The '60s has been described as a period of great social change especially in the Western world. The United States Food and Drugs Administration (FDA) approved the use of the oral contraceptive, the Pill, in 1960. With the advent of the Pill, women, at last, had not only a powerful and effective means of preventing unintended pregnancies, but a method which, at once, separated sexual intercourse from reproduction. Free from the fear of unintended pregnancy, couples on the Pill, could engage in sexual intercourse as an expression of love or for pleasure. The ability to time their pregnancies, allowed women on the Pill, to postpone marriage and childbearing, take advantage of educational, employment and economic opportunities and raise their social standing in the community. But the Pill also forced people to confront the whole issue of human sexuality, fertility regulation and reproduction. It brought into sharp focus the moral, social, health and human rights implications of “free love”.
The controversy, debate and discussions generated by the widespread use or non-use of modern contraception have continued unabated for the past 50 years. They centre on moral and religious principles and human rights concerns as well as programmatic considerations about the most effective ways of organizing and providing comprehensive reproductive health services including quality family planning information and services to those who need them. What should be the roles and responsibilities of state governments and civil society organizations in securing the rights of couples and individuals to decide freely and responsibly, the timing and number of pregnancies?
Governments, organized religion, rights groups, academic and research institutions and non-governmental organizations have taken sides on the issue. Over the past 30 years or so, efforts have been made at national, regional and international levels to broker some measure of consensus. Among the many individuals who have made outstanding contributions to the debate and efforts to build a global consensus on population, sexual and reproductive health and family planning stands Dr. Frederick Torgbor Sai.
Arguably the best known and internationally renowned Ghanaian physician, Dr. Sai has earned the respect of both friend and opponent as a vigorous, articulate and passionate advocate of women's rights to self-determination and protection from preventable risks to their lives and health and those of their children. At national, regional and international levels, Dr. Sai has played a leadership and champion's role in making reproductive health, including quality family planning information and services available and accessible to couples and individuals.
In “WITH HEART AND VOICE” Dr. Fred Sai tells us about his life-long devotion and commitment to the health of women and children and the events that have influenced and shaped his life. His account of his early memories as a male child growing up under the influence and protection of an extended family dominated, at least numerically, by women will resonate with many Africans who read this book. So will the painful experience of circumcision, the comical circumstances of his sexual debut as well as the prayerful invocation of “there but for the Grace of God”
Fred Sai was academically gifted as a child. Seen from that perspective, his progress from primary school (Salem Presbyterian School) through Achimota Secondary School to University of London Medical School was predictable. His scholastic achievements at medical school culminating in his graduating with an Honours Degree simply confirmed the expectations of his teachers and peers.
The first few chapters of the book chart the course of promise fulfilled. In due course of time, Fred Sai would add, after his name, a string of impressive academic laurels and accolades acquired from some of the most prestigious institutions of medical training and learning (London, Edinburg and Harvard) in the world. He became the recipient of many international honours and decorations. These established his academic and professional stature and credibility. But “WITH HEART AND VOICE” is not about Fred Sai's impressive scholastic achievements.
This book tells the story of how the harrowing experiences of a young Ghanaian physician while attending to the needs of the sick and dying children and mothers in his own country moved him to take a wider but closer look at the living conditions and circumstances of his patients. Fred Sai describes how during the course of many years, through assignments to different parts of the country and postings to administrative positions within the Ministry of Health, he gained wide clinical experience as well as valuable insight into the administrative and political dimensions of health care delivery in a developing country setting.
Fred Sai held many important positions and played a major role in the development and establishment of various institutions and programmes in Ghana. He served at various times as Assistant to the Chief of the Ministry of Health, Director of Medical Services, Chairman of the Medical and Dental Council, Physician Specialist in Human Nutrition and Professor of Preventive and Social Medicine at the Ghana Medical School, Fellow and later president of the Ghana Academy of Arts and Science among other high profile positions. He played major roles in the establishment of the Ghana Medical Association, the Ghana Medical School, the National Food and Nutrition Board, the Planned Parenthood Association of Ghana (PPAG) and the National Population Council among other institutions.
But it was Fred Sai's deep appreciation and concern about the link between unregulated fertility and preventable causes of death and morbidity among mothers and children in his native Ghana that was to define the future course of his professional and international career. For the rest of a long and successful life and career, Fred Sai was to deploy his considerable talents, energy, passion and skills in drawing the world's attention to the importance of population and family planning in preventing the untimely death and long term illnesses of mothers and children.
Much of “WITH HEART AND VOICE” sub-titled “Fred Sai remembers” gives an account of his work and contribution to the evolution of a global consensus on population, reproductive health and family planning at the international level. Fred Sai's involvement with the International Planned Parenthood Federation (IPPF) has been long and distinguished. He has served in many capacities within that organization, notably as Assistant Secretary General and President. He was instrumental in setting up the Africa Regional Office of IPPF as well as the Centre for African Family Studies (CAFS in Nairobi). His appointment as Senior Advisor on Population to the President of the World Bank (1985–90) gave him the opportunity to influence and assist several developing countries to integrate population issues into their social and economic development strategies.
The parts of the book I enjoyed most were his accounts of the many important international conferences in which he played pivotal roles. Notable among these were the WHO/UNICEF Infant and Young Child Feeding Meeting (Geneva, 1979), the International Conference on Population (Mexico, 1984), the Safe Motherhood Conference (Nairobi, 1987), the International Conference on Population and Development (ICPD, Cairo, 1994) and the Women Deliver Conference (London, 2007). These conferences were huge even by international standards not only in terms of numbers of countries, institutions and delegates participating but also in the level of disagreements and controversies generated before and during the meetings. As Chairman of these conferences, Fred Sai had the unenviable task of crafting a consensus and creating an environment in which nations, groups, organization and people with strong and opposing views could state their positions and yet be prepared to respect and even accommodate their differences. In this book, Fred Sai leads the reader into the inner chambers and workings of the big international conferences from the preparatory activities through the negotiations and, finally, to the adoption of international agreements. It is a fascinating story told from an insider's perspective and knowledge.
Anyone interested in the history of the evolution of the medical services in Ghana, the challenges and opportunities faced by newly qualified doctors returning from abroad to serve in their own country should read this book.
In it, they will learn about the interface between medicine, health and politics even at the national level. Those with more than just a passing interest in the history of population, reproductive health and family planning will find much to ponder about in this book. The international population, reproductive health and family planning community, including many of the key players and leaders in this movement will welcome this book as a timely reminder of where we have been and how we got to where we are today. It is written by and tells us many things we have often wondered about in the life of one of the leading lights in this long journey, Dr. Fred Sai. It is a story well told. Enjoy it.
Dr. Andrew A. Arkutu, FRCOG
Reproductive Health Specialist and Advocate, Management Strategies for Africa P.O. Box K.A.30377, Accra-Ghana