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This paper reviews 44 National Adaptation Programmes of Action (NAPAs) to assess the NAPA process and identify the range of interventions included in countries' priority adaptation actions and highlight how population issues and reproductive health/family planning (RH/FP) are addressed as part of the adaptation agenda. A majority of the 44 NAPAs identify rapid population growth as a key component of vulnerability to climate change impacts. However, few chose to prioritise NAPA funds for family planning/reproductive health programmes. The paper emphasizes the need to translate the recognition of population pressure as a factor related to countries' ability to adapt to climate change into relevant project activities. Such projects should include access to RH/FP, in addition to other strategies such as girls' education and women's empowerment that lead to lower fertility. Attention to population and integrated strategies should be central and aligned to longer-term national adaptation plans and strategies.

Tens of thousands of African women die every year because societies and governments either ignore the issue of unsafe abortion or actively refuse to address it. This paper explores the issue of abortion from a feminist perspective, centrally arguing that finding appropriate strategies to reclaim women's power at an individual and social level is a central lever for developing effective strategies to increase women's access to safe abortion services. The paper emphasises the central role of patriarchy in shaping the ways power plays itself out in individual relationships, and at social, economic and political levels. The ideology of male superiority denies abortion as an important issue of status and frames the morality, legality and socio-cultural attitudes towards abortion. Patriarchy sculpts unequal gender power relationships and takes power away from women in making decisions about their bodies. Other forms of power such as economic inequality, discourse and power within relationships are also explored. Recommended solutions to shifting the power dynamics around the issue include a combination of public health, rights-based, legal reform and social justice approaches. (Afr J Reprod Health 2004; 8[1]:43-51) RÉSUMÉ Pouvoir dynamique qui perpétue l‘avortement à risque en Afrique: une perspective féministe. Des dizaines des milliers des femmes africaines meurent chaque année parce que les sociétés et les gouvernements négligent la question de l‘avortement à risque ou refusent carrément de l‘aborder. Cet article étudie la question de l‘avortement d‘une perspective féministe, en avançant l‘argument que la recherche des stratégies appropriées qui permettent de reclamer le pouvoir de la femme au niveau individuel et social constitue un lévier central pour l‘élaboration des stratégies efficaces pour augmenter l‘accès de la femme aux services de l‘avortement sans risque. L‘article met l‘accent sur le rôle central du patriarcat en modélant les façons dont le pouvoir se mousse au niveau des rapports individuels: sociaux, économiques et politiques. L‘idéologie de la supériorité masculine nie le fait que l‘avortement est une question importante de statut et encadre la moralité, la légalité et les attitudes socio-culturelles envers l‘avortement. Le patriarcat sculpte des rapports de pouvior inégaùx et nie à la femme le pouvoir de prendre des décisions en matière concernant son corps. D‘autres formes de pouvoir telles l'inégalité économique, le discours et le pouvoir au sein des rapports sont aussi explorés. Pour effectuer un changement dans la dynamique de pouvoir à l‘égard du problème, nous préconisons, entre autres, une approche qui sera basée sur la santé publique, sur les droits, la réforme légale et la justice sociale. (Rev Afr Santé Reprod 2004; 8[1]:43-51)

There are at least three basic reasons for the indispensability of scientific knowledge dissemination to the improvement of reproductive health in Africa. First, Africa is the only major region of the world with extremely heavy burdens of reproductive ill-health, the main causes of which proven low-cost solutions are known but have not been implemented on a massive scale in many of the countries that make up the continent1 . Second, several key reproductive health (RH) issues including family planning (FP), sexual practices, pregnancy, sexual and gender-based violence, sexuality education, abortion, and infertility have persistently been shaped by widespread misinformation, myths, ignorance and a culture of silence2,3. Third, most of the published scientific evidence on a number of critical RH issues in Africa are produced in other geographies and culture areas4,5 . Thus, their associated recommendations and policy prescriptions are sometimes irrelevant or inappropriate to countries in Africa especially for RH outcomes that are largely determined by sociocultural beliefs, attitudes and practices. A key need therefore was for regular production and dissemination of rigorous scientific evidence and analysis on Africa, and especially by Africans, on the determinants, correlates and consequences of the major reproductive health challenges confronting Africa. This was and remains the gap that the African Journal of Reproductive Health (AJRH) has been working so hard to narrow in the last 20 years. Simply put, by continuously disseminating African RH research results to many of those who need to have such information, the AJRH has been shaping with scientific evidence, actions in the RH policy, programme development, and service delivery across Africa. It has by so doing added a lot of value to African RH knowledge production since a research is as useful as the sharing of its results with those who need to know6 . As a scholar-practitioner in this field, I had the rare privilege, for 11 unbroken years as a Senior Programme Officer with the Ford Foundation (1997- 2008), of working to support the efforts of the Women‘s Health and Action Research Centre (WHARC) at building the AJRH into a world-class scientific journal. It is thus from my first-hand experience as a witness to the growth of the AJRH that I am able to further outline some of the specific ways the journal has contributed to reproductive health promotion in Africa and some of the critical success factors in this process. In my considered view, notable among the hitherto often neglected but significant RH issues in sub-Saharan Africa that the AJRH helped to call needed policy and research attention to over the last twenty years are: (i) Level and determinants of HIV serodiscordance among married couples (ii) Etiology of and responses to primary and secondary infertility (iii) Sexual health-seeking behaviors of unmarried adolescents and young adults and related policy interventions including sexuality education and youth-friendly services (iv) Multiple dimensions of unmet need for FP, unintended pregnancy, and unsafe abortion (v) Sociocultural and economic drivers of intergenerational sexual relations (vi) Biomedicine, prevention and management of reproductive tract infections (and cancers) (vii) Key populations (including men who have sex with men) in HIV prevention and impact mitigation (viii) RH needs of persons living with HIV (ix) Correlates and effective solutions associated with preventable maternal mortality and morbidities (x) RH effects of child marriage, female genital mutilation (FGM) and other forms of genderbased violence As exemplified by many of the papers in this issue of the journal, the range, depth, diversity and cross-cutting nature of the issues that have been addressed by the AJRH since 1997 helped to reaffirm the interconnectedness of sexual and reproductive health and rights, and sustainable development, thereby firmly placing the former within the mainstream of public policy discourse across Africa. I strongly believe that it is not a mere coincidence that as the AJRH grew in stature so did we witness a progressive increase in the rate of enactment of strong evidence-based national policies and strategies on critical RH issues in most African countries7.8 . It is to the eternal credit of Professor Friday Okonofua, founder of WHARC, the publisher of the AJRH and his associates and supporters that the AJRH did not suffer premature death or stunted growth. Rather, it successfully navigated several growing pains that made it stronger. Key to this successful evolution of the AJRH into a thriving and credible international scientific journal is a number of factors that deserve to be underlined and these include: (i) Visionary leadership and astute management of the organization behind the journal (ii) Agility and adaptability in the face of operational challenges (iii) Mission fidelity, uncompromising emphasis on quality, and an unwavering Afrocentric-cum-Pan African ethos (iv) Loyal and sustained partnerships with international, academic, civil society, and funding institutions (v) Institutional humility and openness to learning and innovation There are so many other lessons to be learned from the AJRH‘s story, but suffice to say that the foregoing short summary represents a veritable template for making success of scientific journal publishing in Africa. But it is not a journey for the faint-hearted. To continuously publish four times a year an international standard scientific journal in a very challenging business operating environment like Nigeria, and on a specialized subject matter that is full of controversies and sensitivities, is indeed a very tall order. Finally, I want to emphasize the huge contribution that the AJRH has made and continues to make to the academic careers of budding African scholars in the fields of public health, gender studies, medicine and allied disciplines. Truth be told, scientific publishing is neither a completely apolitical enterprise nor a level playing field. It is thus often extremely difficult for a young unknown and locally based African scholar to break into a major international journal9 . We must therefore fully appreciate the role of the AJRH in availing this category of academics the door-opening opportunity to be published on an internationally recognized and respected scientific platform. All those associated with the ARJH are to be saluted for their courage, tenacity, and drive for excellence and are encouraged to stay the course that has led the journal this far. Nonetheless, the crowded and highly competitive world of scientific publishing offers no guarantees even for a successful journal like the AJRH. So, it is recommended that the ARJH begins to focus more on issues and topics related to improving our understanding of the barriers to effective RH-related policy implementation. It needs to also encourage scholars to investigate more rigorously the factors, processes and outcomes associated with institutional adoption of innovations and individual adoption of new behaviors. For we now have across Africa a largely favorable policy environment and know the solutions to the bulk of the RH challenges still confronting the continent. Africa just needs to seriously get on with universalizing the application of the well-documented proven solutions. The AJRH‘s continued relevance and sustained value additionally may well derive from giving increasing attention to this cluster of issues in the years to come.

This paper examines the rapid increase in Nigeria's sex ratio at birth from 1.03 boys born for every 1 girl born in each year from 1996-2008 to 1.06 in each year from 2009-2014, second only to Tunisia in Africa at 1.07. The average sex ratio at birth in the world in 2014 was 1.07. In most Black African nations or Black majority nations, it is 1.03 or less. Among the factors presented for this development are: historical fluctuations of sex ratio at birth; geography and ethnicity; male preference/chasing a son; Age of parents; high death rates of male infants and males in general; and wealth/socioeconomic status. Among the potential implications are: young and poor men in Nigeria may not be able to find brides and form families due to a potential shortage of females; emigration of young and poor Nigerian men to West (Africa) and elsewhere to seek brides and form families; immigration of marriage age women from West (Africa) and around the world to Nigeria to seek husbands; and low contraceptive use and high fertility rates in Nigeria.

There is no research on the timing, sequencing and number of changes in family environment and their influences on sexual and reproductive health outcomes in Africa. Using a population-based survey with data on family structure at three points in the life course, this paper examines the influences of these family structure dynamics on the timing of first sex among unmarried males and females aged 12-24 years in Cameroon. The number and timing of family transitions significantly impacted the timing of sexual debut for both males and females. The median age at first sex (18.7 years) is higher among young people without family transition than among those with one transition (18.2 years) or two transitions (17.7 years). Family transitions occurring during childhood were significantly associated with premature sexual initiation for females but not for males. Reproductive health and social development interventions for young people in Africa should integrate the changing contexts and transitions in family structure.

Addressing adolescent sexual and reproductive health issues are central to efforts for reducing childhood and maternal mortality embedded in MDG4 and MDG5. This paper reviews these issues in Africa and uses statistical methods for measuring changes to analyze recent and comparable time series data from 51 African countries. The contribution of adolescent fertility to total fertility and mortality remains quite high. Delayed marriage is occurring concomitantly with postponement of sexual debut among unmarried adolescents. Six African countries are likely to achieve the MGD4 and five are likely to reach the target for the MDG5; the majority of sub-Saharan African countries will fall short of achieving these goals, not even by 2100 for many at current rates of change in progress indicators. Implementing ground-breaking nationally owned mortality-reduction schemes covering preconceptional and interconceptional periods and well-functioning comprehensive health-care system secured by sustained commitments and financial investments in health and social services are urgently needed, in order to repeal trends of further undoing successes achieved so far or slowing recent progress, thus hastening the pace of child and maternal mortality decline.

The two important questions that this paper will attempt to answer are: (1) why is it that regardless of race/ethnicity or geographic location, the sex ratio data at birth show more males than females?; and (2) Why is it that regardless of geographic location compared to other racial/ethnic groups, Black women or Women of sub-Saharan Black African descent tend to give birth to more females? Or to put this question the other way around, compared to Black women, why do non-Black women give birth to more males?

Along with governments from around the world, African leaders agreed at the International Conference on Population and Development (ICPD) in 1994 to address unsafe abortion as a major public health problem. At the five-year review of the ICPD, they decided further that health systems should make safe abortion services accessible for legal indications. Based on this mandate, the World Health Organization (WHO) developed norms and standards for quality abortion services, Safe Abortion: Technical and Policy Guidance for Health Systems, released in 2003. While abortion-related maternal mortality and morbidity remains very high in many African countries, stakeholders are increasingly using WHO recommendations in conjunction with other global and regional policy frameworks, including the African Union Protocol on the Rights of Women in Africa, to spur new action to address this persistent problem. Efforts include: reforming national laws and policies; preparing service-delivery guidelines and regulations; strengthening training programs; and expanding community outreach programs. This paper reviews progress and lessons learned while drawing attention to the fragility of the progress made thus far and the key challenges that remain in ensuring access to safe abortion care for all African women.

This paper critically synthesises available research that examines young people's relationships with sugar daddies and mummies. It considers definitional, measurement and analytical issues involved in assessing these relationships, their magnitude, patterns, determinants and consequences. The review compares and contrasts the experiences of young people in a variety of settings in developing countries versus developed countries, and identifies key associated factors perpetuating those relationships. The implications of this endeavour for data needs and future research and intervention studies targeted at promoting young people's health and well being are discussed within the contexts of globalisation and localisation and recommendations for dealing with these experiences.

A major drawback of research on sexual behaviour in Africa is the separation between theories and empirical work. This paper reviews three major theoretical perspectives on female sexual behaviour in Africa, and constructs a conceptual framework in which various hypotheses deriving from these theories can be empirically tested. This framework, which draws from Coleman's model of social capital, shows the linkages between sexual behaviour and key factors of (1) patrilineal bias, (2) rational adaptation, and (3) social disorganisation theories. It is suggested that, as a dynamic process, sexual activity and its key covariates must be measured and analysed within event history models.