Women's health.

Although women live longer than men, new evidence indicates women bear a disproportionately heavy burden of disease. The effect of disease on economic productivity of women in developing countries has been largely ignored. Infections are often causes of disease in women, including those that affect reproductive health. Although men and women usually experience similar rates of many diseases, rates of exposure and treatment vary between men and women. If untreated, factors adversely affecting women's health in one stage compound women's ill health in succeeding stages.

PIP: This article discusses women's health in developing countries, urges improvements, identifies specific causes of death by age, and indicates future trends and effective strategies for improvements. A number of international conferences have been held to discuss women's health issues. Reference is made to the World Bank's "World Development Report for 1993" and the statistic that women suffer more disability than men. Women are considered to have a greater disease burden than men. Effective strategies include preventing or delaying births to women who do not desire any more children. Increased use of family planning and safe abortion might avert 100,000 maternal deaths each year due to pregnancy related causes and 200,000 maternal deaths due to unsafe abortion. Health services might be extended through use of non-health professionals who are trained as health providers. Well-trained traditional birth attendants and an effective referral system were found to be effective in northeast Brazil. The "safe motherhood" interventions of the World Bank are considered to be the most cost effective. Women need to take more responsibility for their own health. Women's disease burden can be reduced by safe motherhood strategies, safe birthing practices, pre- and postnatal care, ready access to quality family planning, safe abortion services, and treatment of sexually transmitted diseases. Women's health might improve with better access to safe water, good hygiene, and knowledge about safe cooking practices and about the maintenance of good health. Strategies must be directed to gender-specific causes of mortality by age group. Migration is expected to affect women's health status. Urban settings and destitute living conditions that force women into prostitution place women at greater risk of morbidity and mortality.

Empowered family planners pass on the feeling.

PIP: The Center for Development and Population Activities (CEDPA) promotes a women-to-women approach to implement integrated programs to improve the status of women. These programs all include family planning services and information and at least maternal and child health care, literacy training, microenterprise, and/or environmental improvement. This approach incorporates women field workers visiting other women living under isolated, secluded, and powerless conditions. The field workers are similar to the women they serve: married with children and having same cultural, social, and economic background. They distribute contraceptives in a culturally sensitive manner. The women accept family planning because the field workers genuinely care about the welfare of their sisters. CEDPA trains the field workers at participatory, interactive workshops, which causes improved self-esteem and team building. Workshop alumni refer to the experience as liberating. Skills learned in the workshops allow them to communicate effectively with other women, community leaders, health care providers, and policy advocates. For example, the women have learned effective means to deal with family opposition to contraceptive use and to bring about social change. Field workers in the slums of Ahmedabad, India, have overcome the initial resistance from men and mothers-in-law as evidenced by the rise in contraceptive prevalence from 12 to 61% in 3 years. In fact, 92% of new acceptors still used contraceptives after 3 years. A CEDPA training graduate in Katibougou, Mali, experienced initial disappointment in her attempts to promote family planning. When she realized that women did not use contraceptives because their husbands disapproved, she involved men in the project and contraceptive prevalence increased. In conclusion, sympathetic counseling, gender awareness, and technical knowledge allows women to receive the quality care to improve their lives and the lives of their families.^ieng

Talking about a revolution. The politics of population.

PIP: 5.7 billion people currently inhabit the Earth, but 100 million individuals are added each year. As population size increased over the past fifty years, there has been a range of political thinking, strategies, and policies to address the issue of and need for population stabilization. Governments have pursued either pro-natalist or anti-natalist policies depending upon their individual perceptions of what should be the ideal rate of domestic population growth. Women have been the primary targets of population policies, strategies, and programs. Women, however, have had only limited roles in making policy, with men holding the reins of power over whether and when women bear children. Much was changed at the 1994 International Conference on Population and Development (ICPD). For the first time, population stabilization went beyond family planning and was considered in the context of sustainable development. The 180 countries' representatives realized that only through the empowerment of women can economic development and population stabilization be realized, and worked out a plan to stabilize population. The author reviews some of the history of the population debate since the early 1960s, the role of nongovernmental organizations, and the program of action resulting from the 1994 ICPD.^ieng