LONDON (TrustLaw) - Ghanaian doctor Frederick Sai chose to study medicine partly because of the "glamour of the white coat", and partly because of what he had seen when dressing sores and advising on hygiene in villages back home in the 1940s.
Over the decades, Sai has become a leading campaigner for the rights of women to reproductive healthcare and family planning – pushing the agenda during stints as senior population advisor to the World Bank, leader of the International Planned Parenthood Federation and advisor on population and reproductive health to the president of Ghana.
Even now, in his 80s, Sai continues to beat the drum for better access to contraception for women in Africa.
"I don't think any technology in the last 50 years – since 1960 – that has come into being has made as much difference to human lives as family planning has," Sai told TrustLaw.
It all began in his student days, when he started coming across deaths caused by botched abortions or suicide as the result of unwanted pregnancy.
One girl, a fellow Ghanaian, died after swallowing barbiturates because she was pregnant and the father of the baby did not want to know. It happened while Sai was attending medical school in London.
"This was a girl whose mother died giving birth to her, and her grandmother was the one who had scraped together something so that she could come here and become somebody," Sai said.
Later, as part of his training, Sai was tasked with carrying out post-mortem examinations. Opening up a womb, he sometimes found parts of a foetus or signs of gangrene and abscesses.
" ... to know all of this was unnecessary, that what could be done to prevent that death was to make it safe for the young lady to be able to go to her doctor to say, 'this is what is troubling me and please would you help me' – that touched me deeply," Sai said.
"And then to find the number one preventive for this thing – family planning – was not available ... I became quite passionate."
The absence of birth control also had stark consequences on the living, Sai discovered as he began to specialise in childhood nutrition in Ghana. He saw how quickly infants could become undernourished when their mothers had little or no gap between babies.
"Since the custom was once you're pregnant you stop breast-feeding it meant the child was going to be deposed from the breast with no good alternative feeding," he recalled.
"What was needed was to teach the mother to postpone the next pregnancy a little bit."
According to U.N. estimates, 215 million women in poor countries lack proper access to family planning.
If they had the necessary birth control, the number of unintended pregnancies would be reduced by over two-thirds to 22 million and the number of infant deaths would be halved to 1.5 million each year.
Sai criticised West Africa for lagging behind Southern and East Africa, which had made gains in widening access to birth control particularly Rwanda, Ethiopia and Malawi.
A few years ago, 7 to 10 percent of women in Malawi, in southern Africa, had access to family planning. Now it's close to 40 percent, Sai said.
The secret was political will which, crucially, translated into bringing services closer to communities.
“Not only close geographically but close structurally and culturally. They haven't put white-coated doctors to help service the women," Sai said. "They've put ordinary women, young women, to do it."
'IT'S NOT RIGHT'
Despite being one of the first countries in sub-Saharan Africa to adopt a comprehensive population policy in 1970, Ghana's contraceptive prevalence rates are only around 20 percent, Sai said.
Society, from political leaders to husbands and wives, still does not fully understand the importance of family planning, he said. People tended to focus on someone who has successfully raised 10 or 12 children, he added.
"They don't quote the one who died after having the first child when they were 13 or the one who died after having the fifth child when they were in their forties," Sai said.
Another factor preventing women, especially upcountry, from accessing healthcare is the long distances they often have to trek to receive any kind of such service.
"To think that the woman should walk 5 kilometres, 10 kilometres just to get a month's packet of pills or to get one injection - it's not right," he added.
Although governments could do more, Sai conceded it was difficult for political leaders faced with a range of pressing priorities, from expanding education to building hospitals and roads, to put family planning at the top of the list.
Another drawback was the fact that the Christian church, which remains highly influential in much of Africa, is not pushing for greater access to family planning.
"Even if the church is not aggressively against, it is not aggressively for, and that neutral stance is just as bad when you combine it with the old traditions of 'the more children you have the better, God will provide, nature will provide, many hands will help the farm'," Sai said.
Despite the obstacles, Sai still fights on.