Skip to main content

Less than healthy

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.

ldquo;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.

All this leads to the birth of children with physical and cognitive disabilities and subsequent development problems. Unplanned pregnancies are common throughout the region, leading many women to resort to illegal abortions that endanger their lives. In most of the region’s countries between a fourth and a third of women up to the age of 18 are pregnant or already have a child, and they usually make little use of contraceptives. One study of eight Latin American countries calculated that half of all pregnancies among young women are unplanned.

Unfortunately, financing for the kind of reproductive health services necessary to reverse these problems is very uneven in the countries of the region. In Brazil and Jamaica, for example, reproductive health spending is at a reasonable level, whereas in Paraguay and the Dominican Republic investment in this sector needs to be increased 11 percent to 15 percent, respectively. Peru and Guatemala require spending increases of between 25 percent rand 50 percent, according to the new study.

The study concludes that, on the whole, reproductive health policies promoted by donor agencies and the region’s governments have had positive results, but that they still fall short, especially among poorer women. Effective mechanisms for including input from women’s health advocates in decision making processes are rare. Ironically, there are a number of well-designed and well-executed reproductive health projects in Latin America today, run by people who understand the real situation of women, which could be used as models by policymakers charged with reforming the health sector. Unfortunately, poorly designed and poorly executed initiatives tend to overshadow the successful ones.

More knowledge makes better investments. What the authors of the new study recommend is simple:

  • Study the problems peculiar to women, adapt health reforms to fit that reality, and include women’s health advocates in the design and execution of relevant projects.
  • Invest in reproductive health and provide information and education to young people in this area.
  • Study the lore and practices of indigenous communities and other groups and apply them to local health programs.
  • Redress the present imbalance in which health systems invest more in high-income sectors than in the poor sectors, and a disproportionately large share of resources in urban hospitals, leaving rural areas in precarious case.

In regard to public and private services, the authors of the study call for reinforcing and coordinating the two systems without overlooking the socioeconomic situation of women who in many cases lack resources of their own and depend on their partner’s willingness to pay for health services.

In the meanwhile, the IDB is adding components relating to women’s health and reproductive health to its portfolio of health-related programs. For example, the program “Support for Modernization of the Ministry of Public Health and Social Welfare,” approved for El Salvador in 1998, is financing a basic package of services for the low-income population that includes maternal and child care, family planning, and treatment of uterine and breast cancer. A similar loan approved for Honduras that same year facilitated the expansion of the Basic Access Program designed mainly to serve women, children and low-income earners. This program gives special attention to domestic violence as a public health problem that mainly affects women and children. Other recent IDB projects in Haiti, Nicaragua, Argentina and Peru also include important women’s and reproductive health components in addition to addressing the problems of adolescent pregnancy and child health.

According to Glassman, priorities within the IDB’s health initiatives have also evolved over time. Formerly, she explains, the Bank gave priority to maternal health, with emphasis on prenatal care and infant nutrition. Today its programs are based on the broader paradigm of reproductive health, which includes other essential services such as family planning, the prevention of sexually transmitted diseases such as HIV/AIDS, and training for health workers.

“The benefits of healthier women in the region are immense,” Glassman asserts. “The rewards of protecting women’s right to a healthy life accrue to them, to their children, and to future generations.”

Jump back to top