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Women in the medical profession and women's health
International Journal of Gynecology & Obstetrics 46 (1994) 231-236
Women in the medical profession and women’s health F. W. Manguyu ’ Medical Women’s International Association, P.O. Box 41307, Nairobi, Kenya Received 28 March 1994; revision received 7 April 1994; accepted 7 April 1994
Keywords:
Women’s health; Medical profession; Equality
IlttJOdUCtiO~
The world is increasingly facing a challenge to be gender sensitive. Women constitute more than half of the world’s population and therefore addressing them and their needs in any and all situations is in itself a healthy approach to responding to this challenge and to the sustainable development of communities. Since the International Women’s Year 1975, and the United Nations Decade for Women that followed, many international forums have highlighted the general status of women and the role women play in all spheres of development. Equality, development and peace were the goals set for the Women’s Decade 1976 to 1985. The end of decade conference held in ‘Nairobi in 1985 developed the Nairobi Forward Looking Strategies for the Advancement of Women to implement these goals. Health was one of the subthemes of these strategies. The gathering and analysis of gender disaggregate data has helped to identify and highlight gender differences and factors that hinder or enhance the health and development of society as a whole. Such analysis and studies uncover the significant inequality in health that lies beneath the ’President-elect, MWIA.
aggregate indicators. Awareness has now been created on the specific gender needs in health. The world is now well aware that sustainable development cannot be achieved when half of its human population is ignored, neglected, discriminated against or just somehow forgotten, whichever that half may be. The World Health Organization (WHO) in its definition of health, emphasizes the significance of the social welfare of population and persons not just merely the medical treatment of disease. The International Conference on Primary Health Care (PHC) in Alma-Ata in 1978, moved priorities in the health sector from a perspective of health that was predominantly disease-oriented and curative, to one that emphasized the prevention of illhealth, removal of health risks and the promotion of health. Good health requires more than services provided for by health institutions such as hospitals, and demands the contribution of other sectors such as agriculture, food production and animal husbandry, commerce, industry, education, etc. Medical science is central in health, but health is determined by a combination of genetic, physiological, environmental, cultural and socialeconomic factors. The health of an individual at any given time is the cumulation of all these factors which must be addressed in determining the health of that individual. Women contribute to
0020-7292/94/$07.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(94)02122-F
232
F. W. Munguyu et al. /ht. J. Gynecol. Obstet. 46 (1994) 231-236
health both in the formal and informal sectors through the many roles they play in society and at household and individual levels. Women’s contribution in the informal health care sector Women’s contribution in the informal health sector has become apparent and appreciated only in the last two decades or so. At the household level, women provide health care through their daily chores of providing food (including breast milk), water, fuel and the love and care for their children and other members of the family including the sick and elderly. This informal contribution by women has unfortunately been overlooked by health planners and policy makers and has been taken for granted without being evaluated. A closer analysis reveals that it is mainly women who have the primary responsibility of providing for the basic home environmental hygiene, sanitation, refuse disposal and general cleanliness. Women provide for the essentials for life namely food, fuel and water. In many poor countries, providing for these three items for the family, is the major preoccupation of women from childhood to old age, yet this responsibility if often undervalued or even ignored. Fetching water and fuel takes a big toll on women’s time, time being the one most precious commodity women can have. It is a heavy workload both in the actual time spent and in the weight carried. One only needs to see the incredible transformation of a women’s life when water and fuel are made available close to her home. The woman similarly spends an overwhelming amount of time and energy looking for and preparing food. In many situations, at the end of the day, the family dish she serves, is not worth in either quantity or quality, the time and effort spent looking for and preparing it. It is a myth, that a woman is considered the ‘weaker sex’ when she exhibits such energy and endurance in her daily chores. Women provide the first environment in which a human being begins life, the womb. The macro environment in which the women live can affect this environment of the unborn child, an example is the effect of smoke inhalation from cooking fires in poorly ventilated huts. Women are the primary
educators and transmitters of health messages and other information that affects health. They often provide home remedies and are often the traditional healers, herbalists and birth attendants. They may be the only source of health care in areas where modem facilities are not available. Women advise when to seek health care for the sick members of the family. They advise on which health care to seek even when their advice may not be taken. They recommend on when to consult second or third opinions and when these services may be combined, i.e. the traditional and western forms of health care. Women and older female children in the family nurse the sick and dying, in hospital and at home, even when the sick in question are not normally under the care of the women now giving care. Girls may be withdrawn from school to help in the home when their mothers are too ill, or need help, to perform the daily chores. When death strikes, the women are the ones who continue to provide for the ‘funeral guests’ and the bereaved. In communities where funerals are elaborate, the mourning period can be very taxing for the women in the homestead. The mourning ceremonies and rituals may last long after the burial. Demands made on widows can be so devastating that many wish they had died before their husbands. Women in tbe formal health care sector In the formal health care sector, women are the majority of health workers constituting the majority of nurses, midwives, laboratory technicians and volunteers in women’s organizations working for health. They are the majority at primary health care level and in the paramedical fields such as laboratories, and pharmacies. They are also the majority in the health support area such as hospital kitchens and cleaning departments. At higher levels in the medical field, the proportion of women to men ranges widely. Female doctors range from 3-30% in developing countries to 8-70% in developed countries. Despite the recognition and acceptance that women provide most of the health care, very few women hold positions of authority in the medical fields even in countries where the majority of doctors are women. Women are evidently absent amongst health planners and
F. W. Manguyu er al. /ht. J. Gynecol. Obsrer.46 (1994) 231-236
policy makers even when they the ones supposed to implement health programs. Opportunities for advanced training and research work are often not offered to women doctors and dentists because the women are viewed as poor investments because of the multiple and traditional roles society demands of them such as child-bearing and home making. Scholarships for further training and experience are not easily offered to women doctors unless so demanded by the sponsors. This state of affairs curtails chances for promotion of women in the profession to positions of leadership or in the hierarchy of the medical profession. Program managers, supervisors and advisers in health are often males even in fields where women’s perspectives are clearly desirable such as in breastfeeding and child welfare activities. Similarly, women’s leadership and views are often lacking in fields where women are the only patients and primary beneficiaries of services as in the field of obstetrics and gynecology. The perspectives of women doctors are often not sought when developing indicators for health care and in monitoring and evahuttion of such health care. Women doctors are also left out of medical professional bodies and associations charged with the responsibilities of setting and maintaining medical ethics and standards. Women doctors’ voices are rarely heard in areas of health promotion, disease prevention and control even when developing primary health care programs. Remuneration at the PHC level is often very low or non-existent. Responsibilities at this level are viewed as basic feminine duties for which there should be no payment. University training for doctors has been until recently a male preserve. The first woman doctor in the United Kingdom, Dr. James Barry qualified in 1812 and became a distinguished army medical officer finishing up as inspector general of army hospitals. It was only after her death in 1865 that it was found out that she was a woman and had borne a child. The first woman doctor in Kenya qualified only recently in 1967, having been trained in the United States of America. Lack of opportunities for high school education for girls in science subjects in some countries has been responsible for the reduced chances for girls to enter medical schools at university level. Some societies,
233
particularly in developing countries, have not yet accepted the fact that women are capable of performing duties of a doctor. It is still quite common for the woman doctor to be referred to as ‘Sister’ or ‘Nurse’ by the patients and their relatives while the males in the health institutions are invariably referred to as ‘the doctor’ even when not so qualified. A woman who has managed to advance in the medical field is viewed as different and wanting in female virtues. The use of the title Doctor (Dr.) in a woman’s name is not always accompanied by the prestige a man may get but with disbelief and uncertainty. Many newly qualified women doctors are discouraged from further training in certain specialties such as orthopedics and neurosurgery as these are considered male domains. Women as heaIth consumers Health is the most fundamental and basic human right. Every human being has the right to enjoy ‘the highest attainable standard of health’ regardless of their sex or gender. It is the responsibility of every government, society and individual to promote good health in order to ensure that this basic right is not violated. Many women throughout the world, are being denied this basic human right through acts of omission or commission. Many women particularly in developing countries go through their entire life span without ever having enjoyed a state of good health. The health disadvantages that women experience have been called injustices. Women have an inherent biological advantage over men which makes their life expectancy 5-7% longer than that of men. The difference is less in the developing countries averaging 2-3%. This biological advantage is often negated by the discriminatory treatment towards girls and women and by the health risks associated with their reproductive health. The gap between men and women in life expectancy in both developed and developing countries is expected to narrow as women adopt health threatening behavior such as smoking and heavy alcohol consumption. Apart from the general health needs, women have special needs specific to them as women and related to their role in child bearing and child
234
F. W. Manguyu et al. /ht.
J. Gynecol. Obstet. 46 (1994) 231-236
rearing. There are many physiological differences between men and women and as such some diseases and conditions affect men and women differently. Some affect only women, for example, cervical cancer, others are more prevalent or more serious in women such as nutritional anemia, and yet others have different risk factors or have more serious outcomes such as sexually transmitted diseases (STDs). Similarly, because of the physiological differences, drugs and interventions in the management of disease may have different effects in women and men. Health researchers as well as health planners, need to take these factors into account when developing projects and programs in health. Ignoring these facts, compromises and actually denies women opportunities of enjoying good health. It is vital to look at women’s health comprehensively and holistically. Comprehensively because health is affected by many factors outside of disease and medicine and holistically because the health of a woman at any one time is the cumulation of her experience in life starting at birth or even before birth and ending with death. The health status of a woman affects more than the individual person. It has an important impact on the survival and development of her children, her family and community. The significance of women’s health and their wellbeing, is a necessity for sustainable development of a nation. There clearly is a need to address women’s health specifically. Women cannot be expected to automatically benefit from community based programs just because they are a part of the community, there has to be a deliberate effort to reach them. Failure to do this results in the situation where women remain as spectators of their own lives standing by and watching as benefits of development bypass them. Health is not a commodity to be dished out to people when and as they want it, but rather it is a complex, physical, and even spiritual phenomenon that demands the full participation and involvement of people. This requires change of policies and political commitment in order to prioritize women’s health issues. A situation analysis of women as health consumers brings out many examples of how women’s right to health is violated.
Motherhood and maternal health It is morally and professionally unacceptable, that any woman, or man for that matter, should die in the process of giving life to another human being. For every maternal death there are up to 100 more women who suffer chronic ill-health related to pregnancy and childbirth. One such morbidity is the development of vesico-vaginal tistulas and, or, m&o-vaginal tistulas. This problem which usually strikes during the first childbirth affects mostly young women as in cases of teenage pregnancies, yet it is entirely preventable. In almost all situations, the woman so afflicted becomes a social outcast abandoned by her male partner and the community. Other distressing maternal morbidities include infertility which may follow sepsis in abortions or deliveries. Such infections may require a hysterectomy which can have devastating social connotations for the woman. STDs in women may cause irreversible damage to the fallopian tubes and may be responsible for ectopic pregnancies and infertility. The ulcerative conditions associated with STDs facilitate the transmission of the human immunodeticiency virus (HIV) thus increasing the chances of developing acquired immunodeficiency syndrome (AIDS). AIDS in a family is a big tragedy for a woman as she may be infected and in turn transmit it to her offspring. Even when not infected, a woman is affected by AIDS in the family as she will be the one to provide care for the sick and surviving members of the family. Gynecological and breast cancers call for special attention because they are responsible for signilicant mortality and morbidity in women. The leading cancer in women in developing countries is that of the uterine cervix. Cancer of the uterine cervix is directly related to an increased rate of STDs made worse by multiple sexual partners. Cancer of the uterine cervix is preventable and can be cured if detected early. Mental illness occurs in both men and women, yet far more men than women get the opportunities for medical care. Depression in women is common because of the different socio-cultural expectations placed on women from childhood. The stigma associated with mental illness in some
F. W. Manguyu et al. /ht. J. Gynecol. Obstet. 46 (1994) 231-236
societies makes the management in women even more difficult. To be female and disabled in many societies is a double tragedy. This is worse when the disabilities are, combined with being poor, illiterate, malnourished and residing in rural areas. For women, disability may lead to complete isolation or abandonment. Disabled women are frequently victims of rape and violence. Opportunities for disabled men to learn some skill or profession to earn a living, are better than for disabled women. Many women find the attitude of society harder to deal with and more disabling than the disability itself. For many women the disability is more of ‘a psychosocial crisis than a physical condition. Factors that influence women’s health are varied and -different in different countries and societies. Underlying all factors are the sociocultural and economic factors which influence the status of women. Women are often victims of violence from men and from traditional practices which negatively affect their health such as female genital mutilation. Education of women and girls is perhaps the single most important measure in ensuring the full integration of women in development. The benefits of education in women cannot be overemphasized, yet many school-going girls are out of school or drop out in alarming numbers. The right to life means more than the right to survival and includes a right to a quality of life that is respected and accorded human dignity. The poor quality of health care services, is in many cases the reason why women do not use the services even where free and physically accessible. Quality health care is not just a greeting, a smile or saying kind words to patients, but rather it is the feeling of profound respect and recognition of the patient’s needs. Quality of care is associated with giving sufficient information for the women to be able to understand the issues at hand. Good quality health care services should be more humane than technical. In family planning for example, methods of contraception in developing countries seem to depend on discriminatory attitudes of policy makers and providers not on per sonal choices and preferences. Quality care is absent when one is forced or coerced into using a particular contraceptive method.
The Medical Women’s Intemational
235
Association
0
The Medical Women’s International Association was founded in 1919 in New York. MWIA is an international non-governmental organization which is non-political, non-sectarian and nonprofit making whose main objective is to promote health for all with particular emphasis on women. The MWIA motto is ‘to heal with the spirit of a mother’ where the ‘mother’ is seen not only from the gender role of a woman but as the giver of life. MWIA enjoys official relations with the WHO and is in consultative status with the United Nations Economic and Social Council. Membership to MWIA is through national associations oflmedical women, and individual memberships in countries where there are no national associations. Over the period of its existence, the MWIA has formed networks and coalitions drawing strength from the diversity of its affiliates. Each national association is autonomous and responds to identified specific needs of the country. The MWIA is not an alternate to, nor is it in variance with, medical associations of male and female memberships, but rather, it is a professional body of medical women whose purpose is to incorporate the needs of women as health providers and consumers. Medical women are well placed to articulate the perspective of women in the medical field and through MWIA, can create effective advocates for women’s health. There have been great advances in the medical field particularly in the development of technologies resulting in better understanding of medical conditions hitherto not well elucidated. Similarly, new challenges in the field continue to emerge but a woman still remains the mother, the primary health provider and the pillar on which generations and societies grow. The MWIA is divided into eight geographical regions with each region being represented on the International Executive Committee by a Vice President. International Congresses and GeneralAssemblies are held every 3 years. The intemational President, President-Elect, Treasurer, Secretary General and the Vice Presidents are elected at the General Assemblies and hold honorary office for
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J. Gynecol. Obstet. 46 (1994) 231-236
3 years. Each Congress focuses on a theme of international concern and priority. The last international congress was held in Guatemala in March 1992 and the next will be held in May 1995 in the Hague on the theme ‘Women’s health in a changing World’. Each of the eight regions is encouraged to hold regional congresses on health issues of regional concern. The Near East and Africa region held its first regional congress from 29th November to 3rd December 1993 in Nairobi Kenya, on the theme ‘The health of women and safe motherhood’. Medical women in the region collaborated with other professional women and men to discuss and develop draft action plans for women’s health, and agreed to start a regional Women’s Health Network. Women in health and the medical profession have an honorable challenge to improve the health status of fellow women in society. Taking up this challenge is not charity but a unique responsibility which requires the support of all medical colleagues. Together we can make a difference.
Bibliography
VI Women’s health: across age and frontier. WHO, Geneva, 1992.
VI Women and Health: Prepared by Patricia Smyke,
131
[41
VI 161 171 181 [91
Women and World Development Series UN/NGO Group on women and development, London, Zed Books, 1991. Women, Health and Development: Progress report by the Director General. WHO, Geneva, 1992. WHO/FHEI WHD/92.5. Human Rights in relation to Women’s Health Promotion and Protection of Women’s Health through Intemational Human Rights law. Prepared by Rebecca J. Cook. WHO /DGH/93.1. Tinker A, Koblinsky, MA: Making motherhood safe. World Bank Discussion Papers, 202. Intersectoral Action for Health: WHO, Geneva, 1986. Health Dimensions of Economic Reform: WHO, Geneva, 1992. World Development Report, 1993. Kapila A: Personal communication,
Women in the medical profession and women’s health F. W. Manguyu ’ Medical Women’s International Association, P.O. Box 41307, Nairobi, Kenya Received 28 March 1994; revision received 7 April 1994; accepted 7 April 1994
Keywords:
Women’s health; Medical profession; Equality
IlttJOdUCtiO~
The world is increasingly facing a challenge to be gender sensitive. Women constitute more than half of the world’s population and therefore addressing them and their needs in any and all situations is in itself a healthy approach to responding to this challenge and to the sustainable development of communities. Since the International Women’s Year 1975, and the United Nations Decade for Women that followed, many international forums have highlighted the general status of women and the role women play in all spheres of development. Equality, development and peace were the goals set for the Women’s Decade 1976 to 1985. The end of decade conference held in ‘Nairobi in 1985 developed the Nairobi Forward Looking Strategies for the Advancement of Women to implement these goals. Health was one of the subthemes of these strategies. The gathering and analysis of gender disaggregate data has helped to identify and highlight gender differences and factors that hinder or enhance the health and development of society as a whole. Such analysis and studies uncover the significant inequality in health that lies beneath the ’President-elect, MWIA.
aggregate indicators. Awareness has now been created on the specific gender needs in health. The world is now well aware that sustainable development cannot be achieved when half of its human population is ignored, neglected, discriminated against or just somehow forgotten, whichever that half may be. The World Health Organization (WHO) in its definition of health, emphasizes the significance of the social welfare of population and persons not just merely the medical treatment of disease. The International Conference on Primary Health Care (PHC) in Alma-Ata in 1978, moved priorities in the health sector from a perspective of health that was predominantly disease-oriented and curative, to one that emphasized the prevention of illhealth, removal of health risks and the promotion of health. Good health requires more than services provided for by health institutions such as hospitals, and demands the contribution of other sectors such as agriculture, food production and animal husbandry, commerce, industry, education, etc. Medical science is central in health, but health is determined by a combination of genetic, physiological, environmental, cultural and socialeconomic factors. The health of an individual at any given time is the cumulation of all these factors which must be addressed in determining the health of that individual. Women contribute to
0020-7292/94/$07.00 0 1994 International Federation of Gynecology and Obstetrics SSDI 0020-7292(94)02122-F
232
F. W. Munguyu et al. /ht. J. Gynecol. Obstet. 46 (1994) 231-236
health both in the formal and informal sectors through the many roles they play in society and at household and individual levels. Women’s contribution in the informal health care sector Women’s contribution in the informal health sector has become apparent and appreciated only in the last two decades or so. At the household level, women provide health care through their daily chores of providing food (including breast milk), water, fuel and the love and care for their children and other members of the family including the sick and elderly. This informal contribution by women has unfortunately been overlooked by health planners and policy makers and has been taken for granted without being evaluated. A closer analysis reveals that it is mainly women who have the primary responsibility of providing for the basic home environmental hygiene, sanitation, refuse disposal and general cleanliness. Women provide for the essentials for life namely food, fuel and water. In many poor countries, providing for these three items for the family, is the major preoccupation of women from childhood to old age, yet this responsibility if often undervalued or even ignored. Fetching water and fuel takes a big toll on women’s time, time being the one most precious commodity women can have. It is a heavy workload both in the actual time spent and in the weight carried. One only needs to see the incredible transformation of a women’s life when water and fuel are made available close to her home. The woman similarly spends an overwhelming amount of time and energy looking for and preparing food. In many situations, at the end of the day, the family dish she serves, is not worth in either quantity or quality, the time and effort spent looking for and preparing it. It is a myth, that a woman is considered the ‘weaker sex’ when she exhibits such energy and endurance in her daily chores. Women provide the first environment in which a human being begins life, the womb. The macro environment in which the women live can affect this environment of the unborn child, an example is the effect of smoke inhalation from cooking fires in poorly ventilated huts. Women are the primary
educators and transmitters of health messages and other information that affects health. They often provide home remedies and are often the traditional healers, herbalists and birth attendants. They may be the only source of health care in areas where modem facilities are not available. Women advise when to seek health care for the sick members of the family. They advise on which health care to seek even when their advice may not be taken. They recommend on when to consult second or third opinions and when these services may be combined, i.e. the traditional and western forms of health care. Women and older female children in the family nurse the sick and dying, in hospital and at home, even when the sick in question are not normally under the care of the women now giving care. Girls may be withdrawn from school to help in the home when their mothers are too ill, or need help, to perform the daily chores. When death strikes, the women are the ones who continue to provide for the ‘funeral guests’ and the bereaved. In communities where funerals are elaborate, the mourning period can be very taxing for the women in the homestead. The mourning ceremonies and rituals may last long after the burial. Demands made on widows can be so devastating that many wish they had died before their husbands. Women in tbe formal health care sector In the formal health care sector, women are the majority of health workers constituting the majority of nurses, midwives, laboratory technicians and volunteers in women’s organizations working for health. They are the majority at primary health care level and in the paramedical fields such as laboratories, and pharmacies. They are also the majority in the health support area such as hospital kitchens and cleaning departments. At higher levels in the medical field, the proportion of women to men ranges widely. Female doctors range from 3-30% in developing countries to 8-70% in developed countries. Despite the recognition and acceptance that women provide most of the health care, very few women hold positions of authority in the medical fields even in countries where the majority of doctors are women. Women are evidently absent amongst health planners and
F. W. Manguyu er al. /ht. J. Gynecol. Obsrer.46 (1994) 231-236
policy makers even when they the ones supposed to implement health programs. Opportunities for advanced training and research work are often not offered to women doctors and dentists because the women are viewed as poor investments because of the multiple and traditional roles society demands of them such as child-bearing and home making. Scholarships for further training and experience are not easily offered to women doctors unless so demanded by the sponsors. This state of affairs curtails chances for promotion of women in the profession to positions of leadership or in the hierarchy of the medical profession. Program managers, supervisors and advisers in health are often males even in fields where women’s perspectives are clearly desirable such as in breastfeeding and child welfare activities. Similarly, women’s leadership and views are often lacking in fields where women are the only patients and primary beneficiaries of services as in the field of obstetrics and gynecology. The perspectives of women doctors are often not sought when developing indicators for health care and in monitoring and evahuttion of such health care. Women doctors are also left out of medical professional bodies and associations charged with the responsibilities of setting and maintaining medical ethics and standards. Women doctors’ voices are rarely heard in areas of health promotion, disease prevention and control even when developing primary health care programs. Remuneration at the PHC level is often very low or non-existent. Responsibilities at this level are viewed as basic feminine duties for which there should be no payment. University training for doctors has been until recently a male preserve. The first woman doctor in the United Kingdom, Dr. James Barry qualified in 1812 and became a distinguished army medical officer finishing up as inspector general of army hospitals. It was only after her death in 1865 that it was found out that she was a woman and had borne a child. The first woman doctor in Kenya qualified only recently in 1967, having been trained in the United States of America. Lack of opportunities for high school education for girls in science subjects in some countries has been responsible for the reduced chances for girls to enter medical schools at university level. Some societies,
233
particularly in developing countries, have not yet accepted the fact that women are capable of performing duties of a doctor. It is still quite common for the woman doctor to be referred to as ‘Sister’ or ‘Nurse’ by the patients and their relatives while the males in the health institutions are invariably referred to as ‘the doctor’ even when not so qualified. A woman who has managed to advance in the medical field is viewed as different and wanting in female virtues. The use of the title Doctor (Dr.) in a woman’s name is not always accompanied by the prestige a man may get but with disbelief and uncertainty. Many newly qualified women doctors are discouraged from further training in certain specialties such as orthopedics and neurosurgery as these are considered male domains. Women as heaIth consumers Health is the most fundamental and basic human right. Every human being has the right to enjoy ‘the highest attainable standard of health’ regardless of their sex or gender. It is the responsibility of every government, society and individual to promote good health in order to ensure that this basic right is not violated. Many women throughout the world, are being denied this basic human right through acts of omission or commission. Many women particularly in developing countries go through their entire life span without ever having enjoyed a state of good health. The health disadvantages that women experience have been called injustices. Women have an inherent biological advantage over men which makes their life expectancy 5-7% longer than that of men. The difference is less in the developing countries averaging 2-3%. This biological advantage is often negated by the discriminatory treatment towards girls and women and by the health risks associated with their reproductive health. The gap between men and women in life expectancy in both developed and developing countries is expected to narrow as women adopt health threatening behavior such as smoking and heavy alcohol consumption. Apart from the general health needs, women have special needs specific to them as women and related to their role in child bearing and child
234
F. W. Manguyu et al. /ht.
J. Gynecol. Obstet. 46 (1994) 231-236
rearing. There are many physiological differences between men and women and as such some diseases and conditions affect men and women differently. Some affect only women, for example, cervical cancer, others are more prevalent or more serious in women such as nutritional anemia, and yet others have different risk factors or have more serious outcomes such as sexually transmitted diseases (STDs). Similarly, because of the physiological differences, drugs and interventions in the management of disease may have different effects in women and men. Health researchers as well as health planners, need to take these factors into account when developing projects and programs in health. Ignoring these facts, compromises and actually denies women opportunities of enjoying good health. It is vital to look at women’s health comprehensively and holistically. Comprehensively because health is affected by many factors outside of disease and medicine and holistically because the health of a woman at any one time is the cumulation of her experience in life starting at birth or even before birth and ending with death. The health status of a woman affects more than the individual person. It has an important impact on the survival and development of her children, her family and community. The significance of women’s health and their wellbeing, is a necessity for sustainable development of a nation. There clearly is a need to address women’s health specifically. Women cannot be expected to automatically benefit from community based programs just because they are a part of the community, there has to be a deliberate effort to reach them. Failure to do this results in the situation where women remain as spectators of their own lives standing by and watching as benefits of development bypass them. Health is not a commodity to be dished out to people when and as they want it, but rather it is a complex, physical, and even spiritual phenomenon that demands the full participation and involvement of people. This requires change of policies and political commitment in order to prioritize women’s health issues. A situation analysis of women as health consumers brings out many examples of how women’s right to health is violated.
Motherhood and maternal health It is morally and professionally unacceptable, that any woman, or man for that matter, should die in the process of giving life to another human being. For every maternal death there are up to 100 more women who suffer chronic ill-health related to pregnancy and childbirth. One such morbidity is the development of vesico-vaginal tistulas and, or, m&o-vaginal tistulas. This problem which usually strikes during the first childbirth affects mostly young women as in cases of teenage pregnancies, yet it is entirely preventable. In almost all situations, the woman so afflicted becomes a social outcast abandoned by her male partner and the community. Other distressing maternal morbidities include infertility which may follow sepsis in abortions or deliveries. Such infections may require a hysterectomy which can have devastating social connotations for the woman. STDs in women may cause irreversible damage to the fallopian tubes and may be responsible for ectopic pregnancies and infertility. The ulcerative conditions associated with STDs facilitate the transmission of the human immunodeticiency virus (HIV) thus increasing the chances of developing acquired immunodeficiency syndrome (AIDS). AIDS in a family is a big tragedy for a woman as she may be infected and in turn transmit it to her offspring. Even when not infected, a woman is affected by AIDS in the family as she will be the one to provide care for the sick and surviving members of the family. Gynecological and breast cancers call for special attention because they are responsible for signilicant mortality and morbidity in women. The leading cancer in women in developing countries is that of the uterine cervix. Cancer of the uterine cervix is directly related to an increased rate of STDs made worse by multiple sexual partners. Cancer of the uterine cervix is preventable and can be cured if detected early. Mental illness occurs in both men and women, yet far more men than women get the opportunities for medical care. Depression in women is common because of the different socio-cultural expectations placed on women from childhood. The stigma associated with mental illness in some
F. W. Manguyu et al. /ht. J. Gynecol. Obstet. 46 (1994) 231-236
societies makes the management in women even more difficult. To be female and disabled in many societies is a double tragedy. This is worse when the disabilities are, combined with being poor, illiterate, malnourished and residing in rural areas. For women, disability may lead to complete isolation or abandonment. Disabled women are frequently victims of rape and violence. Opportunities for disabled men to learn some skill or profession to earn a living, are better than for disabled women. Many women find the attitude of society harder to deal with and more disabling than the disability itself. For many women the disability is more of ‘a psychosocial crisis than a physical condition. Factors that influence women’s health are varied and -different in different countries and societies. Underlying all factors are the sociocultural and economic factors which influence the status of women. Women are often victims of violence from men and from traditional practices which negatively affect their health such as female genital mutilation. Education of women and girls is perhaps the single most important measure in ensuring the full integration of women in development. The benefits of education in women cannot be overemphasized, yet many school-going girls are out of school or drop out in alarming numbers. The right to life means more than the right to survival and includes a right to a quality of life that is respected and accorded human dignity. The poor quality of health care services, is in many cases the reason why women do not use the services even where free and physically accessible. Quality health care is not just a greeting, a smile or saying kind words to patients, but rather it is the feeling of profound respect and recognition of the patient’s needs. Quality of care is associated with giving sufficient information for the women to be able to understand the issues at hand. Good quality health care services should be more humane than technical. In family planning for example, methods of contraception in developing countries seem to depend on discriminatory attitudes of policy makers and providers not on per sonal choices and preferences. Quality care is absent when one is forced or coerced into using a particular contraceptive method.
The Medical Women’s Intemational
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The Medical Women’s International Association was founded in 1919 in New York. MWIA is an international non-governmental organization which is non-political, non-sectarian and nonprofit making whose main objective is to promote health for all with particular emphasis on women. The MWIA motto is ‘to heal with the spirit of a mother’ where the ‘mother’ is seen not only from the gender role of a woman but as the giver of life. MWIA enjoys official relations with the WHO and is in consultative status with the United Nations Economic and Social Council. Membership to MWIA is through national associations oflmedical women, and individual memberships in countries where there are no national associations. Over the period of its existence, the MWIA has formed networks and coalitions drawing strength from the diversity of its affiliates. Each national association is autonomous and responds to identified specific needs of the country. The MWIA is not an alternate to, nor is it in variance with, medical associations of male and female memberships, but rather, it is a professional body of medical women whose purpose is to incorporate the needs of women as health providers and consumers. Medical women are well placed to articulate the perspective of women in the medical field and through MWIA, can create effective advocates for women’s health. There have been great advances in the medical field particularly in the development of technologies resulting in better understanding of medical conditions hitherto not well elucidated. Similarly, new challenges in the field continue to emerge but a woman still remains the mother, the primary health provider and the pillar on which generations and societies grow. The MWIA is divided into eight geographical regions with each region being represented on the International Executive Committee by a Vice President. International Congresses and GeneralAssemblies are held every 3 years. The intemational President, President-Elect, Treasurer, Secretary General and the Vice Presidents are elected at the General Assemblies and hold honorary office for
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3 years. Each Congress focuses on a theme of international concern and priority. The last international congress was held in Guatemala in March 1992 and the next will be held in May 1995 in the Hague on the theme ‘Women’s health in a changing World’. Each of the eight regions is encouraged to hold regional congresses on health issues of regional concern. The Near East and Africa region held its first regional congress from 29th November to 3rd December 1993 in Nairobi Kenya, on the theme ‘The health of women and safe motherhood’. Medical women in the region collaborated with other professional women and men to discuss and develop draft action plans for women’s health, and agreed to start a regional Women’s Health Network. Women in health and the medical profession have an honorable challenge to improve the health status of fellow women in society. Taking up this challenge is not charity but a unique responsibility which requires the support of all medical colleagues. Together we can make a difference.
Bibliography
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