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Key Issues at WSSD: Women, Health
Major Debate Expected on Reproductive Health Care Part THREE in a series of background resources for journalists. Click here for more information
SITE EXCLUSIVE! Worldwatch Institute's upcoming report: Women’s Welfare and the Environment
August 19, 2002 - Cutting across the entirety of the sustainable development agenda – food, water, energy, poverty eradication, environmental protection – are issues related to women and human health. Ensuring that every person in the world has basic health, and that women’s human rights are respected are among the great issues and challenges surrounding the upcoming World Summit on Sustainable Development. At Johannesburg, issues of health, including reproductive health and women are likely to be key areas of discussion – and major debate, as described below.
Women and Sustainable Development
In developing countries throughout the world, women shoulder an enormous set of responsibilities, including both paid and unpaid work. Paid labor may take the form of small business (e.g. handicrafts), agriculture or work in the manufacturing sector. On top of these, women take care of the overwhelming majority of domestic responsibilities: women bear and raise the children, and maintain family health. They are the principal providers of nutrition, and in rural areas of developing countries, they tend to domestic livestock and are responsible for collecting and managing most essential household resources, such as clean water, fuel for cooking and other staples.
Not surprisingly, then, women’s work is long and hard -- in many countries, women work 12 hours or more a day in and out of the home; in Africa and Asia, women work an average of 13 hours more each week than men do.
All told, women make up more than half of the world’s agricultural workforce and in many places, women produce most of the food their families consume. In Sub-Saharan Africa, women are responsible for 80-90% of food production; for 50-60% in Asia. Up to 80% of all fish and shellfish caught in tropical Africa, Asia and the Pacific are cleaned, dried, smoked and marketed by women and children.
In contrast to the full set of responsibilities they carry, too many women around the world are denied the basic opportunities they need to contribute fully to sustainable development and their own fulfillment. Shockingly, it has been estimated that women own less than 1% of the world’s landed property, even as they are often responsible for the majority of agricultural production. Moreover, women often have little control over the basic conditions of their lives – in too many places they lack legal rights to own, inherit and control land and other resources they need for survival; they often are victims of violence and are given little say in community or household decisions.
As leading resource managers, women constantly come in contact with the air, water, and soil in their environments. For this reason, their health is profoundly impacted by environmental factors. Degraded environments, in particular, threaten women’s health in numerous ways:
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Of the 3 million people who die annually from air pollution, more than two thirds die as a result of indoor air pollution. This type of pollution usually results from the indoor burning of biomass for cooking, thus primarily affecting women and girls. The burning of biomass produces other negative health effects, including respiratory infections, lung disease, and low birth weight babies.
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Deforestation and water shortages or contamination augment the time and energy women must expend seeking fuel or potable water. For example, it is estimated that, on average, women in developing countries walk 6 kilometers each day to collect water, carrying the equivalent of a suitcase. The World Health Organization estimates that the energy required by a woman to carry water may use up to one third of her daily calorie intake. Therefore, when water is depleted, it is not just an environmental issue, but also a matter of women’s status, health and well-being.
- Toxic chemicals and pesticides in air, water, soil, food, or urban work environment create a variety of women’s health risks. When these substances enter body tissues and breast milk they can be transmitted to infants.
For additional information about women and the environment, click here.
To access a statement on the WSSD issued earlier this year by women environment ministers, click here.
Health and the Environment
Health will be one of focal points of the WSSD. While global health has improved markedly over the last 50 years – as measured, for example, by life expectancy and child survival – great global challenges persist. These challenges must be addressed to achieve sustainable development. Yet, hundreds of millions of people still lack access to basic health services and diseases that are easily and inexpensively treated continue to take a toll.
Health is inextricably linked to environmental conditions; when the environment is compromised, so is health. Poor environmental quality contributes significantly to communicable diseases that account for 20-25% of deaths worldwide, including infectious and parasitic diseases and respiratory infections and diseases.
Currently, 1.5 billion people do not have access to potable water and 3 billion – half the global population – lack sanitation facilities, such as a sanitary latrine, covered wastewater drain, or a flush toilet. Diseases associated with dirty water kill between 5 and 12 million people a year, mostly women and children. The World Health Organization (WHO) estimates that every year about 2 billion people, one-third of the world population, suffer from diseases linked to water.
Sixty per cent of the global disease burden related to acute respiratory infections, 90 per cent related to diarrhea; 50 per cent related to chronic respiratory infections; and 90 per cent related to malaria could be avoided by well known environmental interventions.
Cancer causing agents like lead, mercury and cadmium, also are widespread health problems around the world as a result of growing human consumption of heavy metals for industrial activity, transportation (e.g. leaded gasoline) and other activities.
Tying It All Together – Women, Environment and Health
Issues associated with reproductive health bring home the central imperatives of women, the environment, health and sustainable development.
The greatest single threat to a woman’s health during her reproductive years is pregnancy. Every minute of every day, a woman dies in pregnancy or childbirth – more than 500,000 deaths a year, almost all of them in developing countries.
Most of the deaths that occur in pregnancy or childbirth could be prevented by access to basic health services, such as presence of a skilled attendant. Nearly half of all women in developing countries deliver without a nurse, doctor, or midwife present. Thirty-eight million women in Africa, Asia and Latin America – 30% of the women in those regions – receive no care during pregnancy. The probability of dying in childbirth in a developed country is one in 4,100, but in a developing nation it is one in 13.
According to experts, certain chemicals such as PCBs, DDT, dioxins and at least 80 pesticides are “endocrine disrupters” that may interfere with normal hormone function and undermine intelligence, disease resistance and reproduction. While research is continuing into these linkages, concern is growing about the impact of endocrine disrupters on infertility among women, miscarriage, declining sperm counts, certain cancers and early puberty in girls.
A variety of chemicals also are associated with cancer in women – including breast, ovarian, cervical, uterine and vaginal – pregnancy failures and childhood development difficulties.
The HIV/AIDS crisis is severely affecting women, who now account for almost half all people living with AIDS. In places hardest hit by the pandemic, infections among women are increasing rapidly. For a host of biological, social, economic and other reasons, young women are substantially more vulnerable to AIDS infection. Moreover, women are most seriously impacted as families and communities are effected by the disease. In communities where families barely survive at subsistence levels, the death of male heads of households from AIDS can place even more extraordinary burdens on women.
For all of these reasons, promoting reproductive health, education and equal opportunity for women are critical challenges for the future. Access to reproductive health services is not within reach for millions of women and access to modern family planning is currently denied to over 350 million couples worldwide. It is estimated that this figure will grow by more than 40% by 2015, as the demand for family planning increases and the global population growths.
To learn more about reproductive health and other basic health care issues for women, click here.
Debate at the WSSD
There is broad consensus among WSSD participants on the general need to promote global health – there is less agreement on certain key goals. For example, while there is agreement that that the proportion of people without access to clean water should be halved by 2015, no such consensus exists on the goal of similarly reducing the proportion of people living without access to basic sanitation.
Issues associated with reproductive health (paragraph 47, especially subparagraph j of the draft document are likely to be even more controversial. During preparatory meetings, little attention has been paid to population issues and matters of reproductive health. At the final “PrepCom” in Bali, compromise language was proposed to address concerns express by the United States and others about perceived promotion of abortion. Although the agreed action plans at a full series of international conferences in the 1990s made clear that reproductive health care does not include abortion services where they are illegal, and that laws related to abortion are a sovereign matter, the United States insists that the phrases “reproductive health care” and “reproductive health services” are unacceptable because they imply a global right to abortion.
In addition, as it did at the Children’s Summit in May of this year, the United States is expected to promote an abstinence-only approach to services for adolescents and to resist inclusion of language regarding reproductive health services and sexuality education for young people, even though they are often married and at greatest risk of HIV/AIDS infection.
At the conclusion of the Bali preparatory meeting, certain delegations disagreed with the US position and the current wording on reproductive health care and services for adolescents. Led by the Canadians and certain European nations, a coalition of delegations plans to resist efforts at Johannesburg to water down the consensus language agreed at the 1994 International Conference on Population and Development, the 1995 World Social Summit, the 1995 Fourth World Conference on Women and other meetings.
At Johannesburg, there is likely to be a major clash on these issues between the United States and a handful of conservative Muslim nations on one hand and the rest of the world on the other.
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