What follows is a radical proposal from a grassroots activist who wants to see a whole new framework for global health. It was written because the Washington DC Global Health Council conference next June is going to emphasize the health related Millennium Development Goals and the Women Deliver Conference also in Washington next June is going to again bring world attention to the subject of maternal mortality with a heavy emphasis on family planning as a great saver of both women's and children's lives.
In much of the world, if you are born a girl, there is often commiseration instead of celebration at your birth. Or earlier you may have been aborted for your gender or your life may be purposefully snuffed out in your first days of life. In your first five years, you may die of simple neglect. There are between 60 and 100 million of you missing in the world today simply because of your gender.
And yet, no human being has ever lived who has not come from the womb of a woman. Right now on this earth, 6.8 billion people are living because a woman did something quite brave. She carried a pregnancy to term even though she probably had some difficult days. She is the giver and keeper of life. In fact, I say this rather facetiously but if every man on the planet disappeared but there were frozen sperm in a sperm bank somewhere, humanity could start over. If every woman disappeared, well, you get my point.
So from a biological scientific point of view, you women of the world are la crème de la crème, the cat’s pyjamas. You are it! But at the present time individuals, governments, religions, cultures and customs do not accord you full equality. In fact, gender inequality is the moral scourge of the age, so huge in its implications that it is almost too big to see, almost invisible.
I have with me a little writing booklet from a United Nations Population Fund sponsored elementary school in Senegal, The times tables are on the back and on the front, in French, this message: Little girls have as much right to food, education, and health care as little boys.
We should all be in a state of utter disbelief that such a thing needs to be said. We all know that girl children (often along with their mothers) eat last and least. What implication for health? After all food and water are the basics of health. What if the world committed to making sure every girl had enough nourishing food and clean water. Wouldn’t that in itself do wonders for global health and the future of coming generations? Because quite frankly, if this were the case for girls, it would also be the case for boys. It would carry over!
We all know that little girls often do not have equal opportunity to attend school. Equality of education is a primary component of the Millennium Development Goals both for girls and women. We know that two thirds of the illiterate people on the planet today are women and girls. Illiteracy equals ill health. Illiteracy equals poverty which equals ill health. What if the world committed itself to the equivalent of a high school education for every girl? If available for girls and women, it would carry over to boys and men. It would be an immeasurable contribution to health. Thus Millennium Development Goals 2 and 3 although they speak of education, are also much related to health.
What if every girl and woman on the planet were given access to health? For instance what if every baby were more or less guaranteed a birth weight of 7 to 8 pounds and to be AIDS-free. That would give every baby a good start. Imagine the revolution in health that this guarantee would imply. It would imply a world commitment to everything contained in the field of reproductive health. It would imply that early marriage would disappear. It would mean the end of FGM. It would probably imply that every pregnancy was wanted, that ante-natal care was universal, that every birth was safe, (immediate emergency obstetric care on the spot) i.e. no more maternal mortality and no more obstetric fistula. It would mean that family planning would be universally accessible as promised in human rights documents (particularly ICPD in Cairo) which have been more honored in the breach than in the implementation. It would mean that the huge toll of unsafe abortion (70,000 deaths and 5 million injuries, hemorrhages, and infections every year) would disappear. The acronym PAC (post-abortion care) would disappear. The fact that abortion remains illegal especially in the developing world results from women’s disempowerment politically and culturally. Gender inequality is the underlying reason that universal access to family planning and access to safe abortion have not been realized.
If the world committed to vaccinate every girl for childhood diseases, believe me, the boys would get vaccinated too. If the world committed to malaria bed nets for all girls and pregnant mothers, all boys and men would have them too. And if the world committed to women’s education, health, and human rights, and made the necessary moral, financial, legal, and cultural commitments to gender equality in all realms of civil society, this planet would be a different place and women and girls and men and boys would benefit equally. Women’s health equals men’s health and global health.
We must talk a little about the issue of human population. The basic reason why there are 6.8 billion of us now is that “making babies” is enjoyable and a natural human activity. Raising children is a much desired and rewarding activity for most people.
Yet, in the 21st century, human population has run up against the carrying capacity of the planet for food, water, and a life sustaining environment. The Food and Agriculture Organization of the UN has just come out with a finding that there are 1 billion hungry people on the planet now. Believe me, women and girls are more than 50 percent of this number! With the percentages of young people on the planet today, the UN Population Division predicts a world population of 9.1 billion by the year 2050. Can anyone seriously doubt that this will be a humanitarian disaster of immense proportions particularly for health?
If you take Africa alone, the UN says that with present fertility rates the population of Africa will double in 40 years to 2 billion. This is unconscionable. India, Pakistan, Afghanistan, the Philippines, southeast Asia are in trouble on population. The global health community can not now insure health for all human beings. How will it do so with another 2.3 billion people, the great percentage of whom are going to come from the least and less developed countries who now offer very low levels of education and health and health infrastructure such as sanitation. What are the health implications of a lack of sanitation? Huge, absolutely huge! And people, to be honest, the status of women in most of these countries is low. This is no accident. There is a little bit of cause and effect here.
Poverty equals ill health. According to the UNICEF “Gender Equality: Big Picture Report for 2007”, women perform 66 percent of the world’s work, produce 50 percent of food, but own 1 percent of property. Women receive only 10 percent of worldwide income and perform more than 70 percent of unpaid work around the globe. Two thirds of the poorest of the poor in the world are women, often women with children. For health to come for women, the feminization of poverty must be addressed. Changes would emphasize girls’ education, gender equality and all of its legal ramifications , economic opportunity and reproductive health and choices. Bref, as they say in French, less poverty for women equals a better life for all.
I have never seen the mental health costs of gender inequality being addressed. There would be huge room for research here.
The world is seeing more and more conflicts over resources. These conflicts often result in violence of all kinds perpetrated against women. Violence against women is a public health nightmare. Increasingly rape is being used as a weapon of war. The public health implications of GBV (gender based violence) (it has its own acronym!) are astronomical, astronomical not being a term used by health professionals but by this grassroots activist retired French teacher.
And when there are typhoons, floods, droughts, 70 percent of those who die are women, often pregnant or with children. The United Nations Population Fund and the Women’s Environmental and Development Agency WEDO have issued a report on the necessity of taking gender issues into account when adopting climate change policies.
Here are some observations. Which comes first, maternal or child health? The Millennium Development Goals have cutting child mortality by two thirds as number 4 and improving maternal health as number 5. I would reverse the order. Improving maternal health is a prerequisite for cutting child mortality. And obviously cutting maternal mortality cuts child mortality big time!
Nicholas Kristof and Sheryl Wudunn in their groundbreaking book “Half the Sky: Turning Oppression into Opportunity for Women Worldwide” share the stories of women caught up in trafficking and sexual enslavement. The root causes of the global human trafficking phenomenon are poverty and illiteracy which result in powerlessness. One must attack the root causes.
If you look up www.un.org/millennium [14] goals and click on number 5, the last line of target two says: “An unmet need for family planning undermines the achievement of several other goals.” I think it undermines all of the MDGs, every single one. But family planning is controversial. When I see the opposition to family planning, let alone to legal abortion, on the part of the religious right in this country I see mind-boggling hypocrisy. They all use family planning. Family planning equals health. With millions of women unable to be the decision makers when it comes to sexual activity, family planning is the crucial element for women’s empowerment. It allows women and girls to go to school, to learn, and to earn both money and respect and to play an active role in civil society. The health benefits of family planning for people, the planet, and peace are so vast as to be almost invisible.
Hillary Clinton at her hearings to become Secretary of State said: Of particular concern to me is the plight of women and girls who comprise the majority of the world’s unhealthy, unschooled, unfed, and unpaid.
Ban Ki-moon says: In women, the world has the most significant but untapped potential for development and peace.
Stephen Lewis: I challenge you to enter the fray against gender inequality. There is no more honorable or productive calling. There is nothing of greater import in this world. All roads lead from women to social change.
I say: When the world takes care of women, women take care of the world. That is my radical grassroots proposal. That the peoples of the world commit in every way imaginable to women’s health and empowerment and equality. The pay-off would put people and the planet on a sustainable course. Women and girls, men and boys would benefit equally. In my little book “34 Million Friends of the Women of the World” I say: “We have to imagine a world where all people, men and women, in equal partnership, with no artificial legal, cultural, religious, or economic barriers, work together for the greater good. We must imagine a world where all people regardless of their gender are judged, as Dr. Martin Luther King might have said, only by the content of their character.”
At the 2007 Women Deliver conference in London, the Lancet put out a special edition with this message on the front: “Since the human race began, women have delivered for society. It is time now for the world to deliver for women.”
We need people, men and women together, who will DELIVER for women, who will climb over the barricades, in a non-violent struggle for enormous change. We have to make it happen. We need a peaceful, purposeful, stubborn and obstinate REVOLUTION!