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Commonwealth medical Association workshops
International news
Better diet, food security and reproductive health Half of all pregnant women in the developing world suffer from iron deficiencies in their diets. For many women dietary deficiency begins in childhood and stays with them throughout their lives. Compared with a normal adult calorific requirement of 2200 per day, a pregnant women requires 2500. These figures are not absolute as variation in climate and types of work undertaken affect requirements. Without adequate diet in childhood girls grow into malnourished women whose physical development is likely to be impaired, making childbirth difficult and dangerous and putting them in a high risk category for complications of pregnancy and childbirth. Half of the women in developing countries suffer from iron deficiencies, a situation which is made worse by unplanned and frequent pregnancies. In some areas of Central Asia the number of women suffering from chronic anaemia is as high as 90%. Severe anaemia plays a part in up to 40% of the 600000 maternal deaths each year in the developing world. Babies born to malnourished women are often of low birth weight and more vulnerable to infections. Breast feeding provides babies with the most complete and perfect diet, but where mothers are unable to breast feed then both mothers and babies suffer. Support for those women during pregnancy, childbirth and the immediate postnatal period is lacking. By equipping these women with appropriate information, conditions for the family could be vastly improved and good reproductive health could help promote good nutrition. Food for the future: women, population and food security, UNFPA, New York, 1996
Implementing the International Conferences on Population and Development (ICPD) 1994, Cairo and Fourth World Conference on Women (FWCW) 1995, Beijing
Day of dialogue Convened as an 'advocacy for women's health' activity by the Commonwealth Medical Association, this day afforded an opportunity to consider how documents Midwifery(1997) 13,44-47
© 1997 Pearson Professional Ltd
from the International Conferences on Population and Development (ICPD) and the Fourth World Conference on Women (FWCW) could be used to improve: advocacy for better health for women, particularly their reproductive and sexual health; and the development and implementation of project and programme activities on women' s reproductive and sexual health, as well as other health needs. The main issues and discussions during the day included:
1. Clarification~definition. The need to be clearer about the content and scope of services for reproductive and sexual health, and how they differ from the traditional concept of family planning. Additionally to look at available options for service delivery, information, education and service provision. 2. Shift of perspective. The need to move from a provider perspective to a client perspective. In the context of the conferences to set targets and delineate standards, to evolve timeframes and find mechanisms for accountability and empowerment. 3. Neglected areas. The life-cycle approach lacks sufficient detail whilst menopausal women and older women are neglected, as are the health implications of violence against women, women's mental health and the right to health for women. 4. Right to health for women. Both conferences were seen to develop the concept of reproductive and sexual rights, but a gap is identified between the work being done by the human rights activists and the work being done in the field of health.
5. Working with health care professionals including training and re-training. Health care professionals are not always aware of the legal situation in their countries that governs the delivery of services to women and adolescents, which needs to be addressed in liaison with lawyers. It was concluded that ethical issues and gender sensitive matters should be included in education and training at all levels, together with an understanding and respect for client choice.
6. Breaking down barriers and forging new alliances. The need for increased collaboration between non-government organisations, and a closer working relationship with sponsors. 7. Fuelling and monitoring the process. It was agreed that pilot funding should be stepped-up from international agencies and foundations as a stimulus to governments to provide money for multiplying and extending projects. The setting-up of a clearing house was considered as an exchange basis of information between organisations.
8. Taking the documents back home. The need for documents to be de-mystified and made more accessible to be used by a wide range of organisations at local, national, regional and international levels was recognised. Onwards from Cairo and Beijing: Report of a Day of Dialogue on Women' s Health, London, January 1996
Commonwealth Medical Association workshops Following the ICPD and FWCW the Commonwealth Medical Association, concentrating on the health of women and young people as being the groups in developing countries who are most at risk, has held workshops in some countries. Three of these are reported here.
Women's health in Barbados There is a high degree of poverty in the Caribbean and a geographically difficult area adversely affects access to basic health care and service administration. With this knowledge the participants considered ways of sensitising health professionals to the special needs and concerns of Barbados, especially the health care needs of women: identifying approaches of providing women in the region with access to quality information; ways of involving national health professional associations; and mobilising joint initiatives. A key health priority was identified as being the need for research on women's health. Research is not available and there is no single source for obtaining information. Following on from this, there is poor dissemination of the information which is available. Recommendations from the participants included: the demonstration of the cost-effectiveness of research; identification of funding sources; identification of research projects; development of a code of ethics on medical health research; settingup of a monitoring body; the submission of proposals; the conduct of workshops on research methodology; the incorporation of research methods teaching in schools; and the means of evaluation and dissemination of findings. Further areas for research were also identified and recommendations made relating to male responsibility, violence against women, and the health needs of older women. Report of a Workshop, Barbados, February 1996
Women's health in Botswana The international group of professionals
International news
participating identified key priorities for women in Botswana as: 1. Violence - widespread in the form of assault, rape and incest. Ignored by the law there are no services to help the victims. 2. Quality o f health care - minimal attempt is made to provide women with health information. Provision of health care for women and adolescents is uneven through the country, being poor in the rural areas. Adolescent girls are exposed to both sexual abuse and substance abuse and are likely to become sexually active at too early an age. 3. Poverty - is the main cause of underlying ill health among women largely due to gender inequality? 4. Sexually transmitted diseases/HIV/AIDS women are not empowered to negotiate safe sexual activity and therefore are unable to prevent themselves becoming infected. 5. Cultural barriers~harmful religions and traditional practices - female genital mutilation, polygamy, food taboos in pregnancy, religious discouragement of family planning and access to antenatal care are all harmful to women. -
The group made recommendations to address these priority areas: in line with government commitment, school attendance should be compulsory and the curriculum include the introduction of violence awareness programmes, rights of the child and gender issues; young people should be involved in the development and implementation of reproductive and sexual health programmes; ways should be sought to increase awareness and sensitivity of law enforcement officers and more severe punishments as a means of deterring violence; laws concerned with property and inheritance, which discriminate against women, should be repealed; job creation schemes should be introduced; programmes should be developed to meet the health care needs of women; and health education should be intensified. Report of a Workshop, Gaborone, January 1996 Women's health in Z i m b a b w e Knowing the high incidence of HIV/AIDS in Zimbabwe the group attending the meeting set out to: review the main causes of ill health amongst women; identify gaps in health service provision; determine the extent of employing ICPD and F W C W to improve the poor health status of women in Zimbabwe; and mobilise joint activities to build, reinforce and monitor activities already in place.
Poverty and a poor economic climate were identified as main impediments to the provision of quality primary health care, including accessible and acceptable reproductive health care, which is seen as a basic requirement, particularly for women living in rural areas. Increased costs of health care and the impact of the HIV/AIDS pandemic were considered to be the main cause of the increase in child mortality and maternal mortality in the country. Far-reaching recommendations were made by the group. Environmental issues needing to be addressed are to ensure a safe water supply, adequate sanitation and improve roads. Ministries are called upon to: assign priority to primary health care; review staffing situations in hospitals and clinics; introduce generic prescribing; introduce a minimum charge for clinic services; empower women by the strengthening of educational services to them; strengthen the roles of traditional birth attendants and community based services. Realistic education regarding HIV/AIDS is required and the introduction of the female condom, together with counselling services, would help to address the HIV/AIDS pandemic. Empowering women to have control over their own reproductive function was recommended through access to the female condom and access to quality antenatal, perinatal and postnatal care, as were access to gynaecology services, maternal and child health care and safe abortion services. Pregnancy during the teenage years is recognised as a major problem in Zimbabwe and initiatives are being undertaken to introduce family life education into schools. The group recommended the removal of barriers which prevented access to contraception. Report of a Workshop, Harare, January 1996
Tuberculosis and Women One million women a year die from Tuberculosis (TB) making it the leading single infectious cause of female deaths in the world. TB affects the majority of women in the most productive years of their life. Because women have such close contact with their children, women sick with TB pose a real threat to them. At least one-third of the six million women sick with TB at any given time die because they are undiagnosed or receiving poor treatment. Tuberculosis and Children: the missing diagnosis, A special supplement to Child Health Dialogue, April-June 1996
45
Trends in Substance Use and Associated Health Problems Psychoactive substance abuse is an increasing public health concern. Problems associated with this use cover a broad spectrum which includes significant health consequences, social and family disruption and economic issues. In many developed countries the levels of illicit substance abuse had remained stable or even declined for a number of years, but there is now a change in this pattern. The trend appears to be an upward one with lower age groups being initiated into drug use, accompanied by a growth in the world's supply of illicit drugs. Despite the difficulty in obtaining reliable statistics, it is estimated that, across the world, approximately 15 million people incur a significant risk to their health as a result of using psychoactive substances. Traditionally, problems associated with substance use have affected males, but with the rapid social and economic changes over past decades, there is now a dramatic increase in their use among women in both developed and developing countries. Owing to physiological reasons, women frequently have a lower tolerance to such substances than men, and as many of these women are of childbearing age, the likely effects on the fetus are a cause for concern. Current work being undertaken by the World Health Organization (WHO) is the development of a global surveillance project to assess and describe patterns and trends of substance abuse, along with the health consequences and national policy responses. Additionally the dissemination of information, development and implementation of primary prevention programmes, identification and development of treatment and rehabilitation approaches, community empowerment, and regulatory control systems, are all part of the complex and integrated approach. Target groups for the focus of the WHO initiative include indigenous people, street children and women drug users. Alcohol is recognised as having dual properties in bringing both benefit and harm to individuals. Whilst, in certain age groups, the incidence of coronary heart disease and ischaemic stroke is reduced, statistics show that there are around three-quarters of a million alcohol-related deaths each year. Women are at a higher risk of alcohol-related harm than men because of the physical differences related to body weight and composition of fatty tissue. Alcohol consumption during pregnancy has been linked
Better diet, food security and reproductive health Half of all pregnant women in the developing world suffer from iron deficiencies in their diets. For many women dietary deficiency begins in childhood and stays with them throughout their lives. Compared with a normal adult calorific requirement of 2200 per day, a pregnant women requires 2500. These figures are not absolute as variation in climate and types of work undertaken affect requirements. Without adequate diet in childhood girls grow into malnourished women whose physical development is likely to be impaired, making childbirth difficult and dangerous and putting them in a high risk category for complications of pregnancy and childbirth. Half of the women in developing countries suffer from iron deficiencies, a situation which is made worse by unplanned and frequent pregnancies. In some areas of Central Asia the number of women suffering from chronic anaemia is as high as 90%. Severe anaemia plays a part in up to 40% of the 600000 maternal deaths each year in the developing world. Babies born to malnourished women are often of low birth weight and more vulnerable to infections. Breast feeding provides babies with the most complete and perfect diet, but where mothers are unable to breast feed then both mothers and babies suffer. Support for those women during pregnancy, childbirth and the immediate postnatal period is lacking. By equipping these women with appropriate information, conditions for the family could be vastly improved and good reproductive health could help promote good nutrition. Food for the future: women, population and food security, UNFPA, New York, 1996
Implementing the International Conferences on Population and Development (ICPD) 1994, Cairo and Fourth World Conference on Women (FWCW) 1995, Beijing
Day of dialogue Convened as an 'advocacy for women's health' activity by the Commonwealth Medical Association, this day afforded an opportunity to consider how documents Midwifery(1997) 13,44-47
© 1997 Pearson Professional Ltd
from the International Conferences on Population and Development (ICPD) and the Fourth World Conference on Women (FWCW) could be used to improve: advocacy for better health for women, particularly their reproductive and sexual health; and the development and implementation of project and programme activities on women' s reproductive and sexual health, as well as other health needs. The main issues and discussions during the day included:
1. Clarification~definition. The need to be clearer about the content and scope of services for reproductive and sexual health, and how they differ from the traditional concept of family planning. Additionally to look at available options for service delivery, information, education and service provision. 2. Shift of perspective. The need to move from a provider perspective to a client perspective. In the context of the conferences to set targets and delineate standards, to evolve timeframes and find mechanisms for accountability and empowerment. 3. Neglected areas. The life-cycle approach lacks sufficient detail whilst menopausal women and older women are neglected, as are the health implications of violence against women, women's mental health and the right to health for women. 4. Right to health for women. Both conferences were seen to develop the concept of reproductive and sexual rights, but a gap is identified between the work being done by the human rights activists and the work being done in the field of health.
5. Working with health care professionals including training and re-training. Health care professionals are not always aware of the legal situation in their countries that governs the delivery of services to women and adolescents, which needs to be addressed in liaison with lawyers. It was concluded that ethical issues and gender sensitive matters should be included in education and training at all levels, together with an understanding and respect for client choice.
6. Breaking down barriers and forging new alliances. The need for increased collaboration between non-government organisations, and a closer working relationship with sponsors. 7. Fuelling and monitoring the process. It was agreed that pilot funding should be stepped-up from international agencies and foundations as a stimulus to governments to provide money for multiplying and extending projects. The setting-up of a clearing house was considered as an exchange basis of information between organisations.
8. Taking the documents back home. The need for documents to be de-mystified and made more accessible to be used by a wide range of organisations at local, national, regional and international levels was recognised. Onwards from Cairo and Beijing: Report of a Day of Dialogue on Women' s Health, London, January 1996
Commonwealth Medical Association workshops Following the ICPD and FWCW the Commonwealth Medical Association, concentrating on the health of women and young people as being the groups in developing countries who are most at risk, has held workshops in some countries. Three of these are reported here.
Women's health in Barbados There is a high degree of poverty in the Caribbean and a geographically difficult area adversely affects access to basic health care and service administration. With this knowledge the participants considered ways of sensitising health professionals to the special needs and concerns of Barbados, especially the health care needs of women: identifying approaches of providing women in the region with access to quality information; ways of involving national health professional associations; and mobilising joint initiatives. A key health priority was identified as being the need for research on women's health. Research is not available and there is no single source for obtaining information. Following on from this, there is poor dissemination of the information which is available. Recommendations from the participants included: the demonstration of the cost-effectiveness of research; identification of funding sources; identification of research projects; development of a code of ethics on medical health research; settingup of a monitoring body; the submission of proposals; the conduct of workshops on research methodology; the incorporation of research methods teaching in schools; and the means of evaluation and dissemination of findings. Further areas for research were also identified and recommendations made relating to male responsibility, violence against women, and the health needs of older women. Report of a Workshop, Barbados, February 1996
Women's health in Botswana The international group of professionals
International news
participating identified key priorities for women in Botswana as: 1. Violence - widespread in the form of assault, rape and incest. Ignored by the law there are no services to help the victims. 2. Quality o f health care - minimal attempt is made to provide women with health information. Provision of health care for women and adolescents is uneven through the country, being poor in the rural areas. Adolescent girls are exposed to both sexual abuse and substance abuse and are likely to become sexually active at too early an age. 3. Poverty - is the main cause of underlying ill health among women largely due to gender inequality? 4. Sexually transmitted diseases/HIV/AIDS women are not empowered to negotiate safe sexual activity and therefore are unable to prevent themselves becoming infected. 5. Cultural barriers~harmful religions and traditional practices - female genital mutilation, polygamy, food taboos in pregnancy, religious discouragement of family planning and access to antenatal care are all harmful to women. -
The group made recommendations to address these priority areas: in line with government commitment, school attendance should be compulsory and the curriculum include the introduction of violence awareness programmes, rights of the child and gender issues; young people should be involved in the development and implementation of reproductive and sexual health programmes; ways should be sought to increase awareness and sensitivity of law enforcement officers and more severe punishments as a means of deterring violence; laws concerned with property and inheritance, which discriminate against women, should be repealed; job creation schemes should be introduced; programmes should be developed to meet the health care needs of women; and health education should be intensified. Report of a Workshop, Gaborone, January 1996 Women's health in Z i m b a b w e Knowing the high incidence of HIV/AIDS in Zimbabwe the group attending the meeting set out to: review the main causes of ill health amongst women; identify gaps in health service provision; determine the extent of employing ICPD and F W C W to improve the poor health status of women in Zimbabwe; and mobilise joint activities to build, reinforce and monitor activities already in place.
Poverty and a poor economic climate were identified as main impediments to the provision of quality primary health care, including accessible and acceptable reproductive health care, which is seen as a basic requirement, particularly for women living in rural areas. Increased costs of health care and the impact of the HIV/AIDS pandemic were considered to be the main cause of the increase in child mortality and maternal mortality in the country. Far-reaching recommendations were made by the group. Environmental issues needing to be addressed are to ensure a safe water supply, adequate sanitation and improve roads. Ministries are called upon to: assign priority to primary health care; review staffing situations in hospitals and clinics; introduce generic prescribing; introduce a minimum charge for clinic services; empower women by the strengthening of educational services to them; strengthen the roles of traditional birth attendants and community based services. Realistic education regarding HIV/AIDS is required and the introduction of the female condom, together with counselling services, would help to address the HIV/AIDS pandemic. Empowering women to have control over their own reproductive function was recommended through access to the female condom and access to quality antenatal, perinatal and postnatal care, as were access to gynaecology services, maternal and child health care and safe abortion services. Pregnancy during the teenage years is recognised as a major problem in Zimbabwe and initiatives are being undertaken to introduce family life education into schools. The group recommended the removal of barriers which prevented access to contraception. Report of a Workshop, Harare, January 1996
Tuberculosis and Women One million women a year die from Tuberculosis (TB) making it the leading single infectious cause of female deaths in the world. TB affects the majority of women in the most productive years of their life. Because women have such close contact with their children, women sick with TB pose a real threat to them. At least one-third of the six million women sick with TB at any given time die because they are undiagnosed or receiving poor treatment. Tuberculosis and Children: the missing diagnosis, A special supplement to Child Health Dialogue, April-June 1996
45
Trends in Substance Use and Associated Health Problems Psychoactive substance abuse is an increasing public health concern. Problems associated with this use cover a broad spectrum which includes significant health consequences, social and family disruption and economic issues. In many developed countries the levels of illicit substance abuse had remained stable or even declined for a number of years, but there is now a change in this pattern. The trend appears to be an upward one with lower age groups being initiated into drug use, accompanied by a growth in the world's supply of illicit drugs. Despite the difficulty in obtaining reliable statistics, it is estimated that, across the world, approximately 15 million people incur a significant risk to their health as a result of using psychoactive substances. Traditionally, problems associated with substance use have affected males, but with the rapid social and economic changes over past decades, there is now a dramatic increase in their use among women in both developed and developing countries. Owing to physiological reasons, women frequently have a lower tolerance to such substances than men, and as many of these women are of childbearing age, the likely effects on the fetus are a cause for concern. Current work being undertaken by the World Health Organization (WHO) is the development of a global surveillance project to assess and describe patterns and trends of substance abuse, along with the health consequences and national policy responses. Additionally the dissemination of information, development and implementation of primary prevention programmes, identification and development of treatment and rehabilitation approaches, community empowerment, and regulatory control systems, are all part of the complex and integrated approach. Target groups for the focus of the WHO initiative include indigenous people, street children and women drug users. Alcohol is recognised as having dual properties in bringing both benefit and harm to individuals. Whilst, in certain age groups, the incidence of coronary heart disease and ischaemic stroke is reduced, statistics show that there are around three-quarters of a million alcohol-related deaths each year. Women are at a higher risk of alcohol-related harm than men because of the physical differences related to body weight and composition of fatty tissue. Alcohol consumption during pregnancy has been linked