W .ORLD HEALTH ORGANIZATION
REGIONAL OFFICE FOR THE WESTERN PACIFIC BUREA.IJ R~GIONAL OU PACIFIQUE OCCIDENTAL
•
ORGANISATION MONDIALE DE LA SANTE
REGIONAL COMMITTEE Thirty -fifth session Suva 5-1 1 September 1984 Provisional agenda item 14
WPRfRC35f10 22 June 1984 ORIGINAL: ENGLISH
WOMEN, HEALTH AND DEVELOPMENT
The Regional Committee, at its thirty-fourth session, adopted resolution WPRfRC34.RJ3 taking note of World Health Assembly resolution WHA36.21 entitled Collaboration within the United Nations system: General matters - Contribution of the World Health Organization to the participation of women in promoting international peace, cooperation and health. As part of the United Nations' activities aimed at improving the status of women within the framework of development, the World Health Organization has given attention to the integration of various aspects pertaining to women within certain of its programmes. The present document summarizes the information available on activities in the Region. Section 3 of the document sets out for the Regional Committee's consideration various proposals concerning the type of action required in the future.
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1. INTRODUCTION
The attainment by aH citizens of the world by the year 2000 of a level of health that will permit them to lead a socially and economicalJy productive life is the main social target to which Member States of the World Health Organization are committed.! The role of women, both as recipients and as providers of health care, is crucial to the attainment of this goal. Unless greater priority is accorded to women's health, the goal will be difficult to achieve, not only because women make up half of the world's population but also because women's health directly affects the health of children and that of the family as a whole. As part of the United Nations' activities aimed at improving the status of women in the context of development and also within the framework of WHO's responsibilities for promoting the Programme of Action during the second half of the United Nations Decade for Women (1976-1985), the World Health Organization has given attention to the integration of various aspects pertaining to women within certain of its programmes. The approaches used by WHO in promoting women's health issues within its overall programme are as follows: (a) (b) (c)
promotion of the intersectoral approach in improving the health status of women; involvement of women's organizations in primary health care; and coJlection, synthesis and dissemination of information concerning women, health and development.
2. CURRENT SITUATION/RECENT DEVELOPMENTS WHO is cooperating with the United Nations in preparing for the World Conference to Review and Appraise the Achievements of the United Nations Decade for Women, to be held in 1985. The WHO Regional Office for the Western Pacific has participated in promoting the Plan of Action of the United Nations Decade for Women, adopted in Copenhagen in 1980. The highlighted areas of the Plan of Action relating to women, health and development are: (a) (b) (c)
health needs and problems specific to women; the relationships between women, health and development; and the role and status of women as providers of primary health care.
lsee resolution WHA30.43. Handbook of Resolutions and Decisions of the World Health Assembly and the Executive Board, Vol. II, 5th ed., 1983.
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Activities relating specifically to women, health and development in the Western Pacific Region may be summarized as follows: 2.1 National activities Papua New Guinea In addition to the technical cooperation provided by WHO to the Government in developing the primary health care activities of women's committees in East New Britain, a national workshop on the role of women in health education in primary health care will be held in Rabaul in August 1984 with WHO support. Republic of Korea WHO is collaborating with the Korean Women's Development Institute in the organization of a consultative meeting on women's health in 1984. This meeting will identify priority areas for women in the context of health, based on currently available data, and formulate a research protocol. Samoa WHO has supported the women's committees in three health districts in developing health activities through the primary health care approach. Planned activities for improving the health status include the following: (a) (b) (c)
preliminary surveys on health facilities; water supplies (water tanks, pipes, etc.); sanitation (refuse disposal, water-seal latrines); nutrition (vegetable gardens, fish-farms, etc.); other community developments for health; and extension of the Faleolupo health centre through the addition of a maternal delivery room.
(d) (e) (f)
South Pacific Support has been provided to the South Pacific Commission for a survey of the health status of women in selected countries of the South Pacific. This wiU be undertaken as part of the work of the Pacific Women's Resource Bureau. 2.2 Regional activities: establishment of a regional profile on the social and health status of women
Among the approaches used by WHO in promoting interest in women's health issues within its overaJl programme is the collection, synthesis and dissemination of information concerning women, health and development. An important step in this
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direction will be the establishment of a regional profile on the social and health status of women. The information gathered in the profile will provide a basis for identifying the issues and problems related to women. To this end, a questionnaire was developed with a view to collecting information on the various social and health aspects of women from countries or areas in the Region. Although the questionnaire on women and health was circulated to 32 countries or areas in the Region, the response was somewhat disappointing and replies were received from only 21 of these. In addition, information was not available on a number of items. Nonetheless, the information provided has been very useful both in identifying problems associated with women's health, and in highlighting a number of difficulties relating to the collection, presentation and analysis of this kind of data. In this connexion, it should be noted that, although a considerable amount of demographic and social statistical data is available in the Region, certain vital statistics are lacking in some countries, and in many cases information that is considered crucial for an understanding of women's social status is either Jacking or incomplete if available. Many health statistics are not disaggregated by sex, while the quality of the available data is often questionable. Thus, there is an urgent need in the Region to collect more complete information on the health status and related aspects and to present this separately by social grouping according to various criteria, including sex and age. The following is a summary review of the social and health status of women in the Western Pacific Region, based on the information received from countries. (1)
Social status of women
The social status of women in the Western Pacific Region cannot be examined in a uniform manner as the Region consists of countries or areas with widely differing societies in terms of industrialization, culture, and political and economic systems. In many countries, women's lives have been negatively affected by cultural bias and prejudice, not only in such areas as education but also in other aspects related to their role and status in the family and the community. For example, the preference for male children is still a widely shared value in a number of countries; the practice of certain taboos during the menstruation, pregnancy and lactation periods adversely affects the health of women, as in many South Pacific islands; traditional beliefs regarding the division of labour between the sexes and the status of men and women limit the scope, nature and estimated value of women's productive capacity. However, certain traditional female functions have begun to be reevaluated, i.e. the role of traditional birth attendants and women's involvement in community activities. An increasing number of women. have been involved in community health development projects. In many developing countries, women have already participated in community activities aimed at better living and environmental conditions. Community-based organizations present a potential for further development and for the active involvement of women in health and development activities.
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Demands for women's social and economic participation have also increased in most countries of the Region, although the degree of such participation varies greatly among countries - from those in which women are claimed to be "fully employed" to others where only a small percentage of women are engaged in a few "female-oriented occupations". The proportion of women in the total labour force ranges from 60% to less than 15%. As far as equality in occupational status between the sexes is concerned, socialist countries generally present a more favourable picture than others. Women's status in the health care service is a typical phenomenon which clearly reveals the traditional pattern of division of labour. At home and in the village, women are the main health care providers and healers. Although women engaged in the health care services constitute a majority (up to 88.9%) of total health personnel, they are concentrated in the lower grades. The increase in women's participation in economic or social activities, however meaningful they may be, poses another problem in that the extra responsibility places too heavy a burden on many women and further complicates their already multiple role. (2) Health status of women
Three fourths of the countries or areas have reduced the crude death rate to below 10 per 1000 and raised the life expectancy at birth up to 60 years or more. On the whole, women are found to have a higher life expectancy than men. In many countries, however, girls and women in the reproductive ages are likely to be more vulnerable to the risks of disease because of child-bearing and related problems and as a result of discrimination in feeding and health care practices. A good proportion of mothers in the Region breast-feed their babies. However, there are also a few countries where only 10-15% of mothers engage in breast-feeding. (a) Reproduction and health
Health problems associated with the reproductive function of women are generally concentrated in the less industrialized parts of the Region. Most of these problems stem from complications arising during pregnancy and childbirth or caused by high fertility, illegal abortion or inadequate health care for women during pregnancy, childbirth and the postnatal period. High fertility rates and malnutrition, particularly during pregnancy, in developing countries often create complications because of their effects on the health of both mother and child. The users of contraceptive devices such as the IUD may also be subject to side-effects in varying degrees. Illegally performed and inappropriate procedures for abortion often create complications, which are sometimes fatal. Problems such as these, associated with women's reproductive functions, become intensified as pregnancy among teenagers increases, especially in countries where women marry at an early age or where rapid socioeconomic changes have relaxed social controls regarding premarital sex.
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(b)
Changes in women's social role and health
New health problems have emerged in the wake of industrial development. The process of industrialization has brought about modifications in the work pattern and life-style of women, resulting in changes in family formation patterns. Factory and other employment, added to the usual household chores, frequently means an overload of work for the women concerned and exacerbates such problems as fatigue and nutritional anaemia. The adoption of new farming methods, such as the use of chemical fertilizers and pesticides, affects the health of rural people. Health problems among women workers in the more modern sectors, such as eye diseases, anaemia, chronic fatigue, poisoning and other chemical intoxications, are often closely associated with the poor physical condition of the worksite, for example, heavy dusts in textile factories. Some countries lack the necessary legislation to protect the health of women, especially during their reproductive life. Other problems associated with economic development and the decline in social control, apart from adolescent pregnancies, are alcohol and drug abuse and sexually transmitted diseases. The latter have already become a serious concern in some countries, particularly with the advent of tourism. The mental health of women is another area that calls for closer attention. The incidence of mental problems in women's lives has increased proportionally to the changes in their social environment and in their role in society.
3. ACTION PROPOSED 3.1 Improving the data base on women, health and development
For the purpose of determining future priorities, studies could be specially designed, and the national and health statistical systems could be reoriented, to focus more closely on and identify the needs and problems of women. Data analysis should be linked more closely with the establishment of priorities. In many countries, even when statistical information is available on certain matters, it is often undifferentiated by sex. In no country, for example, is it possible to identify the proportion of women's contribution to the gross national product. The plan of action proposed to improve the data base on women, health and development is as follows: (1)
Encourage governments to incorporate sex and age factors in the existing national data collection and reporting system. Provide international support for improving the national data base by: (a) preparing global guidelines on the concepts and indicators for measuring the social and health status of women; and
(2)
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(b)
orgamzmg workshops and seminars to promote awareness, among planners and administrators dealing with the data, of the importance of women's role and their health in national development.
3.2
Designing strategies for the more active involvement of women's organizations in health development
For the purpose of identifying the scope, nature and extent of women's participation in health activities as well as the structure and functioning of women's organizationsin local communities, strategies need to be formulated and promotional activities undertaken to ensure the more active involvement of women's organizations in health development. The proposed plan of action is as follows: (1)
Strengthen the capacity of women's groups or organizations to ensure their effective participation in primary health care in a manner that is best adapted to the local conditions of each country. Involve women, individuals and organizations in the planning, management and implementation of primary health care programmes at aHlevels. Improve the quality of education and family planning services. Strengthen health education programmes to improve the health status of women by: (a) providing systematic education programmes for women, particularly in the more disadvantaged sectors, in such areas as maternal and child health, nutrition, environmental health; promoting awareness of the impact of working .conditions upon health, particularly the health of mothers and their families, and of preventive measures against health hazards at work; encouraging teaching institutions to include information about women's health roles in their curriculum.
(2) (3) (~)
(b)
(c) 3.3
Formulating a monitoring system for improving the social and health status of women
In most societies, women and men traditionally work in different types of occupation, both in the public and private sectors. Economic development and demographic changes have resulted in different life-styles for women. Many women, for example, have to play the dual role of housewife and worker, and this type of work pattern undoubtedly affects their health. To improve the social and health status of women, the following activities are proposed:
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(l)
Develop a mechanism for continuously monitoring the social and health status of. women in local communities, including identification of problems related to the social and health status, as an integral part of the primary health care mqnitoring system. Undertake research to help identify problems and needs specific to women of various groups, with particular reference to: (a) (b) (c) (d) the relationship between women's changing roles and their health; mental health problems and factors associated with mental health; the relationship of poverty, work, food and health; women's organizations and their involvement in health development.
(2)
(3)
Institutionalize national bodies for coordinating the monitoring activities.