Photo: Ivelina Taushanova / World Bank
On a recent road trip over the holidays, one of us had a good chat with his college-aged daughter about her views on gender. She was quite adamant in rejecting arguments voiced by some people about “innate intellectual differences” between males and females. She views these arguments as sexism that ignores the fact that there are women who are not getting the same opportunities as men because they are subject to cultural norms that limit their potential.
We not only agree with her views but also know that healthy women are at the core of healthy societies. The health of women is not, however, innate to any society. Development experience has shown that deliberate policies and programmatic strategies aimed at nurturing women’s health and well-being across the life cycle are vital for realizing the full potential of women and girls.
The World Bank Group Gender Strategy, which builds on the 2012 World Development Report (WDR) on “Gender Equality and Development,” makes the point that while some women may face fewer disadvantages now than in the past, major gaps remain. One significant gap is excess female mortality, which could be avoided with better access to quality health care services, particularly during pregnancy and child delivery. Early detection and treatment for conditions such as cervical cancer help increase survival rates as many women are diagnosed only after the disease is in an advanced stage, leading to higher case fatality. As noted by the US CDC, since the human papillomavirus (HPV) is the main cause of cervical cancer, vaccination among school-aged girls is another critical intervention.
Social conditions and cultural norms that limit women’s access to health services, education, and economic opportunities are at the root of women’s health disparities and exacerbate the feminization of poverty as measured by the higher percentage of female -headed households who are poor. The prevalence of gender-based violence (e.g., in the midst of conflict situations, human trafficking, and domestic violence) is another often hidden determinant of women’s excess morbidity and mortality.
Research has shown that many maternal illnesses and lifestyle behaviors also affect children, amplifying their negative impact on society. For example, tobacco and alcohol use, anemia, over-nutrition, and under-nutrition all have potential long-term consequences on children. Gestational diabetes is a strong predictor of future health, both of the mother, who may develop diabetes and cardiovascular diseases (CVD) later in life, and the child, who has increased risk of developing Type II diabetes later in life. Poor maternal nutrition before and during pregnancy, as well as tobacco and alcohol use during pregnancy, contribute to poor intrauterine growth, resulting in low birth weight (LBW), which in turn predisposes the child to metabolic disorders and risk of non-communicable chronic diseases (NCDs) later in life. These problems are compounded by HIV and malaria. For example, LBW and malnutrition are more frequent in HIV-infected children, and malaria infection during pregnancy is a common cause of anemia and LBW.
Findings from new research also provide evidence about the impact that the well-being of women has on the intergenerational propagation of good physical and mental health. The findings published in late 2016 indicate that pregnancy is associated with substantial changes in brain areas of pregnant women that are responsible for social cognition and the ability to understand the thoughts and intentions of others and that they may help intensify the bonding between mothers and their babies, and hence, the survival and healthy development of children.
Supporting access to effective interventions such as reducing malnutrition, preventing anemia, and improving access to essential health services, including effective contraception, are not only important for ensuring women’s well-being but also for improving nutrition in the early years of children and as important preventive measures for arresting the explosive growth of NCDs worldwide as noted above. The promotion of breastfeeding – which protects against diarrhea, respiratory infections, and obesity -- also helps prevent NCDs and protects against infection, apart from its nutritional benefits. Screening for gestational diabetes and screening for and prevention of malaria, HIV, and tuberculosis could also be part of an integrated antenatal care program with multiple benefits. And in conflict-and post-conflict contexts, programs targeting displaced populations and refugees are found to maximize their impact by combining nutrition, maternal mental health, and psychosocial stimulation interventions that address the symptoms of post-traumatic stress linked to exposure to extreme violence. Such integrated interventions have been shown to reduce the disabling impact of post-traumatic stress on mothers’ ability to nurse and feed their children.
Investing in women’s education is another critical contributor to child health. Again, research data highlight the strong correlation between mother’s primary school completion and better infant health (as measured by incidence of very low birth weight) and child health (as measured by height-for-age and weight-for-age), even after controlling for many potential confounding factors. The data also shows that mother’s primary school completion leads to earlier preventive care initiation and reduces smoking. An assessment of increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009 showed that half the reduction in child mortality over the past 40 years can be attributed to the better education of women--that is, for every one-year increase in the average education of reproductive-age women, a country experienced a 9.5% reduction in child deaths. Economic empowerment of women is also transgenerational, women who have the dignity of a roof above their heads and food on their tables make better choices not just for themselves but for their families, including their children.
In short, it should be clear that addressing the root causes of ill health, premature mortality, and disability among women, and enhancing women’s voice and agency to deal with limiting, and in some cases, oppressive, social and cultural norms and gender-based violence that impede the health and human capacity development of women is a cross-sectoral development priority. Policies that help turn the tide against the feminization of poverty and toward enabling women to lead lives of sustainable economic advancement and self-reliance will at the same time improve the health and mental well-being of future generations, and contribute to ensure that development is socially and economically inclusive.