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Key issues affecting the status of women
International Journal of Gynecology & Obstetrics 46 (1994) 209-214
Key issues affecting the status of women N. Sadik UnitedNationsPopulation Fund, (UNFPA).
’
220 East 42nd Street, New York, NY Mt_l17, lJSA
Received 7 February 1994; revision received 7 April 1994; accepted 7 April 1994
Keywords:
Women’s
status;
Development;
Family planning;
Introduction
The issue of women’s status has long been crucial to development. Indeed, many of the inequalities that women suffer in every sphere of development, whether it is health, education or employment, are a consequence of deep-seated social and cultural perceptions that consider women to be of less value to society than men. Unfortunately, conventional development approaches have tended to reinforce such misconceptions about women by ignoring or undervaluing their role in development, as well as their contributions to the advancement of their societies. As a result of 30 years or so of advocacy and constant pressure, much of it from women themselves, women’s issues are now an integral part of the international agenda for development and human rights. Today, no discussion of development is complete without addressing the role of women in development. Most governments now acknowledge that improving women’s status and increasing their participation in development activities are key development concerns. Women not only constitute roughly half the population, they ’Executive Director, UNFPA.
Health;
Education;
Gender
make valuable contributions to the development of their countries through their multiple roles: reproductive, productive, environment and community. In addition, equal rights under the law and equal access to health care, education, and employment are increasingly seen as human rights and as ends in themselves. However, despite the progress made, women continue to be at a serious disadvantage in every sphere of development, since too many societies, even today, show a preference for sons over daughters. Men are still viewed as assets in whose health and education it is well worth investing. Women, on the other hand, are considered burdens. This means that right from the start, societies deny girls and women the same nutrition, health care, education and legal rights and employment opportunities as men. Health and family planning Largely as a result of widespread reductions in infectious and parasitic diseases, life expectancy in developing countries, including that of women, has lengthened over the past two decades or so. Women tend to outlive men everywhere except in Bangladesh, Bhutan, Maldives and Nepal. How-
0020-7292/94/%07.00 0 1994 International Federation of Gynecology and Obstetrics SSDl 0020-7292(94)02119-J
210
N. Sadik /ht.
J. Gynecol. Obstet. 46 (1994) 209-214
ever, women in developed regions live 6.5 years longer than men. In developing countries, women’s comparative advantage is less. The average difference is 5 years in Latin America and the Caribbean, 3.5 in Africa and 3 in Asia and the Pacific [l]. Women have also gained from the progress made in family planning. Family planning has won wide acceptance. Only four countries now limit access to family planning services, whereas 144 provide direct or indirect support to family planning. The contraceptive prevalence rate (CPR) in developing countries has more than tripled in the past 30 years, from 14% in 1960-65 to 51% in 1990 [2]. It is estimated that this rate rose to 55% in 1993. Fertility rates in developing countries have dropped from 5.7 children per woman to 3.6 in the same period [3]. The revolution in contraceptive technology has widened a woman’s choice of more effective and safer methods of family planning. As a result, more and more women are able to exercise choice in the number and spacing of their children, thereby improving their health and widening their options in life to pursue higher levels of education, seek better employment opportunities and become more active in community life. However, although facts and figures about life expectancy are widely known, what is less widely known is that there are not as many women in the world as there are men. Of the world’s 5.3 billion people in 1990, somewhat fewer than half - 2.63 billion - were women [4]. In the developed regions, there are 106 women for every 100 men. In sharp contrast, in many countries of the Asia and Pacific region, there are fewer than 95 women for every 100 men. This is due, in part, to the fact that women have higher death rates than men, especially during their early and late childbearing years. Indeed, mothers aged 15- 19 years are two to three times as likely to die in childbirth as mothers in their early twenties. Those under age 15 are five times as likely. And women over 35 are just about as vulnerable, especially if they have had many previous pregnancies, and if those pregnancies have not been properly spaced. But women also die as a result of acts of violence against them
on the basis of their sex, such as female infanticide and dowry deaths. Discrimination against girls starts from birth. Indeed, it may now start even before birth since a new phenomenon - abortion of female fetuses on the basis of male preference - is known to occur. Girls are born with biological advantages that make them more resistant than boys to infection and malnutrition. Yet in many developing countries, there is evidence that girls aged 2-5 years have higher death rates than boys the same age. This is true in Brazil, Burundi, Guatemala, Indonesia, Togo, India and China [5]. Studies in many parts of the world have shown that girls under 5 are given less to eat than their brothers and consequently are more likely to be malnourished. Research in Bangladesh, for example, showed that boys less than 5 years old were given 16% more food than girls of the same age and that girls were more likely to be malnourished in times of famine. Furthermore, girls were over four times as likely as boys to be malnourished but more than 40 times less likely to be taken to hospital [6]. Women’s health concerns are different from men’s in many ways. Most importantly, their reproductive role means that they face special health risks, including complications and, in many developing countries, death from causes related to pregnancy. The tragically high maternal mortality rates prevailing in developing countries are, in themselves, just one of the factors that attest to the neglect of women’s health. Half a million women die every year in childbirth. There are more maternal deaths in India in 1 month than in North America, Europe, Japan and Australia put together in 1 year. Even so, fifteen times as many women suffer from very often permanent and disabling illness related to pregnancy than die from causes relating to pregnancy or childbirth. Almost all countries in developed regions have reduced maternal deaths to very low levels - in some cases close to zero. Many developing countries have made dramatic reductions, often with limited resources. Mexico, for example, reduced the number of deaths per 100 000 live births from
N. Sadik/lnt.
J. Gynecol.
193 in 1960 to 65 in 1986 [7], and Sri Lanka from 120 in 1971 to 60 in 1985 [8]. However, rates of maternal mortality in many developing countries remain unacceptably high. They are highest in Africa and southern Asia - over 650 per 100 000. Abortion is a major cause of maternal deaths, with as many as 150 000 to 200 000 deaths each year resulting from abortions performed by unskilled attendants under unsanitary conditions [9]. More than half these deaths occur in Southern and South-eastern Asia, followed by sub-Saharan Africa and then Latin America and the Caribbean. Family planning could save the lives of most of these women by helping to prevent unwanted or poorly timed pregnancies. These deaths are also just one indication of the huge unmet demand for family planning. It is estimated that at least 350 million couples worldwide do not have access to the full range of modern methods of family planning [lo]. Surveys in developing countries show that as many as 50-80% of married women already want to limit or space births. Women are only too aware of the health risks to themselves and their children of too many and closely spaced pregnancies and, for this reason, are very receptive to messages concerning better reproductive health care and family planning. The example of the highly successful Matlab experience in Bangladesh is often cited, and with good reason. Health care and social support delivered consistently over a long period made a fundamental difference to women’s health and fertility behavior. Furthermore, Matlab had a beneficial effect on women’s capacities to fulfil their responsibilities as mothers and workers. The lesson is that women, no matter how poor or powerless, respond very positively when their concerns as individuals are addressed with care and compassion. Education
Education is perhaps the strongest variable affecting the status of women. Although the relationship between fertility and education is complex, education is nevertheless a key factor in reducing fertility levels and infant mortality rates,
Obstet.
46 (1994)
209-214
211
improving the overall well-being of the family, facilitating the participation of women in the labor market, and empowering and equipping them for leadership roles in community and national life. The major demographic and health survey programs of the last two decades have documented the magnitude of difference in the developing world between uneducated and educated women in fertility, contraceptive practice and health of children. The cumulative evidence is reasonably clear. For example, African countries in which a high proportion of girls do receive primary education, e.g. Botswana, Mauritius and Zimbabwe, have also had success with family planning programs. In Asia, the. experience of the Republic of Korea is particularly dramatic. Between the early 1960s and 1988, the proportion of girls completing secondary school increased from 25% to 86%. During the same period, the number of women using contraceptives increased from less than 10% to more than 75%, and total fertility rates fell from 5.4 children per woman to below 2 [ll]. In Indonesia, wider educational and employment opportunities for women in the last 25 years have been important in raising the average age of marriage to around 22 years, and enabled greater participation of women in development programs
WI. Women have also made progress in the field of education. The goal of universal primary education is now accepted by all governments. As a result of extensive efforts over the past two decades to expand primary education, literacy rates for women have improved. There is now near-universal primary education for girls in most countries of Asia and Latin America and the Caribbean, though not in southern Asia and subSaharan Africa. In the latter regions and in western Asia, over 70% of women over 25 years old are illiterate [ 131. More women are receiving higher education, too. In fact, in 33 countries, women actually outnumber men in secondary school, including in some developing countries, such as Lesotho, and in west Asian countries, such as Kuwait and Bahrain, By and large, though, women lag far behind men. For example, in Africa, including
212
N. Sadik/lnt.
J. Gynecol.
North Africa, there are only 51 women for every 100 men in higher education [14]. However, families as well as governments almost always invest less in girls’education than in that of men and boys. As a result, illiteracy rates for men have fallen faster than those for women, and the literacy gap is growing between men and women. In terms of absolute numbers, the number of illiterate women actually increased between 1970 and 1985, from 543 million to 597 million. The number of illiterate men has increased much less, from 348 million to 352 million, showing that women are still at a great disadvantage. One reason for the increase in illiteracy among women is that growing populations are outpacing development efforts. Another is that early childbearing is incompatible with schooling. Even when girls are able to enter the school system, they drop out sooner than boys and in greater numbers. This can be seen in India, where roughly 60% of rural boys and girls enter primary school, but after 5 years, only 16% of the girls are still enroled, compared with 35% of the boys [ 151. Even when women receive education, they are much less likely than men to be trained in science, technology, management, agriculture, forestry, or fishing. It is typical that more women are being trained as teachers, but mainly at the lower levels. Yet, in those countries where they have been given the opportunity, they have nearly caught up with men, as in law and business in Latin America and the Caribbean, and in a wide range of disciplines in the developed regions. Employment
Women’s share in the labor market has been rising in the past two decades. Nearly everywhere, women are more often working outside the household, although the household continues to be a major center of work for women. Much of the increase in the women’s labor force has been absorbed by the service sector in Latin America and Caribbean and the developed regions, and by agriculture in Asia and sub-Saharan Africa. In general, economically-active women are concentrated in low-productivity agricultural or service industries in developing countries. Excluded from wage em-
Obstet. 46 (1994)
209-214
ployment, women have resorted to work in the informal sector. Since 1975, when the World Plan of Action for the implementation of the International Year for Women was adopted in Mexico City, women have sought better measurement of their contribution to development and to the economies of their countries. Despite greater awareness of their contribution to economic output, national data collection systems still do not accurately or adequately record women’s productive output or the unpaid work that women do in the household. Failure to do this leads to distortions and biases in economic decision-making at both micro and macro levels. For example, structural adjustment programs have affected women disproportionately because they are over-represented in the informal sector. In addition, laws and social practice very often deny women the same opportunities as men to become economically independent. Laws regarding credit eligibility and inheritance in the matter of property and landownership are known to favor men at the expense of women in many societies. Conclusion and recommendations
Improving the status of women is a key factor in meeting any development challenge, whether eliminating poverty, slowing population growth, or cutting the environmental costs of development. As the above analysis shows, there has been marked awareness of this during the past 30 years or so, as a result of which women’s status has improved in many instances. Yet, even minimal requirements for women’s development are not being met in much of the developing world, in part because of the unprecedented increase in world population in terms of absolute numbers. Consequently, women continue to be denied a basic requirement for their development - equality of opportunity. Action needs to be taken to address gender inequities. There are three priority actions that cut across all spheres of development. These are: to sensitize development planners and policy makers to gender concerns; to allocate adequate resources to women-in-development activities; and to enhance participation of women in the formulation and implementation of development policies
N. Sadik/Int.
J. Gynecol. Obstet. 46 (1994) 209-214
and programs, especially at the decision-making and management levels. Some priorities in specific areas of development are as follows: Health care and family planning
Health care, like education and economic autonomy, is a human right and an end in itself. It assumes even greater significance when we consider that it is one of the most important determinants of the status of women, their fertility and the health of their families. Moreover, if women are to realize their full potential in their productive roles, they must be able to manage their reproductive lives. The ability to decide freely and responsibly the number and spacing of one’s children is the first step in enabling women to exercise other choices. A top priority thus is to adopt goals and implement programs to improve the health of women and girls, including those aimed at reducing maternal mortality and morbidity, infant and child mortality rates. Governments should make family planning a development priority. They should ensure universal access, especially for women, to primary health care, which includes reproductive health care, maternal and child health and family planning (MCH/FP) information and services. MCH/FP services should be improved in terms of quality of care, including widening the choice of family planning methods, training medical personnel, and providing accurate and full information to clients. Emphasis should be given to develop improved and new contraceptive technology in order to broaden contraceptive choices. These should include contraceptives for men as well as methods that provide women with both more control and less dependence on health care providers, and that offer protection against sexually transmitted diseases. Laws should be introduced and enforced regarding minimum age at marriage so as to discourage early childbearing, which is detrimental to the health of women, and to encourage and enable girls to stay in school.
213
affecting the status of women. It is a key requirement for ensuring their empowerment and enhancing their ability to make decisions concerning their own lives. Priorities should include efforts to expand girls’ enrolment in school and adopt measures to allow girls to remain in school and prevent dropping-out, with the goal of assuring universal access to and completion of primary education. This would include halting the practice of expelling pregnant teenagers from school, counseling drop-outs, reducing school fees if necessary, and providing incentives to parents to send and allow girls to remain in school. Efforts should also be made to expand literacy programs, especially for adult women; to improve the quality of education for girls and women, including, especially at advanced levels, instruction in science and technology, agriculture and management; to include population education in formal and non-formal education programs. Economic activities
Economic development affects women in different ways than men. Women’s working conditions are more difficult than those of men because of the obligations associated with their reproductive roles and also because their access to production resources is often restricted on the basis of their sex. Some priorities are to improve national data collection systems such that they can accurately record the economic contribution that women make to the economies of their families and countries, including the capacity to measure unpaid work in and outside the household; to provide women with opportunities for employment and training in commerce, management, science and technology; to ensure that women are accorded legal recognition and equality in their own right, not merely in relation to male family members, especially in marriage and inheritance laws, property and land ownership and credit facilities. References [I] United Nations: The World’s Women 1970-1990:
Education
Education
is perhaps
the strongest
variable
Trends and Statistics, p. 55. New York, 1990. [2] Ross JA et al.: Family Planning and Child Survival Pro-
214
I31 I41 [51 [61 171
PI
N. Sadik /ht.
J. Gynecol. Obster. 46 (1994) 209-214
grams as Assessed in 1991, p. 3. The Population Council, New York, 1992. United Nations: The World’s Women 1970-1990: Trends and Statistics, p. 60. New York, 1990. United Nations: op. cit., p. 55. United Nations: op. cit., p. 59. UNFPA: Investing in Women: The Focus of the ’90s. p. 9. New York, 1989. World Health Organisation: Maternal Mortality, A Global Fact Book, (WHO/MCH/MSM/91.3), p. 366. Genevali991. World Health Organisation: op. cit., p. 554.
191 World Health Organisation: Abortion: A tabulation of available data on frequency and mortality of unsafe abortion, (WHO/MCH/90.14), p. 2. Geneva, 1990. [lOI UNFPA: The State of World Population, p. 5. New York, 1992. 1111 UNFPA: The State of the World Population, p. 8. New York, 1991. 1121 United Nations: The World’s Women 1970-1990: Trends and Statistics, p. 15. New York, 1990. 1131 United Nations: op. cit., p. 45. I141 United Nations: op. cit.. p. 46-47. I151 United Nations: op. cit., p. 2.
Key issues affecting the status of women N. Sadik UnitedNationsPopulation Fund, (UNFPA).
’
220 East 42nd Street, New York, NY Mt_l17, lJSA
Received 7 February 1994; revision received 7 April 1994; accepted 7 April 1994
Keywords:
Women’s
status;
Development;
Family planning;
Introduction
The issue of women’s status has long been crucial to development. Indeed, many of the inequalities that women suffer in every sphere of development, whether it is health, education or employment, are a consequence of deep-seated social and cultural perceptions that consider women to be of less value to society than men. Unfortunately, conventional development approaches have tended to reinforce such misconceptions about women by ignoring or undervaluing their role in development, as well as their contributions to the advancement of their societies. As a result of 30 years or so of advocacy and constant pressure, much of it from women themselves, women’s issues are now an integral part of the international agenda for development and human rights. Today, no discussion of development is complete without addressing the role of women in development. Most governments now acknowledge that improving women’s status and increasing their participation in development activities are key development concerns. Women not only constitute roughly half the population, they ’Executive Director, UNFPA.
Health;
Education;
Gender
make valuable contributions to the development of their countries through their multiple roles: reproductive, productive, environment and community. In addition, equal rights under the law and equal access to health care, education, and employment are increasingly seen as human rights and as ends in themselves. However, despite the progress made, women continue to be at a serious disadvantage in every sphere of development, since too many societies, even today, show a preference for sons over daughters. Men are still viewed as assets in whose health and education it is well worth investing. Women, on the other hand, are considered burdens. This means that right from the start, societies deny girls and women the same nutrition, health care, education and legal rights and employment opportunities as men. Health and family planning Largely as a result of widespread reductions in infectious and parasitic diseases, life expectancy in developing countries, including that of women, has lengthened over the past two decades or so. Women tend to outlive men everywhere except in Bangladesh, Bhutan, Maldives and Nepal. How-
0020-7292/94/%07.00 0 1994 International Federation of Gynecology and Obstetrics SSDl 0020-7292(94)02119-J
210
N. Sadik /ht.
J. Gynecol. Obstet. 46 (1994) 209-214
ever, women in developed regions live 6.5 years longer than men. In developing countries, women’s comparative advantage is less. The average difference is 5 years in Latin America and the Caribbean, 3.5 in Africa and 3 in Asia and the Pacific [l]. Women have also gained from the progress made in family planning. Family planning has won wide acceptance. Only four countries now limit access to family planning services, whereas 144 provide direct or indirect support to family planning. The contraceptive prevalence rate (CPR) in developing countries has more than tripled in the past 30 years, from 14% in 1960-65 to 51% in 1990 [2]. It is estimated that this rate rose to 55% in 1993. Fertility rates in developing countries have dropped from 5.7 children per woman to 3.6 in the same period [3]. The revolution in contraceptive technology has widened a woman’s choice of more effective and safer methods of family planning. As a result, more and more women are able to exercise choice in the number and spacing of their children, thereby improving their health and widening their options in life to pursue higher levels of education, seek better employment opportunities and become more active in community life. However, although facts and figures about life expectancy are widely known, what is less widely known is that there are not as many women in the world as there are men. Of the world’s 5.3 billion people in 1990, somewhat fewer than half - 2.63 billion - were women [4]. In the developed regions, there are 106 women for every 100 men. In sharp contrast, in many countries of the Asia and Pacific region, there are fewer than 95 women for every 100 men. This is due, in part, to the fact that women have higher death rates than men, especially during their early and late childbearing years. Indeed, mothers aged 15- 19 years are two to three times as likely to die in childbirth as mothers in their early twenties. Those under age 15 are five times as likely. And women over 35 are just about as vulnerable, especially if they have had many previous pregnancies, and if those pregnancies have not been properly spaced. But women also die as a result of acts of violence against them
on the basis of their sex, such as female infanticide and dowry deaths. Discrimination against girls starts from birth. Indeed, it may now start even before birth since a new phenomenon - abortion of female fetuses on the basis of male preference - is known to occur. Girls are born with biological advantages that make them more resistant than boys to infection and malnutrition. Yet in many developing countries, there is evidence that girls aged 2-5 years have higher death rates than boys the same age. This is true in Brazil, Burundi, Guatemala, Indonesia, Togo, India and China [5]. Studies in many parts of the world have shown that girls under 5 are given less to eat than their brothers and consequently are more likely to be malnourished. Research in Bangladesh, for example, showed that boys less than 5 years old were given 16% more food than girls of the same age and that girls were more likely to be malnourished in times of famine. Furthermore, girls were over four times as likely as boys to be malnourished but more than 40 times less likely to be taken to hospital [6]. Women’s health concerns are different from men’s in many ways. Most importantly, their reproductive role means that they face special health risks, including complications and, in many developing countries, death from causes related to pregnancy. The tragically high maternal mortality rates prevailing in developing countries are, in themselves, just one of the factors that attest to the neglect of women’s health. Half a million women die every year in childbirth. There are more maternal deaths in India in 1 month than in North America, Europe, Japan and Australia put together in 1 year. Even so, fifteen times as many women suffer from very often permanent and disabling illness related to pregnancy than die from causes relating to pregnancy or childbirth. Almost all countries in developed regions have reduced maternal deaths to very low levels - in some cases close to zero. Many developing countries have made dramatic reductions, often with limited resources. Mexico, for example, reduced the number of deaths per 100 000 live births from
N. Sadik/lnt.
J. Gynecol.
193 in 1960 to 65 in 1986 [7], and Sri Lanka from 120 in 1971 to 60 in 1985 [8]. However, rates of maternal mortality in many developing countries remain unacceptably high. They are highest in Africa and southern Asia - over 650 per 100 000. Abortion is a major cause of maternal deaths, with as many as 150 000 to 200 000 deaths each year resulting from abortions performed by unskilled attendants under unsanitary conditions [9]. More than half these deaths occur in Southern and South-eastern Asia, followed by sub-Saharan Africa and then Latin America and the Caribbean. Family planning could save the lives of most of these women by helping to prevent unwanted or poorly timed pregnancies. These deaths are also just one indication of the huge unmet demand for family planning. It is estimated that at least 350 million couples worldwide do not have access to the full range of modern methods of family planning [lo]. Surveys in developing countries show that as many as 50-80% of married women already want to limit or space births. Women are only too aware of the health risks to themselves and their children of too many and closely spaced pregnancies and, for this reason, are very receptive to messages concerning better reproductive health care and family planning. The example of the highly successful Matlab experience in Bangladesh is often cited, and with good reason. Health care and social support delivered consistently over a long period made a fundamental difference to women’s health and fertility behavior. Furthermore, Matlab had a beneficial effect on women’s capacities to fulfil their responsibilities as mothers and workers. The lesson is that women, no matter how poor or powerless, respond very positively when their concerns as individuals are addressed with care and compassion. Education
Education is perhaps the strongest variable affecting the status of women. Although the relationship between fertility and education is complex, education is nevertheless a key factor in reducing fertility levels and infant mortality rates,
Obstet.
46 (1994)
209-214
211
improving the overall well-being of the family, facilitating the participation of women in the labor market, and empowering and equipping them for leadership roles in community and national life. The major demographic and health survey programs of the last two decades have documented the magnitude of difference in the developing world between uneducated and educated women in fertility, contraceptive practice and health of children. The cumulative evidence is reasonably clear. For example, African countries in which a high proportion of girls do receive primary education, e.g. Botswana, Mauritius and Zimbabwe, have also had success with family planning programs. In Asia, the. experience of the Republic of Korea is particularly dramatic. Between the early 1960s and 1988, the proportion of girls completing secondary school increased from 25% to 86%. During the same period, the number of women using contraceptives increased from less than 10% to more than 75%, and total fertility rates fell from 5.4 children per woman to below 2 [ll]. In Indonesia, wider educational and employment opportunities for women in the last 25 years have been important in raising the average age of marriage to around 22 years, and enabled greater participation of women in development programs
WI. Women have also made progress in the field of education. The goal of universal primary education is now accepted by all governments. As a result of extensive efforts over the past two decades to expand primary education, literacy rates for women have improved. There is now near-universal primary education for girls in most countries of Asia and Latin America and the Caribbean, though not in southern Asia and subSaharan Africa. In the latter regions and in western Asia, over 70% of women over 25 years old are illiterate [ 131. More women are receiving higher education, too. In fact, in 33 countries, women actually outnumber men in secondary school, including in some developing countries, such as Lesotho, and in west Asian countries, such as Kuwait and Bahrain, By and large, though, women lag far behind men. For example, in Africa, including
212
N. Sadik/lnt.
J. Gynecol.
North Africa, there are only 51 women for every 100 men in higher education [14]. However, families as well as governments almost always invest less in girls’education than in that of men and boys. As a result, illiteracy rates for men have fallen faster than those for women, and the literacy gap is growing between men and women. In terms of absolute numbers, the number of illiterate women actually increased between 1970 and 1985, from 543 million to 597 million. The number of illiterate men has increased much less, from 348 million to 352 million, showing that women are still at a great disadvantage. One reason for the increase in illiteracy among women is that growing populations are outpacing development efforts. Another is that early childbearing is incompatible with schooling. Even when girls are able to enter the school system, they drop out sooner than boys and in greater numbers. This can be seen in India, where roughly 60% of rural boys and girls enter primary school, but after 5 years, only 16% of the girls are still enroled, compared with 35% of the boys [ 151. Even when women receive education, they are much less likely than men to be trained in science, technology, management, agriculture, forestry, or fishing. It is typical that more women are being trained as teachers, but mainly at the lower levels. Yet, in those countries where they have been given the opportunity, they have nearly caught up with men, as in law and business in Latin America and the Caribbean, and in a wide range of disciplines in the developed regions. Employment
Women’s share in the labor market has been rising in the past two decades. Nearly everywhere, women are more often working outside the household, although the household continues to be a major center of work for women. Much of the increase in the women’s labor force has been absorbed by the service sector in Latin America and Caribbean and the developed regions, and by agriculture in Asia and sub-Saharan Africa. In general, economically-active women are concentrated in low-productivity agricultural or service industries in developing countries. Excluded from wage em-
Obstet. 46 (1994)
209-214
ployment, women have resorted to work in the informal sector. Since 1975, when the World Plan of Action for the implementation of the International Year for Women was adopted in Mexico City, women have sought better measurement of their contribution to development and to the economies of their countries. Despite greater awareness of their contribution to economic output, national data collection systems still do not accurately or adequately record women’s productive output or the unpaid work that women do in the household. Failure to do this leads to distortions and biases in economic decision-making at both micro and macro levels. For example, structural adjustment programs have affected women disproportionately because they are over-represented in the informal sector. In addition, laws and social practice very often deny women the same opportunities as men to become economically independent. Laws regarding credit eligibility and inheritance in the matter of property and landownership are known to favor men at the expense of women in many societies. Conclusion and recommendations
Improving the status of women is a key factor in meeting any development challenge, whether eliminating poverty, slowing population growth, or cutting the environmental costs of development. As the above analysis shows, there has been marked awareness of this during the past 30 years or so, as a result of which women’s status has improved in many instances. Yet, even minimal requirements for women’s development are not being met in much of the developing world, in part because of the unprecedented increase in world population in terms of absolute numbers. Consequently, women continue to be denied a basic requirement for their development - equality of opportunity. Action needs to be taken to address gender inequities. There are three priority actions that cut across all spheres of development. These are: to sensitize development planners and policy makers to gender concerns; to allocate adequate resources to women-in-development activities; and to enhance participation of women in the formulation and implementation of development policies
N. Sadik/Int.
J. Gynecol. Obstet. 46 (1994) 209-214
and programs, especially at the decision-making and management levels. Some priorities in specific areas of development are as follows: Health care and family planning
Health care, like education and economic autonomy, is a human right and an end in itself. It assumes even greater significance when we consider that it is one of the most important determinants of the status of women, their fertility and the health of their families. Moreover, if women are to realize their full potential in their productive roles, they must be able to manage their reproductive lives. The ability to decide freely and responsibly the number and spacing of one’s children is the first step in enabling women to exercise other choices. A top priority thus is to adopt goals and implement programs to improve the health of women and girls, including those aimed at reducing maternal mortality and morbidity, infant and child mortality rates. Governments should make family planning a development priority. They should ensure universal access, especially for women, to primary health care, which includes reproductive health care, maternal and child health and family planning (MCH/FP) information and services. MCH/FP services should be improved in terms of quality of care, including widening the choice of family planning methods, training medical personnel, and providing accurate and full information to clients. Emphasis should be given to develop improved and new contraceptive technology in order to broaden contraceptive choices. These should include contraceptives for men as well as methods that provide women with both more control and less dependence on health care providers, and that offer protection against sexually transmitted diseases. Laws should be introduced and enforced regarding minimum age at marriage so as to discourage early childbearing, which is detrimental to the health of women, and to encourage and enable girls to stay in school.
213
affecting the status of women. It is a key requirement for ensuring their empowerment and enhancing their ability to make decisions concerning their own lives. Priorities should include efforts to expand girls’ enrolment in school and adopt measures to allow girls to remain in school and prevent dropping-out, with the goal of assuring universal access to and completion of primary education. This would include halting the practice of expelling pregnant teenagers from school, counseling drop-outs, reducing school fees if necessary, and providing incentives to parents to send and allow girls to remain in school. Efforts should also be made to expand literacy programs, especially for adult women; to improve the quality of education for girls and women, including, especially at advanced levels, instruction in science and technology, agriculture and management; to include population education in formal and non-formal education programs. Economic activities
Economic development affects women in different ways than men. Women’s working conditions are more difficult than those of men because of the obligations associated with their reproductive roles and also because their access to production resources is often restricted on the basis of their sex. Some priorities are to improve national data collection systems such that they can accurately record the economic contribution that women make to the economies of their families and countries, including the capacity to measure unpaid work in and outside the household; to provide women with opportunities for employment and training in commerce, management, science and technology; to ensure that women are accorded legal recognition and equality in their own right, not merely in relation to male family members, especially in marriage and inheritance laws, property and land ownership and credit facilities. References [I] United Nations: The World’s Women 1970-1990:
Education
Education
is perhaps
the strongest
variable
Trends and Statistics, p. 55. New York, 1990. [2] Ross JA et al.: Family Planning and Child Survival Pro-
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I31 I41 [51 [61 171
PI
N. Sadik /ht.
J. Gynecol. Obster. 46 (1994) 209-214
grams as Assessed in 1991, p. 3. The Population Council, New York, 1992. United Nations: The World’s Women 1970-1990: Trends and Statistics, p. 60. New York, 1990. United Nations: op. cit., p. 55. United Nations: op. cit., p. 59. UNFPA: Investing in Women: The Focus of the ’90s. p. 9. New York, 1989. World Health Organisation: Maternal Mortality, A Global Fact Book, (WHO/MCH/MSM/91.3), p. 366. Genevali991. World Health Organisation: op. cit., p. 554.
191 World Health Organisation: Abortion: A tabulation of available data on frequency and mortality of unsafe abortion, (WHO/MCH/90.14), p. 2. Geneva, 1990. [lOI UNFPA: The State of World Population, p. 5. New York, 1992. 1111 UNFPA: The State of the World Population, p. 8. New York, 1991. 1121 United Nations: The World’s Women 1970-1990: Trends and Statistics, p. 15. New York, 1990. 1131 United Nations: op. cit., p. 45. I141 United Nations: op. cit.. p. 46-47. I151 United Nations: op. cit., p. 2.