Chapter Nine

1. Chapter Nine Women’s Health

2. The Importance of Women’s Health • Being born female is dangerous to your health, especially in low- and middle-income countries • Women’s health is linked closely with the MDGs

3. Table 9.2: Selected Definitions on Women’s Health Data from University of Kentucky HealthCare. Glossary Index. Available at: http://www.ukhealthcare.uky.edu/content/content.asp?pageid=P00527. Accessed April 15, 2007; University of New South Wales. UNSW Embryology Glossary Index. Available at: http://embryology.med.unsw.edu.au/Notes/ Index/index.htm. Accessed April 15, 2007; The White Ribbon Alliance. Glossary. Available at: http://www.whiteribbonalliance.org/Resources/default. cfm?a0=Glossary. Accessed April 15, 2007; Wikipedia. Sepsis. Available at: http://en.wikipedia.org/wiki/Sepsis. Accessed April 15, 2007.

4. Table 9.2: Selected Definitions (cont.)

5. The Determinants of Women’s Health Biological Determinants • Iron deficiency anemia related to menstruation • Complications of pregnancy • Increased susceptibility to some infections • Conditions, such as ovarian cancer, specific to women

6. The Determinants of Women’s Health Social Determinants Related to gender norms and roles • Female abortion or infanticide • Often fed less nutritious food than male children • Male dominance leads to physical and sexual abuse • Cooking with poor ventilation contributes to respiratory disease • Low social status limits access to health care

7. The Burden of Health Conditions for Females Sex-Selective Abortion • Skewed ratios of males to females in some countries, including China, India, Taiwan, Singapore, South Korea • Rising incomes and levels of education have led to more sex-selective abortion in these countries

8. The Burden of Health Conditions for Females Female Genital Cutting • Estimated 100-140 million worldwide have had some form of genital cutting performed on them • Practice appears to be diminishing • Can initially cause shock, infection or hemorrhaging • Long-term problems include retention of urine, infertility, and obstructed labor

9. The Burden of Health Conditions for Females Sexually Transmitted Infections • Biologically more susceptible • Risk factors for women are young age, sex with high risk partners, and inability to use a condom • 1.9% of total DALYs lost to women aged 15-44 were due to STIs

10. The Burden of Health Conditions for Females Violence and Sexual Abuse Against Women • UNAIDS estimates 10-50% of women worldwide have been abused physically by a partner • Can lead to injuries, unwanted pregnancy, STIs, depression, disability, and death • Risk factors include low socioeconomic status, young age of the male partner, proximity to alcohol, and gender inequality

11. The Burden of Health Conditions for Women Maternal Morbidity and Mortality • Estimates suggest that there are about 342,000 maternal deaths per year • 50% of all maternal deaths occur in six countries- Nigeria, Pakistan, Afghanistan, Ethiopia, and the Democratic Republic of the Congo

12. The Burden of Health Conditions for Women • 20% of maternal deaths are from indirect causes, 80% are from direct causes • Risk factors include general health and nutrition, level of education and income, ethnicity, location, age, and having a skilled birth attendant present

13. The Burden of Health Conditions for Women Unsafe Abortion • A “safe” abortion is one performed by a trained healthcare provider, with proper equipment, technique, and sanitary standards • Estimates suggest that 70,000 women die from unsafe abortions every year • Rates of unsafe abortion vary among regions

14. Figure 9.2: Unsafe abortion

15. The Burden of Health Conditions for Women Obstetric Fistula • Condition in which a hole opens up between bladder and vagina or rectum and vagina • 50,000 to 100,000 women each year will suffer a fistula • Women with fistulas are often stigmatized or abandoned • Risk factors are those associated with an obstructed delivery

16. Differences Between the Health of Men and Women • Greater focus has recently been put on the extent to which gender discrimination affects women’s health • 19 conditions disproportionately affect women- some are specific to women, some are related to women’s higher life expectancy, some are a result of gender discrimination

17. The Cost and Consequences of Women’s Health Problems • Violence, STIs, and fistula tend to isolate women socially • When a woman dies in childbirth, her family is typically left without a primary caregiver • Substantial economic costs from women’s health issues

18. Addressing Future Challenges Female Genital Cutting • Efforts that promote change need to be specifically tailored to local practices and beliefs • Promote female empowerment, education, and control over economic resources

19. Addressing Future Challenges Violence Against Women • Protecting women through legislation • Shelters for abused women • Ensuring police, judges, and healthcare workers are trained to deal with violence against women in effective ways

20. Table 9.4: Selected Measures to Reduce Intimate Partner Violence

21. Addressing Future Challenges Sexually Transmitted Infections • Surveillance of STIs • Program of health education • Appropriately trained health workers to provide proper treatment

22. Addressing Future Challenges Maternal Mortality • Provide hygienic and appropriate post-abortion care at the lowest level of the health system possible • Provide effective family planning methods • Births attended by a skilled healthcare provider • Enhance emergency obstetric care