International Women's Day 2022: Healthy Women are the Bedrock of Sustainable Development and Prosperous Societies
The global community comes together on March 8th to celebrate this year's International Women's Day under the United Nations (UN) theme "Gender Equality Today for a Sustainable Tomorrow”. This is the time to celebrate women's achievements and contributions to our individual lives and to the wellbeing of society as a whole.
In my case, I will just say a heartfelt “muchas gracias” to the core women who make my life: Mother Elena, Wife Lani, and Daughter Laura. And on this day, I would also congratulate my sisters and daughter-in-law, other family members, and female friends and colleagues for all their achievements and contributions.
As discussed below, we should also use this occasion to reflect on the impact that the COVID-19 pandemic has had on women.
State of the World’s Women
While women may face fewer disadvantages now than in the past, major gaps still remain. Indeed, UN data show that the “glass ceiling” still keeps women in support positions rather than allowing them access to strategic management functions (only 28 percent of managers and 18 percent of chief executive officers are women), and women have low representation in country politics (25 percent in national parliaments or congresses and 38 percent in local governments). UN data also show that while enrollment in tertiary education is increasing faster for women than for men, gender disparities still persist in the fields of study chosen by women and men: women continue to be underrepresented among graduates in the science, technology, engineering, and math (STEM) fields, including computer science, and in information and communication technology (ICT) jobs.
Additionally, the UN data highlight that family responsibilities and the unequal distribution of unpaid domestic and care work between women and men add to women’s daily work and hinder women’s participation in the labor market, particularly in countries that lack or have limited child care support services.
On top of this, there is the “hidden reality” of intimate partner violence (IPV), the most common form of violence, which disproportionately affects women, peaking during women’s reproductive years in both developed and developing countries. A 2018 analysis of prevalence data from 2000-2018 across 161 countries and areas, conducted by the World Health Organization (WHO), found that worldwide, nearly 1 in 3, or 30 percent, of women have been subjected to physical and/or sexual violence by an intimate partner or non-partner sexual violence or both. The prevalence estimates of lifetime intimate partner violence range from 20 percent in the Western Pacific, 22 percent in high-income countries and Europe, and 25 percent in the Americas to 33 percent in the African region, 31 percent in the Eastern Mediterranean region, and 33 percent in the South-East Asia region. Globally, as many as 38 percent of all murders of women are committed by intimate partners, and 6 percent of women report having been sexually assaulted by someone other than a partner, although data for non-partner sexual violence are more limited. And, data from some countries such as the UK, show that suicide by domestic violence is a hidden toll in women’s lives.
Impact of COVID-19 on Women
While COVID-19 is affecting women and men differently (women above age 20 appear to be more likely to be diagnosed with the coronavirus, men in all age groups under age 80 are more likely to die from it), women have been at the frontlines of fighting the pandemic as they account for 70 percent of health and social workers.
Looking at effects of COVID-19 on gender disparities globally, the findings of a recent study by Flor and colleagues published at The Lancet are serious. Between March 2020 and September 2021, it was found that women were more likely to report employment loss (26%) than men, as well as forgo going to work in order to care for others (ratio of women to men: 1.8 by March 2020 and 2.4 by September 2021). Women and girls were 1.21 times more likely than men and boys to report dropping out of school for reasons other than school closures, and women were also 1.23 times more likely than men to report that gender-based violence had increased during the pandemic.
The most significant gender gaps identified show intensification of pre-existing widespread inequalities between women and men during the COVID-19 pandemic. For example, lockdowns during the pandemic and its social and economic impacts have increased the exposure of women to abusive partners and known risk factors, while limiting their access to social support services. And in situations of humanitarian crises and displacement, which may exacerbate existing violence, such as by intimate partners, as well as non-partner sexual violence, may also lead to new forms of violence against women.
These findings should lead political and social leaders to adopt and support policies and interventions that facilitate and encourage women to participate in the labor force and continue their education, equipping them with greater ability to overcome the social, cultural, and economic barriers they face.
This is an important call for action, since, as my daughter has stressed to me on many occasions, the international community often ignores the fact that in many countries there are women who are not getting the same opportunities as men because they are subject to cultural norms that limit their potential.
I not only agree with her views on the need to overcome cultural norms and stereotypes that implicitly or explicitly subjugate women, but as a public health worker and researcher, I would add that the development experience of countries shows that deliberate policies and programmatic strategies and actions by governments and societies at large aimed at nurturing women’s health and well-being across the life cycle are vital for realizing the full potential of women and girls.
The Imperative of “Healthy” Life Expectancy among Women
The World Bank Group 2012 World Development Report (WDR) on “Gender Equality and Development” made the case that while conditions for women are improving, some major gaps still remain, impacting negatively their wellbeing across the world. One significant gap is excess female mortality, which could be avoided with better access to quality health care services, particularly during pregnancy and child delivery. Early detection and treatment for conditions such as cervical cancer and breast cancer (approximately half of breast cancers develop in women who have no identifiable breast cancer risk factor other than gender (female) and age (over 40 years), help increase survival rates, as many women are diagnosed only after the disease is in an advanced stage, leading to higher case fatality. Since the human papillomavirus (HPV) is the main cause of cervical cancer, vaccination among school-aged girls is another critical disease prevention intervention.
Social conditions and cultural norms that limit women’s access to health services, education, and economic opportunities are at the root of women’s health disparities and exacerbate the feminization of poverty as measured by the higher percentage of female-headed households who are poor, which may have been aggravated during the COVID-19 pandemic as noted above. The prevalence of gender-based violence (e.g., in conflict situations, human trafficking, and domestic violence) is another often hidden determinant of women’s excess morbidity and mortality.
Research has shown that many maternal illnesses and lifestyle behaviors also affect children, amplifying their negative impact on society. For example, tobacco and alcohol use, anemia, over-nutrition, and under-nutrition all have potential long-term consequences for children. Gestational diabetes is a strong predictor of future health, both of the mother, who may develop diabetes and cardiovascular diseases (CVD) later in life, and the child, who has increased risk of developing Type II diabetes later in life. Poor maternal nutrition before and during pregnancy, as well as tobacco and alcohol use during pregnancy, contribute to poor intrauterine growth, resulting in low birth weight (LBW), which in turn predisposes the child to metabolic disorders and risk of non-communicable chronic diseases (NCDs) later in life. These problems are compounded by HIV and malaria. For example, LBW and malnutrition are more frequent in HIV-infected children, and malaria infection during pregnancy is a common cause of anemia and LBW.
Research findings also provide evidence about the impact that the well-being of women has on the intergenerational propagation of good physical and mental health. The findings indicate that pregnancy is associated with substantial changes in brain areas of pregnant women that are responsible for social cognition and the ability to understand the thoughts and intentions of others. Depressive disorders during pregnancy and the post-natal period are common in both developed and developing countries, impacting negatively both mothers and children.
And in some countries, suicide (which is frequently caused by mental disorders) is a leading cause of death among women aged 15 to 49. Diverse factors, including poverty, gender discrimination, marital conflict, domestic violence, crime, post-traumatic stress, substance use disorders, and lack of control over economic resources, contribute to the onset of mental illness, which can cause functional impairment at a time when the mother is performing tasks vital to an infant’s growth and development. Research suggests that maternal depression is associated with compromised parenting behavior, nonresponsive caregiving practices, and a lower likelihood or shorter duration of breastfeeding.
Although the full extent of domestic abuse related suicide among women is unknown given the scarcity of data, the little that has been established is chilling. Data from the UK indicate that on average 30 women and 94 men took their own lives every week in in 2018, and research has suggested that around one third of the number of female suicides could be related to IPV.
Also, while the full scope of trauma that abuse survivors are living with is being understood, little is known about how the combined presence of post-traumatic stress disorder (PTSD) and traumatic brain injury might affect the brain. Research in the US shows that survivors of abuse can sustain head trauma more often than professional athletes, but they are almost never diagnosed. In a 2014 study, researchers found that women of childbearing age experienced worse post-concussive symptoms than postmenopausal women or women taking hormonal birth control, especially when the concussion occurred during the luteal phase of the menstrual cycle (after ovulation, before the period begins). Recent data from the US Department of Veterans Affairs’ Translational Research Center for T.B.I. and Stress Disorders (TRACTS), found alterations in brain structure and function among abuse survivors with a history of brain injuries and PTSD. Notably, women whose brain injuries were sustained in the context of domestic violence displayed decreased cortical thickness and impaired function in the frontal limbic system, which may cause poor impulse control and difficulties with regulating emotions. Research in the US shows that survivors of abuse can sustain head trauma more often than professional athletes, but they are almost never diagnosed. In a 2014 study, researchers found that women of childbearing age experienced worse post-concussive symptoms than postmenopausal women or women taking hormonal birth control, especially when the concussion occurred during the luteal phase of the menstrual cycle (after ovulation, before the period begins).
Supporting access to effective interventions to promote good nutrition, prevent anemia, and deliver reproductive health and other essential health services, including effective contraception, pre-natal care, child delivery, and post-natal care, are not only important for ensuring women’s well-being but also for improving nutrition in the early years of children and as preventive measures for arresting the explosive growth of NCDs worldwide. The promotion of breastfeeding – which protects against diarrhea, respiratory infections, and obesity -- also helps prevent NCDs and protects against infection, apart from its nutritional benefits. Screening for gestational diabetes and screening for and prevention of malaria, HIV, and tuberculosis could also be part of an integrated antenatal care program with multiple benefits. Promoting the physical and mental health of pregnant and lactating women help intensify the bonding between mothers and their babies, and hence, the survival and healthy development of children. And adopting new ways of assessing risk in a coercive and controlling relationship is needed to prevent future deaths.
And in conflict-and post-conflict contexts, programs targeting displaced populations and refugees are found to maximize their impact by combining nutrition, maternal mental health, and psychosocial stimulation interventions that address the symptoms of post-traumatic stress linked to exposure to extreme violence. Such integrated interventions have been shown to reduce the disabling impact of post-traumatic stress on mothers’ ability to nurse and feed their children.
Health and social policies and programs that target the needs of women across the life cycle are also important for ensuring and supporting “healthy” life expectancy (the average number of years that a person can expect to live in full health—that is, not hampered by disabling illnesses or injuries). This, as marked gender differences in health and mortality patterns, is present in older ages as well. Indeed, the world has more women than men aged above 50, and in the age group 60-64 years, there are five fewer men per 100 women. In the age group 90-94 years, women outnumber men by a ratio of 2-to-1 and by 4-to-1 among centenarians. As women live longer than men, they face a double burden: not only are they at higher risk of dementia (20 to 30 percent of women are more likely than men to die from Alzheimer’s disease and other types of dementia), of living alone (24 percent of women vs 12 percent of men aged 65 years and above), but they are also likely to be the main caregivers as partners, daughters, and daughters-in-law.
Investing in the Education of Women is also good for Children
Investing in women’s education is another critical contributor to child health. Again, research data highlight the strong correlation between mother’s primary school completion and better infant health (as measured by incidence of very low birth weight) and child health (as measured by height-for-age and weight-for-age), even after controlling for many potential confounding factors. The data also show that mother’s primary school completion leads to earlier preventive care initiation and reduces smoking. An assessment of increased educational attainment and its effect on child mortality in 175 countries between 1970 and 2009 showed that half the reduction in child mortality over the past 40 years can be attributed to the better education of women--that is, for every one-year increase in the average education of reproductive-age women, a country experienced a 9.5 percent reduction in child deaths. Economic empowerment of women is also transgenerational: women who have the dignity of a roof above their heads and food on their tables make better choices not just for themselves but for their children.
The 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals (SDGs) adopted by world leaders in 2015, embodies a roadmap for progress that is sustainable and leaves no one behind. Achieving gender equality and women’s empowerment is integral to each of the 17 goals. Only by ensuring the rights of women and girls across all the goals will we get to justice and inclusion, economies that work for all, and sustaining our shared environment now and for future generations.
As we celebrate and reflect on the International Women’s Day 2022, it should be clear that addressing the root causes of ill health, premature mortality, and disability among women and enhancing women’s voice and agency to deal with limiting, and in some cases, oppressive, social and cultural norms and gender-based violence that impede the health and human capacity development of women, should be a cross-sectoral development priority going forward.
Indeed, dedicated policies and sustainable investments to help turn the tide against the feminization of poverty and toward enabling women to lead lives of economic advancement and self-reliance, should be prioritized. And, at the same time, these measures stand to contribute to the improvement of physical health and mental wellbeing of future generations, to the development of critical human capital that underpins economic growth and prosperity, and for building less vulnerable and more resilient societies in the post-pandemic era.