Hesperian Health Guides
Causes of Poor Health in Women
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It is easy to name the direct causes of most of women’s health problems. For example, we can say that STIs are caused by different germs, poor nutrition comes from not eating enough good food, and problems during pregnancy are often caused by a lack of prenatal (before birth) care. But beneath these direct causes are 2 root causes — poverty and the low status of women — that contribute to many of women’s health problems.
Two out of three women around the world are poor. Women are not only much more likely than men to be poor, but are most often among the poorest of the poor. Millions of women are caught in a cycle of poverty that begins even before they are born. Babies born to women who did not get enough to eat during pregnancy are likely to be small at birth and to develop slowly. In poor families, girls are less likely than their brothers to get enough to eat, causing their growth to be further stunted. Girls are often given little or no education, so as women they must work at unskilled jobs and receive less wages than men (even if they do the same kind of work). At home, their daily work is unpaid. Exhaustion, poor nutrition, and lack of good care during pregnancy place the woman and her children at risk for poor health.
Poverty forces her to live under conditions that can cause many physical and mental health problems. For example, poor women often:
- live in bad housing, with little or no sanitation or clean water.
- do not have enough good food, and must spend precious time and energy looking for food they can afford.
- are forced to accept dangerous work, or to work very long hours.
- cannot use medical care, even if it is free, because they cannot afford time off work or away from their families.
- are so busy struggling to survive that they have little time or energy to take care of their own needs, to plan for a better future, or to learn new skills.
- are blamed for their poverty and made to feel less important than those with more money.
Poverty often forces women into relationships in which they must depend on men for survival. If a woman depends on a man for her—or her children's—support, she may have to do things to keep him happy that are dangerous to her health. For example, she may allow him to be violent or to have unsafe sex because she fears losing his economic support.
Low status of women
Status is the importance that a person has in the family and community. Status affects how a woman is treated, how she values herself, the kinds of activities she is allowed to do, and the kinds of decisions she is allowed to make. In most communities in the world, women have lower status than men. Women’s lower status leads to discrimination—that is, being treated poorly or denied something simply because they are women. Discrimination may take different forms in different communities, but it always affects a woman’s health.
Wanting sons rather than daughters. Many families value boys more than girls because boys can contribute more to the family’s wealth, support their parents in old age, perform ceremonies after their parents die, and carry on the family name. As a result, girls are often breastfed for a shorter time, are given less food and medical care, and receive little or no education.
Because so much of the work that women do is not recognized, they often lack legal protection in the workplace.
Lack of legal rights or power to make decisions. In many communities, a woman cannot own or inherit property, earn money, or get credit. If she gets divorced, she may not be allowed to keep her children or her belongings. Even if a woman has legal rights, her community’s traditions may allow her little control over her life. Often a woman cannot decide how the family’s money is spent or when to get health care. She cannot travel or participate in community decisions without her husband’s permission.
When women are denied power in these ways, they must depend on men to survive. As a result, they cannot easily demand things that contribute to good health, like family planning, safer sex, enough food, health care, and freedom from violence.
Women make up half of the world’s population, but work 2 out of every 3 hours worked in the world, receive only a tenth of the world’s income, and own only a hundredth of the world’s property.
Having too many children, or having children too close together. Discrimination against women can also lead them to get pregnant more often, because bearing children may be the only way that women can gain status for themselves or their partners. Under all these conditions, women live less healthy lives and get less health care. They also often accept their low status, because they have been raised to value themselves less than men. They may accept poor health as their lot in life and seek help only when health problems are severe or life-threatening.
The medical system does not meet women’s needs
Poverty and discrimination in the family and community not only lead to more health problems for women, they also make the medical system less likely to provide the services women need. Government policies and the global economy may add to this problem.
In poor countries, many people do not have access to health services of any kind. (The box below explains one reason why this problem has become worse in recent years.) And because of discrimination against women, the little money that does exist will probably not be spent on women’s health needs. So a woman may not be able to get good care even if she can afford to pay for it. Some reproductive health services may be provided, but to meet all of her health needs, she would have to travel to the capital city or perhaps even leave her country.
In many countries, the skills needed to care for women are considered ‘special’ and are provided only by doctors. Yet many of these services could be provided at lower cost by trained community health workers.