Threats to Women’s Health in Developing Countries
What are the main threats to women’s health in developing countries?
Introduction
Women’s health has rarely been at the forefront of international developmental programs and national health planning policies. The focus on women’s health in developing countries has been influenced largely by other concerns such as achieving specific targets like family planning and child survival. (1) Developing countries bear a large burden of a vast plethora of diseases affecting women and it is hard to imagine how serious reforms and improvements could occur without colossal investment in the health care sector. Nevertheless, it is possible that the responsibility for women’s health be assumed by certain communities and groups in such a way that prioritizes women’s own perceptions and primary needs. (2, 3) Among the main threats to women’s health living in developing countries include gynaecological and obstetrical problems, nutrition, domestic violence etc as is shown in the schematic diagram below.
Adapted from (3)
Main Threats
Gynaecological and obstetrical problems
Women in developing countries are faced by a number of diverse gynaecological and obstetrical problems including sexual health issues, abortion, cancer and complications related to pregnancy such as obstetric trauma (eg, obstructed labor, post-partum hemorrhage, vesico-vaginal fistulae, perineal lacerations). The ubiquity of sexually transmitted infections (STIs) including HIV is alarming in developing countries particularly Sub-Saharan Africa whereby 40-50% of women attending antenatal care clinics are HIV positive. Moreover, studies carried out in Kisumu, Kenya and Zambia highlighted significantly high HIV prevalence rates of 30-73% in women of reproductive age. Thus STIs remain a leading cause of morbidity with far reaching biological, social and economic consequences especially among women.
Cervical cancer
Cervical cancer is the commonest cancer among women in developing countries. Annual global estimates in the year 2000 were for 470,600 new cases and 233,000 deaths from cervical cancer yearly. Human Papilloma Virus (HPV) is prevalent in 99.7% of cervical cancer cases with subtype HPV 16 and HPV 18 present in more than 80% of invasive cervical cancers. (2) India, Bangladesh, Nepal and Sri Lanka together contribute around one third of the global cervical cancer burden as shown in the table below. (4)
Maternal deaths and cervical cancer burden in South Asian countries
|
Country |
Maternal deathsa |
Maternal mortality ratio (per 100,000 live births) |
Cervical cancer casesb |
Cervical cancer deathsb |
| India |
136,000 |
540 |
132,000 |
74,100 |
| Bangladesh |
16,000 |
380 |
13,000 |
6,600 |
| Nepal |
6,000 |
740 |
2,150 |
1,100 |
| Sri Lanka |
300 |
92 |
1,550 |
840 |
Adapted from (4)
a Estimated in the year 2000 (approximately).
b Estimated in the year 2002 (approximately).
Complications of Pregnancy, Abortion and Female Genital Mutilation
Complications of pregnancy and childbirth have been recognized as being the leading cause of death among women of reproductive age. Of over 500,000 maternal deaths that occur annually, 95% take place in resource poor countries of Africa and Asia. (5) Unwanted pregnancy poses great threat to women’s health. Despite under-reporting around 36-53 million women unwanted pregnancy are terminated by induced abortion annually throughout the world. Unsafe termination of pregnancy may result in death or morbidities such as infection, haemorhage, uterine injury and toxic effects of interventions. Furthermore, unsafe abortion has other consequences, namely economic costs to health systems and families, stigmatization, and psychosocial effects on women. Deaths related to unsafe abortion symbolizes about ¼ to 1/3 of the estimated 500,000 maternal deaths that occur worldwide annually, the vast majority in developing countries. (2, 6) Furthermore, female genital mutilation practiced in some Asian and African countries can cause extreme injury and extensive tearing during childbirth because the scarred vaginal opening cannot stretch to allow passage of the fetal head. Every year nearly 2 million girls aged 4-12 years old are mutilated mainly in Egypt, Ethiopia, Kenya, Nigeria and Somalia so as to preserve their virginity and ensure marriage thereafter. (9)
The 585,000 women who die worldwide in pregnancy annually leave behind them at least 1 million motherless children. The death of a mother is almost twice as dangerous for her surviving children as the death of a father. In developing countries, women are the major breadwinners and are responsible for the 60-80% of all food production in Africa. Hence, for the sound development of children and a family, gynaecological and obstetrical practices must be improved. (9)
Nutrition
In developing countries, poor nutrition among women is a conspicuous cause of low birth weight (LBW). Studies show that maternal nutrition factors both before and during pregnancy account for greater than 50% of cases of LBW in many developing nations. (7).Several factors including poverty, women’s status, cultural beliefs and practices may act as barriers to the birth of a normal weight baby. Poverty acts to limit access to care and the choice and amount of foods available to pregnant women. Similarly, anaemia, which is commonly due to iron deficiency is a problem in the same areas where LBW is a concern. Studies revealed that rates of anaemia have decreased neither among pregnant nor non-pregnant women. (8) Most women in developing countries suffer from malnutrition during pregnancy and lactation. In certain poor countries, men and boys are preferentially fed before women and girls. About a third of women in Sub-Saharan Africa have an inadequate daily calorie intake. (9)
Healthy maternal nutrition is considered as the lifeblood for the healthy and reproductive performance of women, survival and fostering of their children. The magnitude of female malnutrition and the subsequent social, economic, health, developmental repercussions of poor, limited prenatal nutrition of women and children provide an impetus for systemic, robust and rapid actions. Likewise, because of the reproductive and long-term effects of childhood malnutrition on adult physical and intellectual productivity as well as impact on women’s health and nutrition on child survival, securing nutrition of women remains a socially and economically prominent objective to be achieved by developing countries. (12)
Violence Against Women and Rape
Domestic Violence is defined by the World Health Organization as “the range of sexually, psychologically and physically coercive acts used against adult and adolescent women by current or former male intimate partners.” (10)It is a serious problem around the globe experienced mostly by women. Violence within intimate relationships might be affected by personal, cultural, religious and psychological factors. Furthermore past studies have shown a nexus between partner violence and social factors like poverty and weak community sanctions against partner violence. Likewise, studies from developing countries and Muslim population found that low education and socioeconomic status and being a Muslim living in a nuclear family, low self-esteem and being with a partner who abuses alcohol and other substances to be linked with domestic violence. Moreover, international research suggests that women with disabilities suffer significantly more from sexual violence compared to other women. In general women with disabilities are ‘assaulted, raped and abused at a rate of at least two times greater than women without. (11)
The risk of domestic violence is higher among women infected with HIV or who perceive themselves to be at high risk of acquiring HIV infection from their spouses because they may be unwilling to have sexual relations with their partners. The latter may thus retaliate with physical violence. Risk factors for domestic violence and HIV infection intersect and overlap. Hence there is a need to raise awareness of the propinquity of domestic violence to HIV infection. (10)
Conclusion
Increased female autonomy has been shown to confer an aura of hope to policies like higher child survival rates and better allocation of resources in favour of children in the household. (13) Furthermore, screening programs, education and training must be made accessible to women because they play pivotal roles in reducing the number of unwanted pregnancies and increasing awareness to women’s health. Finally, the arsenal of existing laws concerning women need to be strengthened so as to protect them against domestic violence and any other forms of violence.
Kevin Mohee is a third year medical student at Leeds University in the UK
um06krm@leeds.ac.uk
References
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