1. Women’s Health In many countries, women suffer from the diseases of poverty: poor nutrition anemia poor reproductive care maternal mortality

2. Measurement How do we measure the differences in health between men and women? The most obvious and clearcut way is survival -- e.g. sex ratio in India is way below 1 -- many fewer females per 100 males Health visits Disability

3. Sex-specific death rates (deaths/1000): Matlab children 1-4 born 1981-82

4. Proportion visiting health care provider in previous 3 months: Matlab, 1996-97 Visits unrelated to pregnancy

5. Percent unable to perform specified ADL, by sex Matlab 1996-97

6. Options and Access These problems are related to their roles in society e.g. more tuberculosis and respiratory disease may be due to exposure to cooking smoke under poor conditions In general, problems are related to differential OPTIONS and ACCESS

7. Human Development The United Nations, in its 1991Human Development Report, published the Human Development Index The HDI is intended to measure the degree to which “people have the options to enable them to lead a long and healthy life, to be knowledgeable and to find access to the assets, employment and income needed for a decent standard of living.”

8. More developed countries (MDC) Finland Sweden France US Canada UK Italy Japan

9. Less developed countries (LDC) El Salvador Philippines Paraguay Sri Lanka Costa Rica South Korea Kenya

10. Human Development Index, 1991 Developed countries have a huge advantage over developing countries in the overall HDI Japan leads the list -- at 99 Kenya is lowest -- at 40

11. Human Development Index, 1991

12. Ratio of female HDI to male HDI In EVERY country, women have a lower HDI than men highest: Finland -- at 93.7 lowest: Kenya -- at 51.5 There is a lower differential between the MDC’s and LDC’s in this ratio than in the actual HDI -- women have less opportunity everywhere than men

13. Human Development Index, Female/Male 1991

14. Disadvantages of women Education Entry into labor force Jobs Nutrition Health

15. Role of women Women are participants in the allocations to themselves and to other females, including their daughters Hanna Papanek has written well on the social construction of biological differences and gender differences in entitlements to resources and socialization for inequality

16. Distribution of resources Reflects power and authority relations ALSO reflects moral basis of the group consensus about distributive justice implicit priorities Both men and women learn these implicit priorities at a very early age “Compulsory emotions” -- the way one is supposed to feel -- play an important role

17. Lessons learned Children may be taught that “girls need less food than boys” lesson about hunger? Or lesson about the value of persons? Boys need “rich foods like curds” to withstand the cold of winter What does this say about effect of cold on females - or about women’s capacity for suffering?

18. Mother’s role Mothers follow group norms Preference for sons status of women is measured by their reproductive performance support in old age sons are only way to acquire daughters-in- law to help her in household

19. Teaching children Teach them men work harder than women and that’s why they need more food - or better food Children know how hard their mothers work This teaching is about value in society Values may be sanctified -- e.g women’s spiritual role

20. Socialization for inequality Women are socialized to behave in certain ways toward their children Foot-binding painful cruel WHY DID WOMEN DO IT TO THEIR DAUGHTERS?

21. Circumcision Carried out by women WHY? Socialize girls for their adult role Evidence of internalization of the social norms of inequality

22. Family planning Family planning challenges some of these old notions that women should have as many children as possible Is reduced fertility healthier? -- for women, reduced risk of maternal mortality unless unsafe abortion used -- for children, evidence is clear that smaller families, longer birth intervals, are beneficial

23. Benefits to women Most women and men are convinced that practicing family planning and having fewer children provide economic and health benefits Family planning offers freedom from fear of unplanned pregnancy and can improve sexual life, partner relations, and family well-being

24. More benefits Where jobs are available, family planning users are more likely than non-users to take advantage of work opportunities Family planning helps women meet their practical needs and is necessary, but not sufficient, to help them meet their strategic needs

25. More benefits In many countries, older women express regret that family planning was not available to them They discuss the burdens of repeated childbearing and child death and the hope that their daughters are much less vulnerable to these burdens

26. Costs to women Contraceptive side effects - real or perceived - are a serious concern for many women, more than providers realize When partners or others are opposed, practicing family planning can increase women’s vulnerability

27. More costs When women have smaller families, they may lose the security of traditional roles and face new and sometimes difficult challenges, including the burden of multiple responsibilities at home and work