The following post by Karen Nielsen, President of Nielsen & Associates, LLC, is part of Disruptive Women’s “The Value of Health: Creating Economic Security in the Developing World” series.

Karen Nielsen has worked in the health care field for over 20 years, predominately focused on collaborative efforts between private and public organizations. Ms. Nielsen consults with industry and non-government organizations (NGOs) to identify and enable public health-centered solutions.

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A young girl in Africa awakens early to fetch water for her families’ daily needs. She will need to make multiple trips, carrying the largest volume possible to shorten the task. This daily ritual can take 3 hours or more. For these young girls there will be no school, basic necessities of life are their first priority. They will marry young, have children and the cycle of limited education and opportunity will begin all over again for the next generation.  Education can help break this cycle. However to change the health and economic status of women, empowerment is the key to success.

In February of 2006, the World Health Organization (WHO) released a report entitled What is the evidence on effectiveness of empowerment to improve health? The report stated that improved education for women, including adult literacy and empowerment, improves child health and reduces fertility. Microenterprises were identified as a faster route to improving health. However, the report warned that “it is not enough to increase women’s percentage of household income; this must be accompanied by increasing women’s autonomy, mobility, decision-making authority and power within the household.” Many argue that one leads to the other: increasing a woman’s percentage of household income leads to the increased autonomy but it is not guaranteed. Providing only micro financing without a contextual understanding of societal restrictions will not ensure women’s empowerment. Effective solutions must be created and offered in an integrated and sustainable manner.

The United Nations (UN) Millennium Development Goals (MDGs) are attempting to create an integrated, sustainable approach to reducing poverty by 2015. If you look at the eight categories you see the impact they have on women and children: (1) reduce poverty and hunger, (2) universal education, (3) improve gender equality, (4 & 5) improve maternal and child health, (6) combat HIV/AIDS, (7) ensure environmental sustainability and (8) global partnerships. The MDGs are a framework, agreed to by all the world’s countries and all the world’s leading development institutions, with a goal to unify efforts to improve the lives of the world’s poorest. You will note that the eight goals are larger themes with many subcategories. For instance, under goal number 7, environmental sustainability, Target 3 is to “halve, by 2015, the proportion of the population without sustainable access to safe drinking water and basic sanitation”. A WHO report on the Self Employed Women’s Association (SEWA) in India has shown that a regular supply of drinking water, adequate housing and proper sanitation not only makes a substantial difference in health status, but also in income generation. Women shoulder the largest burden of water collection, reducing the amount of time that can be used for income generation. The UN estimates that in sub-Saharan Africa alone, 40 billion hours each year are spent collecting water, equal to a year’s labor for the entire workforce of France. The same report reinforces that lack of sanitation negatively impacts women beginning at a young age. In areas where no latrine is available for students, adolescent girls quit school instead of facing the humiliation of relieving themselves in front of others. The system as a whole must be considered when addressing the needs of women and girls.

Although the MDGs are in place, we have a long way to go. The 2009 WHO report, Women and health: today’s evidence tomorrow’s agenda, states that there is an “urgent need for more coherent political and institutional leadership, visibility and resources for women’s health” if progress is to be accomplished in saving the lives and improving the health of women and girls. The report highlights some important facts:

• Gender-based inequalities – for example in education, income and employment – limit the ability of women and girls to protect their health.
• Complications of pregnancy and childbirth are the leading cause of death in young women aged between 15 and 19 years old in developing countries.
• Globally, the leading cause of death among women of reproductive age is HIV/AIDS.
• Suicide is among the leading causes of death for women between the ages of 20 and 59 years globally.  While the causes of mental ill-health may vary from one individual to another, women’s low status in society, their burden of work and the violence they experience are all contributing factors.

These are just a few data points from a robust report. The WHO made it clear that societ­ies are still failing women and too many women and girls are still unable to reach their full potential because of persistent health, social and gender inequalities. The world leaders must address these issues, and pressure must also come from all levels of society for this change to occur. And when possible, individuals must organize at a grassroots level to force change within their own communities.

SEWA based in Ahmedabad, Gujarat (India), is one example of how individuals organized into a collective to bring about change. SEWA was founded in 1971 by a small group of poor and largely illiterate women that were led by Ela Bhatt. They believed economic security was crucial to the empowerment of women, and worked to achieve social and economic wellbeing of women through full employment and self-reliance. The founding members turned SEWA into a social movement across various states of India. At present SEWA is the largest trade union of informal workers in India, with nearly 1 million women members.

SEWA members demand fairness and justice in their fight to seek a livelihood. As a collective, they fight against harassment at the hands of the police and municipal authorities. As trade and service based cooperative, members have increased their ability to bargain with middlemen and contractors. A SEWA Bank was started to provide microcredit to its members and train members in skills that enable them to start or expand their businesses. The bank also provides insurance to protect members from property and asset losses. SEWA understands that health is directly related to the ability to work, productivity levels and income generation. Health programs were organized in addition to health insurance. The SEWA pushed forward with social change in a bottom up or grass roots approach, empowering women and providing a framework for the next generation.

You may wonder what the United States is doing to support this issue. Multiple federal channels have supported women’s empowerment. The U.S. Agency for International Development (USAID) is one example of an agency that has worked on education, political participation and entrepreneurship for women. Under Secretary of State Hilary Rodham Clinton, the U.S. State Department will be focused on financial inclusion: ensuring that women have access to savings accounts, health insurance, home ownership and business funding. Secretary Clinton has announced that she will launch a fund for international women’s empowerment in Fall 2009. The money raised will go to combat violence against women and girls, promote girls’ education, and create economic opportunities for women. A great next step would be for the U.S. to ratify the 30-year-old Convention on the Elimination of All Forms of Discrimination Against Women. The U. S. is one of only a handful of countries that have not ratified the treaty. Treaty supporters point out that America’s lack of participation is used as a reason for other countries to not enforce the agreement. The treaty is reported to be on the Secretary of State’s priority list, and should be on the priority list of those outside of Capitol Hill.

Empowering women must be a united approach, a cause that requires continued attention and stewardship by all. Awareness is part of the solution. The recent book Half the Sky: Turning Oppression into Opportunity for Women Worldwide brings attention to the issue. The authors, Kristof and WuDunn, provide examples of how empowerment has transformed lives while generating a call to action. Their blog provides ways for individuals to get involved in the cause by spreading the word or by supporting organizations committed to the needs of women and children. Empowerment and health are tied together. When a woman is empowered, her health and the health of her family improve, thus benefiting communities and societies at large. As the 2009 WHO report so eloquently concluded, “Improve women’s health – improve the world.”

This entry was posted on Thursday, December 3rd, 2009 at 11:15 am and is filed under Global Health. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.