International Women’s Day: an opportunity to reflect on the importance of meeting women’s health needs
Women fish traders in Malawi
Eleanor MacPherson is a post-doctorate researcher at the Liverpool School of Tropical Medicine, UK.
Health is a vital component of women’s wellbeing across the lifecycle from birth to old age. Women’s right to health has been globally recognised since the UN conferences of the mid-90s. Following the 1993 World Conference on Human Rights, the Vienna Platform for Action recognised that gender-based violence and sexual harassment constituted an abuse of human rights. This in turn paved the way for the International Conference on Population and Development (Cairo 1994) to articulate a range of human rights related to sexual and reproductive health, including the right of individuals and couples to decide whether or not to have children. Finally, at the Fourth World Conference on Women (Beijing, 1994) the Platform for Action included a statement which recognised that “the right of all women to control all aspects of their health, in particular their own fertility, is basic to their empowerment” (Beijing Declaration, 1995). The Millennium Development Goals (MDGs), while including some components related to women’s and girls’ rights, failed to build on the progressive work of these earlier UN policies.
In the global South (as well as in the global North), widely held societal expectations of men and women’s behaviour, roles, and responsibilities shape men and women’s lives. These expectations create inequalities in access to resources and information, as well as the power to make decisions, both individually and within communities. In relation to health, these gender-based inequalities combine with biological factors to place women in a vulnerable position to ill health.
Gender inequalities based on social and cultural structures and norms can also limit women’s access to quality health care to address the full range of their health needs. Women make up the majority of both paid and unpaid health workers yet they are more likely to work in a lower paid position. This in turn means that women are often working at the community level, with the most vulnerable groups and yet, based on their position, with the least ability of all health cadres to influence health policy-making.
I work with the Gender and Health Group at the Liverpool School of Tropical Medicine. With my colleagues, we work in partnership with researchers in the global South to apply gender analysis to understand:
(1) the ways in which the health system responds to women’s needs
(2) the need to prioritise gender-based approaches in health-service delivery and
(3) the interplay between gender and other axes such as age and ethnicity and their effect on vulnerability to ill health
Gender and the health system: In the health system, gender and women’s needs are often overlooked. In PERFORM, we challenged the limited attention to gender in human resources for health. In particular, we looked at gendered differences in health workforce performance and the strategies to address these differences in Ghana, Uganda, and Tanzania.
There is also a number of key challenges related to women’s access to health services in conflict-affected states. Services are often fragmented and depleted and this needs to be addressed in health systems strengthening. As part of the ReBUILD consortium and in partnership with global partners we are exploring the opportunities and challenges of building gender-responsive health systems in post-conflict and fragile contexts with case study analysis from northern Uganda, Timor Leste, Mozambique, and Sierra Leone.
Gender and health service provision: One of the most striking expressions of the failure to adequately provide for women’s health needs is the persistence of extremely high rates of maternal mortality in many parts of the world. There has been an enormous drive globally to encourage women to give birth in institutional facilities, yet the quality of services women receive may contravene their right to receive appropriate standards of care. We are working as part of an EU-funded consortium, MATIND, evaluating two large-scale state-run programmes in India that are designed to remove the financial barriers to accessing delivery care.
Gender and vulnerability: Gender and age interact to affect vulnerability to HIV: in sub-Saharan Africa, 72% of young people (aged 15-24 years) infected with HIV are women. Through partnership with colleagues in Malawi, we explored how the broader social environment, poverty, and gender place women fish traders in a vulnerable position to HIV in fishing communities. In Malawi, women are excluded from fishing and often have to negotiate access to fish to sell through sexual exchange with fishermen. Condoms are rarely used in these exchanges.
Removing gender inequalities in health requires social transformation at multiple levels, both inside and outside the health system. The UN is currently formulating a new plan for post-2015 to expand upon the MDGs. These negotiations provide an opportunity for renewed efforts to further women’s rights and it is vital that gender equality is fully integrated into this plan.
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