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When a woman is healthy, she has the energy and strength to do her daily work, to fulfill the many roles she has in her family and community, and to build satisfying relationships with others. In other words, a woman’s health affects every area of her life. Yet for many years, ‘women’s health care’ has meant little more than maternal health services such as care during pregnancy and birth. These services are necessary, but they only address women’s needs as mothers. Except for the ability to produce babies, a woman’s health needs have been treated as no different from a man’s.
¨ Good health is more than the absence of disease. Good health means the well-being of a woman’s body, mind, and spirit.
In this book we offer a different view of women’s health. First, we believe that every woman has a right to complete health care, throughout her life. A woman’s health care should help her in all areas of life - not just in her role as a wife and mother. Second, we believe that a woman’s health is affected not just by the way her body is made, but by the social, cultural, and economic conditions in which she lives.
While men’s health is also affected by these factors, women as a group are treated differently from men. They usually have less power and fewer resources, and lower status in the family and community. This basic inequality means that:
· more women than men suffer from poverty.
· more women than men are denied the education and skills to support themselves.
· more women than men lack access to important health information and services.
· more women than men lack control over their basic health care decisions.
This larger view helps us understand the underlying (root) causes of women’s poor health. Improving women’s health includes treating their health problems, but it also requires changing the conditions of their lives so they can gain more power over their own health.
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When this happens, everyone - the woman, her family and community - benefits. A healthy woman has a chance to fulfill all of her potential. Plus, she will have healthier babies, be better able to care for her family, and can contribute more to her community. This kind of view also helps us see that a woman’s health problem is almost never her problem alone. Women’s health is a community issue.
Because a woman’s body is different from a man’s, and because of the basic inequalities between men and women, women face a greater risk of disease and poor health. Here are some of the health problems that affect women most.
Poor nutrition
Poor nutrition is the most common and disabling health problem among women in poor countries. Starting in childhood, a girl is often given less food to eat than a boy. As a result, she may grow more slowly and her bones may not develop properly (which may later cause difficulty during childbirth). The problem worsens as she becomes a young woman, because her need for good food increases as her workload increases, and as she starts her monthly bleeding, becomes pregnant, and breastfeeds.
¨ Not getting enough good food can keep a girl from growing properly, and can lead to serious health problems.
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Without enough good food, she may begin to suffer from general poor health, including exhaustion, weakness, and anemia. If a woman who is already malnourished becomes pregnant, she is more likely to have serious complications with childbirth, such as heavy bleeding, infection, or a baby that is born too small.
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A woman’s health cannot be isolated from her social status. In most of rural India, women drink less milk than their husbands and sons and they eat only after the men have been served. This usually leaves women with a limited diet, and it also tells about how she is valued. - CHETNA, Ahmedabad, India |
Reproductive health problems
Sexually transmitted diseases (STDs), including HIV/AIDS. A woman is physically more at risk for getting STDs and AIDS than a man. This is because a man’s semen stays inside her and the germs it carries can pass through the lining of the vagina into her blood. And, since a woman often has no signs of infection, she may not get treatment.
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¨ Because women must often have unsafe sex against their will, STDs are a social issue.
But the problem is really a social one. Women often have little control over decisions about sex and often cannot refuse unsafe sex. As a result, 165 million women get an STD every year, and 1.65 million became infected with HIV in 1995 alone. Without treatment, STDs can cause disabling pain, severe pelvic inflammatory disease (PID), infertility, problems during pregnancy, and an increased risk of cervical cancer. HIV/AIDS causes death.
Frequent pregnancies. In many parts of the world, a third to half of young women become mothers before they are 20 years old. Without family planning, many of these women will not have time to get strong again between births. This puts a woman at risk for poor health and complications of pregnancy and childbirth. Frequent childbirth also means she is less able to control her own life, to get an education, and to learn skills to support herself.
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Complications from pregnancy and birth. In the last 30 years, the number of infant deaths has been greatly reduced. Yet the number of women who die from pregnancy and birth has not, Every minute, one woman dies from a problem related to pregnancy. Every minute, 30 women develop a lasting health problem related to pregnancy. This means that over time, about a quarter of all women living in poor countries will be seriously affected by complications from pregnancy and birth.
¨ Every minute, one woman dies from a problem related to pregnancy.
Unsafe abortion. When a woman tries to end a pregnancy by having an unsafe abortion, she risks her life. But every day about 50,000 women and girls try to end their pregnancies in unsafe ways because they have no way to get a safe abortion. Many are left unable to have children or with lasting pain, infection, and other health problems.
¨ Every year 75,000 women die from unsafe abortions.
Female circumcision. Female circumcision, in which part or all of a girl’s outer genitals are cut off, can cause serious health problems. These include pelvic and urine system infections, sexual and emotional problems, and difficulties during childbirth. Yet despite these problems, it continues to be widely practiced. Every year about 2 million girls are circumcised, mostly in Africa, but also in the Middle East and Asia.
General medical problems
Women are more likely than men to suffer from certain health problems because of the work they do, because of poor nutrition, or from being too tired. A disease can also cause a different kind of harm to a woman than a man. For example, a woman who suffers from a disease which weakens or disfigures her may be rejected by her husband.
¨ Men and women get many of the same diseases, but women can be affected differently.
Once they are sick, women are less likely to seek and receive treatment until they are seriously ill. For example, tuberculosis (TB) is spreading among both men and women, but fewer women than men get treatment. Almost 3000 women die every day from TB - at least 1/3 of whom did not receive proper treatment or never even knew they had the disease. Other health problems that in the past affected mostly men are now risks for women, too. For example, more women are suffering from problems related to smoking cigarettes or drinking too much alcohol.
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Work hazards
Women face health risks every day from the work they do. At home, lung diseases from smoke or burns from cooking fires are so common that they are considered the main work-related health problem for women. Diseases spread through water are also common, because of the amount of time women spend washing clothes, hauling water, or standing in water while farming.
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¨ A woman faces health risks from her work inside and outside of the home. Working long hours, the ‘double work day’, can make her body too tired to fight disease.
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Millions of women who work outside the home suffer health problems due to unsafe conditions in the workplace. And when they come home from their jobs, they usually continue to work at home, so they end up with twice as much work. This leads to exhaustion and an increased risk of illness.
Mental health problems
Women and men have about the same risk of developing a mental health problem. Severe depression, however, affects many more women than men. It often affects women who are poor, who have experienced loss or violence, or whose communities have been destroyed or undergone great change. But women who suffer any kind of mental health problem are much less likely than men to get help.
¨ Problems with mental health can be as serious as other health problems.
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Violence
Violence is often overlooked as a health problem. But violence can lead to serious injuries, mental health problems, physical disabilities, and even death. Many girls are sexually abused by family members or friends. Many women are forced to have sex or are physically abused by their partners. Rope and sexual harassment are a constant threat to all women. These kinds of violence happen in almost all parts of the world, and under all social conditions.
¨ Women usually suffer violence from men they know. But most violence is not reported, and the men are not punished.
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Still, most violence against women is not reported, because the police and others often blame women rather than men for the problem. The men causing the violence are rarely punished.
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How women are forced into a life of poor health Although not all women suffer from the health problems described above, most will suffer from 3 of them: poor nutrition, pregnancies that are too close together, and overwork. Each of these problems affects a woman’s general health and wears her body out, making her more likely to get sick. Pregnancy also makes certain medical problems - like malaria, hepatitis, diabetes, and anemia - worse, just as they make pregnancy more difficult. All these things make a woman much more likely to suffer from general poor health than a man.
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It is easy to name the direct causes of most of women’s health problems. For example, we can say that STDs are caused by different germs, poor nutrition comes from not eating enough good food, and problems during pregnancy are often caused by a lack of prenatal (before birth) care. But beneath these direct causes are 2 root causes - poverty and the low status of women - that contribute to many of women’s health problems.
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POVERTY Two out of three women around the world are poor. Women are not only much more likely than men to be poor, but are most often among the poorest of the poor. Millions of women are caught in a cycle of poverty that begins even before they are born. Babies born to women who did not get enough to eat during pregnancy are likely to be small at birth and to develop slowly. In poor families, girls are less likely than their brothers to get enough to eat, causing their growth to be further stunted. Girls are often given little or no education, so as women they must work at unskilled jobs and receive less wages than men (even if they do the same kind of work). At home, their daily work is unpaid. Exhaustion, poor nutrition, and lack of good care during pregnancy place the woman and her children at risk for poor health. Poverty forces her to live under conditions that can cause many physical and mental health problems. For example, poor women often: · live in bad housing, with little or no sanitation or clean water.
Poverty often forces women into relationships in which they must depend on men for survival. If a woman depends on a man for her - or her children’s - support, she may have to do things to keep him happy that are dangerous to her health. For example, she may allow him to be violent or to have unsafe sex because she fears losing his economic support. |
LOW STATUS OF WOMEN
Status is the importance that a person has in the family and community. Status affects how a woman is treated, how she values herself, the kinds of activities she is allowed to do, and the kinds of decisions she is allowed to make. In most communities in the world, women have lower status than men. Women’s lower status leads to discrimination - that is, being treated poorly or denied something simply because they are women. Discrimination may take different forms in different communities, but it always affects a woman’s health.
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Wanting sons rather than daughters. Many families value boys more than girls because boys can contribute more to the family’s wealth, support their parents in old age, perform ceremonies after their parents die, and carry on the family name. As a result, girls are often breastfed for a shorter time, are given less food and medical care, and receive little or no education.
Lack of legal rights or power to make decisions. In many communities, a woman cannot own or inherit property, earn money, or get credit. If she gets divorced, she may not be allowed to keep her children or her belongings. Even if a woman has legal rights, her community’s traditions may allow her little control over her life. Often a woman cannot decide how the family’s money is spent or when to get health care. She cannot travel or participate in community decisions without her husband’s permission.
¨ Because so much of the work that women do is not recognized, they often lack legal protection in the workplace.
When women are denied power in these ways, they must depend on men to survive. As a result, they cannot easily demand things that contribute to good health, like family planning, safer sex, enough food, health care, and freedom from violence.
Having too many children, or having children too close together. Discrimination against women can also lead them to get pregnant more often, because bearing children may be the only way that women can gain status for themselves or their partners.
¨ Women make up half of the world’s population, but work 2 out of every 3 hours worked in the world, receive only a tenth of the world’s income, and own only a hundredth of the world’s property.
Under all these conditions, women live less healthy lives and get less health care. They also often accept their low status, because they have been raised to value themselves less than men. They may accept poor health as their lot in life and seek help only when health problems are severe or life-threatening.
The medical system does not meet women’s needs
Poverty and discrimination in the family and community not only lead to more health problems for women, they also make the medical system less likely to provide the services women need. Government policies and the global economy may add to this problem.
¨ The medical system does not provide all the services women need.
In poor countries, many people do not have access to health services of any kind. (The box below explains one reason why this problem has become worse in recent years.) And because of discrimination against women, the little money that does exist will probably not be spent on women’s health needs. So a woman may not be able to get good care even if she can afford to pay for it. Some reproductive health services may be provided, but to meet all of her health needs, she will probably have to travel to the capital city or perhaps even leave her country.
In many countries, the skills needed to care for women are considered ‘special’ and are provided only by doctors. Yet many of these services could be provided at lower cost by trained community health workers.
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Debt and structural adjustment: keeping the poor poor During the 1970s, many poor countries were pressured to borrow money from banks in rich countries. Some poor countries used this money to try to improve the lives of their people. Many new schools, hospitals, clinics, and other projects were started. But as the banks demand that their money be paid back, the poor countries have been forced to change or “adjust” their economies. They are forced to pay these banks much of the wealth the people produce, and to make it easy for foreign companies to make money by using the poor countries’ resources and labor. As a result, poor countries can no longer spend as much money on programs that help the poor - such as schools, health centers, hospitals, and programs that help people get food and fuel at a fair price. Governments now are left with less money to pay doctors, nurses, and other health workers, or to provide medical supplies or equipment. The health of all poor people suffers from these changes, but the health of poor women and children suffers most of all.
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Mira’s Story When Mira was a little girl, she dreamed of living in a big house, with electricity and a tile floor. Her husband would be handsome and kind, and she would be able to do whatever she wished. But Mira’s family was poor, and she was the youngest of four daughters. Sometimes, when her father was drinking, he would beat her mother, and weep at his misfortune of having so many girls.
When Mira was 14, and old enough to be married, she cried when she learned her dreams would never come true. It was already arranged: Mira would marry a man whom her father had chosen. He had some land, and Mira’s father thought the family would benefit from their marriage. Mira had no choice in the matter. With the birth of Mira’s second child - a son - her husband stopped insisting on sex so often. Mira was very glad for that. Although he did not hurt her, he had warts all over his penis that disgusted her. Over the next 20 years, she had 6 more children, including a little girl who died at age 3, and a boy who died at birth. One day, Mira was using the latrine and she noticed a bloody discharge coming from her vagina when it wasn’t time for her monthly bleeding. She had never had a health exam, but now Mira asked her husband if she might see a health worker. He replied that he didn’t trust doctors, and besides, he didn’t have the money to spend every time she felt worried about something. Mira was 40 when she began to suffer constant pain low in her belly. The pain worried her, but she didn’t know who to talk to about it. Some months later, Mira finally decided she had to go against her husband’s wishes and get medical help. She was frightened for her life, and borrowed some money from a friend. At the health center, Mira got some medicine for the vaginal discharge, although the health worker did not examine her first. Mira returned home that night, exhausted and upset that she had defied her husband and spent her friend’s savings. As weeks passed, Mira’s health continued to worsen, and she became discouraged, realizing that something was still wrong. Finally, Mira became so weak that her husband believed she really was ill, and they begged a ride to a hospital in the big city far away. After waiting several days, Mira was seen at the hospital. Finally, she was told that she had advanced cancer of the cervix. The doctor said they could remove her womb, but that the cancer had already spread. The one treatment that might save her life was available only in another part of the country, and was very expensive. The doctor asked, “Why didn’t you get regular Pap tests? If we had found this earlier, we could have treated it easily.” But it was too late for that. Mira went home, and in less than two months, she died.
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WHY DID MIRA DIE?
¨ There are many reasons why poor women get - and die from - diseases that can be prevented or cured.
Here are some common answers to this question:
A doctor may say...
Or a teacher...
Or a health worker...
All these answers are correct. Women who start having sex at a young age and are exposed to genital warts are at a greater risk for cancer of the cervix. And if the cancer is found early (usually by having a Pop test), it can almost always be cured.
Yet these answers show a very limited understanding of the problem. Each of them blames one person - either Mira or her husband - and goes no further. Mira was at greater risk of dying of cervical cancer because she was a poor woman, living in a poor country.
How poverty and the low status of women worked together to cause Mira’s death
Mira and her family were poor, so she was forced to marry and start having sex when she was very young. As a woman, she lacked power in her relationship with her husband. She had no control over when and how many children to have, or over her husband’s relationships with other women. Her family’s poverty meant that she suffered from poor nutrition her whole life, which weakened her body and left her more at risk for disease.
¨ You can explore the root causes of Mira’s death or other health problems by using the excercise called “But Why?”.
Although Mira’s community lacked health services, the nearest health center did have some women’s health services, like family planning and information about preventing HIV/AIDS. But the health workers had no information or training about other women’s health problems, even such serious ones as cancer of the cervix. They did not know how to do a pelvic exam (to look at the vagina, cervix and other reproductive parts) or a Pap test. So even if Mira had gone for medical care sooner, the health worker would not have been able to help her.
As a result, Mira had to travel a long distance at great cost to see a doctor who could tell her what was wrong. By that time it was too late.
Finally, Mira’s country was poor, with little money to spend on health care. Like the governments of many poor countries, her government chose to focus on other important health services, but not on women’s health. What money her government did spend on women’s health went to expensive hospitals in the big city instead of community health programs that women like Mira can get to. This meant that the services to find and treat cervical cancer - and many other women’s health problems - early were not available.
Poverty and the low status of women worked against Mira at all 3 levels - in her family, in her community, and in her country - to create the health problem that caused her death.
These are some of the links in
the chain of causes that led to Mira’s death. They are the same links that
cause many of women’s health
problems.
IT DOES NOT HAVE TO BE THIS WAY
The way societies are organized forces most women into lives of poverty and poor health. But societies could be organized in a way that favors health instead of disease.
Since the causes of poor health exist at the family, community, and national levels, changes to improve women’s health must happen at each of these different levels.
Working for change in your family
You can improve your health by learning about women’s health problems and by making changes in your own life and in your family. Talk with your partner about what you each need to have better health, including practicing safer sex and sharing the workload fairly. You can also work to improve the health and future of your children. Here are some ideas:
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Raising our children for a better world How we raise our children, from the moment they are born, will determine much of what they believe and how they act as adults. As mothers, we teach our children every day of their lives: · When we feed our husbands and sons first, we teach our children that girls’ and women’s hunger is less important.
As mothers, we have the power to change who our children will become: · We can teach our sons to be kind and compassionate, so they will grow up to be kind and compassionate husbands, fathers, and brothers.
We can raise our children for a better world. |
¨ For other ideas of how your partner can help, see HOW MEN CAN HELP
Working for change in your community
You can improve your health and the health of other women in your community by sharing this book and by talking with them about women’s health problems.
Talking with others can be hard. Women often feel shame (for example, when talking about parts of the body) or fear about what others will think. Yet talking with others is the only way to learn more about health problems and to discover their causes. Often you will find that other women are worried about the same things, and want to discuss them.
¨ Because social conditions affect them differently, women and men may need to find different solutions for the same health problems.
Get a small group of women together to talk about health problems in your community. Try inviting women who are friends of your friends, neighbors, or women you work with. Once you have identified a health problem that many women share, it is often helpful to meet again and invite others to discuss it and learn more. When you meet, think about the root causes of the health problem, and plan the changes you can make in your families and community.
By meeting with a small group
of women, you can learn more about a health problem and what can be done to
solve it.
Think about involving men as well as women in discussions about women’s health. It may seem difficult to talk about women’s health problems with men, because this kind of talk is considered taboo, or ‘women’s secrets’. But since men are often in positions of power, their help can be very important. Look for men who are supportive of women, are good role models for boys, or who treat women as their equals.
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HOW MEN CAN HELP Any man can help improve women’s health by: · raising his children to respect women, and treating boys and girls as equals. A man can also set a good example in his community by: · encouraging women in his community to come to meetings, and making sure that they have a chance to speak. Or by encouraging women to hold their own, separate meetings, where men will not speak. · working to change the image that a strong man is one who has sex with many women. A strong man is a strong partner. |
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Here are some other activities that can help improve health in a community:
· Share information. Find ways to spread information about the common health problems in your community, so that everyone will know about them.· Form support groups. Women who share common problems - such as women who have survived rape or abuse, breastfeeding mothers, women with disabilities, or sex workers - can form groups to support each other and work together to overcome their problems.
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In Zimbabwe, the Musasa Project was created to help women who suffered from violence, particularly violence in the home and sexual assault Musasa found that women who were beaten by their partners were not protected by the law. Many people said that men should have power over women because that was the way it had always been or because it was part of their community’s beliefs. These people also said that regular beatings reminded women of their ‘place’.
Musasa’s goal is to change this attitude through public education and by counseling those who have survived violence. In this way, women, men, teachers, students, police, and health workers are learning that violence is an abuse of power. Musasa plans to set up a house where women and children can stay when they are in danger. |
· Work toward more independence. Projects that help women earn money and improve their working conditions also help women start to make their own decisions and gain self-esteem.
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In a tiny Mayan village in Guatemala, a group of women formed a weaving group. They sold their weavings through a cooperative store for women’s crafts in the capital city. The women now earn more income than most of the men in their area. As a result, women have gained new status in their families and communities and have more opportunities in their lives.
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· Develop community projects. For example, try to find ways for every family in the community to get enough to eat, or to improve community sanitation and access to clean water.
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The Green Belt movement in Kenya has involved many women in planting and protecting trees, which prevent soil erosion and provide fuel, The women’s success at protecting the environment and providing fuel for their families has built their confidence and helped them earn a living.
As one Green Belt member said, “Our forests were running out because of our constant need for firewood. We meet weekly to collect seeds, to do potting land fencing, and tend the trees in our nursery. We also talk to groups and schools about the environment In this way, we are both helping ourselves and bettering the environment.” |
Simple and low-cost community efforts can make a difference
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When you first look at a problem, it often seems very hard to make changes. But, in fact, communities can make many improvements that do not cost too much. For example, here are some of the suggestions this book contains for preventing or helping solve women’s health problems:
· Start a community stove project. Women often suffer from lung infections, burns, and back problems. Low-cost cook stoves that are safer, use less fuel, and produce less smoke can prevent many of these problems.· Establish an emergency transportation system. Many women die from complications of pregnancy, childbirth, and unsafe abortion. These deaths could often be prevented by reaching medical care quickly.
· Low-cost cancer screening can prevent many women from dying from cervical and breast cancer. Cancers are much easier to treat if they are found early.
· Make family planning services and good prenatal care accessible to all women. Doing so can prevent many deaths due to complications of pregnancy, childbirth and unsafe abortion.
· Train health workers to care for women’s health. They should be trained in pelvic exams, Pap tests and visual inspection, manual vacuum aspiration (MVA), breast exams, and counseling. They should also learn how to use medicines for women’s health.
Working for change in your country
You can improve your health, and the health of many other women in your country, by working together with other groups in different parts of the country. By working together, you can make important changes in the way your government treats women and women’s health. For example, community groups can pressure the government to punish men who rape or abuse women, or to make safe abortion available. Or you can get laws passed to allow women to own or inherit property - so that women are not forced to depend on men.
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Many women and men are struggling to get their governments to: · equip rural clinics and train health workers to treat common women’s health problems. This way, rural women will not be forced to go to urban hospitals for care. · distribute unused land to those who have been forced from their land.
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GAINING POWER OVER OUR OWN HEALTH
Just as ‘women’s health’ means more than maternal health, it also means more than access to health care. To be truly healthy, women need the chance to make the decisions necessary for good health. And they need access to a fair share of the resources in their communities and in the world.
By joining other women and men in the struggle for health, we can demand the chance to live healthy, full, and joyful lives - free of disease, pain, and fear.
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