Fact sheet No 251: Gender, Health and Poverty - June 2000

Despite many development gains in the last century, poverty continues to grow, and the gap between rich and poor is widening. Recently, understanding has grown that poverty affects men and women differently, and hence effective policies and interventions will not necessarily be the same. Yet gender issues are rarely openly acknowledged in national anti-poverty strategies.

A disproportionate share of the burden of poverty rests on women's shoulders, and undermines their health. For example:

 

• 70% of the 1.2 billion people living in poverty are female

• Estimates over a 20-year period found the increase in numbers of poor rural women in 41 developing countries to be 17% higher than the increase in poor men

• There are twice as many women as men among the world's 900 million illiterates

• Iron deficiency anaemia affects double the number of women compared to men

• Protein-energy malnutrition is significantly higher in women in South Asia, where almost half the world's undernourished reside

• Half a million women die unnecessarily from pregnancy-related complications each year, the causes of which are exacerbated by issues of poverty and remoteness

• On average, women are paid 30-40% less than men for comparable work

• In developing countries, only a tiny fraction of women hold real economic or political power.

Much attention has been given in the last 20 years to policies and strategies for alleviating poverty. Yet there is still little data and information available about the health status of the bottom 20% of the world's poorest people - of which women are bound to comprise a high proportion. What information does exist shows a strong urban bias, with little information on rural poverty and links to health. Nor has there been sufficient acknowledgement of the links between gender inequality and the many forms of impoverishment suffered by women.

Poverty, particularly for women, is more than income deficiency. Women continue to lag behind men in control over the means of production such as cash, credit, and collateral: but they are also disadvantaged by other forms of impoverishment in areas such as literacy, education, skills, employment opportunities, mobility, political representation, and pressures on their available time and energy linked to role responsibilities. These factors diminish their human development capacity and affect their health status both directly and indirectly. For these reasons, women are often poorer relative to men of the same household and social group.

The following facts emerge from analyses of health and poverty:

 

• For the poor and near-poor of both sexes, sickness is a catastrophe which can lead to economic ruin

• In 20 developing countries, under-five mortality was found to be greatest among women with no education, and in rural agricultural communities

• Where traditional medicine or healers are available, many women choose these systems first for reasons of cost, convenience, and comfort

• The increasing trend towards uncontrolled privatization may result in a proliferation of health services with little guarantee of quality of care. Poor men and women risk investing scarce resources for ineffective treatment

• Imposition of user fees for basic services such as health care, or water supply, may particularly disadvantage poor women with limited decision-making power and control of income

• In some parts of the world, social roles and cultural norms for poor women may inhibit their willingness or ability to seek health care. In others, perceptions of masculinity keep men away from health services.

• Poor families tend to be larger than richer ones, which increases the reproductive and caring burden on women. Adolescent pregnancy is high in poor families

• Socioeconomic change in many parts of the world causes loss of jobs and roles for men. Women are increasingly becoming breadwinners in addition to their domestic and caring roles; but as their earnings are likely to be lower, and child care often suffers, patterns of poverty are easily perpetuated

• Women tend to make good the deficiencies caused by reduced public spending and services, which squeezes their time and energy till further

• Poverty is a significant factor behind stress and depression in women, with domestic violence a frequent contributing factor.

For reasons such as these, WHO is now concentrating considerable effort on health and poverty work. Part of this will involve applying a gender perspective, to ensure that knowledge about gender, health, and poverty linkages can inform the work of our Member States.

To do this, we need to know more about the processes and mechanisms that create and maintain poverty for men and women respectively, and how this relates to their health. We need to know what coping strategies men and women use in situations of acute and chronic poverty. What are the best means of bringing men and women respectively out of poverty? How is health produced and maintained at household level? Does existing health policy reach the poor? How do changes in men's roles affect their own and women's health? What is the impact on poor people's health of the policy of other sectors? Does the aggregate finding that increased wealth leads to better health hold true from a gender perspective? Answering questions of this kin is expected to provide more comprehensive information on men's and women's different experience of poverty, thereby informing research, policy, and programmes in countries.

WHO Response

The Department of Health in Sustainable Development at WHO is therefore preparing an integrated planning framework addressing linkages between gender, health and poverty issues. The framework will show how the use of gender perspectives contributes to more effective strategies for protecting and promoting the health of the poor. More specifically, it will lay out the processes, linkages, and mechanisms needed to create and implement programmes to address gender, health and poverty issues. To do this, a wide array of partners from civil society, academia, and government are being called on, together with HSD counterparts in WHO's Regional Offices.

This approach is different from one which shows how gender and biology affect disease outcomes; rather, the intention is to use a number of topics relevant to health and development to demonstrate the integrated planning needed for multi-dimensional gender and poverty issues. The main focus of the framework is therefore on processes and mechanisms rather than issues.

The following are the main principles of the approach taken:

 

• It will look at broad determinants of health affecting the poor, rather than restricting itself to a health services/health systems approach

• It will stress the need for a strong gender and pro-poor perspective in the health sector reform process, with emphasis on preventive public health

• It will examine the capacity of men's and women's gender roles to protect or prevent good health for themselves and others

• It will emphasise the view of health as a capital asset for the poor

• It will underscore the contribution to health and sustainable livelihoods for the poor of both sexes made by voice, effective participation, and control

• Using a case study approach, it will assess existing policies, processes, and institutional mechanisms, which can contribute to integrated planning in the area of gender, health and poverty, and identify where these are lacking.

The first version of this tool is expected to be available for the UNGA Beijing + 5 Review Meeting in June 2000. Further work will be necessary with countries interested in working on gender equity and poverty alleviation issues to refine and contextualise the framework.

For further information, journalists can contact:
WHO Press Spokesperson and Coordinator, Spokesperson's Office,
WHO HQ, Geneva, Switzerland/Tel +41 22 791 4458/2599/Fax +41 22 791 4858/e-Mail: inf@who.int