Decade for women 76/85 [full issue]

D CAD OR OV 19(6/85 THE MAGAZINE OF THE WORLD HEALTH ORGANIZATION • AUGUST-SEPTEMBER 1976 • USA $1.60 Helvi UN Assistant Secretary- General for Social Development and Humanitarian Affairs. (Photo UN) Contents IWY was only a beginning by H. Sipila 2 Equity under the law by R. Cook and K. Piepmeier . 4 Harsh realities by C. Ndeti 10 A promise unfulfilled by M. Carballo 16 An honest living Marion Janjic interviewed by J. Bland 22 Out of reach by P. K. Devi 26 Women at work by F. Kaloyanova 32 Faith and determination Nicole Grasset interviewed by N. Willard 36 A medical majority by V Lyubovny 40 News in brief 44 Young World Health 46 World Health appears in Arabic, English, French, German, Persian, Portuguese, Rus- sian and Spanish. Articles and photographs not copyrighted may be reproduced provided credit is given to the World Health Organization. Signed articles do not necessarily reflect WHO's views. World Health, WHO, Av. Appia, 1211 Geneva 27, Switzerland. Left: Cotton picker in Chad. (Photo ILO) Front cover design by Peter Davies. IWY WAS ONLY A BEGINNING • • About ten years or so ago, women's movements began to "raise consciousness" of women's inferior status and to seek ways of improving it. These move- ments grew up wherever women had ac- cess to national, regional and global ac- tivities and were becoming more aware of the realities of the present situation, their own and that of other women. More than ever before, women under- stood that participation in local, national and international affairs was not only their right, but very much their responsibility. Lack of full appreciation of the situa- tion of women and of its vital impor- tance to society as a whole had prevent- ed most governments and intergovern- mental organizations, including those in the United Nations system, from giving any priority to the various international resolutions adopted by the UN and its agencies in order to improve the status of women and integrate them into the life of society. Only a limited number of non-governmental organizations, mostly women's organizations, dealt with these issues in "splendid isolation" amongst themselves, especially on the national level, where joint efforts alone could strengthen their position as pressure groups. International Women's Year, in 1975, brought about a tremendous change, National Committees were formed, con- sisting often of representatives from ministries and other government offices as well as from non-governmental circles. Their purpose was to study the situation and role of women in their country, to identify obstacles and to make definite plans for improvement. Intergovernmental organizations in general, and those of the UN system in particular, devoted a great deal of atten- tion to IWY right from its preparatory stage. Upon evaluating their own activi- ties, many of the UN organizations rea- lized how limited was women's partici- pation in their work, either in their policy- making bodies or in their administra- tions. There were in fact few women for- mulating policies and programmes any- where. The extent to which women had benefited from UN programmes was not always known or easy to define, owing BY HELVI SIPILA to lack of data, but in many cases it was clear that women had not shared in the fruits of developments on equal terms with men, and that their special needs had not been given due attention. Many organizations in the United Nations system which had never specifi- cally dealt with issues concerning wom- en had these questions on their agendas during IWY. They adopted resolutions stressing the need to devote special at- tention to the role of women in agricul- ture, industry, trade and development in general. Field personnel were request- ed to study all projects with a view to ensuring women's involvement in them as participants and as beneficiaries. The focal point of the Year at the in- ternational level was the World Confer- ence of International Women's Year, held in Mexico. Its most important and far-reaching results were the adoption of a Declaration of Mexico, a World Plan of Action, and 34 Resolutions. The World Plan of Action can be considered as the first international in- strument to contain proposals for action to fully integrate half of the world's population into the life of society, taking into account the positive effect this will have on the lives not only of women, but of entire families and society at large. The Declaration included a number of important principles which had not been formulated before, while the Resolutions underline the importance of certain issues concerning women and their role in society, and their impact on other questions such as population and rural development. The proposal to establish an International Institute for Research and Training for the Advancement of Women, which it is hoped will start functioning some time in 1977, was also just adopted in Mexico. The results of the World Confer- ence—and in particular the World Plan of Action—indicate that recognition of the role of women is a basic element in the development process and must be made an integral part of the establishment of the new international economic order. Much as International Women's Year achieved in various fields, this is still only a beginning. What are the guaran- tees for the continuation of this effort? Resolutions have been adopted, pro- grammes have been planned, meetings have been held—but the actual situation has often remained much the same. What has changed as a result of IWY? I have every reason to believe that the effort will be kept up. The UN General Assembly which once proclaimed Inter- national Women's Year has now pro- claimed a Decade for Women with the same aims. Governments have been called upon to examine as a matter of urgency the recommendations of the World Plan of Action of the Mexico Conference and its related Resolutions, and to act on them. They are asked to define their targets and priorities, taking into account certain minimum objec- tives to be achieved by 1980, to adopt national strategies, plans and pro- grammes within their development framework, and to make regular reviews and appraisals of progress achieved. As a result of the IWY activities, govern- ments are more conscious than ever before that the implementation of these recom- mendations does not serve the interests of women only but is a prerequisite for the success of their own development en- deavours. Women in each nation will be most directly concerned in this action. They form half of the population, but usually their political power is rather limited. On the other hand, IWY certainly made women more aware of their own poten- tial and prompted them to create net- works of information and cooperation which will hardly remain passive. Wom- en's organizations everywhere are most eager to continue and to intensify their activities. In any event, women themselves will have to be the most forceful agents for change and active participants in the development effort, wherever they have the opportunity to play a dynamic role. As most of the activities recommended in the World Plan of Action and its Res- olutions go far beyond the so-called "women's" issues, the new impetus which their implementation will give to the total development effort should con- tribute to making the Decade for Wom- en a most successful decade for develop- ment in general. ■ EQUITY UNDER THE LAW Recent legal reforms in many countries of the world should bring improvements in the status of women— provided their spirit and intent are upheld in practice BY REBECCA COOK AND KATHERINE PIEPVEIER The very process of debates on how equal status be- ; tween women and men can be meaningfully translated into law has awakened both women and men to consider their own status within their families and professions, to articu- late their own points of view and by so doing slowly change customs, practice, and ultimately the law. Since 1970, at least 13 marriage laws have been reformed, 21 abortion laws have been liberalized to allow for abor- tion on broader grounds of physical and mental health or for socio-economic rea- sons, and about 11 employment bills have been enacted to require employers to give equal pay for equal work. Besides these enactments, there are many more draft bills that have been introduced which are still pending or have been rejected. The influence of these legal changes on the actual status of women has to be viewed within the context of the particu- lar society. For example, in some coun- tries where urban female unemployment is correlated with strong prejudices and laws discriminating against female wage earners, a change in the labour laws might be the most effective way of cor- recting the discrimination. In other countries where there is a large gap be- tween the literacy rates of women and men, the offer of economic incentives to parents to educate their daughters could be an appropriate tool to raise the status of women. Countries have generally taken two complementary approaches to improve the status of women. One is to amend their constitutions or enact laws so that the legal equality of women and men is expressly stipulated as a fundamental principle of general application. Mexico succeeded in doing this in 1974. Howev- er, in the neighbouring USA the Equal Rights Amendment still needs ratifica- tion by four more states by 1979 before it can become part of the US Constitu- tion. The Colombian National Congress gave its President the unusual authority to issue a decree which in 1974 autho- rized equal rights and obligations to Colombian women and men. The other approach is to amend specific laws, as outlined below, to require equality with- in the family, institutions and profes- sions. A series of recent reforms in family law imply changes in assumptions and attitudes deeply affecting the structure of the family itself. For example, Cuba adopted a new Family Code in 1975 which covers marriage, divorce and rights of children, and defines marriage not in the traditional sense of a contract, but as a "voluntary union of a man and woman ... with the purpose of building a life together". The new code requires both spouses, while they are free to study or work, to partake in household chores. The traditional concept that the legal head of the family must be a man is being challenged. This patriarchal sys- tem can require that the man as legal head of the family must legally represent his wife in court, administer her proper- ty, consent to her employment (e.g. Tur- key, Lebanon, Peru) and in some cases consent to her foreign travel (e.g. Iran). Austria, Colombia and Italy have all passed legislation in the past three years replacing this patriarchal system with equal partnership. In some countries inheritance laws favour men. For example, where laws are based on the Koran women general- ly inherit only half of what the men receive. In Nepal a new Ordinance was promulgated in 1975 which amends the provision on inheritance rights to allow, among other things, unmarried daugh- ters over 35 years of age to have an equal share of the property as well as the wife having an equal share with the son. In South Korea, efforts are under way to reform the inheritance laws, which at present discriminate against women, depriving them of their fair share of property accrued during mar- riage when they are divorced or widowed. In Africa, the Ghanaian Law Reform Commission recently submitted its recommendations to the Attorney General which, among other things, proposed that it should be made an of- fence for anyone to deprive the spouse and children of a deceased person's pro- perty. It is hoped that such recommen- dations will improve the legal rights of widows to intestate succession. The reforms since 1970 in laws regu- lating the minimum age at marriage (see Chart I) have resulted in the repeal of two sources of discrimination. The first set of reforms have equalized the age at marriage between women and men (mostly European countries) thus elimi- nating the unequal treatment of sexes with respect to age at marriage. The Turkish village girls. In Turkey the law I> governing the minimum age at marriage pro- ved unenforceable. It has now been lowered to 15 years for women and 17 years for men. (Photo L. Sirman ©) 4 ' CHART I Changes in Laws Regulating Minimum Age of Marriage Since1970 Country Previous Law Woman Man Latest Law Woman Man Year of Latest Reform Austria 16 21 19 19 1973 Colombia 18 21 18 18 1974 Cuba 16 18 1975 Federal Republic of Germany 16 21 18 18 1974 France 15 18 18 18 1974 India 15 18 18 21 1976 Indonesia* 15 18 16 19 1974 Iran 15 18 18 20 1974 Ireland" 12 14 16 16 1974 Italy 14 16 18 18 1975 Malaysia** — 18 18 1975 Nepal*** 14 16 16 18 1975 Tanzania — 15 18 1971 * Parental consent is necessary for both women and men under 21. ** For non-Moslems only. Parental consent is necessary for women under 18 and men under 21. CHART II Equality of Opportunity and Employment Acts Since 1970 Country Act, Regulation Commission or Decision Argentina Amendment of Law of Labour Contracts 1976 Australia National Wage Case Decision 1974 Belgium Commission on Employment for Women 1 974 Denmark Law No. 32 on Equal Pay for Men and Women 1976 Greece National Collective Agreement on Equal Remuneration 1975 India Equal Remuneration Ordinance 1975 Ireland Anti-Discrimination (Pay) Act 1974 Luxembourg Equal Remuneration Regulations 1974 Mexico Federal Labour Act Amendment 1974 Netherlands Equal Pay Act 1975 United Kingdom Equal Pay Act 1970 Sex Discrimination Act 1975 second category of reforms includes raising the age at marriage (mostly Asian countries) thus erasing the legal basis for allowing young girls to be mar- ried off at an early age by their parents, often without their consent, because of social custom or economic circum- stances. The effectiveness of such measures has to be weighed particularly in coun- tries where there is no marriage registra- tion system, like India. India passed a Hindu marriage act in 1955 to raise the age at marriage to 15 and 18 for women and men respectively, but has found it very hard to enforce such a law with no marriage registration system and very mild penalties. So it will be interesting to see if India institutes any economic or social sanctions to enforce its 1976 law which further raises the age at marriage to 18 and 21 for women and men re- spectively. Turkey set the age at mar- riage at 18 for women and 20 for men in 1926. However, since that time, because this law was not enforceable, particular- ly in rural areas, the legal age at mar- riage has been lowered to 15 for women and 17 for men. If the minimum age at marriage is raised but there are no constructive op- portunities for girls, the degree to which these laws can actually delay marriages is questionable. On the other hand such laws can give support to women who already would like to delay their mar- riage but are subject to social pressure not to do so. Seven divorce laws in the past five years have been changed in two dif- ferent ways either to broaden the specif- ic grounds for divorce (Italy, France, UK) from narrower grounds or actual prohibition, or to permit it on grounds of no fault or mutual consent (Austra- lia, Federal Republic of Germany, India and Senegal). The UK has changed its 1957 law which was primarily based on the concept of adultery. Under the 1973 UK Matrimonial Causes Act, divorce is now granted on the basis of "irretriev- able breakdown of marriage" which must be proved on the basis of at least one of five facts. These five facts are : adultery which is intolerable, behaviour which a spouse can't reasonably be ex- pected to live with, two years desertion, two years separation with consent, and five years separation without consent. The Italian Parliament in 1967 intro- duced an Act to permit divorce, which was previously totally prohibited. However, as a result of controversy over the law, divorce advocates went to the populace with a referendum in 1974 and successfully established the present Ita- Tian divorce law which permits divorce on several grounds, the broadest of which is five years of uninterrupted sep- aration. In other Catholic countries, such as Brazil, Philippines and Spain, where divorce is prohibited, there is an increasing demand for similar reforms. In 1975 France reformed its narrow divorce law which was enacted in the nineteenth century as part of the Napo- leonic Code, to permit divorce on grounds of incompatibility. Last year Australia and this year the Federal Republic of Germany passed legislation to eliminate the need to ap- portion blame for the breakdown of the marriage to one of the partners, thereby permitting no-fault divorce. In the case of the Federal Republic of Germany no- fault divorce is permitted if uncontested following one year of separation. The problems of change in divorce law are particularly difficult in countries where a dual system of customary and common law exists. In Ghana, for ex- ample, customary law is based on the customs of extended families, and the practice of polygamy. In such societies, children are the responsibility of the kinship group and divorce is relatively easy. Common law, on the other hand, is based on a nuclear family where only monogamy is permitted. Children are the basic responsibility of the parents, and divorce is relatively difficult. While there have been some legislative at- tempts to eliminate the so-called legal dualism, the last successful attempt be- ing in 1971 with the enactment of the Matrimonial Causes Act, the attempts have been disparate and evidently not comprehensive enough to solve inequi- ties in the grounds for divorce arising from legal dualism. In January 1973 the Senegalese Fami- ly Code replaced its system of legal dualism, based on the old Islamic and Napoleonic Codes, and now requires the partners to give full and free consent to marriage and to permit divorce by mutual consent. In a majority of Moslem countries, men have the right to terminate a mar- riage unilaterally, while women have no such recourse. Tunisia and Turkey are two Moslem countries which have abo- lished the man's rights to such divorce by repudiation and now permit divorce by both women and men. Egypt may soon be counted in this category. Recent Egyptian efforts to reform their mar- riage law, giving women important rights in the initiation of divorce, origi- nally met with much opposition, but have now been espoused by the Sheikh of Al Azhar, who represents the greatest religious authority in the country. Women with no means to regulate their fertility are disadvantaged in their attempt to benefit from other social reforms. Furthermore, women who do not have basic rights of equality within the family and within their society can have difficulty in using fertility services even when they are available. So it is not surprising that a change in the Phil- Dam-builders. A number of countries have adopted equal employment legislation since 1970 (see table opposite). ( Photo L. Sirman ©) ippine Government policy in the early seventies making contraceptives more widely available has been followed by a debate on the reform of the divorce law. Policy changes on the availability of contraceptive services have proceeded rapidly in the 1970s. At least a dozen and a half African and Latin American countries have changed policies since 1970 to facilitate the availability of con- traceptives. European countries are pro- viding contraceptive services free of charge through national health schemes (e.g. UK, Italy) or making them reim- bursable under Social Security (e.g. France). Japan finally authorized the use of the IUD in 1974, but has still to authorize the use of the pill for con- traceptive purposes. But inequities still exist. For example, a woman generally tends to require the consent of her husband for a doctor to perform a voluntary sterilization on her, but the husband does not require the consent of his wife for such services. Or women are viewed solely as "acceptors" of contraceptive services and manipulat- ed as instruments of a broader popula- tion policy. Countries are moving to institute pol- icies which view women as people with rights to a total range of integrated fer- 7 Encouragement for fathers to become more involved in the care of their young children is a new concept in legislation. (Photo K. Lyczywek ©) tility services, including provisions to amend the problem of increased contraceptive failure inevitably arising from increased contraceptive use. For example, since 1970, in so far as is known, 21 countries have broadened the grounds for medical termination of pregnancy (see Chart III). Europe has been the area of most reform and Africa and Latin America the least. Reform of such laws evolved from an increasing recognition of the woman's right of privacy and integrity to have the means to determine the number and spacing of her children. In the continen- tal legal system the concept is called the right of integrity, and in common law systems, the right of privacy. In 1973 the US Supreme Court concluded that the right of privacy, "founded in the Four- teenth Amendment's concept of per- sonal liberty ... is broad enough to en- compass a woman's decision whether or not to terminate her pregnancy". Reform has also grown out of the real- ization that the majority of abortion laws were developed in the nineteenth century under totally different health conditions when it might have made medical sense to restrict the availability of the procedure for reasons of maternal health. Now, however, once medical technology has provided safe and effec- tive means for medical terminations, particularly in the earlier stages of preg- nancy, governmental authorities are moving to broaden the grounds for medical terminations to decrease high maternal mortality and morbidity figures resulting from restrictive laws. At least seven countries have broad- ened their laws to allow abortion on request for a specified period at the beginning of pregnancy, which is usually the first trimester, and on specified grounds thereafter. Other countries have broadened the grounds for abortion from only allowing it if it would save the life of the woman to allowing medi- cal termination of pregnancy on such grounds as : physical or mental health, eugenic indications such as foetal defor- mity or a hereditary disease, rape or incest, or finally countervailing socio- economic conditions. The experience in a majority of these 21 countries shows that while the neces- sary first step of changing the law has been taken, the subsequent steps of universal interpretation and broad im- plementation have yet to be made. In some of these countries the actual law might be quite broad, but in practice narrow interpretation or lack of com- mitment and funds to implement the law may delay or even limit the avail- ability of abortion services. For exam- ple, the requirement of approval by a hospital committee or of the opinion of a second doctor can lead to unequal in- terpretation. As a result many women, particularly in areas where there is no health infrastructure, are denied any ac- cess to such services. Consequently, the woman must resort to unqualified per- sonnel, frequently suffering medical complications and possibly risking her life, or have an unwanted child, whose birth may result in psychological or eco- nomic problems for the whole family. The importance of the economic inde- pendence of women is supported by evi- dence that the greater the resources a woman brings into a marriage in com- parison with those of her husband, in- cluding in particular her education and earning potential, the more significant her role within the family. The fact that women are economically dependent is usually a serious stumbling block to their achievement of equality in society. Most women in countries with an agri- cultural economy still work long hours each day at subsistence farming or domestic work which is frequently un- paid or undervalued. Even where wom- en are included in the paid labour force, and they constitute one third of the world's labour force, their earnings may be only half those of men holding the same jobs. Legislation, regulations, equal pay commissions or decisions have been es- tablished in at least ten different coun- tries since 1970 to equalize discrepancy between payments to women and men for equal work (see Chart II). Most leg- islation requiring equal pay and condi- tions includes provisions on benefits, emoluments and pension rights for equal work. Some countries have created commissions for the enforcement of such laws and others link the require- ment of equal pay for equal work to minimum wage acts. In many others, courts have moved to require equal remuneration for similar work. In April of this year, the European Court of Jus- tice ruled that under the Treaty of Rome women in EEC countries are en- titled to the same pay for equivalent work. The implementation of equal employ- ment legislation is hindered by numer- ous obstacles. Inadequate recognition of 8 CHART III Liberalization of Abortion Laws Since 1970* Country Indications for granting an abortion 0 a) ' (9 _ 0 ,_E 'c'o" „_• a) 4, ›- _c 4-, m a) -a ... 0 ..v ch it .o 4, To 0 .c 73 ._ . >. .c a. ..o +4 To a) ..o +, c Sc = al .., a) H- — 0 a) z w -, CI) a) 0 To c .-E oi z a a E -7 --- 0 o c o U O . 3 0 cr.) E 4-, (I) * 4, L. * 0 .- --- , 4- L. c >- a) g -7-0. ,i,' ' c) E c = ,: 0 --- 4-, Australia New South Wales Capital Territory Northern Territory Austria Bulgaria Cyprus Denmark El Salvador Fed. Rep. of Germany Finland France German Dem. Rep. Hong Kong Iceland India Korea, Rep. of Norway Singapore South Africa Sweden Tunisia USA Zambia x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 1974 1974 1973 1974 1974 1974 1973 1973 1976 1970 1975 1972 1976 1975 1971 1973 1975 1974 1975 1974 1973 1973 1972 * It is hoped that the information contained in the chart is comprehensive and exact but, because of the problems of documentation and interpretation of new laws, the authors would welcome any corrections. ** Where the law permits abortion on request usually during the first trimester, X's are also marked for the grounds on which abortion is permitted in subsequent trimesters . di the economic value of women's work, lack of commitment of employers to the principle of equal pay for equal work, the traditional attitude that the man should be the breadwinner and inade- quate enforcement machinery are some of the barriers. However, enforcement machinery, when it places the burden of proof of discrimination upon the indi- vidual woman, may still be inadequate. The woman's fear of losing her job, the difficulty of proving discrimination out- side the clearcut case of unequal remu- neration for the same work, and the socially ingrained feeling in women of their inferiority and resignation, can cause all but the most determined wom- an to hesitate before going through such a process to gain her rights. The difficulties of combining mother- hood and economic activity have been recognized by a number of countries which have enacted legislation covering maternity protection and child care. Such legislation may include provision for women to take paid or unpaid leave from their jobs for a specified time before and after delivery, transfer to less strenuous jobs if necessary during preg- nancy, provision of ante- and post-natal care and child care facilities. Maternity protection operates either through national social security schemes or is the responsibility of the employers. The latter approach is less desirable since employers may tend not to hire women due to the extra economic bur- den which the legal requirement of maternity protection places on them. Such an approach is probably only fea- sible if, as in the UK, the Government reimburses to employers the maternity pay which they are required by law to give their employees. Women in the Eu- ropean countries now enjoy the most developed system of maternity leave and benefits and in some East European countries a woman may take unpaid leave for up to three years. Most Latin American countries use some sort of social security system to cover maternity protection. In Africa, Tanzania has enacted legislation in 1975 giving three month's paid maternity leave to em- ployed women, whether married or un- married. Tanzanian women are only eli- gible for such paid leave every three years. Legislation for the provision of child care has advanced less. A few countries (e.g. Bolivia and Egypt) now require certain employers to provide creches. In 1974 Colombia legislated that all em- ployers must contribute two per cent of their monthly wage bill to the state to establish pre-school centres. In the USA, where parents have to rely for the most part on private child care, tax deductions for child care costs are granted to families with incomes below a certain level. Other new concepts in legislation to ease the dual role of motherhood and work include the 1974 Swedish law to encourage the involvement of fathers in the care of their young children. Under this new scheme, either the father or the mother is entitled to "parenthood bene- fits" which enable them to take leave from employment to care for a newborn infant for seven months, receiving com- pensation for most of the income they lose during that period. The French Government has also enabled fathers as well as mothers to take time off from work in the Civil Service to look after their sick children. In concluding, it should be said that it is too early to judge whether the practi- cal application of these new laws will satisfy the intentions behind their enact- ment. If the courts interpret the laws ac- cording to traditional principles of the supremacy of the man and if govern- ments do not move to give authority and funding to implement the new laws, the spirit and intent of the reform will be largely nullified. Meaningful interpre- tation and implementation of the acts will require reforms fundamentally af- fecting the society, which cannot be ex- pected to occur merely as a consequence of the legal reform itself. For instance the full realization of equality between women and men will necessitate changes in deep-rooted assumptions and atti- tudes about women's and men's roles, and in social and economic arrange- ments. But the law is a beginning and the very process of legal reform has and can stimulate the increased awareness necessary for further reform. ■ 9 HARSH REALITIES The African rural woman has always participated in her society's economic and social activities. Is it fair to ask more from her than she already contributes? BY CECILIA NDETI The integration of the Afri- can woman into the eco- nomic, social and cultural aspects of her country has been the subject of many post-Indepen- dence conferences and seminars on development, and indeed, the point has been hammered home outside the con- ference hall as well. President Samora Machel of Mozambique has suggested that the revolution and emancipation of women were so closely linked in his country that "just as there can be no revolution without liberation of women, the struggle for women's emancipation could not succeed without the victory of the revolution". Since 80-90 per cent of the African population live in rural areas, the Afri- can women who are actually being called upon for more and more partici- pation in development must be to a large extent the rural African women. This being the case, several questions arise. What role or roles is the African rural woman playing now? What facili- ties are available to her to help her play these roles productively? Is it realistic and fair to ask more from the rural woman than she is already contribut- ing? African women's contribution in agri- culture is an acknowledged fact. In most rural areas in Africa, men do the initial clearing of the bush by felling trees. The routine farm work that follows—plant- ing, weeding and harvesting—is carried out by the woman. She also carries the harvest home and stores it. But food production, processing, transporting and storage constitute only part of the rural woman's workload. After her 8-10 hours of scratching the earth with her hoe or manually collecting maize cobs, she then has to look for the vegetables for supper, and some days for firewood as well. Food preparation is done by her, or by her daughters under her guid- ance. (The daughters also help her in cleaning the house, fetching water and baby-sitting with the young ones.) The entire responsibility of feeding the family very much rests on the wom- an. The quantity and quality of the food her family gets depend on what she grows and harvests—provided the rains don't fail her. Her husband may buy commodities like salt, sugar, kerosene and soap for her, and sometimes she buys things with whatever meagre in- come she can get from selling her crops or her hand-woven baskets or bead necklaces. In this respect, the West Afri- can woman, especially in Ghana and Nigeria, is much more self-sufficient economically, having been involved in such trading for many years. The health of the family therefore depends greatly on the woman, not only through her contribution to proper feed- ing, but also through her role when fam- ily members are ill. It is she, sometimes with her husband, who will have to seek medical help either from the traditional medicine-man or from the modern health centre or dispensary. Her choice is usually influenced by the degree of her education and/or by any contact she may already have had with the modern health practitioners. Because of her close contact with her children the mother is their first teacher. She imparts to them whatever she knows. In these days, when most chil- dren go to school, she is also expected to help and guide her children in their studies at home, even though she may never have been to school herself. A number of women in rural areas now also assume roles that were tradi- tionally played by men. Migration into towns in search of employment is becoming a common feature of many African rural populations. In Zambia, men migrate to the copperbelt to work in mines In South Africa, they move to the diamond mines in search of employ- ment. In Kenya, 400,000 rural house- holds are headed by women whose hus- bands are either dead, have abandoned them, or are in towns searching for jobs that they may never find. In such situa- tions the woman is left at home with her children, and she has to be fully respon- sible for the welfare of the family. If the husband is lucky enough to find a job in town, he may from time to time bring her money for school fees and other household needs. If he finds no job, the remittance may not be forthcoming, in which case she will have to find the school fees as well herself. The rural woman, therefore, plays a multitude of roles in the rural society, Rural women in Africa play a multitude of I> roles. They produce and transport food, feed and care for the family, are their children's first teachers, and may be head of the family too. They need the benefits of development and modernization just as much as men. (Photo WHO/E. Mandelmann) 10 ' 4404000 • d - • ' Z77. /-r•- using more or less the methods her fore- mothers used. She produces food, trans- ports and stores it. She feeds the family, looks after their health, trades to subsi- dize her farm income, is her children's first teacher, and may also be the head of her family in her husband's absence. Surely this is quite a full participation on her part in her country's economic, social and cultural life. It is not her fault that her country is still agrarian and still depends on subsistence farming. She would be more than willing to learn the new methods of agriculture so as to pro- duce more food for her family—but such modern agricultural innovations are normally brought to men, despite the fact that the woman contributes over 60 per cent of labour going into food production. She would definitely want to be taught modern nutrition so that her children need not be perpetual- ly malnourished. Because of traditional attitudes towards the education of girls and wom- en, about 80 per cent of the adult female population in Africa is illiterate. If she cannot read or write herself, it is no wonder that the mother cannot help her children in their studies. She is unable to read about the rules of hygiene, and therefore cannot really be blamed for being superstitious; she does not know any better. Under the circumstances the rural African woman is contributing more than her share. Before we can ask her for more participation we need to improve her living conditions, lift her daily work burden, and give her health facilities. Realizing the disadvantage at which the rural woman finds herself, most African countries are stressing equal op- portunities in education for both girls and boys, but because of the traditional habit of keeping girls at home to help the mothers with household chores, girls still lag behind in education. Studies in African countries show, for example, that only about 40 per cent of primary school enrolment is made up of girls. The proportion in secondary schools is still lower—only 29 per cent, according to 1969 figures. Technical and voca- tional training absorbs even fewer girls. Finally, dropout rates are very high among girls for a variety of reasons, in- cluding pregnancy, lack of school fees, or being made to work as housemaids to earn income for their parents. Strong campaigns have also been launched by African governments to correct this situation. Tanzania, for ex- ample, has abolished all school fees in government schools from Standard I to University level. From time to time reports appear in Tanzanian papers of parents who have been prosecuted in court for failing to enrol their children in schools. A similar spirit is prevalent in Kenya. Free primary education has been given to children from Standard I to Standard IV. To give girls the chance to catch up with boys, girls are admitted to secondary schools on slightly lower marks. Village polytechnics are spring- ing up in many rural areas so that more young people can get technical training. Adult education campaigns are also very vigorous throughout Africa in order to slightly broaden the scope of rural pop- ulations by teaching them the skills of reading and writing. The second area where a rural woman is very much at a disadvantage is in health facilities. The protection from health hazards of mothers and children Harsh realities Left: West African women, in Ghana and Nigeria especially, have long experience as traders. Although modernization seems to be squeezing women out, they still control 60 per cent of marketing activities in rural areas. Right: Grinding corn on a stone slab, in the traditional way. Rural women need better liv- ing conditions, health care and a lighter work- load before they can participate morefidly in development. ( Photos WHO/P.: Almasy & E. Schwab) in rural areas is still one of the major challenges facing public health adminis- trators in African countries. Doc- tor/patient ratios are still very unsatis- factory. In areas such as the North- Eastern District of Kenya a ratio of one doctor to 250,000 inhabitants is quite common. In other areas of Kenya the ratio is in the region of 1:50,000. This situation prevails because virtually all the doctors are in the cities while over 80 per cent of the country's population live in the rural areas. The ratio for other health staff is about the same. Physical health facilities in rural areas are also very scarce. Taking the example of Kenya again, which in fact is not worse off than most of her neighbouring African countries, one hospital bed was available for 715 persons in 1967. The situation is slightly better now as government expenditure on health has increased from 1.7 per cent in 1966/67 to 6.3 per cent in the 1972/73 budget. It has to be borne in mind, however, that the effect of increased expenditure on health may not be so greatly felt, as the annual population growth rate in Kenya is around 3.3 per cent. Because of this scarcity in health facil- ities 80-90 per cent of births take place in the home, unattended by trained health personnel. The services of tradi- tional, untrained midwives are therefore still very much in demand. Many Afri- can women are known to have to be their own midwives during childbirth, when they cannot manage to contact a local one. Ethiopia runs a strong programme for integrating the traditional midwife into the national health system. A similar ap- proach was tried in the Kwale District of Kenya but was dropped after a while. Making use of the services of the tradi- tional midwife and sometimes of tradi- tional medicine-men needs to be further looked into and tried out, because there is such a lack of trained health person- nel in most African countries that some other source of manpower needs to be tapped. Since the traditional medicine- men and midwives have the medical orientation already, training periods can be shortened for them. In their training, general hygiene must be emphasized since this is one of the areas in which their practice fails. Clean water supplies are one of the prerequisites of good health. In many African countries water development ministries are a prominent feature and they are charged with the duty of sup- plying rural populations with clean wa- ter. Most countries have set targets such that by year 2000 all villages should have water. Through her Ujamaa vil- lages, Tanzania hopes to be able to pro- vide water and other facilities to groups of people who are not scattered over distant hills and across extensive valleys. Kenya managed to give rural clean wa- ter to 9 per cent of the rural population in 1974, but is ambitious to increase supplies to serve 25 per cent of the rural people by 1978. Drought spells usually mean long hours of walking by women in search of water. In the drier areas of Kitui in Kenya women can go as far as ten miles with gourds on their backs looking for water. Large numbers of domestic ani- mals, that normally provide the badly needed protein for children, die during these drought periods. Yet during rainy seasons there is too much water to the extent of floods in some areas. The pos- sibilities of tapping this rain-water resource that spills to waste out of flooded rivers need to be further investi- gated, and the resulting programmes need to be given priority in many Afri- can development plans, if necessary at the expense of some few "prestige" pro- jects. Also vital in the health services is the availability of family planning informa- tion and services within close enough reach of the majority of rural women so that those who need the service can use it. However, one factor to bear in mind here is that family planning services can- not be singled out and delivered on their own in the absence of other health ser- vices. If the threat of high infant mortal- ity prevails due to malnutrition and dis- ease, women will be sceptical of having few children lest they lose them all. If the women remain basically illiterate and ignorant of modern innovations they will hang on to their traditional beliefs and attitudes, some of which hinder acceptance of modern family planning practices. In short, family planning will have to be integrated into total development programmes aimed at improving life for the whole person. A step in this direction is the PBFL (Pro- gramme for Better Family Life) being tried out in Kenya under the auspices of FAO. In an attempt to cope with their im- mense rural problems governments are trying various approaches, some of which can bring both advantages and disadvantages to rural women. One such attempt is the establishment of settle- ment schemes in the rural areas. This arrangement enables governments to give services at a given area with a high concentration of people. It is easier, for example, to provide water to a settle- ment scheme than to scattered home- steads. Modern farming methods are usually used so that at least some of the women's chores, such as going long dis- tances for water, and cultivating and Above: Midwives being trained in Niger. They carry much of the responsibility for the good health of women and children, since health facilities in rural areas of Africa are very scarce and most births take place at home. Right: 80 per cent of the adult female population of Africa is illiterate, and only about 40 per cent of children in primary schools are girls. However, African govern- ments are making vigorous efforts to improve the situation. (Photos WHO/R. da Silva & P. Pittet) firewood-finding, may now be reduced. Services like grinding-mills, day-care centres, health centres and schools are normally provided in the village. Vil- lagers are also helped in marketing their crops. One of the disadvantages women may face in the schemes is having to give up cultivation rights of some lands, since on their own individual farms women 14 were able to grow some cash-bringing crops. In Tanzania, however, this prob- lem does not arise, and in fact women for once can have an equal share of the product of their labour in the Ujamaa villages. Every villager's contribution is equally rewarded after the selling of the farm produce. Women in Tanzanian Ujamaa villages also benefit from equal participation in the running of village affairs. Land consolidation, to give individual owners title-deeds, was intended to in- crease productivity of the land because title-holders can raise loans for agricul- tural development against the security of their deeds. (But titles in Kenya, for example, were given to men, leaving women out in the cold. The men decided how the titles were to be used, and how the loans raised against their security were to be spent.) In order to grow more cash crops to be able to repay these loans, some of the land orig- inally used for food crops may need to be turned into cash-crop land, which reduces food production. However, ex- perience in Nyeri District of Kenya has shown that after consolidation dairy farming increased, which in turn tended to improve diets because increased milk on the farm meant that more could be consumed at home. Production of other crops like maize, potatoes and beans also improved in the consolidated farms, probably because the farmer did not have to waste time wandering from one plot to another, but was able to concentrate efforts on the one farm. Modernization of the marketing sec- tor has tended to decrease the participa- tion of women in petty trading. The small petty traders seem to be being squeezed out, but still women control 60 per cent of the marketing activities in rural areas. Formation of cooperative societies to produce foodstuffs as well as market commodities may help women maintain their hold in the food production and marketing field. Women have also formed cooperatives for production and marketing of handcrafts. Since coopera- tive activity is part and parcel of African living, it should be encouraged to help the lot of the rural people, and training in cooperative movements should be in- tensified—Kenya gives such training at her Cooperative College in Nairobi. On a cooperative basis it may be possible to turn the areas that are usually drought- stricken into productive lands. Irriga- tion schemes are expensive and individ- ual farmers on their own cannot cope, with their meagre resources. The African rural woman has always participated in the economic, social and cultural activities of her society; but she has been doing this under tough condi- tions. Emancipation for her will have to mean first of all emancipation from poverty, hunger, thirst, ignorance, ill- health, and all the harsh realities of her everyday life. After this is done, what- ever else is being asked of her will natu- rally follow. ■ 15 A PROMISE UNFULFILLED Development should theoretically further emancipation for women, but the high speed of social change may mean a sharp contradiction between expectations and reality BY MANUEL CARBALLO It is a commonly held belief that accelerated economic development is one of the main ways in which the pressing problems of poverty and in- equality will be relieved, if not totally eradicated. Particularly with respect to developing regions, socio-economic change is increasingly being presented as the necessary catalyst for bringing about social improvement and emancipating women from traditional status and role patterns. The underlying assumption—by no means a new one—is that as agricultural technology is modernized, subsistence farming replaced by that of cash crops, and national processing industries devel- oped for international markets, so there will be an automatic growth in produc- tivity and a consequent absorption of the population into new patterns of gainful employment. A corollary of this is that, as industry becomes increasingly specialized and dependent upon improved skills and techniques, the need for higher educa- tion will rise. This in turn will result in wider enrolment in education systems and improved opportunities for all. Women will share equally in the process of national development, and new ave- nues of self-improvement will open up for them. These assumptions are partially based on the experience of certain highly in- dustrialized countries where this classic growth sequence has occurred, and where women have indeed been inte- grated, as apparently equal partners, into the work force. In raising hopes of rapid sociocul- tural change through economic develop- ment, however, such assumptions may do a disservice, for they are inclined to overlook the realities of the transition and many of the contradictions implicit in industrial society. From the long historical process of change in Europe, it is clear that the benefits of industrialization, especially where the transition occurred against a background of unstructured markets, were long in coming Industrialization did not bring about immediate positive changes in either the quality of life or in opportunities for women. On the con- trary, together with the growth of cities it resulted in a profound erosion of tra- ditional family and social life that in turn opened the door to new forms of female labour exploitation. The change from cottage industries and land-based activities gave rise to a different type of dependency, where women and children fast became a high- ly prized but low paid labour commodi- ty. Highly excessive workloads and dual and conflicting responsibilities of facto- ry productivity and family care became the rule. Technological improvements and material gains during the period of in- dustrialization far outpaced the social ones. The time lag between them was characterized for many by a deteriora- tion in lifestyle, especially so around the urban conglomerations that soon grew up, unplanned and unregulated, near centres of industry. Even in contemporary industrialized society, where there are often compre- hensive social regulations designed to ensure labour rights, the ambiguous position of women in industry and soci- ety is a matter of acute concern. For while equality of opportunity is ap- plauded, and educational and social value systems pay lip service to that concept, traditional conflicts and dis- criminatory practices continue to exist. There are contradictions between what women are led to anticipate in terms of economic integration and occupational mobility, and what is actually possible. Though the skills and responsibilities called for in modern industry have pro- duced new values and expectation, the continuing lack of a more liberal defini- tion of male and female and familial roles poses new problems for the com- munity at large and for women in par- ticular. Relatively few of the societies that are highly developed industrially have given priority to the creation of broad social support systems designed to adapt fami- ly life to the needs of the parents. State supported creches, kindergartens and other means of easing the adaptation of the working mother to industry have not been adequately institutionalized outside Eastern Europe, Sweden, China and, more recently, Cuba. In so-called highly developed societies then, the evolution of women's rights and their integration into the employ- ment structure continues to be difficult. Seen in terms of values and expectations on the one hand and needs and actual Especially in Latin America, migrants to the 1> cities have tended to be young women. They often end up as low-paid domestic and service workers, living in poor slum areas, and suffer from insecurity, isolation and lack of support. (Photo WHO/P. Almasy) 16 ti , I al $ 1.111-114 timuiltatas i aisauriff" wl who possibilities on the other, the current sit- uation is clearly far from satisfactory. In the case of many of the developing areas a second consideration must also be borne in mind Contrary to the trends that were observed in Europe and other developed regions during their periods of industrial growth, the ap- parent long-term trend in many deve- loping countries is one of increasing population expansion and decreasing work activity. Recent estimates indicate for instance that whereas the total labour force grew by only 70 per cent between 1900 and 1960 (from 477 mil- lion to 817 million), the overall increase in the population was closer to 100 per cent. The significance of this inbalance is clearly that a greater proportion of the population must remain unem- ployed or underemployed and, while the trends are by no means uniform and are governed by a variety of labour factors, women represent the higher percentage of the unemployed. Still only marginal to the industrial labour force and gener- ally engaged in lower paid and less skilled positions, they become increas- ingly vulnerable to irrational and un- planned market forces. Moreover, expectations for self-im- provement as an immediate conse- quence of industrial economic growth are unlikely to be fulfilled unless tradi- tional concepts of the female role change to permit real equality of oppor- tunity. In a recent study of the status of women in Mexico, Lefler° has pointed out that, although women constitute 19 per cent of the work force in that coun- try and thus represent a significant group, 70 per cent of them are employed in service industries, 500,000 of them as household servants (Maria del Carmen Elu de Lefler°, "El trabajo de la Mujer en Mexico", Imes, Mexico, 1976). They have negligible security, few if any ave- nues of mobility and little more than subsistence wages. Of those in profes- sional posts, the majority are slotted into stereotyped "female" jobs—school- teaching, nursing and social work. Their average earnings moreover are 20-25 per cent lower than those of men. The channelling of women into low- paying jobs however is not unique to The trend in many developing countries is ap- parently one of increasing population and decreasing work opportunities. At a time when more women are being educated, there- fore, the chances are that the difference be- tween their hopes of a better life and the dis- appointing reality will only increase. (Photos WHO/P. Almasy) Mexico. Common to many countries (although most evident in developing ones), it is apparently being institutiona- lized through programmes of training and selection geared to meeting market demands for a constant supply of cheap mobile labour. There is evidence that the same sort of thing is happening in other countries of Central and South America, where the employment of women in processing and even primary enterprises such as plantations has stag- nated and in some areas has decreased over the past decade. This low participa- tion of the female labour force contrasts sharply with the fact that the number of women attending school is in general in- creasing. Thus, just when actual possi- bilities for employment are diminishing, women are being increasingly offered formal systems of education that inevi- tably raise expectations and open up new vistas that cannot be attained. If these patterns of selective discrimi- nation were occurring in static tradi- tional socio-economic systems, their sig- nificance for health might not be as great. The fact that they are taking place within a context of disintegrating tradi- tional orders, however, does present massive public health problems. Mass media communications and bet- ter transportation systems have exposed otherwise rural traditional populations to new aspirations and hopes for better living conditions, and the association of consumer goods with urban life has in turn created a strong "pull" factor to cities. This already well-known phenomenon has recently been exacerbated by chang- ing patterns of land use in many coun- tries. Demands for agricultural labour are stagnating and are creating a "push" that is producing a heavy exodus from the land. It has been estimated that in Latin America alone 14.6 million people left the land for cities during the decade 1950-1960. Given the limited capacity of the cities to absorb them, a new mass of shanty towns have sprung up that now characterize most major urban centres. These urban slums, invariably lacking sanitation and water facilities and abounding in problems of overcrowding and poor housing are high risk areas for communicable disease, malnutrition and exposure to social problems. Especially in Latin America the migration to cities has been female- selective. Because employment possibili- ties have focussed around the domestic service industry, the pattern has been predominantly one of young single women or of married women moving alone in the hope of being able to sup- port children they leave behind in the villages. These women's average age is low. In such cities as Guayaquil (Equa- dor), Panama City, Santiago and Mex- ico City, the migration is highest among teenagers. These women's problems of adjust- ment are severe and aggravated by the fact that, for many of them, the break with family—even though initially seen as temporary—represents also a break with traditions that prepared women for non-mobility. Often lacking in "urban skills" and unprepared for labour bargaining, they quickly join the army of low-paid maids and other service workers dependent on the whims of a middle-class domestic market that is itself prone to economic fluctuations. Few if any support services exist to assist these women and, because of the traditional discrimination and exploitation levelled not only at women but at all marginal workers, their possibilities for improvement are nil. Mentally they suffer the classic isola- tion of the migrant who does not suffi- ciently understand the ways of the host community. Their consequent attempts to seek relationships and emotional security often end in out-of-wedlock pregnancies that in turn further threaten their job security and may ultimately en- tail a precarious existence for the child. Since their work is irregular and they are engaged individually by families, they are rarely registered in social secu- rity systems and remain ineligible for whatever health and welfare benefits might exist. A recent study of out-of- wedlock births in Mexico showed that 25 per cent were to domestic and other service employees with little or no edu- cation, or knowledge about family plan- ning. Over 70 per cent of the women interviewed felt that their children were doomed to have increased problems, particularly of a psychological nature. In the case of those who leave families and children behind in order to migrate isigram- ni 11- ! 1114.44F4 Ft--144IRRIRM! Fitt9qqgR!gqqqggq'Mgi g777!!777gg4q 1 9114qqggi99i 9N11133

to cities, the consequences of breaking up the families are severe and the possi- bilities of a healthy and productive inte- gration into the new community are slight. Not only do these women, who constitute a high percentage of the rural-urban migration in Latin America, earn little, but what they do earn is largely sent back to their families. More than any other category of migrant, they tend to remain at the lowest echelon of society, undernourished and increasing- ly dependent. Prostitution and deviant behaviour are rampant in the appalling environ- mental conditions of slum areas and make integration of these women into the urban economy even harder. Per- haps more significantly, they also limit the possibilities of a return to their fami- lies of origin, and thus increase the psy- cho-social and economic isolation of what is fast becoming a new hard-core proletariat. That a similar pattern of female-domi- nated migration does not appear to be common to other areas of the Third World is no cause for complacency. In those regions the greater preponderance of males leaving the rural communities may mean that the female is left to sup- port the family and maintain the culti- vation of crops. In Kenya in 1960, one- third of all rural households were headed by women. Similar patterns to those in Latin America are witnessed however through- out the Mediterranean regions of Eu- rope, whence the economies of northern European countries draw upon the semi-skilled labour required to maintain adequate levels of productivity. While some of the receiving countries are open to family immigration, others have resorted to legislation specifying "sin- gle" migrants. The effects of this type of migration on family life and child devel- opment are not well documented but early indications suggest a negative in- fluence. It is evident that the existing pattern of economic development in many parts of the world, and particularly in the Third World, is not likely to lead to an improvement in the status of women. To be sure there will be some degree of integration into systems providing occu- pational and social mobility, but this may be limited to a small socio-econom- ically and educationally advantaged group which would have experienced an improvement in status regardless of the rate or type of development. The emerging profile is one of ever- increasing problems: accelerated urban- ization yet stagnating industrialization, increasing rural-urban migration yet fewer possibilities for absorption into the urban economic structure. The lack of social support services designed to assist women to integrate or at least accommodate themselves to new social environments is significant, as is the inadequacy of legislation and policies that regulate migration. Modern social change, because of the rapidity with which it occurs, provokes dramatic contradictions between pro- mise and reality. These contradictions apply to all the disadvantaged. Because of their own special aspirations, women constitute what might be termed a new class. Yet the obstacles they face are those of all groups whose existence and prospects are unplanned and influenced by attitudes and interests negative to change. The nature of the problem clearly eludes any easy solution but certain steps are called for. In both industria- lized and developing societies clear legis- lation is required to define and ensure the type of support required. Social wel- fare and health services must increasing- ly focus on the complex of somatic and psycho-social problems that emanate from long-standing and acute conflicts of dual responsibilities and roles. They must also become more concerned with the problem of migrant workers, wheth- er temporary or permanent, and with the lot of the family, particularly of the children. Rural community structures should become priority issues for national and international agencies, and the status of agricultural work and life should be en- hanced. The growth of urban centres needs to be critically evaluated, and the problems it entails, directly and indirect- ly, should be brought to the attention of planners and policy makers. Finally, it goes without saying that—just as for all underprivileged groups—positive steps should be taken to change social attitudes toward women and to gear educational systems more appropriately to the realities of existing and foreseeable situations. ■ 21 Two faces of Peru. Economic development in its present form, particularly in the Third World, is not likely to lead to an improve- ment in the status of women, except for those few who would have achieved it anyway. Though women form what might be termed a new class, they face obstacles common to all who are opposed by attitudes and interests negative to change. ( Photos WHO/P. Almasy and L. Sirman ©) AN HONEST LIVING Marion Janjic, in charge of the Office for Women Workers' Questions at the International Labour Office in Geneva, talks to John Bland of World Health about women and employment WORLD HEALTH: In general terms, how do you see the situation of women in the labour market today? Ms JANJIC: Women's position in em- ployment is still only marginal—perhaps not quantitatively but certainly qualita- tively. Although their rate of economic activity has increased during the past ten years, with more married women employed than ever before, the sectors in which women can seek and find jobs are limited, and are not generally those at the spearhead of the economy. In effect, the division of labour be- tween the sexes continues to be unfa- vourable to women. They are still less well qualified, lower paid, and more vul- nerable. This has become clear during the current recession, which has hit em- ployed women harder than men. I see two main reasons for this. Wom- en do not approach their working life in the same way as men. They are inclined to look on a job as a temporary expe- dient, and consequently they leave school earlier and without the qualifica- tions they would need to equip them- selves adequately for careers. The majority continue to enter professions like nursing, secretarial work and teach- ing and to neglect the technical, mechanical and scientific professions. This may be partly because they are conditioned—by the way they are brought up, by textbooks, by the media and by society as a whole. They haven't as much freedom of choice as boys. The second reason is that maternity is still a great handicap in a working wom- an's life because it is not given proper recognition by society. It is still thought of as women's problem, and not as soci- ety's problem. Take the social services, for instance. Why should a day care centre be consid- ered a facility for women workers, Marion Janjic. (Photo WHO/D. Henrioud) whereas in fact it helps both parents? And why, when there is a shortage of such facilities, should women be the ones who are expected to give up their jobs? Is this not in direct contradiction to the right to work proclaimed by so many international instruments, among them the Declaration and Resolution on Equality of Opportunity and Treatment for Women Workers adopted by the In- ternational Labour Conference in 1975? The fact is that so long as parents are unable to rely on good services for the care of children while they work, wom- en's employment opportunities will con- tinue to be limited. WH: What steps can be taken to help women in this respect? MS JANJIC: One positive step forward is the progress achieved in the field of maternity protection. It is now fairly common practice to allow leave to women before and after delivery. The difficulty arises with regard to the ques- tion of pay. There are still many coun- tries where, contrary to ILO conven- tions, no provision is made for payment during maternity leave or, perhaps worse, where such payment is the re- sponsibility of the employer. This goes against the interest of women because they then become a financial burden and employers are reluctant to recruit them. Another encouraging fact is that legis- lation is being adopted in more and more countries to enable women to take extended leave after maternity leave whilst their children are very young, with a full guarantee that their jobs will be held open for them. Legislation should also make it possible for either spouse to take leave, as is already the case in Sweden. WH: Do women in developing countries face special problems? Ms JANJIC: Yes. There, the main prob- lems are chronic poverty, and endemic unemployment or underemployment. As a result, it is even more difficult for women to find jobs than in the indus- trialized countries, because the tendency is to give the few that are available to the presumed heads of families, the men. In numerous countries, however, particularly in Latin America, there are Tram-driver in Peking. Women should widen I> their occupational horizons and enter new jobs, particularly in the technical, mechanical and scientific professions. (Photo L. Sirman (0) 22 ire • An honest living Left: Transistor assembly-line in Japan. When women enter in a majority into a profession, the average wage tends to go down. Yet on the contrary, the enormous stress of the intri- cate jobs women often do, and their capacity to withstand production-line monotony, ought to be taken into account by employers, and remunerated accordingly. Right: Rural Somalia. In developing countries the most pressing needs for women are educa- tion and training facilities, particularly any training that will enable them to become self- employed. But first they need improved basic facilities to alleviate the drudgery of their daily lives safe, accessible water, for example, or mechanical aids for grinding food-grains. (Photos WHO/E. Schwab) many women who are heads of families, but their opportunities for work are slight because they have had no proper education. Furthermore, in rural areas, moderni- sation sometimes eliminates the very tasks that women used to have before, and they cannot avail themselves of the few training opportunities that exist because of the drudgery of their daily life at home and in the fields. Clearly, one of the first things to be done is to al- leviate their daily burden by introducing improved basic facilities such as safe water supplies or perhaps mechanical means of grinding corn-meal. WH : What do you think is the best way of improving employment opportunities for women in the world as a whole? Ms JANJIC: Education and training are essential. In developed countries, where theoretically the opportunities are equal, the most pressing need is to broaden the occupational choice by encouraging girls to enter new jobs, especially in the technical and scientific fields. This is ea- sier now that there are fewer and fewer jobs requiring physical strength. It is surprising, however, that in spite of this evolution there is still much reluctance, both on the part of girls and their fami- lies and from employers, when it comes to girls entering these traditionally mas- culine fields. Proper manpower policy and planned economic development are also very im- portant. A recent report by the French Economic and Social Council has pro- posed that the problem be tackled on a regional basis so that there is a balance between heavy and light industries in a given area. Where only heavy industries are developed, there are very few em- ployment possibilities for women. In developing countries the most pressing need is to improve the educa- tion of girls and to wipe out illiteracy, as well as to encourage all types of training facilities that can help women to become self-employed, since wage-earn- ing employment will be limited for both women and men in coming years. A sine qua non for any progress in these coun- tries, however, is the political will to im- prove the status of women. WH : Are conditions satisfactory, would you say, for those women who do have jobs? Ms JANJIC: Although the ILO Equal Remuneration Convention has been rat- ified by many countries, there is still a great difference between the wage rates of men and women, but this is not always due to discrimination. The most difficult aspect of the problem is that 24 women, as we already discussed, do not work in the same fields as men. As soon as women enter in a majority into a pro- fession, the average wage tends to de- scend, and this type of phenomenon is very difficult to fight against. In the industrialised world, women are often employed in unskilled jobs on the production line, sometimes with vir- tually no training. These types of jobs entail considerable nervous stress, but this is not taken into consideration in the calculation of salaries, whereas physical effort is well remunerated. Women are also thought to stand monotonous jobs better than men, but this is another aptitude not taken into account by employers. These are some of the reasons why women's salaries are still lower than those of men. Another reason is that many coun- tries have adopted protective legislation, for instance prohibiting night work for women, in compliance with ILO conven- tions. This prevents women from work- ing on the third shift and thereby doing the same jobs as men and receiving the same rates of pay. WH : Has there been any progress in terms of social security? Ms JANJIC: We are today at the cross- roads. In fact, social security systems used to be based on the principle that the man supported the family, so that the wife at home was entitled to benefits only through her husband. Today, women are claiming social security in their own right, which is only just, in view of their contribution, visible or in- visible, to the national economy. So a slow change has begun towards autono- my for women in this area. WH : Would you not agree that many women still see marriage as a potential escape from the need for long-term em- ployment or a career? Ms JANJIC: That is so. There is no doubt that marriage is considered by some women as an alternative way of making a living. Indeed, society encour- ages them in this, whereas men would be criticised if they decided to devote themselves only to their family. So long as there is such a difference between women's and men's attitudes to their working life, it will be difficult to achieve a true equality of opportunity for women. During International Women's Year, of course, there was much talk of the need to change men's mentality as well as women's. There are encouraging signs that the new male generation seems to have taken the point better than the old! ■ 25 OUT OF REACH A number of problems specific to women make a range of health services essential for them. But in Asia, as elsewhere in the world, millions of women still have no access to health care BY P. K. DEVI Among the many new movements which have spread through several developing countries in the last decade, increased concern for the welfare and status of women and recog- nition of the need for urgent action on their behalf are significant steps forward in the history of humanity Yet, in most of these countries, although a few wom- en now occupy some of the highest posi- tions, there are still millions who remain untouched by the winds of change sweeping across the world. The maternal mortality rate (the num- ber of deaths per year among women from causes related to pregnancy, abor- tion or childbirth) is a good illustration of this. While this rate reflects to a con- siderable extent the quality of medical and health care a pregnant woman receives, it is also an indicator of a whole host of other aspects including social, economic and cultural factors. That childbirth ought to be safer today than at any other time in human history is shown by the fact that the maternal mortality rate in developed countries in Europe and elsewhere has dropped to 0.15 per 1,000. But in the developing countries of Asia and Africa it still ranges from four to eight per 1,000 births, equivalent to the developed countries' rates at the beginning of the century. In India, according to social scientists and demographers, the sex ratio (num- ber of females to 1,000 males) of 930 suggests more deaths among women in all age groups than among men and this is also reflected in the slightly lower ex- pectation of life at birth for women (45.6) as compared to men (47.1). The factors which led to this decline in maternal mortality rates in developed countries included easy availability of good medical care, improved social con- ditions, better nutrition, acceptance of family planning, which reduces the number of children a woman bears, and—most important of all—education to promote better and more effective utilization of all available facilities at the right time by women who needed these services. If one analyses the causes of maternal deaths in developing countries today, one again finds the same order of things that obtained in developed countries 50 years ago. Haemorrhage, post-delivery infection and septic abortions are the immediate cause of most deaths related to pregnancy. Tetanus still contributes to high mortality among mothers and newborn children since 70-80 per cent of deliveries still occur in the villages without assistance from trained person- nel. Yet it can be prevented by immu- nization and good quality of care. A large-scale national programme has been instituted during the last five years in India to immunize each mother with tetanus toxoid so that both she and her baby will be protected. It is impossible, however, to catego- rize the causes leading to maternal deaths accurately, as many of these deaths are not certified by qualified practitioners. Anaemia, malnutrition, infections and parasitic infestations seriously undermine the vitality and resistance of women and hence are con- tributory causes to the end result of death due to complications occurring at delivery. Among women living in urban areas the small family norm has been largely accepted, except by urban slum dwellers. But in the rural areas it is not unusual to see a woman with four to five children by the time she is thirty. Thus a reproductive life cycle of preg- nancy, childbirth and lactation conti- nues uninterruptedly, starting from an age when the growth spurt of adoles- cence is barely over, for a period of ten years or more. This has several conse- quences on the health and well-being of those mothers who form 20 per cent of the population living under subsistence levels. Such problems can be solved not by improved medical care alone but by a concerted effort to improve economic and social conditions as well. Among many problems related to reproduction that afflict women in most parts of the developing world is infertili- ty or the inability to conceive and bear a child. The extent of this problem is esti- mated to be not less than 10 per cent of An auxiliary nurse-midwife at work in the D state of Bombay. Maternal mortality in devel- oping Asia and Africa is the equivalent today of the developed countries' rates around 1900. (Photo WHO) 26

Out of reach Left : In rural areas women start their repro- ductive life when they are barely out of ado- lescence, and may have four or five children by the time they are thirty. This adversely af- fects their health and well-being, particularly when a visit from the nurse is a rare occasion. Right: A traditional midwife, the dai, makes her first delivery after being retrained in the fundamentals of safer childbirth. Meanwhile, a neighbour bangs on a tin tray in lime- honoured fashion to make the baby cry. (Photos League of Red Cross Societies and WHO/E. Schwab) all married couples. Even when popula- tion growth in general is a problem health centres and hospitals have to devote considerable time and effort to the treatment of these couples. Several reports have identified the various causes which lead to infertility in India. One-third of such causes relate to the male partner (for example, ab- sence of sperm or diminished number of sperm, often due to preceding infec- tions), while among women the impor- tant causative factors are blockage of the tubes due to infection, absence of ovulation and infections of other parts of the genital organs. Tuberculous infec- tion of the genital tract, usually secon- dary to a focus in the lung or in the intestines, is an important cause ac- counting for 7-10 per cent of female in- fertility as reported from several areas. The true prevalence of sexually trans- mitted diseases, and therefore their con- tribution to sterility, are not known because of the lack of facilities for pre- cise diagnosis. There are several regional centres spread across a number of Indian states for the treatment of cancers of the female reproductive organs, but still the clinics are crowded with women in an advanced state of disease. The over- all incidence of cancer in the Indian population is estimated to be 150-200 per 100,000 total population, and cancer of the cervix alone would account for at least half of all these cases. The ratio of cancer of the cervix to cancer of the body of the uterus still remains at around 8:1, whereas in most developed countries it is almost 1:1. Women belonging to poor socio-economic groups where early marriage is prac- tised, childbirth is frequent and obstetri- cal care poor more often develop cancer of the cervix, whereas women with few children belonging to higher socio-eco- nomic groups with a longer life-span tend to develop cancer of the body of the uterus. In fact in developed coun- tries like the United States breast cancer causes two and a half times as many deaths as cervical cancer, whereas in In- dia breast cancer accounts for only 15- 20 per cent of total cancers, with cancer of the oral cavity (10-12 per cent) next in frequency. Cervical cancers are large- ly preventable today, and this empha- sizes the need for education of women and of the community to solve a major health problem that affects India and other developing areas. The abortion laws in several countries in South-East Asia including India have been revised liberally, in accordance with world trends. In India, the law was liberalized on health grounds in 1972 to avoid needless suffering to millions of women who were resorting to illegal abortions for unwanted pregnancies. Facilities for abortion are still to be developed in peripheral areas, and un- less that is done the full impact of the liberalized law on either population growth rate or decrease in mortality due to induced abortions will not be felt. Furthermore, rural women especially need to become fully aware of the recent changes in the law, to understand where and how to obtain an abortion, and to appreciate the importance of taking ac- tion at the earliest possible moment in the pregnancy. From statistics available it is also known that 40-60 per cent of women receiving medical care for abortion ac- cept dependable contraceptive methods, including sterilization, at the same time. This more than any other measure has contributed to the larger number of female acceptors of contraception, and should greatly diminish the need for induced abortion within this decade. 28 In most developing countries, low birth weight (below 2500 grams) either as a result of premature deliveries or due to faulty intrauterine development constitutes an important threat to sur- vival of the newborn. Work in the last ten years in many countries has identi- fied several of the "risk factors" in mothers of such babies. These include short stature, poor weight gain during pregnancy due to inadequate intake of calories and proteins, and poor environ- mental conditions, plus complications like anaemia, hypertension and previous pregnancy losses, conditions all fre- quently found in relatively young preg- nant women. Identification of such fac- tors can help clinic or field staff to pay special attention to such "at-risk" moth- ers. Low birth weight leads in turn to higher infant mortality and mothers in socio-economically deprived groups tend to have more babies to ensure that at least some of them will survive to adult age. For the development of effective pro- grammes for the prevention of death and illness among pregnant mothers and their babies, it is imperative to have an intimate understanding not only of pre- valent health conditions but also of some other closely related factors. It is well known that an increase in the gen- eral standard of living resulting in im- provements in education, production, income and food can raise health stand- ards even without any specific health- oriented actions. A close look at India's vital statistics provides a good illustration of this point. The Indian subcontinent has sev- eral states which are primarily adminis- trative units but differ also in cultural, social, economic, linguistic and even ethnic respects. As a result there are large differences in patterns of mortality and morbidity between different states. For example, the crude death rate is the lowest, i.e. 8.4, and comparable to that of the most highly developed countries, in the Southern State of Kerala, whereas the highest death rate in the country, i.e. 19.4, is in the Northern State of Uttar Pradesh. Similarly the infant mortality rate, which reflects socio-economic con- ditions and health care availability and utilization, also shows a wide difference, being 55 per 1,000 births in Kerala and 160 per 1,000 in Uttar Pradesh. Yet if one looks at the per capita income reported from the two states, they are practically the same, being 279 Rs or about US$31.00 (at constant prices) in Kerala and 276 Rs or about US£30.60 in Uttar Pradesh for 1970-71, which in- dicates that economically speaking Ker- ala has not advanced much more than Uttar Pradesh, though it is possible that distribution patterns of income could differ in the two states. Though it is too early for a positive assessment, it can safely be predicted that at least one fac- tor which will undoubtedly emerge as significant is literacy, especially among women. The urban and rural overall lit- eracy rates in Kerala are 66.3 per cent and 59.3 per cent respectively, whereas in Uttar Pradesh they are 44.1 per cent and 18.1 per cent respectively. Female literacy in Kerala is also the highest for the country (54.3 per cent), whereas Ut- tar Pradesh has a female literacy rate of only 10.6 per cent. Certainly other im- portant differences will relate to trans- port and communication facilities, envi- ronmental and social factors and extent of availability and utilization of health services. In the context of India's new health plans which aim at taking better care of the health status of 80 per cent of its 616 million people who live in a little over half a million villages scattered over 29 32,000,000 sq. km . of land, epidemiolo- gists are engaged in identifying the fac- tors responsible for such significant regional differences in health parame- ters. A plan of action based on the un- derstanding of these factors is likely to be more fruitful in achieving the desired objectives in any country's development programmes. The question of mental health among women in India has been studied inten- sively in recent years by many investiga- tors. As in others parts of the world, a special characteristic of emotional prob- lems in women has been the presenta- tion of these problems in the form of physical illness, resulting in repeated visits to medical rather than psychiatric clinics. Studies in various places have also brought out the fact that the suffer- ing of women during any chronic illness is considerably more than that of men, because the social pressures on women inevitably cause disruptions in personal, social and professional life when they are ill, and have greater impact on the family. Women seek help more often than men at hospital clinics and also at- tend more regularly for treatment. The implications of these studies are two-fold. Firstly, the magnitude of the problems faced by emotionally dis- turbed women is considerable, and secondly, for socio-cultural reasons they tend to think in terms of physical rather than mental symptoms. The key impor- tance of the mental health of women for a happy family and society is so consid- erable that it can bear repetition wherever health problems and priorities are discussed. Several new experiments are being carried out in developing countries all over the world to evolve efficient sys- tems of delivering health care to moth- ers and children under prevailing condi- tions and with the available resources. The use of village-level health workers supported by the local community, training of traditional birth attendants, Literacy, especially of women, seems to be a significant factor in differences in the mortali- ty and morbidity rates between various Indian states. The highest crude death and infant mortality rates coincide with a very low female literacy rate. ( Photos L. Sirman © and WHO) and evolution of village-level health committees closely linked with agencies for education, agriculture and social welfare are all innovations which stress heavily the role of auxiliaries in the delivery of health care. It is gratifying to note the keen in- terest and enthusiasm spreading among the developing nations of the world to seek and find practical and imaginative solutions, suitable to their own culture, environment and resources, for the prob- lems of health and medical care of their own people, with particular reference to improving the status of women. ■ 30 '`" WOMEN AT WORK Bulgaria believes that the protection of women from hazards in the work environment is a vital safe- guard not only for present but for future generations BY FINA KALOYANOVA Maturity of mind, intelli- gence, strength of character, inventiveness, skilfulness— women can develop all of these attributes against the background of contemporary society. For Bulgarian women, inequality was abolished with the establishment of the socialist state system in 1944, and they are now ac- complished and respected citizens. Since that time women have worked on equal terms with men in industry, the adminis- tration, the economy and agriculture, as well as in science, culture and education. Equality of the sexes, prescribed by the Constitution, has given them the oppor- tunity to become highly qualified, to specialize in their chosen field, and to work as managers in different domains. Today, about 44 per cent of workers in Bulgarian industry are women. Some professions in the textile, dressmaking and tailoring, food and tobacco indus- tries, in shoe-manufacturing and in oth- er branches of industry are almost com- pletely feminized. Protection of the health of all em- ployees is considered extremely impor- tant in our country. Particular attention is paid to women workers, taking into account three basic considerations. The first of these is the anatomic and physio- logical particularity of the female body (in comparison to men, women are on average smaller and shorter and their normal lung capacity and blood haemo- globin content are lower; overall, it has been estimated that they have 15-20 per cent less physical strength, in terms of physical effort, than men); the second is the reproductive function (a woman menstruates, she becomes pregnant, she gives birth and she breastfeeds her chil- dren, and in the course of these processes many regulatory mechanisms in the body are altered); and the third is woman's social status (that is, her role in bringing up and educating children and caring for the family). From the psychological point of view there are no substantial differences, and in fact the physiological differences just mentioned have no negative influence either on women's activity or on their mortality rate. On the contrary, women in our country have a higher life expec- tancy— 73.6 years, as compared to 68.9 years for men. Almost all occupations in Bulgaria are today open to women, and where there are restrictions and special regula- tions applying to women only, this is primarily with the aim of safeguarding their special function of reproduction. Such restrictions can in no way be con- sidered discriminatory, nor do they result in the underemployment of wom- en. Our country has in fact a continuing lack of manpower. Noxious agents in the work environ- ment can cause various pathological conditions and even death. Among wom- en these conditions can include disturb- ances in the menstrual cycle or during pregnancy, premature birth, fetal mal- formations, abnormal delivery, and so on. Some hazards specifically affect the reproductive organs, and therefore also affect future offspring the woman may have. One important consideration is spar- ing women's physical strength. Nowa- days physical loading in most profes- sions has decreased considerably and women can do many modern produc- tion jobs in the chemical industry, in mechanized construction work, and so on. However, at the present stage of technological development, there are still jobs which require a considerable physical effort. Heavy lifting and hard physical work can lead to gynaecologi- cal illnesses, disturbances in the men- strual cycle, and problems during preg- nancy. Other possibilities are displace- ment of pelvic organs, varicose veins and spinal troubles. With this in mind, Bulgarian health legislation specifies the following stand- ards for women for manual lifting and carrying: not more than 20 kg if for less than four hours and over short dis- tances, or 15 kg over a longer period of time. The tendency now is in fact to reduce maximum loading to 12 kg for four hours per day at the most. Noise and vibration are among the most widespread harmful factors to be found nowadays in the work environ- ment. Apart from the well-known ef- fects of these two, vibration in addition has a specific effect on the reproductive organs, frequently causing menstrual disturbances and aggravating existing problems. Low-frequency vibrations of the type encountered when working with agricultural machinery can alter the normal position of the womb. Women of childbearing age need special pro- D tection against certain hazards at work. (Photo WHO/M. Jacot) 32 '4!".1- • mow ,.••• ilfr ` • • • . 11.11r _ For this reason, there are special reg- ulations in Bulgaria for women working in mechanized agriculture. No girls un- der 18 or women with menstrual disturb- ances are permitted to work where there are intense vibrations, and there are similar restrictions to cover exposure to intense noise. Other regulations concern the protection of female em- ployees against ionizing radiation (used for X-rays in medicine, for example). There is no doubt that the reproduc- tive organs are particularly sensitive to ionizing radiation, even in small doses, and repeated exposure has a cumulative effect. Radiation can injure both fetus and placenta and cause abortion, mal- formations and still-birth. This is why, in addition to the general precautions to be applied in work with radiation, par- ticular care has to be taken to avoid ex- posure in women of childbearing age. Work with high-frequency radio-waves and micro-waves (used, for example, in telecommunication, radio-navigation, radar and heating for medical and in- dustrial purposes) also requires special protective regulations for women who may have children. Heat is another common occupa- tional hazard occuring in a wide variety of industries and in outdoor work in hot climates or weather. There is evidence of a sex difference in the pattern and degree of physiological response to work in heat. Women respond with a higher body temperature, lower sweat production, higher pulse rate, and more subjective distress. The menstrual cycle is disturbed, and there are changes in the functioning of the ovaries. Heat stress is particularly serious for pregnant women because the cardiovas- cular system, which plays a fundamental role in regulating the body's tempera- ture, is already under higher demand. Severe heat stress may result in toxae- mia of pregnancy (a form of blood poi- soning of the mother), birth defects or suffocation of the fetus. Also, infants whose mothers have been subjected to high heat levels during pregnancy have a higher mortality rate. In setting standards for exposure to heat, consideration must be given to the type of work performed, and to the av- erage amount of heat radiated in the im- mediate environment of the worker over a long period of time. In Bulgaria wom- en are not allowed to work in industries where very high temperatures occur, in smelting and casting of certain metals, for instance. Heat usually increases the harmful ef- fects of chemicals and certain other oc- cupational hazards, and the combina- 34 tion of heat and other hazards is often found in industry. In the past, standards for occupational exposure to harmful factors have not taken into account the interaction of different stresses of this type, and there is a question as to whether these standards should be revised. WHO's Office of Occupational Health is carrying out a special pro- gramme on combined effects of occupa- tional hazards in which the Bulgarian Institute of Occupational Health is col- laborating. The presence of chemical substances in the work environment can also pre- sent special problems for women. Some of these substances have been proved to injure the gonads (the reproductive glands) and to penetrate the placenta, damaging the fetus. They can also be ex- creted in the mother's milk. allowable concentrations and could en- ter the body through contact with the skin. The same sort of studies have been done by the Institute of Occupational Health on workers in the oil-processing and other industries in contact with ben- zene and numerous other solvents. By noting cell modifications during the menstrual cycle, it is possible to detect early changes in hormonal pro- ductivity before there is any manifesta- tion in other organs or systems. The harmful effect of some metals— such as mercury, lead, manganese, cad- mium and beryllium—on pregnant women is indisputable. Chronic expo- sure to mercury leads to disturbances in the menstrual cycle and in ovarian func- tion. The more mercury in the atmo- sphere the more is excreted in the urine, and the higher the percentage of abnor- mal menstrual cycles in exposed work- ers. Women exposed to mercury pollu- tion also have been shown to have more trouble during pregnancy, abortions and premature births. There are some indications from ani- mal experiments and observations of humans that deleterious effects may result in the offspring of mothers heavi- ly exposed to some pesticides and to compounds such as polychlorinated biphenyls that are widely used in indus- try. The Institute of Occupational Health and the Institute of Obstetrics and Gynaecology have carried out in- vestigations on workers engaged in plant-growing in greenhouses. These women had more spontaneous abor- tions and disturbances in the menstrual cycle, thought to be related to the effect of high temperature in combination with different pesticides. The Institute of Occupational Health has also carried out tests on experimen- tal animals to evaluate the effect of new prospective chemical compounds on pregnancy and on future offspring. We discovered, for example, that some fungi- cides have a teratogenic effect, that is cause serious physical defects in the fetus. We paid special attention to deter- mining the most dangerous periods after conception for the causation of malfor- mations, and whether there is a relation- ship between dose and effect. We were able to establish threshold and non- effective dose levels, and provided these levels are observed there are no risks for a woman or her future children. If a substance has definite teratogenic prop- erties, of course, we prohibit its use in industry or in agriculture completely. Women likely to become pregnant should never be exposed to physical or chemical agents which may have any Creches and day-nurseries are widely avail- able in Bulgaria. (Photo ILO) It has been well established, for in- stance, that in pregnant women organic solvents pass from the maternal blood stream to the placenta. One of the most dangerous solvents, benzene, can become fixed in and damage certain structures of the ovary, causing hormo- nal changes that result in disturbances of the menstrual cycle. Also, statistics that have been collected in various countries on the reproductive functions of women workers in contact with or- ganic solvents, and certain data avail- able on intoxication by chemicals, all point to a lower ability to conceive among these women, as well as patho- logical disturbances during pregnancy and birth and during the early post- natal period. Spontaneous abortions were twice as frequent in the women ex- posed as in the control group. These ef- fects are attributed to unfavourable in- dustrial conditions where organic sol- vents repeatedly exceeded the maximum Nowadays almost all occupations are open to women. Some professions, in the textile in- dustry for example, are almost completely feminized. (Photo ILO) mutagenic or teratogenic effects. Al- ready pregnant women should not per- form heavy physical work, particularly work which involves heavy pushing or lifting. In Bulgaria, for instance, the leg- islation specifies no workload above 2.5 kcal/min or lifting of weights above 5 kg. In addition, all factories have a list, drawn up by a committee of experts, of areas in the factory where pregnant women or nursing mothers may not work. These are places where the concentrations of noxious chemicals are higher or where there are intense vibra- tions and noise, high temperatures, or high-frequency radiation of any type. Once it is known that they are pregnant, women are transferred from these work- places within seven days. During preg- nancy they are given light work without a decrease in salary. The critical period for the develop- ment of the child is the early months of pregnancy, when malformations can ap- pear. Contact with chemical compounds is especially dangerous during the first month. However, pregnancy is not always detected within this period. Therefore, with the safety of both the woman and her future children in mind, our labour legislation forbids women to work in such heavy or potentially harm- ful industrial activities as underground work in mines, production of lead, mer- cury or arsenical compounds, work con- nected with the vapours of benzene and its products, and so on. No women of childbearing age are permitted to work on production of dithiocarbamates (fungicides), organochlorine or organo- phosphorus compounds, or polystyrene (including polystyrene fibres), nor are they allowed to work with selenium. The general problem of work-rest regimens for women is vast and includes a number of basic questions such as duration of the working day and work- ing week, shift work, annual leave, and so on. Naturally the rearing and educa- tion of children and family obligations have a profound impact on women's working activity. Studies have been done on these regimes but mainly in in- dustries where women are in the majori- ty. This year in Bulgaria, however, we shall be completing an ergonomic ass- essment of workplaces throughout the whole country, using a number of in- dices. To prevent exhaustion of women workers and to preserve their physical capacities we foresee a number of mea- sures, including rational organization of their work within the family as well as of their social and public activities. One measure that could substantially facili- tate women's work is the introduction of part-time employment at times that pose difficulties for the family—while children are very young, for example, or when they start school. In Bulgaria the part-time working day does not affect the length of employment required for retirement and women are allowed to return to full-time employment when they so desire. The results have been considerable in terms of health and social factors. Other facilities at the disposal of women in Bulgaria are convenient and rapid-service public facilities like laun- dries, catering establishments and can- teens, and boarding-schools and semi- boarding schools. Day nurseries and creches, in which children are reared and educated free of charge or for mini- mum fees, are very popular in our coun- try. A large expansion of such facilities is envisaged over the next five years as part of the programme of social and economic development. In Bulgaria we give the utmost impor- tance to the protection and promotion of the health of our women workers. Systematic health examinations, includ- ing early detection tests for certain dis- eases, are carried out at regular inter- vals. Obstetricians and midwives with special knowledge of occupational hazards complement the usual health team, and pregnant women are kept un- der constant observation. All-round health care can only be said to be provided for women when there is a comprehensive occupational health programme at all workplaces. But wom- en too must be aware of labour and health standards and regulations and they must observe them, for their own sake and for that of their children. ■ 35 FAITH AND DETERMINATION Nicole Grasset, until this year WHO's Regional Ad- viser for Smallpox Eradication in South-East Asia, was interviewed for World Health by Nedd Willard WORLD HEALTH : You seem reluctant to be interviewed. Why? DR GRASSET: "Words, words, words" ! I feel more than ever that words, spoken or written, are of no use unless they lead to action. Thought—the essential basis of any human endeavour—is translated into words but words should be spoken or written only if they make others think and act. More time should be given for thought and action, and words should be cut down to a minimum. WH : What was your background before you worked for WHO? DR GRASSET: After obtaining my M.D. in Geneva and doing six years' hospital work in dermatology and venereology, I took the course of Tropical Medicine and Hygiene in London. Then I worked in the field of virology for 10 years in Europe and Africa, mostly at the Pas- teur Institute, Paris, concentrating mainly on viral communicable diseases and immunization programmes. WH: What circumstances led you to join WHO in the Smallpox Programme? DR GRASSET: In 1969 during the war in Nigeria, at the request of the Interna- tional Red Cross, I organized a Small- pox/Measles/BCG immunization cam- paign in certain regions of the country with the assistance of UNICEF and other agencies. For this, I contacted a number of WHO experts who gave me valuable advice. One of these was Dr D. A. Hen- derson, Chief of Smallpox Eradication, and it was he who asked me in 1970 to join the Smallpox Programme in Asia. WH: What factors led you to accept? DR GRASSET: I had always wanted to work in developing countries, as the needs are much greater than in Eu- rope—the work more challenging—and I had always admired Pasteur's ideal, that the results of research work should be applied throughout the world for the benefit of mankind. Also Dr Henderson easily convinced me by his faith, and by a number of concrete facts, that small- pox could be globally eradicated. Faith is as contagious as any infectious disease and is perhaps the most important fac- tor for any endeavour. WH : What has been the greatest satis- faction of your career here? DR GRASSET: During my first five years in Asia I thought the elimination of smallpox—a terrible disease and the first to be eradicated since the beginning of mankind—would, in itself, be a wonder- ful satisfaction. Now, I am in awe of the manner in which it was achieved. When, in the past, have hundreds of men and women from 34 nations come to work in one country—for example India—for a common goal? When have people of different races and religions united as a dedicated team, together with a hundred thousand local workers of different socio-economic groups and professions, for the common good? The eradication of smallpox is being acclaimed as an achievement in health, but I feel it should be further publicized as an achievement of humanity to serve as an example to all people of how they might unite in other peaceful endeavours. WH : What were for you the greatest set- backs and frustrations? DR GRASSET : It has never been the amount of smallpox that demoralized me. When we had up to 14,000 smallpox cases recorded in one week in India, I never for a moment lost faith nor doubted that smallpox would be eradi- cated. It was human failure that frus- trated me. On the other hand, my greatest satisfaction was witnessing the excellent work, goodwill, total dedica- tion and cooperation of the many out- standing people who worked for and with the smallpox eradication effort. WH : What was your most wearying task? DR GRASSET: I think fighting against delays. We were continually battling against time, as areas free of smallpox in Asia were constantly in danger of being re-infected by the highly endemic regions; so we had to act rapidly. We always set a specific time limit to any operation. Let's be frank—we did not always achieve our targets, but this made us all the more determined to do so next time. To move a pawn on our Nicole Grasset in her office in New Delhi.> (Photo WHO) 36 STH4 strategy chess-board involved the work of a number of persons in a variety of jobs and offices. One human failure and the chain of team work was broken. When working in hospital I always ad- mired the coordinated human effort when a patient was admitted, injured in an accident. The ambulance driver, the stretcher-bearers, surgeons, anaesthetist, lab. technician, nurses, all would come rushing in the middle of the night to save one life. All routine hospital work and personal considerations were put aside—for one life. In Asia, thousands of patients are waiting to be assisted ev- ery hour of the day. A delay of 24 hours of staff, drugs, vaccine, jeeps or of a cabled message often means illness and death for hundreds of human beings. For us technical people, the urgency of action in a health programme is easier to understand since we see patients suf- fering, see lives saved and we daily fol- low up the results of our actions. It is so much more difficult for civil authorities, administrators, etc., to realize why we insist on everything being done rapidly, to realize that they are holding in their hands more lives than any one surgeon. We personally contacted many people holding a variety of different jobs—air- line authorities, jeep manufacturers, finance officers, telex operators, and so on—and they usually responded magnif- icently when they understood their per- sonal responsibility in saving lives. WH: What lessons can be learnt from the programme here? DR GRASSET : What we have left behind, I feel, is a way of tackling a problem, not just a disease. The basic element of success in any field is to get good peo- ple—the right people. Good people equate with a good programme, and funds will then always be made avail- able to assist that programme. A vacant post is better than having it filled with the wrong person. Our workers, who will now be involved in other pro- grammes, have understood that the "ideal" solution is worthless if it cannot be implemented. They will remember that our daily problems were constantly analysed, that priorities were always es- tablished, and that they were tackled, above all, with a practical approach. Our way of thinking was "What is going wrong?" "Why?" "What must be done?" and especially, once the solution was found, "How shall we implement the new plan of action?" and then "How shall we assess its success?" We have also left behind the understanding of how true surveillance is carried out. We have demonstrated that the meticu- lous training of staff, especially at the grass-roots, is essential: explaining to all why and how they must work, periodi- cally discussing and analysing their progress of work. We have left behind us the notion that efficiency in every as- pect is more important than hypotheses or long reports, that workers at all levels must spend more time working in the villages than in the offices, that effective supervision from the highest to the lowest level is critical for getting the job done. Left: The last case of smallpox on the Asian sub-continent, discovered on 16 October 1975, was a little girl living in Bangladesh. This was also the last known case of the more virulent form of smallpox, variola major. Right: The huge campaign for smallpox vaccination in India began in 1962. In New Delhi, doctors vaccinated thousands of people, most of them schoolchildren. (Photos WHO/ D. Tarantola & T. S. Satyan) WH: For this did you use only physi- cians? DR GRASSET: No. A variety of staff was recruited such as operational officers, administrative officers, mechanics, sociologists, etc., who were invaluable to the programme, as were the auxiliary staff. For example, the surveillance tech- niques used in markets and with the beggars and other street dwellers in Cal- cutta were mainly developed and imple- mented by two young anthropologists. Similarly, it was often more important to have a good mechanic to keep our jeeps rolling than an M. D. with post- graduate degrees, because if the jeeps transporting staff and vaccination equipment were not in working condi- tion in an affected district, the whole operation there would collapse. WH: I think you were willing to be unor- thodox! DR GRASSET: Yes. The unorthodox can often lead to change and only with change can progress be made. What you are told is impossible can often become possible if you tackle the problem in an unorthodox or imaginative way. For ex- ample, one of our biggest problems was eliminating smallpox amongst the beg- gar and nomad populations. Someone suggested we feed the infected beggars and their families and isolate them in hired houses or tents until they were no longer infectious. At first it seemed im- possible to implement this and use funds in such an unorthodox way. Yet finally we succeeded. WH: You said "good people" were the basic element of a good programme. What did you mean by "good?" DR GRASSET: A good programme needs only a few highly experienced and quali- fied people at top levels. We had these. Out of the hundreds recruited by WHO and the different governments, many had no past experience in smallpox eradication when they first arrived. The qualities they needed, rather than past experience, were faith in their work, courage and perseverance, adaptability to any situation, imagination, efficiency, capacity to take on responsibility yet flexibility to work easily as part of a team, and last but not least, willingness to work hard. WH: Did being a woman prove to be a disadvantage in your career? DR GRASSET : No. WH: What are your future plans? DR GRASSET : At the moment, I feel like a runner at the end of a race, who would only be able to give second best if she began running another race, still breathless and thirsty. When you give you should give your best. I need some time to replenish myself physically and spiritually and while doing so I hope to determine where and how I can give the most. ■ A MEDICAL MAJORITY In medical fields particularly, Soviet women demonstrate vividly that, when opportunities are equal, sex is no bar- rier to professional excellence and an outstanding career BY VLADIMIR LYUBOVNY "You call that equality?" complained Konstantin Varsaladze, Professor at the Tbilisi Medical Institute, joking with journalists who had been in- vited to meet the medical deputies to the Supreme Soviet of the USSR. "It's domi- nation by the fair sex—matriarchy, that's what I call it!" And indeed, 20 out of the 24 doctor- members of the Soviet parliament are women. "... The complete and all-round development of the country, the well-be- ing of the whole world and the cause of the establishment of universal peace require that women participate to a maximum degree in all spheres of life on an equal footing with men." For Lyud- mila Bogatiryova, a Russian, Klara Samsonova, a Yakut, Zakhra Kuliyeva, an Azerbaijanian, Hilda Perelyainen, a Karelian, and Milva Miidla, an Esto- nian, this appeal contained in the United Nations Declaration for the Elimination of Discrimination against Women comes a little late. They find it hard to believe that in one Western coun- try there are only seven women among every 100 physicians, and that in anoth- er even paediatrics is an exclusively male monopoly. Women predominate in Soviet medicine, accounting for over 70 per cent of the total of 800,000 doctors. In recent years the interest displayed by men in the profession of doctor has considerably increased, but young girls still form the majority of medical students. They enjoy no special privi- leges, face no discrimination during the entrance exams, and usually make better progress in their studies than young men. This results to a certain extent from the preference given at admittance to those who have some practical ex- perience, particularly in medical institu- tions. Almost 100 per cent of such appli- cants are women—former nurses, hospi- tal attendants, midwives and laboratory workers. Despite some concessions made to progressive public opinion, the official view on women's education in Tsarist Russia was exactly in line with Emperor Wilhelm's famous maxim: "Kinder, Kirche and Kfiche" (children, church and kitchen). A certain high-ranking of- ficial of St. Petersburg kindly explained to the famous scientist Sophia Kovalev- skaya that "a woman's business is to produce mathematicians, not to become one". It is not surprising therefore that, having achieved equal rights with men and consequently free access to higher education, women in Russia after the October Revolution of 1917 started tak- ing particular interest in activities that had been half-forbidden to them before, particularly when these were clearly in the interests of society in general. The "feminization" of Soviet medicine was therefore an objective, historically con- ditioned process. Medicine and public health protection in the USSR developed against the background of enormous social and technical changes and the simultaneous transformation of a backward agrarian country into a powerful industrial one. Therefore for several decades men were most attracted by industrial professions directly connected with labour-intensive production. Medicine, on the other hand, corresponded to the qualities of the female nature, requiring of its devo- tees kindness, gentleness and compas- sion ; it opened wide its gates to the rep- resentatives of the fair sex, who were es- pecially endowed with these gifts. Not that this prevented women from becom- ing engineers, metallurgists and builders of bridges, from piloting aircraft and becoming sea captains. But their greatest success was in the field of medi- cine. Hospital No. 81 is perhaps the most typical in Moscow from the point of view of the organization and quality of medical aid that it runs. It has an out- patient department, 885 in-patient beds, four therapeutic departments, two gynaecological ones, three surgical ones and three ophthalmic ones, as well as departments of neurology and endocri- nology. It has several specialized con- sulting rooms, a big laboratory with clinical, bio-chemical, histological and other departments, as well as a pharma- cy and X-ray and physiotherapy depart- ment. The hospital staff numbers 160 doctors, over 400 nurses and laboratory Over 70 per cent of the Soviet Union's > 800,000 doctors are women. (Photo Novosti Press Agency) 40 m Left: Professor Nadezhda Puchkovskaya emi- nent Soviet eye specialist, performs a corneal graft. Right: Lecture at the Institute of Oncology and Radiology in Alma-Ata, Kazakh S.S.R. (Photos WHO/M. Jacot and Novosti Press Agency) workers—over 1,000 altogether. Galina Dolganova, who is still a young woman, is the head physician of this large hospi- tal. Women also work in district poly- clinics, as hospital interns, and as doc- tors in sanitary and epidemiological sta- tions and factory clinics—in a word, there is not a single speciality among the 100 medical professions that they have failed to master. Valentina Antipova has lost count of the number of complex surgical opera- tions she has performed; she was trained in emergency surgery, as well as in first-aid, dentistry and gynaecology. It does not matter that seafarers are young and healthy people, for a ship's doctor must be ready to meet any emergency. Dr Antipova is physician aboard the motor-ship "Mechanic Riba- chuk". She is based at the port of Vladi- vostok, and has also sailed the North Sea Route to Archangel, crossed the At- lantic to Cuba and wintered for nearly six months among the ice with the crew of the motor-ship "Lazarev". She has no intention of leaving the ship even though she still suffers from sea-sickness and has to put up with many hardships and even dangers at sea. One of those who attended the medi- cal deputies' meeting was Valentina Kozhina, a deputy of the Supreme Soviet of the USSR and assistant profes- sor at the department of hospital thera- py of the Tadjik Medical Institute. She sees nothing extraordinary in her life, nothing that might be of interest to a journalist, and therefore refuses to speak about herself. She preferred to tell me about the life of Professor Saadiniso Khakimova, corresponding member of the USSR Academy of Medical Sciences. "Her life is a real-life adventure story", said Valentina Kozhina. "Saadi- niso was born in a village in the north of the Republic. Her family scrupulously observed local traditions. Though he had allowed her to finish school, her fa- ther refused to let her continue her studies further. According to the old customs he wanted to marry her off at once. So Saadiniso Khakimova actually had to run away from home and hide from her angry relatives in Dushanbe, where she entered a medical institute. She used to attend lectures secretly so that her father should not hear about it. Our Institute had just opened at the time and she was among its first students. After graduation she conti- nued in her pioneer role. She was the first woman surgeon to work in the vil- lages of the Vakhsh valley and the first Tadjik woman with the degree of a Doc- tor of Medicine to be elected to the Academy." The words " the first woman" recur frequently. Microbiologist Zinaida Yer- molyeva, geneticist Alexandra Prokofye- va-Belgovskaya, parasitologist Polina Petrishcheva, Margarita Fateyeva, spe- cialist in radio-isotope diagnostics, pae- diatricians Yulia Dombrovskaya and Yekaterina Speranskaya, ophthalmolo- gist Nadezhda Puchkovskaya—all have been the first women in their field and have contributed to new advances in medicine. Konstantin Skryabin, three times an Academician and a world-famous scien- tist, has described his pupil Varvara Podyapolskaya: " ... She came to me in 1922 when quite a young doctor. I looked at her energetic face, at her eyes shining with the thirst for knowledge that testifies to a great inquisitiveness of mind, and I thought that if she started taking an interest in helminthology (the study • of parasitic worms) she would devote herself completely to it." Podyapolskaya did not disappoint the Academician. She worked very hard and very persistently. She was awarded a USSR State Prize and became not only a Professor and Doctor of Medicine, but also the first woman helminthologist in the world and an outstanding special- ist in this discipline. She has taken part in dozens of expeditions which have resoundingly refuted the old notion that the helminth world was very limited. Though before 1917 only 15 species of helminths found in the human organism were known to science, Varvara Podya- polskaya alone discovered over 50 new species, while the number of their "rela- tives" found in cattle, wild animals, birds and fish has exceeded several hun- dred. Such hard work has paid dividends, and at the sessions of the USSR Acade- my of Medical Sciences venerable scien- tists of world renown stand up respect- fully when their colleague enters the room, paying tribute to her not only as a lady, but as an outstanding woman of science as well. These sessions reflect in fact the prominent place that women oc- cupy in Soviet medicine. The names of the female Soviet Academicians—micro- biologist Pelageya Vershilova and pae- diatricians Valentina Bisyarina and Nina Nisevich, as well as physician Lyu- bov Malaya—are known to specialists the world over. Among the executives of all medico- scientific research institutes attached either to the Academy of Medical Sci- ences or to the ministries of public health there are women who occupy the posts of managers and heads of departments, not to speak of leading senior resear- chers. In the city of Gorky, for instance, women head four out of five scientific centres, and in Sverdlovsk, five out of seven. In Leningrad, they head the im- portant Institutes of Traumatology and Orthopaedics, of Children's Infectious Diseases, and of Experimental Medi- cine. In Moscow they run the Institutes of Rheumatism, and of Children's and Adolescents' Hygiene, of Pharmacology, of Doctors' Advanced Training, of Ob- stetrics and Gynaecology, of Radiology (the Erisman Institute), of Cosmetic Surgery, of Ophthalmic Diseases (the Helmholtz Institute) and others. Over half a century ago Lenin, the founder of the Soviet State, wrote : "The work that Soviet power has begun can only make progress when, instead of a few hundreds, millions and millions of women throughout Russia take part in it. We are sure that the cause of socialist development will then become sound." Lenin's prediction has come true. In- deed, millions upon millions of Soviet women, free and equal with men, active- ly participate in creating the material and intellectual values of socialist soci- ety and in running the state. A consider- able contribution to the indubitable achievements of the USSR has been made by those women who have chosen medi- cine as their profession in a bid to relieve suffering and misfortune, as well as by women scientists and women spe- cialists working in every medical field. ■ 43 WHO NEWS IN BRIEF Midwives training course in Western Samoa. (Photo WHO/R.J. Gobius) Village midwives in Samoa Western Samoa, the small island nation in the centre of the Pacific Archi- pelagos, independent since 1962, has traditionally brought its citizens into the world with the help of a village midwife. Although its capital, Apia, now boasts a modern hospital and an obstetric service that performs approximately 1,800 deliveries annually, most of the newborn babies first see the light of day in their villages, their mothers having been as- sisted by the village midwife, the fa'ato- saga. Western Samoa has a population of around 155,000 and a birthrate of ap- proximately 34-35 per thousand, resulting in a total of about 5,400 births annually. As there are approximately 300 traditional birth attendants, these deliver about 65 per cent of all the births, or about 3,600 infants a year. Al- though the number of deliveries per fa'atosaga is therefore small in compari- son with the numbers of deliveries per traditional birth attendant in other countries, the training of the fa'atosaga is considered justifiable in the frame- work of the Samoan social organization. Women of the Samoan villages are or- ganized in Women's Committees, each numbering an average of 75 to 200 members, which for the last 50 years have taken responsibility for coopera- tion with the health authorities, specifi- cally in matters concerning maternal and child health (and more recently family planning too). Each of these women's committees has one fa'atosaga. Under a project sponsored by the United Nations Fund for Population Activities, WHO has assisted the Govern- ment of Western Samoa in implement- ing a family planning programme as well as assisting in strengthening the maternal and child health services. It is in the context of these latter services that traditional birth attendants are now being trained. The UN Fund for Population Activi- ties has provided finance for the training and necessary equipment, including UNICEF Type I Midwifery Kits, with which those who attend the courses are familiarized. Training consists of a three-day course of lectures and demon- strations, followed by a one-month period during which the trainees carry out supervised practice under the tute- lage of a District (Maternal and Child Health) Nurse. They also attend the District Hospitals to observe and partic- ipate in sterilization procedures, and are required to "write up" the cases that they attend during the month. There fol- lows one day when they submit their reports and discuss them, after which the midwifery kits are formally handed over to the fa'atosaga. The fa'atosaga is thereupon expected to report monthly on her activities. The Women's Com- mittees are required to provide satisfac- tory facilities for the midwife to practice her profession. These facilities are in- spected by the health authorities and unsatisfactory ones are required to be improved. Since Samoan society sets great store on having as good or better facilities than one's neighbour, most of these facilities are adequate for their purpose. It is hoped that the training of these traditional birth attendants will contrib- ute to a lowering of the perinatal mor- tality rate through a better understand- ing of ante-natal care, the prompt recog- nition of abnormalities during delivery, and improved post-natal care, infant care and family planning. Pragmatic planning The community of Pec, with a popu- lation of around 45,000, lies at the foot of the Prokletije Mountains in the Kosovo Province of Yugoslavia. The river Pecka Bistrica, which flows through the centre of the town, issues from a deep canyon cut in the limestone mountains behind the settlement, and helps to make the area a tourist attrac- tion. The lack of a sewerage network had long posed problems for the town au- thorities, who were only too glad to col- laborate with a joint WHO/UNDP (United Nations Development Programme) pro- ject for community water supply, waste disposal and pollution control in Koso- vo Province. Careful advance planning enabled the community to start by building two main trunk sewers—each serving the part of the town on either side of the river—well in advance of the entire sewerage network. This meant that the town's main streets could be completely resurfaced ahead of schedule, thus im- proving the appearance of the commu- nity. To help with financing the project, particularly at a time when public spending was being cut back all over the world, the population was asked to con- tribute two per cent of all workers' sal- aries over the next five years. A big pro- motional campaign preceded the referendum, held in January this year, and involved the use of such slogans as "The perspective for tourist develop- ment in Pec depends on the construction of, sewerage and water supply." The 44 Pec: need for community action. (Photo WHO/Dr Watter) citizens voted wholehearted support for the authorities. A later problem arose : one part of the town did not yet have final development plans and had therefore not been in- cluded in the first phase of sewer con- struction. Unfortunately this area con- sists largely of low-level housing, where a significant proportion of the people of Pec live. They too were contributing their two per cent of salary towards the sewer construction, and quite reason- ably asked : "Why are we not to be con- nected to the system when we are contri- buting towards it?" The planning had the advantage of being flexible. Additional survey work showed that the scheme could be adapted to include this area of Pec, the alterations are being made, and all the citizens are well pleased. The project is seen in the region as a good example of pragmatic planning, carried out always in close consultation and collaboration with the community whose well-being it will serve. Five-year Plan A Five-Year International Public Health Development Plan, aimed at strengthening national public health as- sociations in different parts of the world, has been adopted by the World Federation of Public Health Associa- tions. The first of its kind, this develop- ment plan is being launched in support of the goal initiated by the WHO of pro- viding health care to 100 per cent of the world's population by the year 2000, as compared with a mere 20 per cent at present. For the first stage of the plan, focuss- ing on Latin America, a sum of US$50,000 is being sought from various sources. Of this amount, $5,000 was ap- proved by the Federation at its annual meeting, held in May at the headquar- ters of WHO in Geneva. Members of the Federation's executive committee were scheduled to travel to selected Central American countries to discuss the five- year plan with leaders of public health associations in that area. Specific pro- jects will be developed jointly between a consortium comprising the Canadian, Mexican and United States public health associations, together with national public health associations in the countries concerned. Another decision taken at the Federa- tion's annual meeting was to hold the Federation's Second International Con- gress in Halifax, Nova Scotia, in May 1978. (The Federation's First Interna- tional Congress took place at Bonn, Federal Republic of Germany, in June 1975.) The 1978 Congress, to which the Canadian Public Health Association has promised a warm welcome, will be held in conjunction with the Canadian As- sociation's national meeting. A major portion of the programme of the Con- gress will be devoted to scientific pre- sentations and discussions. Water on film In recent months, increasing concern has been focussed on the problem of drought in many parts of the world. WHO's film catalogue includes a 15- minute animated cartoon, "Water", which is a concise expression of an im- mense subject: the world water crisis. Distributed by United Nations Informa- tion Centres, this colour film is available in English and French and for either 35 mm or 16 mm screening, and seeks to stimulate both national and interna- tional action to face this . global crisis. Although made in the 1960s, its message is as fresh today as when it first ap- peared. ■ it's time for action A resolution approved at the 29th World Health Assembly in Geneva in May underlined that the full integration of women into the de- velopment process requires "a strong commitment on the part of society and a change of attitudes". It urged the Member States of WHO: to initiate and strengthen mea- sures, including legislation as re- quired, for the provision of social services that will enable women to contribute to development without detriment to their own health and welfare and those of their children; to strengthen their national health care systems, giving special attention to the health care needs of women, especially when fulfilling a maternal role; to encourage greater participation by women at all levels in the health sector by expanding policies of train- ing, recruitment and promotion of women health workers, by eliminat- ing discrimination against women, where it exists, and by promoting the active participation of women in the activities of WHO, including the constitutional bodies of the Organi- zation. bibliography United Nations: Equal Rights for Women—Call for Action: the United Nations Declaration on the Elimina- tion of Discrimination Against Wom- en. New York: 1973 UNESCO: International Women's Year, 1975. Paris: 1975 World Bank: Integrating Women into Development. Washington : August 1975 World Conference of International Women's Year, Mexico City, 1975: Declaration of Mexico; Plans of Ac- tion. New York: United Nations, De- cember 1975 WHO: "The Health of Women: How it Affects their Needs and Status". Conference Background Paper for the World Conference of Interna- tional Women's Year, Mexico City, 1975. Geneva : 21 May 1975 (E/CON F.66/BP/14) WHO: "International Women's Year: Participation of Women in Health and Development". Report of the Director-General to the World Health Assembly. Geneva: 6 April 1976 (A29/37) WHO: "A Perspective on Activities of the World Health Organization and Women's Health Needs". Paper prepared for World Conference of the International Women's Year, Mexico City, 1975. Geneva: 1975 ( MC H /75.2) WORLD HEALTH MEET THE MYSTERIOUS VIRUS Have you ever had measles? Have you ever had a cold with a cough and stuffy nose? These are only two examples of diseases caused by "viruses". There are other diseases; some are very mild but there are very serious ones, poliomyeli- tis for instance. Do you want to know what these viruses are and what they look like? They are very tiny organisms—so small that they cannot even be seen with the ordinary microscope. You need a spe- cial electron-microscope which can magnify things as much as 300,000 times. You will then see something the size of a small button. Scientists have demonstrated that viruses have different shapes; some look like diamonds, other look like small springs. It is a strange and fascinating world. Viruses cannot live outside cells. They attach themselves to living cells of your body. They penetrate the cell membrane and there they live. They themselves cannot reproduce but they force the cell to work as a factory producing their own kind. That is, instead of contribut- ing to the life of the cell they force it to work exclusively for the production of viruses. Each virus may force the cell to produce over a thousand of its kind. That is how you get a rash with measles or a running nose with the common cold. How can you protect yourself against viruses? At present there is no drug that can kill the virus in your body and help you to recover. With viral diseases, the saying "Prevention is better than cure" applies very well. Cleaner standards of living at home, whether in the village or in the city, will lessen the risks of picking up these dis- eases. In addition, people who general- ly eat good food and are in good health are better able to resist even if they pick up such a disease. There are some very good vaccines against a number of common diseases. What is a vaccine? The scientists have found a trick by which they can give you a virus which has lost its power to cause disease but can still cause your body to build up a defence system against a strong virus that. would have caused the disease. That is how Dr Ed- ward Jenner (1749-1823) brought about the first vaccination against smallpox, a virus disease which used to terrorise the whole world. His discovery nearly 180 years ago has helped us to wipe out this disease which now lingers only in a single country, Ethiopia. WHO hopes to be able to announce within a matter of months that no new cases have been found, and our planet will be rid of a major evil. ZOONOSES Animals are for the most part the friends of mankind. All the same, several of them are capable of trans- mitting dangerous diseases. The eight pictures show some of these animals and below is a list of eight diseases. See if you can match which animals are the major agent of transmission of these diseases: start with the easy ones first and then see what you are left with : Goat 1. Rabies Geese 2. Psittacosis Chickens Horse 3. Tuberculosis Parrot 4. Salmonellosis (Salmonella food poisoning) Vampire bat 5. Tapeworms (Taeniases) Pig 6. Brucellosis (Malta fever or undulant fever) Rats and mice 7. Leptospirosis (Weil's disease, hemorrhagic jaundice, Cow 8. Anthrax ricefield fever) 46 World Health Day, 7 April 1976, was devoted to the theme of "Foresight Prevents Blind- ness", and all around the world special arrangements were made to bring this vital mes- sage home to as many people as possible. In the Congo, for instance, primary school children were invited to draw scenes show- ing the plight of blind people, and the best of these young artists were awarded prizes. We have only space to show two of the many vivid draw- ings—"Woman Beggar" by Georgine Soka, and "Two Blind Persons" by Noel Koudissa. 'D 8 :D L :V 9 :d g :9 t :H E 4Z:] :siannsuV Authors of the month HELVI sIPILA is Assistant Secretary- General of the United Nations for Social Development and Humani- tarian Affairs, and was Secretary- General of International Women's Year 1975. REBECCA COOK and KATHERINE PIEP- MEIER are Law and Planned Parent- hood Officer and Research Officer respectively at the International Planned Parenthood Federation, London. Dr CECILIA NDETI, a Tanzanian, is currently Deputy Director of a research project on Cultural Values and Population Policy in Kenya. Dr MANUEL CARBALLO is a member of the WHO Maternal and Child Health Unit in Geneva. JOHN BLAND is a member of the WHO Division of Public Information in Geneva. Professor P. K. DEVI is Head of the Department of Obstetrics and Gynaecology at the Postgraduate In- stitute of Medical Education and Research in Chandigarh, India. Professor FINA KALOYANOVA iS Director of the Institute of Occupa- tional Health at the Medical Acade- my, Sofia, Bulgaria. NEDD WILLARD is Public Informa- tion Officer at WHO's Regional Office for South-East Asia. Dr VLADIMIR LYUBOVNY of Moscow, physician and journalist, writes on medical subjects for the Soviet press. WORLD HEALTH ORDER FORM Please enter my subscription to "World Health" as follows: US$' Sw.fr.* One year 10.— 25.— Two years 18.— 45.— Three years 24.— 60.— One year : Two years: Three years: I enclose cheque/postal order in the amount of Name: Street : City : Country : *or equivalent in local currency. World Health, WHO, Avenue Appia, 1211 Geneva 27, Switzerland Getting off to a good start ( Photos WHO/P. Altnasy)