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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.”
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
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