GENDER, HEALTH AND POVERTY
Despite many development gains in the last century, poverty continues to grow, and the
gap between rich and poor is widening. Recently, understanding has grown that poverty
affects men and women differently, and hence effective policies and interventions will not
necessarily be the same. Yet gender issues are rarely openly acknowledged in national
anti-poverty strategies.
A disproportionate share of the burden of poverty rests on women's shoulders, and
undermines their health. For example:
70% of the 1.2 billion people living in poverty are female
Estimates over a 20-year period found the increase in numbers of poor rural
women in 41 developing countries to be 17% higher than the increase in poor men
There are twice as many women as men among the world's 900 million illiterates
Iron deficiency anaemia affects double the number of women compared to men
Protein-energy malnutrition is significantly higher in women in South Asia, where
almost half the world's undernourished reside
Half a million women die unnecessarily from pregnancy-related complications each
year, the causes of which are exacerbated by issues of poverty and remoteness
On average, women are paid 30-40% less than men for comparable work
In developing countries, only a tiny fraction of women hold real economic or political
power.
Much attention has been given in the last 20 years to policies and strategies for
alleviating poverty. Yet there is still little data and information available about the health
status of the bottom 20% of the world's poorest people - of which women are bound to
comprise a high proportion. What information does exist shows a strong urban bias, with
little information on rural poverty and links to health. Nor has there been sufficient
acknowledgement of the links between gender inequality and the many forms of
impoverishment suffered by women.
Poverty, particularly for women, is more than income deficiency. Women continue to lag
behind men in control over the means of production such as cash, credit, and collateral:
but they are also disadvantaged by other forms of impoverishment in areas such as
literacy, education, skills, employment opportunities, mobility, political representation,
and pressures on their available time and energy linked to role responsibilities. These
factors diminish their human development capacity and affect their health status both
directly and indirectly. For these reasons, women are often poorer relative to men of the
same household and social group.
The following facts emerge from analyses of health and poverty:
For the poor and near-poor of both sexes, sickness is a catastrophe which can
lead to economic ruin
In 20 developing countries, under-five mortality was found to be greatest among
women with no education, and in rural agricultural communities
Where traditional medicine or healers are available, many women choose these
systems first for reasons of cost, convenience, and comfort
The increasing trend towards uncontrolled privatization may result in a proliferation
of health services with little guarantee of quality of care. Poor men and women risk
investing scarce resources for ineffective treatment
Imposition of user fees for basic services such as health care, or water supply, may
particularly disadvantage poor women with limited decision-making power and
control of income
In some parts of the world, social roles and cultural norms for poor women may
inhibit their willingness or ability to seek health care. In others, perceptions of
masculinity keep men away from health services.
Poor families tend to be larger than richer ones, which increases the reproductive
and caring burden on women. Adolescent pregnancy is high in poor families
Socioeconomic change in many parts of the world causes loss of jobs and roles for
men. Women are increasingly becoming breadwinners in addition to their
domestic and caring roles; but as their earnings are likely to be lower, and child
care often suffers, patterns of poverty are easily perpetuated
Women tend to make good the deficiencies caused by reduced public spending
and services, which squeezes their time and energy till further
Poverty is a significant factor behind stress and depression in women, with
domestic violence a frequent contributing factor.
For reasons such as these, WHO is now concentrating considerable effort on health and
poverty work. Part of this will involve applying a gender perspective, to ensure that
knowledge about gender, health, and poverty linkages can inform the work of our
Member States.
To do this, we need to know more about the processes and mechanisms that create and
maintain poverty for men and women respectively, and how this relates to their health.
We need to know what coping strategies men and women use in situations of acute and
chronic poverty. What are the best means of bringing men and women respectively out of
poverty? How is health produced and maintained at household level? Does existing
health policy reach the poor? How do changes in men's roles affect their own and
women's health? What is the impact on poor people's health of the policy of other
sectors? Does the aggregate finding that increased wealth leads to better health hold
true from a gender perspective? Answering questions of this kin is expected to provide
more comprehensive information on men's and women's different experience of poverty,
thereby informing research, policy, and programmes in countries.
WHO Response
The Department of Health in Sustainable Development at WHO is therefore preparing an
integrated planning framework addressing linkages between gender, health and poverty
issues. The framework will show how the use of gender perspectives contributes to more
effective strategies for protecting and promoting the health of the poor. More specifically,
it will lay out the processes, linkages, and mechanisms needed to create and implement
programmes to address gender, health and poverty issues. To do this, a wide array of
partners from civil society, academia, and government are being called on, together with
HSD counterparts in WHO's Regional Offices.
This approach is different from one which shows how gender and biology affect disease
outcomes; rather, the intention is to use a number of topics relevant to health and
development to demonstrate the integrated planning needed for multi-dimensional
gender and poverty issues. The main focus of the framework is therefore on processes
and mechanisms rather than issues.
The following are the main principles of the approach taken:
It will look at broad determinants of health affecting the poor, rather than restricting
itself to a health services/health systems approach
It will stress the need for a strong gender and pro-poor perspective in the health
sector reform process, with emphasis on preventive public health
It will examine the capacity of men's and women's gender roles to protect or
prevent good health for themselves and others
It will emphasise the view of health as a capital asset for the poor
It will underscore the contribution to health and sustainable livelihoods for the poor
of both sexes made by voice, effective participation, and control
Using a case study approach, it will assess existing policies, processes, and
institutional mechanisms, which can contribute to integrated planning in the area of
gender, health and poverty, and identify where these are lacking.
The first version of this tool is expected to be available for the UNGA Beijing + 5 Review
Meeting in June 2000. Further work will be necessary with countries interested in working
on gender equity and poverty alleviation issues to refine and contextualise the
framework. |
