) account for 62% of all people living with HIV in Sub-Saharan Africa, with young women infected almost 10 years earlier than their male counterparts.

Social stigma compounds the challenges faced by infected women, leading to severe consequences such as family break-ups, abandonment by husbands, loss of inheritance, and social exclusion.

The question is, what makes African women more vulnerable to HIV acquisition?

1. Biological risk factors:

   Women are at a greater physiological risk of contracting HIV because they have a greater mucosal surface area exposed to pathogens and infectious fluid for longer periods during sexual intercourse, and are likely to face increased tissue injury.

2. Contextual risk factors

   In many African societies, patriarchal norms often diminish women's agency in sexual decisions. Women risk facing violent repercussions for initiating sex, rejecting sexual advances, or suggesting condom use.

   In some cultures, men are positioned as decision-makers and financial controllers, while women are expected to respect their husbands, accept polygamy, and perform family and community duties.

3. Socioeconomic risk factors

   Low economic status increases vulnerability to HIV transmission in women.

   It is associated with earlier sexual activity, lower condom use, multiple sexual partners, a higher likelihood of non-consensual first sexual experiences, and a greater likelihood of transactional or forced sex to meet financial needs.

HPV and Cervical Cancer

We’re highlighting HPV because it’s the cause of over 65% of cervical cancer cases in Sub-Saharan Africa, the leading cause of cancer deaths among African women.

Africa has the highest incidence of cervical cancer in the world.

As well as the highest rates of death.

Every year ~118,000 African women are diagnosed with cervical cancer, and ~65% die from the disease.

Cervical cancer can be prevented through:

1. HPV vaccination

2. Screening and treatment of precancerous lesions

3. Early diagnosis and treatment

Barriers to prevention

1. Lack of progress in the implementation and performance of HPV vaccination programs

   HPV vaccines became available in 2006. Data indicates that the vaccine cuts cervical cancer cases by ~90%.

   However, the high cost of the vaccine has hampered uptake in Sub-Saharan Africa as many countries cannot afford the negotiated $450 per dose.

   Other explanations include:

   • Lack of awareness and education on the benefits of the vaccine

   • Lack of awareness of where to receive the vaccine

   • Fear that vaccine could affect fertility

   • Inadequate cold chain capabilities

   In 2011, Rwanda was the first Sub-Saharan country to introduce the vaccine. Subsequently, there has been a slow increase in the number of countries adopting the vaccine each year.

   

2. Low uptake of cervical cancer screening

   Although screening has proven to reduce cervical cancer incidence, coverage is limited in developing countries. Average screening rates are 19% compared with 63% in developed countries.

   In Sub-Saharan Africa, screening coverage is ~10%. Factors for low uptake include:

   • Lack of formal education

   • Lack of awareness of where to get screened

   • Negative attitudes and perceived susceptibility

   • Whether the provider screening was male

   • Facilities with overcrowding and overburdened healthcare providers

   • Fear of hidden charges

Maternal Health

Having a child is monumental and, for many women, the greatest joy in life.

Women living in the West are offered a range of services to ensure safe delivery, leading to low levels of maternal death.

However, for several reasons, maternal mortality is disproportionately higher in Sub-Saharan Africa.

Maternal mortality refers to the death of a woman as a result of pregnancy or delivery and includes women who die within 42 days of the termination of their pregnancy.

According to the WHO, Sub-Saharan Africa accounted for ~70% of global maternal deaths in 2020. Most deaths occur due to severe bleeding (hemorrhage), hypertensive disorders in pregnancy, and pregnancy-related infections.

Most deaths are preventable and occur due to:

1. A lack of resources to provide quality care

2. Patient-related factors such as the ability to afford care

Hemorrhage, the leading cause of death, is typically associated with a lack of resources

1. Unskilled delivery assistance

   

   Sub-Saharan Africa suffers from a lack of skilled healthcare providers due to poor working conditions and inadequate pay. Additionally, staff recruitment and retention is a challenge.

2. Delivery in ill-equipped facilities

   Women giving birth frequently encounter delays in accessing necessary care.

   Many deliver at home, and in cases of complications like hemorrhage, there's often a delay in presenting at a health facility.

   Even when a woman reaches a health facility, it might lack critical resources like transfusion blood, necessitating transfer to another center with adequate care.

   This delay can be fatal.

   For example, in Guinea, maternal death odds were significantly elevated in cases that involved transfer to another hospital.

Hypertensive disorders are the second most common reason for pregnancy-related death

These conditions should be diagnosed and treated early in prenatal care.

The WHO recommends at least 4 prenatal visits, yet most Sub-Saharan countries have low coverage of prenatal care.

Factors that affect the likelihood of prenatal care include a woman’s income bracket, education level, and residence (urban versus rural).

When we regroup, Part 2 will discuss:

• Section 3: Non-tech and FemTech solutions tackling these challenges

• Section 4: Whitespace for future founders to build

Bringing us full circle, these solutions will play a role in allowing more women to contribute to the economy, reaching the 2025 goal of a 10% increase in GDP or $316B contribution to Africa’s economy.

That’s all we have for you this week!

Thanks so much for making it to the end!

If there’s anything else you’d like us to explore, send us a note. We’d love to hear from you! You can find us on:

• Twitter: Marge, Ona

• LinkedIn: Marge, Ona

• Email (Reply to this email)

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