Gender and health
Gender equality in families, communities and society at large has a direct impact on women’s health. Children’s chances to survive the most critical first 28 days in life largely depend on the health and nutritional status of their mother as well as on the care and support she receives during pregnancy, labour and immediately after giving birth. Issues of gender equality therefore relate directly to infant and child health.
In the Eastern and Southern Africa region (ESAR), every year some 80,000 women die during pregnancy or childbirth, and 440,000 infants do not survive their first month.
Maternal mortality: In ESAR, on average almost ten women die every hour in circumstances related to the most basic and natural act of giving life. The region has one of the highest maternal mortality ratios in the world, estimated at 550 deaths per 100,000 live births in 2008 (750/100,000 in 1990). Much too little progress has been made so far towards the Millennium Development Goal of reducing maternal mortality by three quarters between 1990 and 2015. Babies who have lost their mothers in childbirth stand a limited chance of survival.
Teenage pregnancies: Only about 40 percent of pregnant women in the region deliver their babies with the assistance of a skilled health professional. Another key contributing factor to the very high maternal mortality rate is early marriage and pregnancy, often a result of poverty and cultural imperatives. More than one third of women aged 20 to 24 years have been married or were in union before age 18. In Malawi and Mozambique, the rate is above 50 percent. Girls under 18 are more likely to die during pregnancy and childbirth than women in their twenties. This risk is five times higher for girls younger than 15 years.
Women’s nutritional status: Children’s survival and development depend to a large extent on the nutritional status of their mother. A woman, whose nutritional status was poor when she conceived, or who did not gain enough weight during pregnancy will give birth to a low birth weight baby. Approximately 14 percent of infants in the region weigh less than 2.5 kilos at birth. Low birth weight is a leading cause of neonatal mortality.
Breastfeeding: Children’s development also depends on their own nutrition. Breastmilk is the best nutrition and protection against disease during a baby’s first six months of life. Breastfeeding rates in the region, however, remain low, often due to inadequate support, work and economic burdens. Only a few countries, including Rwanda, Madagascar, Zambia and Malawi have achieved exclusive breastfeeding rates of more than 50 percent.
Female genital mutilation/cutting (FGM/C): Many girls and women in the region are also affected by harmful traditional practices such as female genital mutilation/cutting (FGM/C) - a gross violation of their rights that has a direct impact on their health. FGM/C is normally carried out on girls between the ages of 4 and 14. It can cause severe vaginal and urinary infections as well as dangerous complications during childbirth. The highest rates of FGM/C in the region are found in Eritrea, Ethiopia and Somalia, where more than 70 percent of girls and women 15–49 years old have been cut.
HIV and AIDS: Girls and young women in the region are also disproportionately affected by the HIV/AIDS pandemic. Young women aged 15–24 are two to four times more likely to be infected than men of the same age. In sub-Saharan Africa, women and girls account for 60 percent of all HIV infections. The inability to negotiate the use of condoms, multiple and concurrent partnerships, age disparate and transactional sex, as well as the incidence of gender-based violence, all of which have a gender component, are propelling the epidemic in the region. A survey of 24 sub-Saharan African countries revealed that two thirds or more of young women lack comprehensive knowledge of HIV transmission.
Limited decision-making power: Underlying the medical causes of maternal mortality are a range of social, economic, and cultural factors that contribute to women’s poor health before, during, and after pregnancy. In their families and communities, women often have limited decision-making power. This affects their own health and the health of their children in a number of ways:
Gender-based violence: While data on the prevalence of gender-based violence is limited, in sub-Saharan Africa, 13–49 percent of women report having been physically assaulted by an intimate male partner. Studies on sexual violence in Ethiopia, Kenya, Namibia, Tanzania, Zambia, and Zimbabwe estimate that 14–59 percent of women have experienced sexual violence at some point during their lives. Women are also physically assaulted during pregnancy: 10 percent of ever-pregnant women in Zimbabwe and 7 percent in South Africa have been attacked during pregnancy.
Such violence poses a threat to the life and health of the mother and her baby. The fear of violence is a barrier to using condoms as well as accessing antenatal care and HIV and AIDS prevention information. Studies from sub-Saharan Africa show that among women who do disclose their HIV status, between 3 and 15 percent report negative reactions including blame, abandonment, anger, and violence.
Most governments have ratified the Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) and other international agreements, which include commitments to provide pregnant women and mothers with maternity care and health services. UNICEF supports women to realize their rights, and works with governments and other partners to strengthen existing services.
UNICEF programmes seek to empower women through life skills and health education. One example is the publication Facts for Life, which provides easy-to-understand information about women’s and children’s health issues, such as pregnancy, nutrition, and breastfeeding.
In partnership with the World Health Organization (WHO), the UN Population Fund (UNFPA) and the World Bank, UNICEF works to ensure a continuum of care that connects essential maternal and newborn health services and to improve the availability and quality of emergency obstetric and newborn care. UNICEF has also taken the lead in scaling up community-based newborn care. In Ethiopia, for example, UNICEF supported the training of some 30,000 health-extension workers in providing safe delivery.
UNICEF also works to improve girls’ access to quality education, because educated women are more likely to have healthy daughters and sons. The “Child-Friendly Schooling” approach helps to ensure that schools implement life skills programmes focused on HIV prevention and other health issues.
More on maternal and newborn health