Less than healthy

A new book charges that Latin American women suffer disproportionately from preventable health problems.

By Charo Quesada

Latin American women are less healthy than they appear.

Over the last 30 years impressive reductions have been achieved in general fertility and mortality rates, and the life expectancy of women in some countries of the region is now close to 80 years. But this gift of longevity is not always accompanied by well-being. In Latin America and the Caribbean many women are disproportionately prone to suffer from chronic diseases such as diabetes and circulatory and rheumatic disorders. They also have high rates of certain kinds of cancers and of the mental and occupational disorders typical of the present age.

Why is this the case? According to Women’s Health in Latin America and the Caribbean, a recent study published by the IDB, the Pan American Health Organization and the World Bank, these health problems are largely due to health policies that take no account of the great biological and socioeconomic differences between the sexes. Decisions on the health of women have traditionally been taken by their partners, community leaders and ministerial officials (most of them men), who act on the basis of uniform collective priorities. However, women’s health needs are in many ways different from men’s, and they pose unique challenges that stem from women’s roles as mothers (or possible future mothers) and from their traditional subordinate status in the home, the community, and the workplace.

The new study states that societies in most Latin American and Caribbean countries invest less in the health of women than in that of men. Even when they have higher income levels, families tend to spend less on health care and education for girls than for boys—particularly in times of economic crisis. In that vein, a revealing study conducted by Duncan Thomas in Brazil in 1994 showed that the tallest girls came from homes in which the decisions on health were made by the mother.

Not surprisingly, the new study confirms that Latin America’s low-income women have less access to healthcare than those who are better off do, and that women in rural areas have less than those in the cities. Indeed, while the middle and high-middle classes enjoy decent public and private care, the poor often do not receive even the most basic services. Health care resources such as specialists and equipment tend to be concentrated in the large urban hospitals and are rarely available in the countryside.

However, the authors of the new study do not claim that these imbalances should be solved by a massive increase in the resources allocated to women’s health. Instead, they propose that the situation could be considerably improved—without drastically adding to the available resources—if the medical, economic and social situation of women were better understood and if that knowledge were applied to the health sector reforms that are currently under way in many Latin American countries.

“The region’s governments are aware of the problem and are making an effort to redress these great imbalances,” affirms Amanda Glassman, an IDB specialist and one of the authors of the study. She adds, however, that in many countries health strategies are only now being designed with a view to meeting the specific needs of women.

Mothers, a rewarding investment. These efforts are propelled by a growing awareness of the importance of healthy women to society as a whole. A woman’s health, her education, and her understanding of health problems all determine how many children she will choose to have, how healthy they will be at birth and how well they will be cared for throughout childhood. In many households women also take care of other adults and elderly relatives. When the health of the woman fails, the repercussions on this circle of dependents are usually dire.

“It is crucial that governments be aware of the intergenerational effect of women’s health,” Glassman asserts. “Information, especially on reproductive health, is very important and is generally very scarce and altogether insufficient.”

Given that women are fertile for such a substantial part of their lives, it is hardly surprising that experts emphasize the importance and benefits of investing in reproductive health. Yet public education concerning this issue is generally scarce, according to the study. In the countries of low and middle status there is evidence of a deficient nutritional situation, undesirably high fertility levels, high-risk maternity and inadequate prenatal services. Between one-third and one-half of expectant mothers in the region suffer from iron-deficiency anemia. The women at greatest risk of pregnancy-related problems generally have no access to basic health services. Though average fertility has dropped from 5.0 to 2.7 children per woman, sharp differences between poor and wealthy women remain. In Peru, for example, the poorest 20 percent of women have an average of 6.6 children in the course of their lives, compared with 1.7 children among higher-income women.

continued…

Date posted: February 2002