Women’s Health

• In many countries, women suffer from the diseases of poverty:

• poor nutrition

• anemia

• poor reproductive care

• maternal mortality

Measurement

• How do we measure the differences in health between men and women?

• The most obvious and clearcut way is survival -- e.g. sex ratio in India is way below 1 -- many fewer females per 100 males

• Health visits

• Disability

Sex-specific death rates (deaths/1000): Matlab children 1-4 born 1981-82

115

75.7

95

0

20

40

60

80

100

120

Girls Boys Total

Death rate GDeath rate BDeath rate T

Proportion visiting health care provider in previous 3 months: Matlab, 1996-97

Visits unrelated to pregnancy

15 20 25 30 35 40 45 50 55 60 65Female

0

0.1

0.2

0.3

0.4

0.5

0.6

0.7

FemaleMale

Percent unable to perform specified ADL, by sexMatlab 1996-97

4.4

8.8

5.1

11.5

3.4

6.7 7.2

11.5

8.1

15.7

3.1

7

3.6

9.1

0

2

4

6

8

10

12

14

16

1 2 3 4 5 6 7

MalesFemales

Options and Access

• These problems are related to their roles in society

• e.g. more tuberculosis and respiratory disease may be due to exposure to cooking smoke under poor conditions

• In general, problems are related to differential OPTIONS and ACCESS

Human Development

• The United Nations, in its 1991Human Development Report, published the Human Development Index

• The HDI is intended to measure the degree to which “people have the options to enable them to lead a long and healthy life, to be knowledgeable and to find access to the assets, employment and income needed for a decent standard of living.”

More developed countries (MDC)

• Finland• Sweden• France• US• Canada• UK• Italy• Japan

Less developed countries (LDC)

• El Salvador

• Philippines

• Paraguay

• Sri Lanka

• Costa Rica

• South Korea

• Kenya

Human Development Index, 1991

• Developed countries have a huge advantage over developing countries in the overall HDI

• Japan leads the list -- at 99

• Kenya is lowest -- at 40

Human Development Index, 1991

0102030405060708090

100F

inla

nd

Fra

nce

Can

ada

Ital

y

El.

Sal

Par

agua

y

Cos

ta

Ken

ya

MDCLDC

Ratio of female HDI to male HDI

• In EVERY country, women have a lower HDI than men

• highest: Finland -- at 93.7

• lowest: Kenya -- at 51.5

• There is a lower differential between the MDC’s and LDC’s in this ratio than in the actual HDI -- women have less opportunity everywhere than men

Human Development Index, Female/Male 1991

0102030405060708090

100F

inla

nd

Fra

nce

Can

ada

Ital

y

El.

Sal

Par

agua

y

Cos

ta

Ken

ya

MDCLDC

Disadvantages of women

• Education

• Entry into labor force

• Jobs

• Nutrition

• Health

Role of women

• Women are participants in the allocations to themselves and to other females, including their daughters

• Hanna Papanek has written well on the social construction of biological differences and gender differences in entitlements to resources and socialization for inequality

Distribution of resources

• Reflects power and authority relations

• ALSO reflects moral basis of the group

• consensus about distributive justice

• implicit priorities

• Both men and women learn these implicit priorities at a very early age

• “Compulsory emotions” -- the way one is supposed to feel -- play an important role

Lessons learned

• Children may be taught that “girls need less food than boys”

• lesson about hunger? Or lesson about the value of persons?

• Boys need “rich foods like curds” to withstand the cold of winter

• What does this say about effect of cold on females - or about women’s capacity for suffering?

Mother’s role

• Mothers follow group norms

• Preference for sons

• status of women is measured by their reproductive performance

• support in old age

• sons are only way to acquire daughters-in-law to help her in household

Teaching children

• Teach them men work harder than women and that’s why they need more food - or better food

• Children know how hard their mothers work

• This teaching is about value in society

• Values may be sanctified -- e.g women’s spiritual role

Socialization for inequality

• Women are socialized to behave in certain ways toward their children

• Foot-binding

• painful

• cruel

• WHY DID WOMEN DO IT TO THEIR DAUGHTERS?

Circumcision

• Carried out by women

• WHY?

• Socialize girls for their adult role

• Evidence of internalization of the social norms of inequality

Family planning

• Family planning challenges some of these old notions that women should have as many children as possible

• Is reduced fertility healthier?• -- for women, reduced risk of maternal

mortality unless unsafe abortion used• -- for children, evidence is clear that smaller

families, longer birth intervals, are beneficial

Benefits to women

• Most women and men are convinced that practicing family planning and having fewer children provide economic and health benefits

• Family planning offers freedom from fear of unplanned pregnancy and can improve sexual life, partner relations, and family well-being

More benefits

• Where jobs are available, family planning users are more likely than non-users to take advantage of work opportunities

• Family planning helps women meet their practical needs and is necessary, but not sufficient, to help them meet their strategic needs

More benefits

• In many countries, older women express regret that family planning was not available to them

• They discuss the burdens of repeated childbearing and child death and the hope that their daughters are much less vulnerable to these burdens

Costs to women

• Contraceptive side effects - real or perceived - are a serious concern for many women, more than providers realize

• When partners or others are opposed, practicing family planning can increase women’s vulnerability

More costs

When women have smaller families, they may lose the security of traditional roles and face new and sometimes difficult challenges, including the burden of multiple responsibilities at home and work