The importance of the educated healthy woman in Africa

Abstract

The 46 countries that make up the Africa region according to the WHO classification cover more than a sixth of the world’s land mass. All are developing countries. Though rich in natural resources, the region is poor in technology; and the huge number of ethnic groups (nearly 400 in Nigeria alone) each with its own language and culture, the varied religious beliefs, political circumstances, and traditional forms of health care make generalisations about social and living conditions difficult. The one outstanding reality is the low status of women. Raising women’s status and so avoiding the dangerous consequences of low status requires massive investments in education and health. Poverty is a major constraint: 60% of the population have to live on less than US$6 per week, so development is unsustainable. Narrowing of the wide disparities between Africa and the rest of the world (table) is a challenge heavily dependent on educated healthy women in Africa, their numerical strength and empowerment being crucial. Basic indicators encapsulating health, marriage and children, education, employment, and social equality have been used by the population crisis committee of Washington, DC, to measure the wellbeing of women; the scores were converted to a maximum total of 100 and the countries were ranked as excellent (scores above 80), through very good, good, fair, poor, very poor, to extremely poor (scores under 30). The 99 countries studied included 18 in the Africa region; all ranked as very poor or extremely poor, except South Africa and Botswana (rated as poor). The underlying reasons for the low women’s status in Africa are tradition and culture, illiteracy and ignorance, and poverty, with the limitations they all place on women’s lives. Those able to engineer their escape from these underlying factors are usually the better educated; they become the advantaged group. Deep divisions exist between them and the remaining disadvantaged group. Factors increasing the risk of maternal mortality and morbidity occur in both groups, but the difference is that the proportion affected in the advantaged group is smaller and the factors operate to a lesser extent than they do in the disadvantaged group. These risk factors are early marriage, early teenage pregnancy, growth stunting from poor childhood nutrition and infection, poor contraceptive usage, and high fertility. During pregnancy and childbirth, neglect—self-inflicted and that imposed by the societal mores—that has operated since childhood intensifies. In the worst-affected areas, there is no prophylaxis against anaemia; hypertension goes unrecognised; neglect in labour leads to obstruction, uterine rupture, obstetric fistula, and fetal death; and postpartum neglect leads to heavy blood loss and infection. Hence, the differences in maternal mortality rates between the two groups in each country and between countries with low and higher status of women. In Botswana, the maternal mortality rate is 200 per 100 000 births, and the number of female per 100 male pupils enrolled in secondary education is 109. By contrast, in Mali the corresponding figures are 2000 maternal deaths per 100 000 births and 48 female per 100 male pupils enrolled in secondary education. The improved knowledge acquired through literacy and education and the enhanced reasoning power conferred by reading raise women’s low status through many channels. Marriage is delayed until after schooling or basic education, by which time physical maturity has probably been reached. Knowledge about marital life, its functions, and duties are acquired through reading. The nature of family planning, unwanted pregnancy, maternal health, childbirth, and the circumstances surrounding them are