The harrowing experiences that Fred Sai faced as a young medical officer in Ghana in the 1960s fuelled his concern about the link between frequent childbearing and preventable death and sickness in mothers and children, and turned him into a passionate campaigner for reproductive rights and health in the developing world.
In his early clinical work, Sai, who has died aged 95, came across many children with protein-energy malnutrition, or kwashiorkor, which in the language of the Ga ethnic group to which he belonged means “the disease of the displaced child”. “I realised that fully a third of my child patients had mothers who were pregnant or had a young sibling born very soon after them,” he told the Lancet in 2012. “The abrupt stopping of breastfeeding was making them sick. I thought that one way to help these women was to teach them family planning and the importance of spacing children properly.”
In 1967 he co-founded the Planned Parenthood Association of Ghana, one of the first family planning associations to be set up in Africa. He went on to be an advocate of women’s right to fertility control, and a campaigner for improved nutrition and girls’ access to secondary education. Over a 50-year career his roles included chief medical officer for Ghana, president of the International Planned Parenthood Federation (IPPF), senior population adviser for the World Bank, and chair of the landmark International Conference on Population and Development (ICPD) in Cairo in 1994.
Born in Osu, a suburb of Accra, in what was then the Gold Coast, Fred spent his early life with his mother, Emelia Shormeh Omaboe, and other female relatives after his father died when he was four. He went to local Presbyterian schools in Osu, then won a Cadbury scholarship to Achimota college, and in 1947 left for London, to study medicine at University College on a government scholarship. He graduated in 1953 in obstetrics and gynaecology, and completed his studies at Edinburgh and the Harvard School of Public Health.
As a medical student in London he learned of the tragedy that unwanted pregnancy could bring: a Gold Coast nurse had become pregnant and, unable to have an abortion, had killed herself; others suffered botched procedures, a common occurrence before the 1967 Abortion Act. Sai returned to Ghana after completing his training, and worked in Accra as a community health physician and as a medical officer with the Ghana government service, becoming deputy chief medical officer in 1961.
When Ghana gained its independence in 1957, the new president, Kwame Nkrumah, although generally an advocate of women’s rights, had banned the import of contraceptives. Sai and other doctors risked their careers by providing family planning to their female patients. After the overthrow of Nkrumah in 1966 the ban was lifted, and the following year Sai co-founded the Planned Parenthood Association of Ghana, a non-governmental organisation that now provides sexual and reproductive health services as well as family planning programmes. He was the first professor of preventive and social medicine at the University of Ghana Medical School (1966-72) and was director of medical services for Ghana for two years from 1970, when he helped plan and implement the country’s population and family planning policy.
In his international career, he worked for the UN Food and Agriculture Organisation, the UN University and the World Bank. I got to know him well when he was president of the IPPF from 1989 to 1995, the first African to hold the post.
Although slight in stature, Fred had a formidable presence as a chairman. He had a gift for creating an environment in which nations, organisations and people with strong and opposing views could be prepared to respect and accommodate their differences.
He chaired the WHO/Unicef meeting on infant and young child feeding in Geneva in 1979, which emphasised the importance of exclusive breastfeeding for the first six months and led to an international code regulating the marketing of infant formula and baby foods. In 1987 he was moderator for the Safe Motherhood conference, in Nairobi, which launched an initiative to reduce the number of women dying in pregnancy and childbirth by 50% by the year 2000.
He also chaired the main committees of the 1984 International Population Conference in Mexico City and of the ICPD in Cairo in 1994. These were not ceremonial functions, but required active involvement in securing positive language on controversial issues such as abortion, women’s equality and adolescent sexuality. His work as chairman at ICPD helped to ensure consensus on a historic agreement, adopted by 179 countries, which placed the discussion of population and family planning within an overarching ethical and policy framework of broader sexual and reproductive health and rights.
In Ghana Sai’s advocacy helped establish the provision in 2007 of subsidised family planning services by the government under the free maternal health policy.
Among his many awards and honours was the UN Population award in 1993. He used the funds from the 1995 Prince Mahidol award from Thailand to set up a fund at the University of Ghana, to support women studying science. In 2006 he was made a member of the Order of the Star of Ghana.
He published a number of books, including Some Ethical Issues in Family Planning (1976); Adam and Eve and the Serpent (1995), about the inequalities and the difficulties faced by African women; Fred Sai Speaks Out (1994), a collection of essays and speeches; and a memoir, With Heart and Voice (2010).
In 1952 he married Florence Dzani, a fellow student in London whom he had known since childhood. They brought up seven children, four of their own and three adopted. He is survived by Florence, four daughters and two sons; one son predeceased him.
• Frederick Torgbor Sai, community health physician and reproductive rights advocate, born 23 June 1924; died 17 September 2019
