A Woman's Health is Her Primary Wealth

A Woman's Health is Her Primary Wealth

Dr. Belkis Giorgis, MSH's Gender Expert 

One hundred years ago on March 8, a handful of countries celebrated the first International Women’s Day. Today it is celebrated around the world as an opportunity to look back on women’s accomplishments and look forward to the realization of their full economic, political, and social rights. The United Nations theme for International Women’s Day 2011 is centered on women’s access to education, technology, and decent work.

For 40 years, MSH has promoted equal access to health care for women by strengthening health systems and building the capacity of women as leaders and managers, technical experts, clinicians, and community health workers. We interviewed Dr. Belkis Giorgis, our NGO Capacity Building/Gender Advisor in Ethiopia about women and development.

Why is International Women’s Day important?

International Women’s Day is an opportunity for the world to pause to honor the amazing achievements women have made worldwide and to reflect on what still needs to be done to ensure equality.

This year’s theme is equal access to education, training, science and technology---a pathway to decent work for women. It acknowledges that women work, but their employment is neither recorded nor valued, their pay is not equal to males.

Decent work implies providing women with the opportunities which are compatible with their lives, that it takes into account their role in production and provides them the necessary support to be able to reach their potential.

This theme is important to women in the developing world, who must work towards creating an environment where women can work and still have the support needed to take care of their children (having maternity leave and equal work for equal pay, etc.).

For me, this moves the agenda beyond having empathy for women and their plight, to giving value for what they do and what they can become given the right opportunity.

How does improved health empower women?

Women have responsibilities in the household and outside the household. All of this is labor intensive, whether it is plowing, fetching water, firewood, weeding, or walking to the market. With their nutritional intake often being low, women are more susceptible to diseases. If women’s health is compromised, they cannot fulfill these responsibilities. Healthy women can produce more.

In many homes in the developing world, women are the primary caretakers of their family’s health and welfare. There is nothing as empowering to women as being able to care for their children and their family’s well-being. Many times we see that women do not want to go to health centers to have children because they do not want to leave their other children alone.

In summary, if a woman is healthy, she can take care of her children and family, she does not depend on others to care for her, she can produce more and this is empowering. A woman’s health is her primary wealth, and sometimes, her only wealth.

What is MSH’s gender approach?

MSH works to strengthen all levels of a health system and this is a critical component of a woman’s life. Women come to health centers with their children to get a variety of services. Time, opportunity costs, and travel all have an impact on whether women use health services or not.

MSH works at the level of the health center by training and helping deploy health providers who understand that women who come to the health center have multiple needs. They work on integrated and comprehensive care for women and their children. A woman who needs family planning should be able to get her child vaccinated at the same time. A woman who needs prevention of mother to child transmission services should be able to get the health center to become an intermediary with her husband or partner to make sure she receives proper care.

MSH also works to improve systems for pharmacies and this allows women to get access to medications they need. Our medicine seller program in eastern Africa trains private licensed drug dispensers to fill the gap left by a scarcity of registered pharmacists. Of the over 4,000 private dispensers trained - 90 percent are women.

Each woman‘s life is unique and this requires health centers to adapt to her needs while also taking into consideration her rights. MSH still has many challenges to overcome in order to make health centers women-centered.

Why is it important to have a gender approach when looking at development programming?

Development programming without looking at gender fails. The most vulnerable, productive, and critical components of any community are women. If they are not included in a meaningful way, the program fails. This means that programming from the design to the evaluation must take into account women’s roles and responsibilities.

A gender approach cannot be abstract and needs to go beyond the rhetoric in development programs. Taking a gender approach in programming is not about women only; it is about the whole community.

A gender approach to programming is not the responsibility of “one unit” or one program.  It is an approach to all things, whether it is water, sanitation, roads, agriculture, or health. The first thing in gender programming is that it does not suffice to talk about changing gender relations - it must include concrete actions which change those relations towards equity.

How far has women’s health come in the past 100 years?

In some ways, it has come a long way and in some ways it has regressed. Health care, particularly immunizations, assisted health deliveries, and increased knowledge and awareness has improved women’s health.

But, at the other end of the spectrum is the loss of traditional mechanisms for women to care for themselves and their families. These may not be effective for disease conditions that require medications, but are effective in providing support for women. Traditional medicine, birth attendants and social norms that were able to support women are becoming less and less relevant particularly in urban areas where women are basically isolated and are left on their own. If this was replaced by modern affordable health systems and social welfare it would be effective, but those are not available yet.

Globalization has also impacted women, and the “feminization of poverty” is evident, with women-headed households becoming more common. Migration of males to the cities makes it also difficult for women to cope. Migration causes the destruction of family units, increase in multiple partners, and transmission of HIV & AIDS.

The age of marriage has increased in many countries and this has its benefits, while at the same time, women who are in between adolescence and marriage engage in sex without protection and sometimes for money.

What else still needs to be done?

The first is to ensure that peace reigns in this region (Sub-Saharan Africa) particularly because women and children suffer the most in conflicts. Women should not be viewed as passive beneficiaries of poverty reduction programs, but the key to solving poverty issues in their communities. The time for sitting and discussing how to help women should be better spent on listening to women themselves and their issues. If we listen carefully, women hold the answers.

Also, what needs to be done is about both men and women and not women alone. We need to stop dissecting communities as men and women when it comes to mobilizing forces to make changes. Women will not change their behavior unless it is a collective action and the consequences are addressed. For now, these consequences are in the hands of patriarchal structures empowered by their own interpretation of religious doctrine which needs to be challenged and corrected. Men have to understand that it is not in their best interests to oppress women and that empowering women is empowering their families.

Men and women must work together. Empowering males does not mean encouraging them to continue their behavior, but changing their behavior. When males decide to empower themselves to go against traditions which are negative for women, they become part of the solution to the problem.

What’s the experience in Ethiopia?

The experience in Ethiopia is unique in that policies, laws, and legislation are extremely progressive. The constitution guarantees the rights of women equal to males. Family law has been revised to protect the rights of women in marriage and custody issues. Traditional customs such as female genital cutting is forbidden and punishable. There are affirmative action programs which are designed to increase the numbers of women in all aspects of life.

However, having said all this, we find that tradition overpowers these positive developments and child marriage, rape, abduction, and early marriage are still being practiced widely. The work of making sure that the laws are properly implemented will rest on creating awareness, mobilizing all stakeholders in the community, and using the rule of law to enforce legislation.

Women themselves must be taught legal literacy to demand their rights and use existing institutions. Centuries of age old practices cannot be reversed by legislation - there are concrete programs such as access to education which will accelerate the process.

Building of roads and other infrastructure will increase mobility and transfer of goods and services for men and women alike. The accelerated expansion of health care services in the country will allow women to have access to more information. A combination of all these will have an impact on the ways people think.

How is HIV/AIDS Care and Support Program empowering women at the community level in Ethiopia?

First and foremost, the program empowers women by training them to be able to do what they normally do with more knowledge and skills at the community level. Through the community outreach workers, MSH has linked the community with the health center.

The alienation of women from the health center is minimized through the work of the outreach workers, who provide counseling support referrals which take into account resources available.

Women at the community level organize themselves into mother support groups and mutually reinforce each other. Their leadership potential is enhanced as they go from household to household helping families affected and infected by HIV. They are heard and acknowledged. They are sought for advice and they provide services.

Dr. Belkis Giorgis is NGO Capacity Building/Gender Advisorfor the HIV/AIDS Care and Support Program (HCSP) in Ethiopia. HCSP, funded by US Agency for International Development, represents the largest national expansion of HIV & AIDS services at the community and health center levels in Africa