Contact n°131 June 1993 : Supporting women: fighting discrimination to improve health

20 Pages·1993·5.6 MB·English

A bi-monthly publication of the
Christian Medical Commission World Council of Churches
150, route de Ferney 1211 Geneva 2 Switzerland
SUPPORTING WOMEN
INTRODUCTION
We want to thank Birgitta Rubenson - who
used to work here at the Christian Medical
Commission of the World Council of Churches
(WCC) - for the inspiration behind this issue of
Contact.
She wrote.to us suggesting that rather than
producing a Contact issue which focused on PUhNoItCoE:F
:s ui)
the role women play as mothers and carers in
Many activities in primary health care are dependent on women.
health promotion, it was time to show more
concern for the health of women themselves.
She pointed out that, over the years, we have
Aruna says that there is now an urgent need to
asked mothers to take on more and more
promote women’s health as an issue of social
responsibilities in primary health care. Mean-
justice. This issue of Contacttherefore aims to |
while, the appallingly high rates of maternal
highlight initiatives which challenge discrimi-
mortality have not fallen and little consideration
nation and support women’s right to enjoy
has been given to meeting women’s health
good health. We have chosen projects which
needs.
show what the community can do to help
improve women’s health.
Aruna Gnanadason, co-ordinator of the
women’s desk at WCC (see also page 11), isin
For example, we introduce the work of Gabriela,
full agreement with Birgitta. She says that she
a women’s organization in the Philippines,
is also concerned that women are burdened
which provides women-friendly health services,
with ever-increasing responsibilities while be-
and campaigns for women’s health and
ing denied greater recognition of their rights.
reproductive rights. PRODUSSEP, a popular
She says: "Breast-feeding and oral rehydration
education and health network in Mexico, has
therapy depend on the mothers - and they are
encouraged a discussion about relations
held responsible if a child dies. However, dis-
between the sexes which is helping women to
crimination against women which denies them
build their health and self-confidence. In South
good health is given little attention."
Africa and India, two projects described are ~
encouraging women to break their silence
regarding physical abuse from their partners.
Contents
Why women’s health? .........ccccsesccssssesssseees 12
The final two articles look at what the churches
Reproductive health: Putting women’s
are doing to support women’s health and well-
needs first: .7..:n:e .ee geuec .ee e 4
being. First, we introduce the work of the
Discovering women’s perspectives on sex. 6
women’s desk of the World Council of Churches
Countering violence against women
and the activities of the Ecumenical Decade
=in south Africa: iieecece aeee 8
1988-1998, Churches in Solidarity with Women.
= in. Indian. patcheaee see e 10
Next, there is the experience of achurch project
Ecumenical decade: Supporting women |
in Egypt which is helping girls to grow up with
means better health...............ccccssssccssessees 11
a more positive image of themselves.
Childhood messages: Rights for girls ....... 13
Useful publications and contacts.............. 15
There is tremendous energy atthe WCC andin
Announcements ............::cssseeee Back page
many churches for promoting women’s right to
better health. We hope thatthis issue of Contact
COVER will stimulate our readers, particularly those
Photo : World Council of Churches, Geneva working in church-related programmes, to start
Women and girls in Egypt are keen to learn about female genital
their own projects in support of women’s health.
mutilation (see story on page 13).
WHY WOMEN’S HEALTH?
Women’s right to health is increasingly recognised as a priority issue for social justice. But why
women’s health? Doesn’t everyone have the right to good health?
When people think about the right to health, which are the result of destructive lifestyles,
they tend to think in terms of the right to health. and of the spiritual anguish of unresolved guilt,
services. However, health does not only de- anger and meaninglessness in life.
pend on whether people have access to medi-
cal care. In fact, being healthy is not primarily Overworked
a medical matter but an issue of social justice. Women’s health suffers because they are over-
worked and undervalued. A Safe Motherhood
Members of the Christian Medical Commission manual(1) published recently recommends that
believe that "health is usually an issue of jus- those trying to promote women’s health should
tice, of peace and of spirituality, which includes begin by looking at what women actually do in
harmonious relationships with God, with our their daily lives. It suggests involving commu-
neighbours, with ourselves and with nature." nities in a systematic study of the actual role
Health suffers as a result of poverty, of human and responsibilities an average rural or urban
rights violations, of the illnesses and injuries woman takes in her home and community.
“Women's day" on a 24-hour clock
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12
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WaSh clothes Sa
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work in Fields
Contact 1
To help the process along, the manual’s author to gain sufficient weight during pregnancy, and
Dr Marie-Thérése Feuerstein has devised the the result is a deteriorationi n their own health.
"Woman's Day" exercise. It was played re- They also have a greater risk of alow birthweight
cently by health service workers in one of the and sickly baby, and less chance of being able
countries in the Pacific region. The partici- to breast-feed successfully(.2 )
pants, who were health staff working at the
national and provincial level, began to piece Itis only relatively recently that maternal health
together what they knew about the typical day has been seen as a priority in public health. At
of a rural woman. They eventually worked out the launch of the Safe Motherhood Initiative in
that she averaged a 16-hour working day, and 1987, the World Health Organization revealed
a 96-hour working week. that 500,000 women were dying each year as
a result of childbirth or unsafe abortion. Mater-
The average rural woman rose between 4 and nal mortality in the developing world is 100-200
3 am, made a fire, got the young children up, times higher than in Europe and North America.
cooked and presented food to the family,
washed the dishes, swept the floor and yard, Up to forty per cent of maternal deaths are
prayed, and then walked to the field around 9 believed to be the consequence of unsafe
am. Until3 pm, she was engagedin agricultural abortion practices. Many pregnancies are un-
work, then she carried foodstuffs back home planned and unwanted. It is of the utmost
along with bamboo containers of water. She importance that this problem is taken seri-
then fed the livestock, washed clothes, made ously. Those groups involved in social justice
another fire, cooked, presented the evening and health care must give more attention to
meal, washed dishes and sweptthe floor again. finding solutions to this urgent problem.
After 7 pm, she mended clothes or did some
handicraft work before going to sleep some- Role as carers
time between 8 pm and midnight. As well as bearing the children, women also do
most of the caring for children. During the past
Bearing children decade, women’s role as carers has become
Women also have to cope with the strain of even more onerous as a result of the debt
childbearing. Although children are a pleasure, Crisis.
enduring a continuous cycle of pregnancy,
childbirth and breast-feeding is not. The drain The effect of the debt crisis has been to force
on women’s physical resources is enormous. down commodity prices. As a result, women
Aswellas the strain of pregnancy, many women and men have to work harder to earn the
have too little food and too much work. They fail money they need to buy the
essentials at the market. Work-
ing longer hours away from
home makes the burden of car-
ing for children heavier. Moth-
ers have less time and energy
for breast-feeding and clinic vis-
its.
Structural adjustment policies,
associated with the debt crisis,
often mean schools and health
services are privatised and
therefore cost more. Women,
as mothers, are the major
consumer of health services and
& ; a ° : AR
oybi e ‘w h eea eih | 4 ake tig iy ‘i are the first to suffer. Not only do
a i a’ x fey B foe %
ed.
Women face risks in childbirth the extent of which have only recently been identifi
2 Contact
education. By the time they reach puberty,
many girls are poorly-prepared for the physi-
cally demanding and vitally-important role they
will play as mothers.
Being undervalued, women endure abuse
which is sometimes violent. At three recent
international women’s meetings, violence was
considered to be the number one concern.
_ According to the International Women’s Trib-
une Centre, 8,906 women are reported to have
been killed in dowry-related incidents in India
in 1987; 33% of women who come to hospital
emergency rooms in Peru are victims of
domestic violence, and 50% of all wives in the
US will experience some form of spouse-in-
flicted violence during their marriage regard-
less of race or socio-economic status.
Discrimination against women does not only
take place in the home. Rape and sexual
harassment can happen anywhere. Examples
of unacceptable and discriminatory treatment
can be found within schools and health serv-
PMShkaoértlgoda: r eta
ices and in government policies. State educa-
In childhood, girls receive less care than their brothers and have
to work harder around the home. (Notice the boys playing in the tion systems, for example, tolerate a situation
background). in which more boys than girls are enrolled in
schools. When girls are lucky enough to attend
medical fees make access to health care im- school, but become pregnant, they are often
possible for some families, but a reduction in expelled and cannot return even after the baby
services results in women having to carry an is born. Health services rarely prioritise women’s
even larger burden of care. needs while relying on a predominantly female
workforce.
For increasing numbers of women, the AIDS
pandemici s presenting another huge burden Governments and international agencies rarely
of caring. In parts of Africa, a large proportion consult women’s organizations on population
of families is affected. Whether it is them- programmes and structural adjustment policies
selves, their husbands, children, relatives or even though itis women who are most affected
friends who are infected, women - both moth- by the decisions taken.
ers and grandmothers - often carry the entire
emotional and practical responsibility on their Even within the church, women’s work is often
own shoulders. Even when there is little or no taken for granted and undervalued. However,
back-up from the health services available, the churches have launched an Ecumenical
many continue their caring role regardless. Decade of Churches in Solidarity with Women
(see page 11) and it is hoped that more and
Undervalued more church programmes will now make
Many women and girls are undervalued and women’s health an urgent priority.
face some form of discrimination everyday and
at every stage in their lives. As children, prefer-
1. Turning the Tide - A district action manual for Safe Motherhood, for
ence for boys means that girls receive less
details see Useful publications, page 16.
care, eat less and are less likely to receive an
2. Morley, D, Lovel, H, My name is tomorrow, London, Macmillan
Publishers, 1986.
Contact 3
PHILIPPINES
Reproductive health:
PUTTING WOMEN’S NEEDS FIRST
Gabriela, a coalition of women’s groups in the Philippines, is building a community-based health
programme on the principle of increasing women’s health and reproductive rights. Contact’s editor
visited two of Gabriela’s clinics to discover how this approach differs from that of other providers
of health care services.
The Gabriela Women’s Health Commission problems can be dealt with at the same place
was set up in early 1988 and is now involved in and at the same time. For example, instead of
campaigning and education work, particularly her having to come one day with her child for
on maternal health, reproductive rights immunization and then having to come
and AIDS. The -Commission is back the next day to another clinic
also involved in the running in order to discuss her own
of six clinOnei isc acslin.ic in stress or need for family plan-
central Manila catering pri- ning, all the services are avail-
marily to the needs of able during one appointment.
Gabriela’s over 40,000
members; two are clinics Clinic for the poor
that Gabriela administers in At Apelo Cruz, Pasay, just
slums in the wider Metro outside Manila, it is particu-
Manila area, and three are larly important that the
rural clinics which Gabriela services are affordable. All
ier the medicines are subsi-
provides with training and
other support. dised, and tuberculosis medi-
cation, immunization and
Dr Joy Salgado, who works family planning services are
1? y J ok Lanes wa
at the Commission on Wom- ~as* pee available free of charge. Atthe
Auge fs hi oP r
en's Health main clinic in Smad i 4 ante-natal sessions, women are
e 4
central Manila, says that the encouraged to book for a hospital
Gabriela's logo
women coming to the Gabriela delivery. To help meet the costs asso-
clinic find a very different reception from the ciated. with hospital delivery, Gabriela has
hostile one that they have come to expect at helped local women to build their own insur-
hospital clinics. "The woman is welcomed and, ance fund. The 70 members of the Apelo
rather than treating her just for the illness she Women’s Health Association contribute five
comes in with, we talk to her and listen to other pesos each month and can draw out 400 pesos
problems she might have," she says. "We take just before the birth of each child.
a feminist approach, offering a friendly and
wholistic service." However, some women in the community feel
so intimidated by hospital services that they
Joy says that another reason why women like are unwilling to deliver their babies there.
the Gabriela clinic service is that all health According to Victoria, known in her Apelo com-
4 Contact
munity as Toyang: "Everyone has hearda story health and fertility. A recent survey in four
about being shouted by doctors or nurses at the villages of Cavité, on the southern side of the
hospital and it puts them off using the services," Manila Bay, showed that 17% of women had
she says. "Many women don’t know how to get’ had one or more illegal abortions. Two Manila
to the hospital, cannot read the signs when they hospitals, Philippine General Hospital and the
get there and they worry about who will take Jose Reyes Memorial Hospital, treat an aver-
care of their child- . age of 80,000
ren while they are and 100,000
away." women each year
for the conse-
The Gabriela & quences of .un-
project is helping to safe abortion.
solve this problem.
Three of the bet- Gabriela is keen
ter-educated to ensure that
women from the more women are
local community, provided with
including Victoria, sound informa-
have been trained tion on family
by Gabriela as planning. They
community health PSDhmioiattnoha: run regular pub-
Victoria, right, with the two other community health workers trained by
workers (CHWs). lic health educa-
Gabriela.
They now accom- tion sessions on
pany other women to the hospital when the family planning and are involved in the cam-
need arises. paign for reproductive rights. They believe
that the challenge is to provide all women with
Reproductive rights the right "to choose if and when and how many
Even if all the women in poor communities like children she shall have regardless of race,
Apelo could be encouraged to use the hospital class, age, disability, civil status, sexual orien-
services, women’s health in the Philippines tation, religious and political affiliation,” (Alli-
would still be compromised by the lack of family ance for Women’s Health, July 1990).
planning. Because it is a Catholic country,
contraception is not discussed as openly in the The Gabriela approach to women’s health is
Philippines as in other Asian countries. based on the principle of upholding women’s
rights. It is an approach which challenges both
As a consequence, scare stories and mis- society’s and the medical profession’s atti-
understandings about family planning and con- tudes towards women’s right to health and
traceptive safety are rife, and fatalistic attitudes family planning, while at the same time helping
are left unchallenged. Dr Sylvia Estrada-Claudio, to build among the women themselves a
convenor of the Gabriela Women’s Health Com- strength with which to fight for health and
mission, says: "| have talked with health work- reproductive rights.
ers among the rural poor who have difficulty
encouraging contraception because women Gabrielais acoalition of more than 100 women’s groups
felt that this (bearing children) was their karma with well over 40,000 individual members. Named after
a woman leader who fought against the Spanish
(destiny) and that fighting this fate would result
colonizers of the Philippines in the 1800s, Gabriela
in ill health and eventual infertility."
"seeks to transform women into an organized political
force and sees its goals as integral to the struggle for
The inadequacies of family planning services national liberation”.
mean that women are unable to prevent un- Gabriela Commission on Women’s Health
8B St William Street
wanted pregnancy. As a result, abortion rates
Nr Immaculate Conception Church
are high, presenting a major threat to women's
Quezon City, Philippines
Contact 5
MEXICO
Discovering women’s perspectives
ONE SEX-LIFE: TWO POINTS OF VIEW
A small team from PRODUSSEP, a popular education and health network in Mexico, has been
focusing on women’s health in the Diocese of San Andres Textla, Textlas, Veracruz. At one of the
first meetings, men and women were asked to talk about the quality of their-sex lives. Several of
the women admitted that they did not enjoy the sexual side of their relationships. The discovery that
this was a shared feeling among many of the women proved to be a liberating experience for those
involved. Guadalupe Abdo, one of the PRODUSSEP’s coordinators, describes how the programme
grew from there.
Three years ago, we decided to investigate tation". Not only were they poor but they also
women’s health problems. We had already faced repeated pregnancies and were seriously
worked on diarrhoea and cholera caused by overworked. They faced discrimination in the
the lack of drinking water and sanitation facilities, home, the community, the church and the
and also onthe respiratory diseases associated media and we felt that it was time to address
with poor housing and inadequate clothing. We this injustice.
considered women’s health to be the next most
important problem. Thef irstworkshowpe organized tothoe tkhe me
of conception and pregnancy. Men and women
Our investigation of women’s living conditions were divided into several groups and asked to
in this tropical, coastal area of southern Mexico recount experiences from within their own
painted a clear picture of their "double exploi- relationships. To start people talking, individu-
als were asked to read
and respond to one or
more questions on a pre-
pared list. The opinions
expressed in each group
were then pulled together
and common themes were
offered to the whole meet-
ing in a plenary session.
During that session, many
men learnt for thef irst time
that women often disliked
having sexual intercourse.
They were amazed. To
them, sex was something
very pleasant. It was hard
for them to believe that
the majority of the women
involved considered
a QU:
PPWehitoletlrol :a ms/WCC / NS sexual intercourse to be
PRODUSSEP found that men were willing to change their attitudes. "unpleasant". They had
6 Contact
never considered the fact that fear of an un-
wanted pregnancy, for example, might affect
women’s feelings about sex.
Although this revelation may have hurt their
egos, we made sure that the men were not
made to feel threatened. The women’s feel-
ings had emerged gently and calmly, and as a
result, the men reacted positively. At the end of
the workshop, they proposed a second meet-
ing to talk about the same issues with a larger
group of men. They said that they were glad to
have become aware of the fact that they were
unconsciously oppressing women, and wanted
to share the discussion with other men. The
meeting took place in June 1990.
Last year, we held a third meeting. In prepara-
tion for it, we made a survey of women’s views
onmen. We asked women in the area questions
about how men behaved and also about how
they would like them to behave. The meeting
was very successful. It proved to be an oppor-
tunity for men to listen to women’s opinion of
PPWheitoletirol :l ams/WCC
them in public for the first time. Women "woke up" to what was happening and changed their
situation for themselves.
Changing attitudes
We cannot claim that these workshops have The women of Textlas now organize their own
created a real change in the situation of the annual workshop. Each meeting takes a differ-
women’s lives. However, we can see small ent topic and after the meeting is over,
differences. The attitude of several men to- PRODUSSEP coordinators, including myself,
wards their wives has changed. There has also try to arrange sessions in other parts of Mexico
been some change in the general attitude to share the experiences and problems of the
towards women, and some change in the way Textlas women. At these meetings, ideas and
boys and girls in the neighbourhood behave plans develop and regional activities often
towards each other. follow.
However, the most important benefit has been Those involved in PRODUSSEP also partici-
the effect on the women themselves. We have pate in women’s networks around the country.
offered capacity-building workshops on We find that the popular education and health
women’s rights, violence and so on, but it is approach is an ideal way to build programmes
they who have done the real work. They have for the liberation of women. We think it valuable
"woken up" to the problems of their heavy that it involves the participation of both women
workload, their poor nutrition, their lack of and men. However, ultimately we believe that
Organization and income, and have learned the transformation of society - including the
how to express their opinions on these issues. men - will only be achieved by the women.
Despite having very little training, they have
organized themselves and now run coopera- PRODUSSEP, A.C.
tive corn mills and vegetable patches. They —"Promoci6on de Servicios de Salud y
have learned how to make baskets and to Educacion Popular, A.C."
Apdo. Postal 73-089
weave products which has helped to improve
C.P. 03310 - Mexico
their incomes.
Contact 7
SOUTH AFRICA
Countering violence against women:
CASTING OFF THE CLOAK OF OPPRESSION
by Zubeda Dangor and Mohammed Seedat*
The Eldorado Park Centre for Peace Action in clude fear of further abuse by their partners;
South Africa is running a programme on the the feeling that these are private matters; and
prevention of violence against women. Before shame, humiliation and ostracism (exclusion —
embarking on the provision of particular inter- from society) in trying to seek help. They sug-
ventions or services, those involved at the gested that men assault their partners be-
Centre conducted aneeds assessment survey. cause of insecurity and poor self-image which
A hundred women were interviewed about combine to produce an excessive need to
their perceptions of violence, what they consid- dominate and subordinate women. Other im-
ered to be the most pressing problems in their portant factors include being under the influ-
area, whether they knew of counselling services -ence of alcohol and drugs, lack of housing,
and what support they would like to see financial problems and unemployment.
established. . |
There are a
numbero f pos-
Survey sible reasons
The results of why the
the survey in- women. inter-
dicated that viewed__re-
unemploy- quested cura-
ment, gang tive, rather
violence, sub- than preven-
stance abuse tive services.
and spouse These include
abuse were a limited
major prob- awareness of
Wteirl liams/WCC
lems. The res- | the issue of
pondents also £| women’s sub-
highlighted the Some women said that they would not seek help if their husband were violent ordination and
because they felt that it would be a private matter.
laofc serkvic es ahelplessness
for abused women and children. They ex- and involvement with the violence in their own
pressed a need for a wide range of resources, lives. Existing mental health services are based
including shelter, police assistance and medi- on individual curative treatment and there is a
cal attention. However, there was a powerful lack of awareness of the nature of proactive
emphasis on curative, as opposed to preventive, and preventive services that could be estab-
resources. lished.
Respondents raised a number of reasons why Curative services are clearly necessary for
abused women do not seek help. These in- women whose lives are consumed by interper-
8 Contact