Which aspects of promoting women’s rights, empowerment, and choice should we prioritise to help increase access to reproductive, maternal and newborn health?
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While the provision of more formal schooling for girls is clearly desirable, experience in Bangladesh shows that even illiterate women can be enabled to exercise their reproductive rights and take control of their fertility, spacing their children and thus improving their own and their children’s health. Culturally-appropriate education programmes aimed at men, stopping them coercing their partners into unwanted pregnancy, are also important in many countries.
Equality of education between men and women is very important. By this means women realise that they may have other functions and goals in life beside rearing children. This education may be in separate schools if this is the cultural norm.
The lack of access to sanitation and drinking water affects women disproportionally; it impacts on their health, contributes to their vulnerability to rape and violence, and frustrates efforts to enable women to lead a productive life. It is essential to recognise
• The importance of provision of separate and adequate sanitation facilities for girls in schools to keeping teenage girls in school – reducing the likelihood of teenage pregnancy and enhancing future mothers’ educational level, which is linked to child health and survival. Poor menstrual hygiene, caused by the lack of sanitation and hygiene facilities, is also linked with reproductive health problems.
• The impact of lack of accessible sanitation and drinking water facilities on the safety of women – having to wait until after dark to use the toilet and to walk long distances to fetch water leaves many women and girls vulnerable to rape, with disastrous effects on their reproductive health and their life course.
• The impact of time lost to water fetching, reducing women’s ability to engage in economically productive activity.
While all these proposed steps offer important promise, in the area of reproductive health and particularly reducing unsafe abortion, supporting the development of true political commitment to women’s rights may be the intervention that can have the most impact most quickly. Research clearly shows a correlation between restrictive abortion laws and deaths and injuries from unsafe abortion. By supporting reform of abortion laws – including by helping civil society organizations hold governments accountable to their international commitments, and other approaches — DFID can help create legal, policy and health-system contexts that translate women’s long-recognized reproductive rights into reality.
Social change comes about slowly. We need to be careful not to impose Western social norms, values and worldviews on non-Western communities – Western secular feminism is not necessarily the answer to the majority of the world’s women’s problems. However, as we argued in our response to question 1, Christian Medical Fellowship would encourage DFID to use an approach that comes from the religious perspectives and cultural values of the community, particularly through the engagement with faith communities and religious leaders.
It will be more acceptable within the culture and society than imposing Western values, and can lead to a locally led agenda for women’s rights and empowerment. Again, we would emphasise that the individualised approach to human rights in the West does not always translate to more communitarian cultures in the South and East.
The last paragraph of Steven Fouch’s message is the key to achieving the UN MDGs and should be put at the top of the list. We only train able and committed women from the Darfuri diaspora in Britain to organise and educate displaced Darfuri women in Khartoum with our Sudanese partners but are limited by cash to sending two for one month twice a year because funders seem to think we are too small to achieve our aims! This is expert, committed empathetic and hard work over a long period. There is no quick fix.
The improvement of women’s rights has to be enshrined in law, and the agents of the law enabled to enforce it. All too frequently the enforcers of the law are themselves offenders where women’s rights and dealing with gender-based violence is involved. The governors of the country, from the highest to the lowest level has to be educated and influenced to accept that enforcing the law in its fullest, including those protecting women’s rights are essential to national development. Furthermore, there can be consideration for instituting the age of consent in countries.
Women’s dependency on men in terms of finance, security, companionship, etc. prevent women from taking their own health seeking decision as well as availing existing health facilities. Steps should be taken to empower women in taking their own health decisions regarding uptake of health services through providing them earning sources, i.e. involving them with income generating activities.
All the interventions proposed are important steps for empowering women and girls, however unless the very process by which programs are designed and implement fully involve and incorporate the views and expertise of women and young people, systematic inequalities will persist at even the intervention and program level. Thus we recommend a focus on civil society participation of women and young people, supporting advocacy for rights of young people/girls, and increasing engagement in political and decision-making processes generally.