March 3, 2007; 369:715
The health of women
March 8, 2007, marks International Women's Day - a day widely recognised as an annual opportunity to focus on the predicaments facing women around the world. The day can be viewed as a celebration of progress made so far towards women achieving equality with men, but it can also act as a reminder of all that still needs to be done. Although there has undoubtedly been major progress to date, in no country in the world can women claim to have the same rights and opportunities as men. This is especially so in the context of health.
Progress in recent years is partly because of the international focus and activity centred around the Millennium Development Goals (MDGs). MDG-3 aims to promote gender equality and empower women. Its associated target is to eliminate gender disparity between primary and secondary education. Indicators are: the ratio of girls to boys in all levels of education; the ratio of literate women to men; the share of women in wage employment in the non-agricultural sector; and the proportion of seats held by women in national parliament. It is a lost opportunity that no health indicator was added to this list.
The latest MDG report highlighted that despite some successes around MDG-3, there are still areas of concern. Globally, more than one in five girls of primary school age are not in school compared with about one in six boys. Women account for three-quarters of the 960 million people in the world who cannot read. Women also represent an increasing share of the world's work force - over a third in most regions except southern and western Asia and northern Africa - but they are disadvantaged in securing paid jobs. On average, women receive up to 40% less pay than men for the same work. Over-representation in subsistence sectors and sociocultural attitudes continue to limit women's economic advancement. In 2006, around 17% of parliamentary seats worldwide were held by women, with some countries, such as Rwanda and Denmark, nearing 50%. However, women's national political representation remains very low in northern Africa and western Asia.
What about the health of women?
Women put their lives at risk every time they become pregnant. They are the primary providers of child welfare. They are increasingly susceptible to HIV/AIDS and other major diseases. And they play a crucial part in the management of household resources. In areas that did not make the MDG priority list, such as sexual and reproductive health and the experience of violence, empowerment of women is even more important, since there is little interest from the international community in tackling these resistant challenges.
Sexual and reproductive ill health accounts for nearly a third of lost disability-adjusted life-years in women of reproductive age. An estimated 90% of deaths from unsafe abortions and 20% of obstetric mortality could be avoided with improved access to contraception, but in many countries only a tiny minority of women have access to contraceptive methods. There is a competitive global market for generic contraceptive drugs but in Africa, for example, 97% of the population cannot afford even generic contraceptives without the help of subsidies. In addition, in some countries, women can only receive contraceptives if they first have laboratory tests that often cost more than a month's salary. Yet the latest figures show that donor funding for family planning has decreased by 36%.
The Lancet Series on sexual and reproductive health also showed that women's health rapidly improves when abortion is made legal, safe, and easily accessible but this is not an option for many women. Anti-abortion laws in 2% of countries, such as Nicaragua and El-Salvador, do not permit terminations when the woman's life is at risk from severe complications of pregnancy. MDG-5 aims to improve maternal health yet over 500 000 women continue to die every year from - often preventable - complications of pregnancy. There can be little progress in improving women's health, or in achieving any of the MDG targets, without considering gender equality.
To date, 150 countries have ratified the UN Convention of the Elimination of All Forms of Discrimination against Women, and 189 countries have agreed an action plan resulting from the Fourth World Conference on Women in Beijing. Despite this progress, women's health rights continue to be neglected by the international community, and no more so than in the health sector. Sustainable solutions to the world's economic, health, political, and social problems will not be found until the rights and full potential of women are achieved. Something to reflect on for International Women's Day.