The cost of neglecting gender-related health issues

According to Amartya Sen, good health enables each individual to “lead the kind of life he or she has reason to value.” Health is both a basic prerequisite for human development and an intrinsic good that society should value in itself. As healthcare providers within society, women play a key role that is underestimated and undervalued. Although not officially recognised as health workers, they provide 70 to 80 per cent of health care in developing countries. They are also responsible for 75 per cent of food production in the developing world.

However, a focus on gender specific health concerns is often lacking. Girls, adolescents, older women, and childless women of reproductive age rarely receive adequate attention in international development. From infancy, females in many parts of the world are treated less often when sick, and at an advanced stage of the disease. In countries where women are less educated and lack decision-making power, they are less able to recognise health problems and seek care. Cultural factors such as restrictions on women’s ability to travel alone and receiving treatment by male healthcare workers hampers their access to health services.

Lack of infrastructure creates additional health risks for women. Poor roads, lack of transport and inadequate obstetric facilities prevent women from receiving timely medical treatment for pregnancy-related complications. Inadequate water supply, lack of electricity and poor sanitation impose extra burdens on women because of their household responsibilities such as fetching water and wood. Studies in Kenya confirm that distance is a larger obstacle to women than men in seeking medical care. The repercussions of this are found in gender disaggregated studies such as one in Thailand that found that six times more men attended malaria clinics for treatment as women.

Maternal health also has large repercussions for the health of children. Children whose mothers die are three to ten times as likely to die within two years of birth. A Tanzanian study found that children with mothers that had passed away in the last 12 months spent only half as much time in school. Women are also more likely then men to spend their income on the health and education of their family. A World Bank study in Guatemala found that improving child nutrition in a given household took 15 times as much spending by the father as the mother to achieve the equivalent result.

Finally, as the principal providers of health care in the family, interventions aimed at improving women’s health are extremely cost-effective. Educating them to detect simple health problems, undertaking basic healthcare and giving them the means to promote proper hygiene and nutrition in their families are extremely cost effective health interventions due to the positive effects they have on the family.

Benefits of investing in women’s health and nutrition

• Improving equity and quality of life: Initiatives to improve women’s health could save millions of women from needless suffering or premature death and enable them to lead fully productive lives. Women are at particularly high risk for certain health problems, largely because of their low socio-economic status and their reproductive role.

• Conferring widespread benefits: Investments in women’s health have multiple payoffs. In addition to improving women’s well-being and productivity, such investments also yield significant benefits for families, communities, and the national economy. In particular, women’s health has a major impact on the health and productivity of children.

• Improving efficiency: Redirecting public spending to highly cost-effective interventions improves allocative efficiency. Measures that address women’s health problems are among the most cost-effective investments available in developing countries.

How to address gender-related health issues

(Source: World Bank)

• Invest more in female education. Women who are better educated take better care of their own health and that of their children. All girls, including those who become pregnant, should be encouraged and given equal opportunity to attend school.

• Strengthen legislative and other support for women’s nutrition. Four policy initiatives can help improve women’s nutritional status: fortification of foods with iodine and iron; consumer food subsidies and targeted food distribution; dissemination of labor-saving devices for women; and better access for women to agricultural extension services and credit.

• Reduce discrimination against females. Discriminatory policies affect women’s health by restricting their ability to adopt healthy behaviors and by limiting their opportunities for economic advancement. Examples of such policies include employment practices that handicap women, limits on women’s control over family resources, restrictions on women’s ability to travel or obtain credit, and laws permitting early marriage for women.

• Abolish practices harmful to women’s health. Through legislation, legal enforcement, and public education programs, governments have the power to curb practices that harm women or are injurious to their health. For example, governments can ban female genital mutilation or lend their authority to campaigns to change public attitudes and behavior. By enacting and enforcing criminal penalties for violence against women, governments can deter such crimes.

• Remove legal impediments to the effect delivery of health services. Governments can change laws and regulations that restrict women’s access to essential health services. Examples are barriers to service use based on age, marital status, or other factors; spousal consent requirements; and import duties on contraceptives and drugs.

• Support appropriate training and increased responsibility for nurses and midwives. Women’s access to health services can be improved by removing legislative and licensing obstacles for health care providers other than physicians. Nurses and midwives could provide many of the essential and expanded services for women. Success in modifying current practices, however, will require the support of professional associations representing physicians and other health practitioners.