Chapter Nine Women’s Health

The Importance of Women’s Health Being born female is dangerous to your health, especially in low- and middle-income countries Women’s health is linked closely with the MDGs

Table 9.2: Selected Definitions on Women’s Health Data from University of Kentucky HealthCare. Glossary Index. Available at: http://www.ukhealthcare.uky.edu/content/content.asp?pageid=P00527. Accessed April 15, 2007; University of New South Wales. UNSW Embryology Glossary Index. Available at: http://embryology.med.unsw.edu.au/Notes/ Index/index.htm. Accessed April 15, 2007; The White Ribbon Alliance. Glossary. Available at: http://www.whiteribbonalliance.org/Resources/default. cfm?a0=Glossary. Accessed April 15, 2007; Wikipedia. Sepsis. Available at: http://en.wikipedia.org/wiki/Sepsis. Accessed April 15, 2007.

Table 9.2: Selected Definitions (cont.)

The Determinants of Women’s Health Biological Determinants Iron deficiency anemia related to menstruation Complications of pregnancy Increased susceptibility to some infections Conditions, such as ovarian cancer, specific to women

The Determinants of Women’s Health Social Determinants Related to gender norms and roles Female abortion or infanticide Often fed less nutritious food than male children Male dominance leads to physical and sexual abuse Cooking with poor ventilation contributes to respiratory disease Low social status limits access to health care

The Burden of Health Conditions for Females Sex-Selective Abortion Skewed ratios of males to females in some countries, including China, India, Taiwan, Singapore, South Korea Rising incomes and levels of education have led to more sex-selective abortion in these countries

The Burden of Health Conditions for Females Female Genital Cutting Estimated 100-140 million worldwide have had some form of genital cutting performed on them Practice appears to be diminishing Can initially cause shock, infection or hemorrhaging Long-term problems include retention of urine, infertility, and obstructed labor

The Burden of Health Conditions for Females Sexually Transmitted Infections Biologically more susceptible Risk factors for women are young age, sex with high risk partners, and inability to use a condom 1.9% of total DALYs lost to women aged 15-44 were due to STIs

The Burden of Health Conditions for Females Violence and Sexual Abuse Against Women UNAIDS estimates 10-50% of women worldwide have been abused physically by a partner Can lead to injuries, unwanted pregnancy, STIs, depression, disability, and death Risk factors include low socioeconomic status, young age of the male partner, proximity to alcohol, and gender inequality

The Burden of Health Conditions for Women Maternal Morbidity and Mortality Estimates suggest that there are about 342,000 maternal deaths per year 50% of all maternal deaths occur in six countries- Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo

The Burden of Health Conditions for Women 20% of maternal deaths are from indirect causes, 80% are from direct causes Risk factors include general health and nutrition, level of education and income, ethnicity, location, age, and having a skilled birth attendant present

The Burden of Health Conditions for Women Unsafe Abortion A “safe” abortion is one performed by a trained healthcare provider, with proper equipment, technique, and sanitary standards Estimates suggest that 70,000 women die from unsafe abortions every year Rates of unsafe abortion vary among regions

Figure 9.2: Unsafe abortion

The Burden of Health Conditions for Women Obstetric Fistula Condition in which a hole opens up between bladder and vagina or rectum and vagina 50,000 to 100,000 women each year will suffer a fistula Women with fistulas are often stigmatized or abandoned Risk factors are those associated with an obstructed delivery

Differences Between the Health of Men and Women Greater focus has recently been put on the extent to which gender discrimination affects women’s health 19 conditions disproportionately affect women- some are specific to women, some are related to women’s higher life expectancy, some are a result of gender discrimination

The Cost and Consequences of Women’s Health Problems Violence, STIs, and fistula tend to isolate women socially When a woman dies in childbirth, her family is typically left without a primary caregiver Substantial economic costs from women’s health issues

Addressing Future Challenges Female Genital Cutting Efforts that promote change need to be specifically tailored to local practices and beliefs Promote female empowerment, education, and control over economic resources

Addressing Future Challenges Violence Against Women Protecting women through legislation Shelters for abused women Ensuring police, judges, and healthcare workers are trained to deal with violence against women in effective ways

Table 9.4: Selected Measures to Reduce Intimate Partner Violence

Addressing Future Challenges Sexually Transmitted Infections Surveillance of STIs Program of health education Appropriately trained health workers to provide proper treatment

Addressing Future Challenges Maternal Mortality Provide hygienic and appropriate post-abortion care at the lowest level of the health system possible Provide effective family planning methods Births attended by a skilled healthcare provider Enhance emergency obstetric care