Documento(s) 11 de 13

Where women have poor health status, it is a result of the different types of poverty from which they suffer. This refers not only to poverty in an economic sense, but to the multidimensional poverty that can start even before birth, when an infant girl is seen as a liability rather than an asset. It is the poverty that results when she is valued less, fed less, put to work at a very early age, denied schooling, and denied access to resources, technology, and essential services that respond to her health needs. This insidious poverty follows her throughout her entire life. These multifaceted and interlinking aspects of poverty ultimately determine health outcomes.

-- A. El Bindari Hammad, World Health Organization, Geneva, Switzerland

In the course of presentations and discussions that explored the four selected priority gender and health-research areas (AIDS, the working environment, tropical diseases, and barriers to quality health care), several themes emerged repeatedly. Four topics were identified as crosscutting issues that influence all aspects of women's health and well-being:

• The links between gender,class, and ethnicity;

• The correlation between women's education and health;

• The relationship between the empowerment of women and health; and

• The role of nutrition.

Gender, class, and ethnicity

There is a growing recognition that class and race variables intersect with gender to compound the complexity of power relations (Ramazanoglu 1989; Stamp 1989; Singer 1994; Strebel 1994). Disadvantaged racial groups in rich countries are often in worse health that better-off groups living in poor countries. The health status of Canadian Indians, for example, lags far behind the general Canadian population. The maternal mortality rate for the registered Indian population was, on average, five times the Canadian rate between 1984 and 1988. In 1988, the Indian infant mortality rate was 2.2 times the Canadian rate (Health and Welfare Canada 1991). And, in the United States, "the intersection of urban poverty and socially devalued ethnicity (especially being African-American and Latino, and in some parts of the country Native American and Asian as well) have proven to be a particularly unhealthy combination" (Singer 1994, p. 931).

A number of interrelated conditions, disproportionately affecting poor African-American and Latino women and men, have led to the health crises in inner cities of America. These include high rates of unemployment, homelessness, residential overcrowding, substandard nutrition, environmental toxins, infrastructural deterioration, forced geographic mobility, family breakup, disruption of social-support networks, youth-gang and drug-related violence, and health-care inequalities (Singer 1994). Although the United States, and to a lesser extent Canada, provide graphic examples of the sharp socioeconomic and health-related differences that exist depending on race and class, these types of disparities can be found in most countries of the world.

An intersectoral approach must therefore be adopted when addressing health issues. The approach must link gender as a system of inequity with other forms of inequity such as class and ethnicity (Breilh 1994). This type of approach may help to explain why men in Bangladesh have a higher probability of survival after age 35 than men in Harlem, New York (McCord and Freeman 1990).

Just as health issues for men are different from those faced by women, diseases of the rich are not the same as diseases of the poor. As remarked by Vivienne Wee: "Poor black women living in the United States are among the worst off. On all three levels -- race, class, and gender -- they are the poorest of the poor." And as echoed by Rosina Wiltshire: "Although there are inequalities related to race and class, it is important to focus on gender ... women suffer most regardless of race or class."

The role of poverty

The majority of the world's poor are women. Women often lack power and social status in society and, therefore, access to economic resources (Strebel 1994). As a result of their differential positioning in society, women are usually poorer than men, and are often economically dependent on men (Campbell 1990; Ankrah 1991; Ulin 1992).

It is impossible to talk about the feminization of poverty without mentioning the increasing number of single women with children who are heads of households. This worldwide phenomenon is the result of national and international migration of men in the search for work, divorce, widowhood, wars, desertion, and the increasing number of births to unpartnered adolescent women. Female-headed households, which make up about one-quarter of households around the world (UN 1995), are particularly disadvantaged and economically vulnerable. The lack of educational opportunities for women and the difficulties obtaining well-paid secure employment mean that the amount of money coming into female-headed households is usually considerably less than into male-headed households (Acevedo 1994). As explained by Richters (1994, p. 41): "Because such mothers are often poorly educated, without investment capital, and attempt to do two jobs at once (domestic and wage work), female-headed households tend to be poor."

Pigsties are better than many of the shacks of these people here. It is difficult to have self-esteem that way, everything points to your undervaluation as a person. They do not take care of themselves as people, they belittle themselves as women, they have no self-respect.

-- A health professional commenting on the lives of women living in extreme poverty outside Montevideo, Uruguay, reported by Maria Bonino, Universidad de la República, Montevideo, Uruguay

Poverty has a powerful influence on health. Female poverty means that less money is available to purchase adequate and nutritious foods, which increases the risk of illness and disease. Inadequate nutrition influences disease recovery. Substandard living conditions, including poor housing, deficient standards of hygiene, unhealthy sources of water, and lack of garbage collection services and sewage systems, also expose populations to increased risk of disease. Poor women are also unlikely to have access to formal health-care services and adequate treatment and tend to give birth to babies of low birth weight who begin life in a disadvantaged state.

Poverty affects a woman's available life choices. Female poverty can mean that a woman has to take whatever job she can get to support herself and her family; this lack of choice greatly increases the probability that she will end up working in an exploitative situation with little or no occupational health and safety protection. Entering into prostitution is another strategy used by women around the world to cope with poverty.

Harsh living conditions can also lead to feelings of negativity and low self-esteem, which are important psychological variables affecting the attitudes of women about their health. Poor self-esteem and self-respect reduce the likelihood that a woman will seek out health-care services for her own needs.

Policies aimed at increasing the economic opportunities of women living in poverty will ultimately improve the health and well-being of women, as well as other household members. Women usually spend additional income on ways that enhance their health -- improving their diet, obtaining safe water, and upgrading sanitation and housing. "In the developing world, women tend to spend whatever wealth they have on food, education, and health care for their children, whereas men tend to spend on such things as prestige goods, alcohol and extra-marital sexual liaisons" (Richters 1994, p. 40)

Women's education and health

A second crosscutting issue influencing women's health and well-being concerns the correlation between the education of women and health. In almost all developing countries, women are disadvantaged as a result of poorer educational opportunities. According to the Report of the International Conference on Population and Development, which was held 5-13 September 1994 in Cairo (un 1994):

There are approximately 960 million illiterate adults in the world, of whom two thirds are women. More than one third of the world's adults, most of them women, have no access to printed knowledge, to new skills or to technologies that would improve the quality of their lives .... There are 130 million children who are not enrolled in primary school and 70 per cent of them are girls.

In Viet Nam, "high rates of school dropout among girls are an indication of both high education expenses and the lack of emphasis placed on female education" (Binh 1995). In India, no more than 33% of girls receive a minimal 5 000 hours of schooling, or about 6 full years; whereas, in China and Latin America, only 60% of girls receive this minimal level of education (World Bank 1993). Women's rates of enrollment in secondary schools lag behind men's by as much as 56% in Bangladesh, 40% in Malawi, and 68% in Togo (Misch 1992). Although some countries have been able to achieve gender equity in enrollment rates at primary schools (Tillett 1994), the higher the education level, the more likely that gender gaps prevail, particularly at the tertiary level (Grandea 1994).

Female education, gender-power relations, and AIDS must be considered not only separately, but also as dynamically interconnected.

-- Maureen Law, International Development Research Centre, Ottawa, Canada (see Law 1994)

Reduced access to education, information, and knowledge means that women are often poorly informed about health issues, about how their bodies function, and about how to protect themselves from disease, and disadvantaged in their ability to recognize and act on signs and symptoms of illness (Manderson 1994; Vlassoff 1994). Poverty of education "creates a vicious circle of myth and misinformation that perpetuates health-damaging behaviours and harmful practices" (Hammad 1994, p. 3).

The call for better educational opportunities for women is often premised on the fact that educated women are better mothers, who raise fewer, better educated, and healthier children (Grandea 1994). As the World Bank (1993, p. 42) pointed out:

In developing countries better-educated women marry and start their families later .... Educated women also tend to make greater use of prenatal care and delivery assistance ... the children of educated mothers continue to enjoy other health-enhancing advantages: better domestic hygiene, which reduces the risk of infection; better food and more immunization, both of which reduce susceptibility to infection; and wiser use of medial services ... slower population growth and lower infant morality rates are closely associated with increasing levels of women's education.

However, greater education for women not only means that their children will be healthier, it also means that women themselves will be healthier. Education "increases [women's] ability to benefit from health information and to make good use of health services; it increases their access to income and enables them to live healthier lives" (World Bank 1993, p. 42). For example, Mbacke and van de Walle (1987) found that the use of mosquito nets and coils was significantly related to maternal education. Education also instills confidence in women to deal with the world.

It is a well-documented fact that educated women visit their health providers more often than uneducated women as education increases self-respect and self-confidence in women. Educated women also have more knowledge of the health-care system. The effect of education extends beyond her to the attitudes of others around her, including health providers who will treat her with more respect and consideration. Education improves communication between the female client and the health provider. As a result, the educated woman's experience with the health provider may be more favourable than that of the uneducated woman.

-- Tehseen Iqbal, Multan, Pakistan

Women with higher levels of formal and nonformal education may have greater family decision-making power on health and related matters (Sermsri 1995). Energy intake of girls in a slum community outside Bombay, India, was found to be positively and significantly influenced by educational status and decision-making power (Udipi and Varghese 1995). A study conducted in rural southern India found that mothers who had been to school were more likely to demand of their husbands and mothers-in-law that a sick child be treated and more likely to use medical facilities. They were also more likely to follow the doctor's instructions and return to the health centre for further care (Caldwell 1993).

Educated women and mothers may have greater decision-making power on health and related matters within both the family and the community, be more knowledgeable about disease prevention and treatment, and be more likely to adopt new codes of behaviour that improve the health of their children.

-- Santhat Sermsri, International Forum for Social Sciences in Health, Nakornpathom, Thailand

Women's opportunities in the work force, and the possibility of obtaining jobs that provide adequate wages² are at least partially linked to education. Education is an important actor underlying gender segregation in the labour market. Women's training tends to be oriented toward particular career paths, such as those in the social sector, such as teaching, nursing, and typing, and away from technical or industrial fields (ILO 1985; Grandea 1994). Unless gender-based inequities in education are removed, women will not have the basic prerequisites to compete for high-skilled, high-paying jobs (Grandea 1994).

Although education can, to some extent, increase the possibility of women obtaining better jobs, the link between eduction and employment, particularly for women, is fragile. Even when women have the right skills, gender stereotypes and cultural dictates, as well as socioeconomic factors, can present barriers to equal opportunity for women (Grandea 1994).

In some societies, parents are reluctant to invest in the education of girls and do not encourage their daughters to remain in school (Atai-Okei 1994; Kerawalla 1994). In an urban slum outside Bombay, India, Muslim families said that girls should not be educated because education causes them to be more vocal, independent, and autonomous and leads them to "talk back" to their elders (Udipi and Varghese 1995). Other reasons why parents keep their daughters out of school include "fear of too much freedom ... a preference for increasing limited resources in their sons' education with a view to parental support in old age ... better job prospects and wage rates for men [and] traditional stereotypes of women's roles" (UN 1995, p. 91).

Investing in the education of children has traditionally been seen as a loan to be repaid by children. Daughters are educated so that they can return much of the "investment" before marriage. They are sent out to work as soon as possible so they can contribute to the family economy, including the education of their siblings, especially their brothers. Although the education of daughters is expected to help the marriage alliance, education of daughters as a value in itself has had very little recognition.

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

The link between education and improved health may be correlated to higher income levels -- indeed, income may be the determining factor. Better-off families can afford to send their girls to school longer and may be more inclined to consider the education of children to be an investment for the future. In poor families, however, demanding household duties often result in children getting taken out of school to work. Young girls, especially, drop out of school to help their mothers. When a mother becomes seriously ill, her daughter is more likely than her son to be kept from schooling to assume increased domestic responsibilities.

Policies to expand schooling for girls are crucial to promote health. Educational facilities must be created and strengthened and girls must be provided the same opportunity for education as boys. Essential health information should be introduced into school curricula at the earliest levels.

Empowerment of women and health

The links between women's health and notions of empowerment, entitlement, and improved self-esteem formed another crosscutting issue. "Empowerment" literally means the investing of power and authority. The word has come to mean enabling or equipping individuals or groups to have power, with the aim of creating and fostering relationships of equals in society. "For women, the process of empowerment entails breaking away from the cycle of learned and taught submission to discrimination, carried from one generation of women to the next" (Tomasevski 1993, p. 24). Nan Peacocke (1995), from the Women and Development Unit (WAND) of the University of the West Indies, believes that a sense of empowerment is critical to get women to accept health-related information and translate this knowledge into behavioural changes.

Once a woman has self-esteem she begins to "find the person within the woman," and starts to take responsibility for her own health needs.

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

The widespread devaluation of women in society can be seen in the relative lack of educational opportunities for women and the unequal allocation of resources to women, such as land and food. Women's interests are undermined, and their work is devalued. The general low status of women, and their internalization of this status, results in the marginalization of women's physical, psychological, and emotional needs (Kwawu 1994; Manderson 1994). As stated by Lin Tan (1995): "Women's position in society directly or indirectly influences their ability to participate in childbearing, sexual conduct, and fertility-rate decisions."

Increased understanding by women of their value in the family and the community and the important contribution their labour makes to the national economy can lead to increased confidence and self-esteem, can affect women's interactions with others, and can lead to positive changes in health behaviour (Peacocke 1995). When a woman's self-esteem improves, increasingly she feels able to make more household decisions and begin to put forward her viewpoints within the family.

The formation of women's groups can lead to increased self-confidence and self-esteem on the part of women (Udipi and Varghese 1995). A women's group, formed in a slum community outside Bombay, India, where the mobility of women was significantly curtailed, provided women with the opportunity to come out of the household as a first step and gradually led them to take the initiative to improve their own health and well-being. The formation of another group in Surkhet, Nepal, helped women to talk openly about their problems and encouraged them to gradually break down traditional discriminatory practices that work against women's health. One women announced after giving birth that she would set her own diet, complete with vegetables; whereas, other women "have begun to quietly tuck away one handful of rice a day to eat later or to sell" (Stackhouse 1995b, p. A7).

In the beginning, women would be absorbed in household affairs and often said they had no time to participate. When some of us got together and started a preschool centre and skill-training program, women became curious. Today we have many women who find that they can manage their household activities and tasks better and spare 2 or 3 hours. More importantly, they feel this spare time is to be devoted to themselves. The [women's group] has gradually helped women to voice their inner feelings first in the group and then [they are better able] to speak within the family.

-- A community worker, quoted by S.A. Udipi and M.A. Varghese, SNDT Women's University, Bombay, India

Women must be encouraged to take control over their own health: "The notions of self-care, and control over one's life, need to be felt at every emotional level" (Pinel 1994, p. 57). Furthermore, women must be taught skills that enable them to effectively change their reality.

Finally, a sense of entitlement can make it possible for women to challenge existing power structures. As an illustration, Peacocke (1995, pp. 278-279) described how one woman, C.J., a member of the Red Thread Women's Development Organization in Guyana, was able to effect change at a workshop on breastfeeding because of her sense of entitlement and her understanding of the sociocultural determinants of health. C.J. provided the following account of her experiences:

I went to a workshop on Thursday and Friday. When I get there I said to myself, "What! [Why did the team leader] send me here?" It was sheer doctors, sheer "up there!" When we [got] into small group discussion I had to tell the doctor who was the facilitator, "I think we [are] starting wrong ... let us look at the chronic diseases first." [C.J. explained that the doctor looked surprised that an alternative approach was offered, while the nurses were shocked that C.J. had contradicted a doctor]. I tell you 20 minutes and they can't start yet! Then, you know what the doctor say? "OK, let's start how C.J. said we should." You know, when we started we had a smooth flow of discussion.

In my evaluation I said, "You know what? I personally feel this workshop here hasn't achieved its aim. We ... needed more grassroots people at this workshop, because the grassroots people could tell you ... doctors and nurses about breastfeeding and tell you why they are not breastfeeding babies." One of the decisions they came up with [was] that they are going to give mothers 4 months maternity leave so they could breastfeed babies. I said, "That 4 months still can't do anything because the mothers ain't getting proper food to eat."

Nutrition

Women's nutrition is another crosscutting issue that influences all aspects of women's health and well-being. Although the nutritional status of women has received significant attention in research and interventions addressing women's health, "in most cases the primary objective has been the improvement of infant nutritional status ... very little attention has been paid to the problem of nutritional deficiencies among non-pregnant, non-lactating women" (Paolisso and Leslie 1995, p. 57).

Women suffer disproportionately from iron-deficiency anemia, iodine-deficiency disorders, and from stunting caused by protein-energy malnutrition (Figure 1). Throughout the world, 43% of women and 51% of pregnant women suffer from iron-deficiency anemia. Pregnancy puts a severe strain on women's iron status and 56% of pregnant women in developing countries are anemic (rising to 88% in India) (WHO 1994b). Anemia is also a risk for nonpregnant women because of the iron demand of lactation and the iron losses associated with menstruation (Paolisso and Leslie 1995).

Women's nutritional status can be significantly affected by the unequal distribution of food among family members, which is linked to women's lower social status (Breilh 1994; Rathgeber 1994a). Discrimination can begin in early infancy with male children being breastfed longer than girl children (Udipi and Varghese 1995). In some regions of the world, men and boys routinely eat first, and women and girls "eat less food which is of inferior quality and nutritive value" (un 1991).

Figure 1. Percentage of women (15 years and above) who are affected by stunting, anemia, iodine-deficiency disorders, and blindness from vitamin A deficiency (1992)
(source: who 1994b).

Discriminatory feeding practices in childhood can lead to protein-energy deficiency. The stunting that results in the girl may cause problems in her subsequent reproductive life such as obstructed labour, birth asphyxia, and many other conditions.

-- A. El Bindari Hammad, World Health Organization, Geneva, Switzerland

A survey in India by the National Committee on the Status of Women found that women ate after men in 48.5% of households (Udipi and Varghese 1995). Mothers "drill[ed] the sacrificial role into daughters with regard to food intake" (Udipi and Varghese 1995, p. 154). Male family members who ate first did not think about whether the amount of food available was sufficient for the whole family and were insensitive to the nutritional needs of female family members (Udipi and Varghese 1995).

Food deprivation is part of the socialization of girls; it is seen as part of their deferential role that they will continue to play as future daughters-in-law. Parents often explain that discrimination against girl children is part of their training, so that they will know what is expected of them in the homes of their in-laws.

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

Research in the Philippines (Illo 1991, p. 4) has also shown that women tend to place themselves last when serving food among their family members.

The male spouse's food has to be secured first, then the children's. This is particularly true during lean months when rice and other food are scarce, and some rationing occurs ... many of the women ... interviewed seemed to consider this abstinence as part of being a good wife and mother.

Selected health effects of inadequate nutrition

Inadequate nourishment limits the physical development of women, compromises their health, and threatens their ability to bear healthy children. "Malnourished women are sick more, have smaller babies, and die earlier" (UN 1991).

• Nutrition and AIDS: Women frequently have a poorer prognosis once infected with HIV and die sooner than men (Jones and Catalan 1989; Berer and Ray 1993; Melnick et al. 1994; Strebel 1994). This may be related to the fact that the progression of AIDS is associated with the basic health and immune status of the individual prior to infection, and women tend to have poor general health and nutrition (Adeokun 1994).

• Nutrition and women's work: Nutritional anemia exacerbates fatigue and reduces the working capacity of women in the workplace and at home (UN 1991). Poor nutrition may also increase the effects of workplace illness (Haile 1994; Puta 1994). As Messing (1991, p. 10) pointed out: "The healthy young body may resist damage from workplace chemicals better than the unhealthy or older body ... the poorly nourished body may be less able to tolerate polluted air."

• Nutrition and tropical diseases: Inadequate nutrition compromises the immunological status of women and enhances their susceptibility to tropical diseases (Ulrich et al. 1992). The depressed health status of women as a result of general malnutrition has been identified as one of the reasons for high levels of mortality and morbidity in women from malaria (Alilio 1994). A synergism between nutrition and visceral leishmaniasis has also been reported, and children with signs of malnutrition are more likely to get this disease (Mutinga 1984).

• Nutrition and barriers to quality health care: Poorly nourished women are less likely to pay attention to health-education messages essential to their own health (Alilio 1994). Not only are poorly nourished women less likely to attend to their own health needs, they may also feel less inclined to participate in activities such as attending prenatal care and taking their children for growth-monitoring and immunization (Alilio 1994).

Hypertension, diabetes, and obesity among Caribbean women

Researchers from the Caribbean highlighted that poor nutrition among Caribbean women coexists with a high susceptibility to nutrition-related diseases such as hypertension, diabetes, and obesity. Indeed, these diseases are among the main causes of death among women in the Caribbean (Patterson 1995). Furthermore, the prevalence of such diseases is several times higher in women than in men (Fraser 1995; Patterson 1995; Thompson 1995).

The presence of these diseases may be related to an imbalance in the nutrient content of the food consumed within households (Patterson 1995). Cultural practices that emphasize the use of salt, simple sugars, and fats in the diet may be partially responsible. Importance continues to be placed on calorie-rich foods, historically a necessity, but no longer relevant in more modern societies. Indigenous foods, rich in complex carbohydrates, fibre, beta carotenes, and other vitamins, are rejected by some segments of the population as "poor people's food" (Patterson 1995). Avenues to change these traditional and cultural perceptions are essential in the management of these diseases.

Fraser (1995) pointed out that high female susceptibility to obesity is also related to the fact that obesity in Caribbean women has traditionally been regarded as a sign of beauty and good health. Women who are thin, even if they are healthy, may be considered to be ill. However, recent evidence has suggested that, at least among the younger generation, these attitudes may be changing (Fraser 1995).

Finally, some research studies in North America have demonstrated a relationship between cardiovascular disease and poverty and social inequality (Singer 1994). These links needs to be explored, particularly from a Caribbean context.

Environmental degradation and nutrition

In Chapter 6, the impact of environmental degradation on women's work is addressed. Environmental degradation not only increases the workloads of women, it can also lead to difficulties for community members in meeting their nutritional needs. In the Tongu area of Ghana, for example, environmental degradation has led to the loss of clams and the deterioration of fishing and farming, which has drastically affected nutritional standards (Tsikata 1994). Lack of food is now one of the most serious problems in this area; community members must buy foods that they once produced, which is particularly difficult for low-income families.

The lack of food places great stress on women who are usually the food providers. They can no longer produce their own carbohydrates and protein. Most food now has to be imported from the Afram plains and other parts of the country to be sold in Tongu communities. Low incomes make it difficult to afford enough food, especially proteins, which are expensive. This situation has significantly contributed to high levels of anemia and malnutrition, as well as reduced resistance to other diseases.

-- Dzodzi Tsikata, Institute of Statistical, Social and Economic Research, University of Ghana, Legon, Ghana

Jacobson (1992a, p. 26) reported that deforestation, and the "scarcity of leaves, twigs, branches, grasses, and other materials used for cooking fuel now rivals the scarcity of food itself as a cause of malnutrition in parts of sub-Saharan Africa, Haiti, Mexico, Nepal, and Thailand." Without wood "women cannot cook the food they have grown and harvested, or do simple things like boil water or heat their homes." With less fuelwood available, women may either cook meals for less time or reduce the number of cooked meals, which leads to undernutrition.

In some parts of the world, agricultural fields have been ravaged by war and this has led to poor levels of nutrition in affected communities. In Cambodia, for example, the use of chemicals and land mines has adversely affected crop growth and therefore nutritional levels (Ren et al. 1995). Women, primarily responsible for feeding their families, feel the effects of these food shortages most acutely.

Crops do not produce as much as before because they have to be sown time and time again to yield enough for sale; the soil grows tired -- and so do we.

- Quoted by Xochitl Herrera and Miguel Lobo-Guerrero, Etnollano Foundation, Bogotá, Colombia

Replacement of indigenous subsistence-farming activities with income-generation activities may lead to a deterioration of community nutritional standards and of the ecology of the land. For example, among indigenous communities in the Orinoco and Amazon basins of South America, an intensification of commercial relations with the nonindigenous world has caused many alterations to traditional society. Traditionally, each indigenous family usually has two or three conucos (plots of land) where they grow a wide variety of crops for home consumption, such as pineapple, mapuey, yucca, peppers, seje, and lulo (Herrera and Lobo-Guerrera 1994). Together, these crops constituted a balanced diet and maintained the quality of the soil (Rojas 1992). However, as indigenous subsistence agricultural societies increasingly turn to income-generation activities, traditional conucos have become dedicated to the planting of a single commercial crop, such as cocoa, bananas, maize, or yucca. A "good" conuco now means "a big conuco, full of bananas," instead of a diverse plot growing a variety of nutritious foods for family consumption. This can have long-term effects on the nutritional levels of the community because the soil used for crops in the Orinoco basin, like the soil used in the Amazon rain forests, is fragile and will not bear intensive commercial cultivation.

²Sufficient to afford nutritious and adequate food and proper accommodations with healthy sources of water and an environmentally safe power supply.

Documento(s) 11 de 13