Elsa Gómez Gómez Tegucigalpa, November 8, 2006

1. Panel 1. “Women, newborn and child health: Social protection in health and the Millennium Development Goals.” Social Protection in Health Forum Elsa Gómez Gómez Tegucigalpa, November 8, 2006

2. Themes for reflection • Gender as a structural determinant of health inequity • MDG 3, “Gender equality and empowerment of women,” as an end in itself, from a rights and citizenship focus • Centrality of MDG 3 for achieving the health objectives of women, mothers and children • Challenges the health sector faces in contributing to progress in MDG 3, accelerating the achievement of the health goals

3. Cultural definitions of differential roles, rights and responsibilities for W(omen) and M(en) determine inequalities in: • Health risks and problems for W and M • Allocation of social resources for meeting the specific needs of each sex • Access for W and M to appropriate resources and services • Contributions of W and M to the financing of care • Distribution by sex of the responsibilities, compensations and powerin the social production of health

4. Men Women Gender and poverty: Poverty affects differently the survival opportunities of men and women Probability of dying (per 1,000) between 15 and 59 years of age, according to sex and poverty condition Non-Poor Poor Brazil Mexico Mexico Brazil Dom. Rep. Dom. Rep. Source: WHO - The World Health Report, 1999

5. 2. Emphasis on W responds to the ethical imperative to rectify unjust inequalities that limit the exercise of the right to health • W have a greater need for services than M • tend to use services more than M • must pay more than M to protect their health • have lower economic capacity • constitute the majority of providers of formal care and the primary providers of family health • are more affected by reductions in public services, as users and caretakers • have less power and representation

6. W and M get sick and die due to different causes Percentage distribution of years of life lost due to premature death and disabilities, by groups of causes. Latin America and the Caribbean

7. % of years lost due to premature death and disability due to illnesses of the reproductive system in the 15-44 year old group, according to sex. Latin America and the Caribbean. Source: Abou Zahr, C. and P. Vaughan 2000. Assessing the burden & sexual reproductive ill-health.

8. Source: National Household Surveys 1997-2000.

9. Health care costs more for W W have greater needs for services, tend to use them with greater frequency and pay more for them • In BRA, ECU, PER, PAR and the DOM REP, out-of-pocket spending on health was 15.45% higher for W than M. • In the USA, out-of-pocket spending on health during the reproductive years was 68%higher for W than M. • In Chile, private insurance premiums during the reproductive years are 3 times higher for W than M.

10. W have lower economic capacity • 50% of W are outside of the remunerated labor market • Unremunerated domestic labor is not eligible for social services • Unemployment is consistently higher for W • W are the majority in occupations in the informal and part-time sectors, with lower social protection • The remuneration of W is 30% lower than that of M • Less W than M are entitled to rights:19% of W and 32% of M contribute to social security in LAC • W’s work history, since interrupted by family roles, limits access to and amount of social protection in old age.

11. Percentage of men and women in the urban labor force. 2000/2003 Source: PAHO/GE Gender, Health and Development in the Americas, Basic indicators

12. Women Men Urban unemployment rate (%) by sex. 2003 Source: PAHO/GE Gender, Health and Development in the Americas, Basic indicators

13. Average weekly hours worked by women and men in the urban labor market. Dominican Republic (2004) # hours Men Women

14. Percentage of women and men employed in low-productivity sectors Dominican Rep. (2004) Women Men

15. Average female income as a percentage of average male income. 2000/2003 *Buenos Aires. **Asuncion. *** National Source: PAHO/GE Gender, Health and Development in the Americas, Basic indicators (CEPAL data) HRSA, Women’s Health USA 2002.

16. 3. MDG 3 and MDGs for maternal and child health Education, reproductive autonomy, W’s access to resources, and a life free of violence are decisive factors for child and maternal health. • 1-3 years of maternal education reduce child mortality by 15%. 1-3 years of paternal education reduce it by 6% (BM, 2003) • Control over their own fertility is critical for the health of women, mothers and children. Numerous, closely-spaced, very early or very late pregnancies put women’s and children’s lives at risk. • Violence against women is the cause of physical and mental pathologies, is a risk for perinatal health and negatively affects self-care during pregnancy and, subsequently, childcare

17. Child mortality (per 1,000 live births), in the 10 years prior to the surveys, by maternal education level, selected countries of LA, 2000. No education Primary Secondary Superior 1 Demographic and Health Surveys Source: IADB: Los Objetivos de Desarrollo del Milenio en América Latina y el Caribe. Retos, acciones y compromisos. 2004.

18. Child mortality (per 1,000 live births) according to duration of birth interval, LAC CMR < 2 years 2-3 years >= 4 years Interval Source: DHS. Taken from: The Alan Guttmacher Institute, 2002 Series, No.2

19. Cuba Argentina Costa Rica Mexico Brazil Colombia Dominican Republic Panama Venezuela El Salvador Paraguay Peru CMR/CMR Chile Guatemala MMR/MMR Chile Jamaica Ecuador Honduras Nicaragua Bolivia Haiti 0 5 10 15 20 25 30 Maternal and child mortality rates in selected countries of the Americas, as multiples of the MM and CM rates in Chile. PAHO, Basic Indicators, 2005

20. Unmet need for contraception in 2 neglected groups: adolescent women and women without education Dominican Republic (2002) Dominican Republic (2002) 15-19 yrs No education Natl. Total Source: OCR Macro. DHS

21. 50 44 42 40 30 29 30 22 17 20 11 10 6 10 Not available 0 Colombia (2000) Peru (2000) Nicaragua (1997- Haiti (2000) Dominican Rep. 98) (2002) Physical Sexual Domestic Violence % of women 15-49 years of age in union, that have ever experienced physical or sexual violence by their partner or companion. Around 2000 Source: Measure ORC Macro, Demographic Health Surveys carried out in each country between 1997 and 2002.

22. 4. Challenges for the sector in contributing to advances toward MDG 3, accelerating the achievement of the health MDGs • Provide integral and integratedsexual and reproductive health services to W and M in the framework of strengthening PHC, emphasizing adolescents, and including care for domestic and sexual violence against W • Separate the labor situation from access to social protection in health, promoting universality and overcoming exclusion and segmentation • Promote solidarity in financing in reproduction to ensure that its costs do not fall mainly on W • Strengthen inclusion and citizen participation of W within the power structures of the local and national health systems