The Politics of Women's Health
Global Women's Health
Women’s health status varies greatly depending on economic class, race, ethnicity, education, and home country. The same, of course, can be said of men. Women, however, are less likely to have educational opportunities and often lack decision-making power within communities--both of which affect our health status.
A woman’s life expectancy in the United States is 80 years, as compared to 85 in Japan, 73 in Saudi Arabia, 63 in India, 53 in Haiti, and 47 in Ethiopia.33 The great variation in life expectancy is strongly related to the wealth of each country and how evenly that wealth is distributed across the population. Life expectancy is also related to whether economic resources have been used to provide basic public health services, such as safe, clean food and water; basic or primary-level health care, including immunizations and well-child programs; and enough education to ensure literacy.
There is also a wide variation in life expectancy within countries. According to data from 2001, in the United States, for example, life expectancy among white women was 80.2 as compared to 75.5 among black women.34 Although there is some evidence that race and ethnicity affect health status, the strong relationship between minority status and poverty clouds the issue. Women with low incomes in all countries have a lower life expectancy than women in the middle and upper classes. Poor women often have limited access to nourishing food and quality health care and may be exposed to more occupational and environmental hazards.
Throughout the world, those of us with access to education are more likely to believe we can control many aspects of our lives, including whether and when to have children. Women with more education will have fewer children than women with less education, even if both groups of women have equal economic status. We may also have more egalitarian relationships with our husbands (if we are married) and more decision-making power.35 Education alone, however, does not guarantee this. Religious or racial oppression, for example, can make educational gains irrelevant for women in certain communities. In other words, knowledge is power only when we’re given the opportunity to use it.
Policies that stimulate economic growth, promote a reasonably equitable distribution of wealth, and provide basic health care and education are essential for improving women’s health throughout the world. Policies that promote the education of girls and women often lead to reductions in the birth rate, as well as improved health for women and for the community as a whole.
In the United States, women deliver an average of two children each, although this varies by ethnic group. (White women have an average of 1.8 children, compared to 2.1 for black women and Asian/Pacific Islanders, and 3.1 for Latinas.)36 Women have an average of 1.3 children in Italy, Spain, and Romania; 4.4 in Guatemala; 5.0 in Iraq; and 7.1 in Somalia.37 In developing countries, many of these children die before the age of five. In poor societies where women do not have enough nutritious food and do not receive adequate health care, bearing children can be dangerous to one’s health. Women who deliver more children have higher rates of anemia and other nutritional deficiencies and suffer more frequent complications of pregnancy and childbirth, including death. In the United States, there are 11 maternal deaths per 100,000 live births. In Austria, there are 4 maternal deaths; in Denmark, there are 5; in Mexico, there are 83; and in Haiti, there are 680.38 Many maternal deaths could be averted if societies had more resources for health care services, or if more resources were put toward quality maternity care. This would require making maternal health a high priority.
In Afghanistan, where internal and external conflicts have ravaged the health system, a 2002 survey found 1,600 maternal deaths per 100,000 live births. The most common causes of maternal death were hemorrhage and obstructed delivery, which often could have been averted or managed if the woman had been attended by a skilled health care practitioner. Women did not receive appropriate care for several reasons. In many cases, a woman and her family did not recognize that the pregnancy and delivery were not proceeding normally. In other cases, the woman did not have the decision-making power to seek care. Some families could not afford medical care or did not have the transportation to reach the health care facility, and in some situations the quality of care received was too poor or the care came too late to save the woman’s life. As a postscript to the tragedy of maternal mortality, the study found that the infant of the deceased mother had only a one-in-four chance of surviving to its first birthday.39
Improving life expectancy and reducing maternal mortality require a sufficient investment in the accessibility and quality of health care--both primary health care and emergency obstetric care--basic health education, women’s empowerment, and availability and accessibility of quality family planning services.
Excerpted from the 2005 edition of Our Bodies, Ourselves, © 2005, Boston Women's Health Book Collective.
33. Population Reference Bureau, 2004 World Population Data Sheet, accessed on November 2, 2004.
34. Elizabeth Arias, United States Life Tables 2001, National Vital Statistics Reports 52, no. 14 (February 18, 2004): 1-39, accessed on November 2, 2004.
35. Teresa Castro Martin and Fatima Juarez, The Impact of Women's Education on Fertility in Latin America: Searching for Explanations, Family Planning Perspectives, June 1995, accessed on November 2, 2004.
36. Population Resource Center, Motherhood in the U.S., accessed at www.prcdc.org.
37. Population Reference Bureau, 2004 World Population Data Sheet, accessed on November 2, 2004.
38. Maternal Mortality in 2000, estimates developed by WHO, UNICEF, and UNFPA, accessed on November 5, 2004.
39. Maternal Mortality in Afghanistan: Magnitude, Causes, Risk Factors, and Preventability, UNICEF, CDC, Afghan Ministry of Health, accessed on November 5, 2004.
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