What she wants

Abstract

The Bezjing Platform for Action, adopted at the Fourth World Conference on Women in 1995, states that “women have the right to the enjoyment of the highest attainable standard of physical and mental health”. Although the majority of women are unaware of this right, they know that they want good, or better, health throughout their lives. This is frequently denied them and, whatever ill-health women suffer in the so-called developed world, the situation is incomparably worse for the great majority who live in developing countries (figure). In developing countries, women are discriminated against as soon as they are born and even before they are born. While the birth of a son is greeted with celebration, the birth of a daughter in many societies is a matter for condolences. In some countries, such as China, with its “one child” policy, prenatal sex selection is practised. The female fetus may be aborted, or the baby girl may be killed or exposed soon after birth. In many parts of the world boys will be fed first and, when food is short, girls will be fed less and suffer from the effects of malnutrition, which can affect their skeletal development predisposing them to later obstetric complications. Meanwhile they, rather than their brothers, will be expected to bear the brunt of the housework, including carrying heavy weights of firewood and water over ever-increasing distances. In some countries they will undergo harmful traditional practices including female genital mutilation, with both short-term and long-term health risks. Teenage pregnancy, resulting from inadequate information and services, is a major issue in both developing and industrialised countries, but medical termination of unwanted adolescent pregnancy is seldom available to girls in developing countries. In Africa, every year thousands of girls are expelled from school for getting pregnant. They have no chance of resuming their schooling and incur high risks to their health from unsafe abortion. Girls are married early in the Middle East and parts of Asia as a result of traditional practice or for dowry to pay for the needs of their family, such as a brother’s education. Early, inadequately spaced, and frequent pregnancies follow, often with obstetric complications (such as fistulae associated with immature pelvic development) and the birth of low-weight babies. Fistulae are unacceptable to husbands, and women with this complication are often rejected and end up on the streets. The World Health Organization has lately uprated its annual estimate of global maternal mortality from 500 000 to 585 000, more than 99% of which occurs in developing countries. Millions of other women suffer for the rest of their lives from the complications of pregnancy or childbirth. Most of this mortality and morbidity is avoidable.