A new report by the World Health Organization released this week suggests that despite considerable progress in the past decades, societies are
still failing to meet the healthcare needs of women at key stages in their lives, especially in adolescence and old age.
WHO Director-General, Dr Margaret Chan told the press earlier this week that action was needed beyond the health sector to improve the health of girls and women worldwide.
"If women are denied a chance to develop their full human potential, including their potential to lead healthier and at least somewhat happier lives, is society as a whole really healthy?" asked Chan.
"What does this say about the state of social progress in the 21st century?" she added.
One of the key messages of the report is that women provide the bulk of healthcare, in the home, in the community, in the health system, but rarely receive the specific care they need to meet the challenges they face throughout their lives.
For example, up to 80 per cent of all healthcare and 90 per cent of care for illnesses related to HIV/AID is provided in the home primarily by women who are in the main unsupported, unacknowledged and unremunerated for it.
There is an imbalance of care provision for women: for example pregnancy services are far more likely to be available than services for mental health, sexual violence and screening and treatment for cervical cancer.
Also, in many countries, services for sexual and reproductive health focus almost exclusively on married women and the needs of unmarried women and girls go unmet, as do the needs of marginalized groups such as rural women, ethnic minorities, intravenous drug users and sex workers.
Chan said it was "time to pay girls and women back," they had a fundamental human right to be healthy and we need to make sure they get the care and support they need.
Another point made in the report is that although women live longer than men, those extra years are not necessarily in good health.
Across the world, the major killers of women who don't reach old age are HIV, pregnancy-related conditions and tuberculosis. But for the women who live past 45, non-communicable diseases take over as the major causes of death and disability.
For example, many people might assume heart attack and stroke are predominantly "male" problems, and be surprised to know that globally these are the two leading killers of middle-aged and older women, who often have different symptoms to men, a fact that is thought to lead to underdiagnosis of heart problems in women.
Women's health also suffers from the fact women tend to have lower socio-economic status: many lack access to education, they don't participate in decision-making, and have lower income. This limits their ability to protect their own health, and that of their families, suggests the report.
For example, in some cultures, biological differences aside, the risk of getting HIV/AIDS is increased for women because they have far less knowledge and education about HIV and they have little power to negotiate safer sex.
In a statement released to coincide with the report, Chan said that:
"Worldwide, more than 580 million women are illiterate, which is more than twice the number of illiterate men. The impact of educational status on the health of women and their families is very well documented. How can we tolerate such a huge difference in such a hugely important opportunity?"
Chan said that we will not see significant progress "as long as women are regarded as second-class citizens in so many parts of the world".
"In so many societies, men exercise political, social and economic control," she added, stressing that the health sector has to be concerned about this. "These unequal power relations translate into unequal access to health care and unequal control over health resources," she said, and called for policy change and action within and beyond the health sector.
As an example of why the action needs to go beyond the health sector, Chan commented that in developing countries, and particularly in Asia, 38 per cent of girls marry before their 18th birthday, and 14 per cent do so before their 15th.
"If these young ladies are lucky, health services will be able to manage at least some of the well-known health risks associated with early childbearing. But public health cannot prevent early marriage," said Chan.
The report suggests the following key areas of reform:
- Increase leadership that involves women's organizations.
- Strengthen health systems to better meet the needs of women throughout their lives.
- Change public policy so it addresses the social and economic causes of poor health in women.
- Track progress through better knowledge of what is going on.
"For example, adolescent pregnancy is a major concern in many countries. In others, suicides in women who ingest pesticides need to be addressed. This is a horrific way to die and a clear signal of utter, unbearable misery," said Chan.
"We must be alert to these signals and respond with the compassion and care that are hallmark traits of what it means to be a woman, anywhere, everywhere," she concluded.
"Women and health: today's evidence tomorrow's agenda."
WHO, 2009, available online from 9th November.
Written by: Catharine Paddock, PhD