Documento(s) 9 de 13

Why should we look at women separate from men? One might point to a few pertinent facts: women have special health problems that men do not experience; women are more vulnerable to certain conditions than are men; some health conditions are less easily detected in women; women's health directly affects child survival chances; and women's needs are often neglected if not specifically identified.

--Eva M. Rathgeber, International Development Research Centre, Regional Office for Eastern and Southern Africa, Nairobi, Kenya

Gender inequities in health

Health, a basic human right that is vital to sustainable development, eludes the majority of women. Although women in most societies live longer than men (for biological reasons), women often suffer greater burdens of illness and disability than their male counterparts. There are sharp inequities in health in both developing and industrialized countries; however, the disparities are more pronounced in developing nations (World Bank 1993). For example, about half a million women die every year from the complications of pregnancy and childbirth. Most of these deaths are preventable with simple technologies that have been available for decades. Maternal mortality ratios (maternal deaths per 100 000 live births) are, on average, 30 times higher (and in some cases are 200 times higher) in developing countries than in high-income countries (World Bank 1993).

As a result of visible and invisible discrimination, subordination, and undervaluation experienced throughout life, women are more vulnerable to poverty, poor nutrition, preventable diseases, uncontrolled fertility, premature death, violence, disability, alienation, and loneliness. The quality of women's lives is further impaired by insufficient education, poor housing and sanitation, long hours of work in physically demanding and often dangerous conditions, inadequate and inaccessible health-care services, and lack of family and community support.

As described by Seble Dawitt (1994):

Harmful cultural practices perpetuated on women and girls ... include child marriage and early pregnancy, forced feeding before a wedding, nutritional taboos, particularly during pregnancy, certain birthing practices, female genital mutilation, less food, education and health care for girls, dowry and bride price, widow inheritance, and female infanticide .... The result for individual women and girls is mitigation of their health or their quality of life. What all these practices have in common is that they evolve from, or are in reaction to, the preference for male children.

Gender inequities, and the preference for male children, sometimes starts even before birth. Diagnostic techniques, such as amniocentesis, chorionic villus sampling, and targeted ultrasound, have made it possible for parents to discover the sex of the fetus and to terminate the pregnancy if they had hoped for a child of the other sex. In a number of countries (such as China, India, and Korea), the selective abortion of female fetuses is becoming more and more common as a result of these new technologies (rcnrt 1993; Oh 1995).

Gaps in gender and health research

In The Female Client and the Health Care Provider, H.V. Wyatt (1995) points out:

Since 1945, there have been several hundred papers published on the topic of polio in India, covering immunization, prevalence of acute and residual paralysis, and rehabilitation. Yet no paper discusses differencing related to gender. Even data that might have been analyzed by gender are always presented as a total ... [researchers] carry out extensive house to house surveys to locate disabled children -- and then file their results in such a way that differences related to gender cannot be examined.

Major gaps exist in our understanding of gender and health, largely because much research in the past has to some extent bypassed women (Rathgeber 1994a). In many countries, there is a serious lack of rigorous sex-disaggregated research. Health research has tended to overlook the specific consequences of disease and illness on women and men and neglected to examine fully the different social, cultural, and economic contexts within which women and men work and live (Rathgeber and Vlassoff 1993).

Studies have also largely failed to investigate the impact that the physical and biological differences between women and men have on the epidemiology and etiology of disease. Medical research tends to have a male bias (Rosser 1991), and health research (other than reproductive health) is often carried out on male subjects and the results are assumed to be relevant to both women and men. As an illustration, women have not been included in clinical trials of the extent to which azidothymidine (AZT) inhibits the progression of AIDS, and researchers therefore do not know how well AZT works on women. Women often respond differently to treatment, metabolize drugs differently, and, according to Donna Stewart of the University of Toronto, "are not just men with menstrual cycles" (Priest 1994, p. A1).

[In Korea] many induced abortions are performed because the sex of the fetus is thought to be female. Recent medical technological advances now allow for the identification of fetal sex during the first trimester of pregnancy. As a result of the high number of abortions of female fetuses, there is now a severe imbalance of the sexes.

-- Kasil Oh, Yonsei University, Seoul, Korea

[It is a mistake] to assume that the norm of male experience is equally applicable to women -- that women have the same attitudes and perceptions, the same opportunities and lack of opportunities, and the same needs as their male counterparts.

-- Eva M. Rathgeber, International Development Research Centre, Regional Office for Eastern and Southern Africa, Nairobi, Kenya

Despite the fact that women make up a rapidly increasing number of those infected with HIV (human immunodeficiency virus), women remain at a disadvantage regarding diagnosis, treatment, and care because of gender inequities in health research (Strebel 1994). Hankins and Handley (1992, p. 967) argued:

A concerted effort on the part of clinicians, researchers, funding agencies, and decision-makers is required for redressing the inequities in both the gender-specific knowledge of the natural history, progression, and outcome of HIV disease and the adequacy of medical and psychosocial care for women with HIV infection. The unique features of HIV infection in women have been subject to both scientific neglect and policy void.

The gender dimensions of many other areas of health research beyond AIDS have also been neglected. In the area of tropical diseases, for example (Rathgeber and Vlassoff 1993, p. 513):

Both biomedical and social research on the effects of tropical diseases on women has taken a narrow perspective. It has focused primarily on sex differences, particularly related to pregnancy and reproduction, and has not examined these in relation to broader social roles and responsibilities.

Timoteo and Llanos-Cuentas (1994) reported that, in a search for studies related to gender and tropical diseases in Peru, they discovered an overwhelming absence of literature on the subject. For example, in bibliographies on leishmaniasis, there were very few studies related to how this disease affects women and men differentially from a socioeconomic and cultural perspective. Even if sex was identified as a variable in studies, there was little or no analysis of the impact of broader gender relations.

The health implications of women's work is yet another area of study that has been highly neglected in research. The limited research has tended to focus on the reproductive health effects of work, rather than on the health of women themselves. Furthermore, there is a dearth of research that explores the direct health effects of women's heavy workloads in and around the household and in the informal work force.

Health services for women usually emphasize and cater to the reproductive health needs of women, and little effort is made by the health sector to help women realize that they are persons in their own right, with their own personal health needs. Women's health needs are given less attention within the structure of health-service provision than the health needs of children. Their quality is poorer, and more often than not, women's needs are subordinated to population-control programs.

-- S.A. Udipi and M.A. Varghese, sndt Women's University,Bombay, India

Beyond pregnancy and reproductive health

One of the goals of these workshops was to adopt a holistic approach to women's health and to place greater emphasis on the quality of well-being of women's lives outside the sphere of fertility and reproduction. In the past, when women's health has received attention, "reproductive health and women's health have been treated in general as if conterminous" (Manderson 1994, p. 2), and more concern has been placed on children resulting from pregnancy than on women themselves. The extent to which women's health and well-being affects perinatal and infant mortality, for example, has been a key focal point. In the area of AIDS research, most early studies in women were largely restricted to preventing transmission of HIV from an infected mother to her child (Cohen 1995), and women themselves were neglected from the beginning of the epidemic.

Commentators have noted that the focus on women when discussing contraception and family planning has had more to do with containing population growth than enhancing the health and well-being of women. Research in this domain has been motivated largely by widespread concerns about the need to curtail high birth rates and control population growth, "rather than by concern with women's health as a good in itself" (Vlassoff 1994, p. 1250).

In service delivery, as well, programs for women have been geared toward the reproductive role of women and a narrow family-planning focus. Women's medical services often have a lower priority within the structure of health-service provision than those for children and men, and their quality is poorer (Udipi and Varghese 1995). This perpetuates the notion that women's needs are secondary to others. Women are viewed "first as mothers or future mothers," whereas men's health "is never defined from a family or fathering perspective" (Rathgeber and Vlassoff 1993, p. 514).

The fields of both medicine and public health have perpetuated the classic androcentric view of woman that focuses on her reproductive capacity and circumscribes her to the singular role of mother.

-- Jaime Breilh, Health Research Consultancy Centre, Quito, Ecuador

Richters (1994, p. 42) called for a deconstruction of "the ideology that women's sole natural destiny is to fulfil the biological role of procreation." Women must be seen as human beings with needs and desires that relate to them personally as women. Research with regard to women should aim to empower them as individuals, as people in their own right, without always looking at their role as nurturers.

Research should also cover the entire life span of women, "from the fetus threatened by malnutrition and gender selection to the post-menopausal woman debilitated and marginalized by osteoporosis."¹Health research and policies must incorporate "the full range of [women's] needs and activities and all the discomforts and illnesses that they face" (Richters 1994, p. 43). As Denise Eldemire (1995), from the University of the West Indies, correctly points out:

The older woman has been essentially ignored, menopausal issues not addressed, and the contribution of older women as grandmothers, child carers and rearers, and housekeepers not given adequate recognition. Such activities are a resource and a contribution to development because they allow other family members to be productive. They also serve to raise the next generation of workers.

¹ Comment of V. Wee at the IDRC workshop on gender, health, and sustainable development held in Singapore, 23-26 January 1995.

Documento(s) 9 de 13