By Lisa Macdonald
May 28 is the International Day of Action for Women's Health. This annual event, part of the Campaign to Prevent Maternal Mortality and Morbidity, was launched in 1987. The 1995 call for action focuses on the feminisation of poverty and its devastating effects on women's health.
Women are the poorest among the poor. It is estimated that women do 67.2% of the work in the world, but possess only 9.4% of the income.
During the 1980s and '90s, under neo-liberal austerity policies, women have suffered a significant increase in impoverishment, ill health and mortality.
With unemployment increasing globally, women are usually the first to be sacked, forced into underemployment or into precarious and hazardous informal work lacking even the most basic social rights.
Women's unpaid domestic work has become more arduous as governments cut funds to public services. Privatisation of land and multinational expansion have displaced small farmers, many of whom are women. Increasing impoverishment in the Third and First Worlds has meant even fewer resources are available to women.
According to the Women's Global Network for Reproductive Rights (WGNRR), which coordinates the international day of action, structural adjustment programs (SAPs), imposed on Third World countries by the World Bank and the International Monetary Fund (IMF) in particular, are directly responsible for the deterioration of women's health and well-being.
It points out, for example, that the World Bank and IMF's system of health care not only pits richer against poorer, but also forces families to decide which of their members are to receive the limited services available. In the context of almost universal gender inequality, the inequity of this system for women is obvious.
Debt crisis
The Third World debt crisis remains the single greatest factor contributing to the deteriorating health of the world's population, and of women in particular.
The global increase in infectious diseases (the cholera epidemic in Latin America, the rise of AIDS and most recently the spread of the ebola virus, for example), are directly related to SAPs and the reduction in resources available for health care services.
Recent studies cited in the 1994 World Health Organisation (WHO) report "Women's Health and Human Rights" show that while women may not be infected more than men by diseases such as malaria, leprosy and tuberculosis, they tend to suffer more severe consequences. This is due to their household responsibilities (women tend to deny the symptoms of disease for longer) and their lower social status (women tend to eat last and least and so have less resistance to the effects of disease).
Another consequence of mass pauperisation resulting from SAPs is the explosive growth of the sex industry, especially in Asia. This has firmly entrenched women's position as mere products on the global market, with all the disastrous consequences for women's health that accompany illegal prostitution and slavery.
One of the most controversial women's health issues is the World Bank's financing of population control programs in targeted countries.
A 1994 report by the Expert National Committee on Population Policy set up by the Indian government, for example, caused outrage among health and women's organisations when it recommended a series of anti-poor, anti-women policies. These included: that numbers of children be used as a disqualification for contesting elections; that persons with more than two children be barred from employment in the organised sector; that victims of child marriage be barred from employment in the organised sector; that the government continue introducing the most expensive and hazardous provider-controlled contraceptive technologies; that the army and paramilitary forces be used to achieve population stabilisation.
Alongside economic policy pressures to reduce populations in the Third World, evidence documented in the 1992 WHO report "Women's Health: Across Age and Frontier" indicates that this is being done selectively in some countries by the use of prenatal diagnosis of foetal sex for the purpose of aborting female foetuses.
On the other side of the coin, some 500,000 women die each year from preventable causes relating to complications of pregnancy.
The example of Zimbabwe provides clear evidence of the direct relationship between SAPs in the Third World and women's deteriorating health. Just two years after the introduction of an SAP in that country, maternal mortality jumped from 104 to 206 per 100,000. This was an immediate consequence of the rising costs of health services, which caused a 39% decrease in attendance at rural health clinics.
"The ability to regulate the timing and number of births is one of the central means of freeing women to exercise the full range of human rights to which they are entitled" (WHO, 1994). An additional consequence of women's declining access to reproductive health services is the increase of 25-50% in maternal deaths caused by unsafe abortions.
First World women
Even in the First World, women are suffering deteriorating health under the austerity programs of advanced capitalism.
There is growing impoverishment of women as a result of mass unemployment. Welfare "reforms" are increasingly punitive towards women as capitalist governments attempt to force more responsibility for social service provision (care for the aged, sick, children) back into the family. This impacts negatively on women's health and well-being.
Government cutbacks in funding to public health systems, the dismantling of collective health insurance systems and the privatisation of health care services have all reduced women's access to information and care.
Women's right to safe and legal abortion has also come under increasing attack from conservative forces, not just in law, but also through terrorist attacks on clinics, service providers and women using the services.
The economic crisis and the erosion of the social safety net are felt unevenly among women in the developed countries. Young women, women of colour, working-class and unemployed women bear the brunt of the attacks. The direct relationship between poverty and ill health is a universal one.
In the former Soviet bloc countries too, the position of the majority, and women in particular, is deteriorating rapidly. Escalating unemployment, massive poverty and virtually non-existent health services create phenomena such as those in former East Germany, where, according to WGNRR, women are having themselves sterilised because they believe it improves their chances of obtaining waged work.
Equality, democracy
The deteriorating health status of women across the globe makes a mockery of the constitution of the WHO, adopted almost 50 years ago, which defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".
As its 1994 report points out, if the goal of improving the health of the world's population is to be achieved, we would first have to guarantee those "rights relevant to the promotion and protection of women's health including the right of women to be free from all forms of discrimination; rights relating to individual freedom and autonomy; rights to health care and the benefits of scientific progress; and rights regarding women's empowerment, including the rights to freedom of thought, assembly and political participation".
The international day of action on May 28 calls for "a democratic, community based comprehensive vision of health care where communities are given the power and the tools to reduce problems of ill-health, problems which are intimately related to the economic and social patterns of their society".
"Promoting democratic health practices", states WGNRR, "would mean placing the definition and control of health care in the hands of those who use the services. This means that people, especially women, will not be treated as the targets of health campaigns, but as members of society with equal political rights, social status and economic value."