Women's Health and Well Being Key to a Better World

Jyoti Tiwari

"Women's empowerment is the only way to ensure peace, social inclusion and prosperity in the world" - these were President Smt. Droupadi Murmu's words while virtually addressing the 'Global Women Summit 2023' recently held in Abu Dhabi. She further said that India aims to prioritise three key aspects- (i) promoting women's leadership at all levels including at the grassroots level (ii) encouraging women's entrepreneurship, (iii) ensuring women's education in order to ensure women's empowerment and equal participation in the workforce. The President's statement sets the tone for India's G-20 Presidency's Women's Empowerment Agenda while underscoring India's sustained commitment to prioritising women's empowerment within the ambit of governance. India has enacted several exemplary legal and policy frameworks to ensure women's right to education, work, and good health. These rights are interdependent and interconnected, and the realisation of one can contribute to the realisation of the others. The right to education for women is essential for their economic independence, empowerment, and their ability to make informed decisions regarding their health. Education facilitates access to health information and resources, promotes critical thinking skills for evaluating health information, and fosters healthy behaviors and practices. Additionally, education can equip women with knowledge and skills to secure better-paying jobs, which, in turn, can enhance access to better healthcare services. The right to work for women is critical for their economic empowerment, which can improve their overall well-being and access to healthcare services. Employment can provide women with financial resources to afford quality healthcare services, and also offer benefits such as health insurance coverage. Meanwhile, the right to good health is a fundamental human right that includes access to affordable, quality healthcare services, nutrition, clean water, and sanitation. A healthy workforce is more productive and contributes to a country's economic growth, while benefiting women's economic and social well-being. Thus the centrality of good health is in realising all other human rights, including women's right to education and work. The World Health Organisation (WHO) recognises that health is a complex phenomenon that is determined by physical, mental, and social well-being, rather than just the absence of disease or infirmity. The concept of health encompasses not only medical factors but also a range of social, economic, and environmental factors. These factors, including Gross National Product, wealth distribution, access to education, urban and rural living environments, and political structures, can be analysed through various statistical indicators of social and economic functioning. In some societies, women are often subject to lower social and economic status, which can result in low selfesteem, inferiority, and devaluation. This devaluation is often perpetuated through cultural, religious, and legal traditions, such as the requirement of dowry payments or the preference for male offspring. The cumulative impact of these cultural and socio-economic factors can result in poor health outcomes and reduced access to health services for women. Women's health is related to multiple human rights, including the right to life, the right to be free from torture, the right to privacy, the right to education, and the prohibition of discrimination. The Convention on the Elimination of All Forms of Discrimination against Women (CEDAW) is the foremost global instrument promoting equal rights for women. Adopted in 1979, it is a comprehensive and far-reaching treaty requiring member countries to eliminate all forms of discrimination against women in all areas of life, including healthcare and family planning.

·         CEDAW mandates that women's right to education includes access to information that promotes the health and well-being of families, including family planning. (article 10)

·         As per CEDAW, women have the right to make informed decisions regarding the number and spacing of their children, and must have access to the necessary information and resources to do so. (article 16)

·         The CEDAW Committee's General Recommendation 24 stresses the importance of preventing unwanted pregnancies through family planning and sex education

·         According to the Committee on Economic, Social and Cultural Rights (CESCR) General Comment 14, providing maternal health services is a non-negotiable obligation and states must take immediate action to ensure this right is upheld during pregnancy and childbirth.

·         The CESCR General Comment 22 advises states to eliminate laws, policies, and practices that obstruct or restrict access to sexual and reproductive health services, goods, and information

·         International human rights standards in this area are outlined in the OHCHR (Office of the High Commissioner for Human Rights) information series on sexual and reproductive health and rights.

Despite these obligations, violations of women's health and rights are frequent. The violations take on many forms, including denial of access to womenspecific services. These violations often stem from deeply ingrained societal beliefs and values surrounding women's sexuality. Patriarchy perpetuates the notion that women are valued based on their ability to bear children and this mindset often leads to early marriage and repeated pregnancies, putting a toll on their health and at times, resulting in fatal consequences. Women who struggle with infertility are often blamed and face ostracism, leading to various human rights violations.

Health Risks in Infancy and Childhood: In certain communities, the practice of prenatal sex discernment may result in female fetuses being terminated. Neglect in providing proper care, such as nursing and feeding, may result in malnutrition, even though girls possess a higher biological resistance to infections and malnutrition. Prejudiced family feeding practices contribute to the malnutrition of surviving girls. A lack of education and reading skills further limit a girl's opportunities and leads to a lack of health knowledge and prevention. Female circumcision, a harmful tradition in certain areas, endangers girls and is driven by cultural beliefs and values. This procedure, often performed prior to puberty, results in direct and indirect health problems, including infections, tetanus shock, bleeding, sepsis, inability to urinate, infertility, menstrual difficulties, fistulas between the bladder and vagina, and childbirth difficulties. The most extreme form of circumcision, infibulation, carries the highest health risks. According to the World Health Organisation (WHO), 80-100 million women in sub-Saharan Africa have undergone circumcision, with 15 million undergoing infibulation. This data does not include women in Southeast Asia and immigrant populations in developed nations where the issue persists.

Health Risks During Adolescence: In addition to the negative health impact experienced by girls as a result of disadvantaged childhoods, they also face additional hazards during adolescence. As they enter their sexual prime, it can leave women vulnerable if they lack the autonomy to choose when and with whom they become sexually active. Premature pregnancy can pose a threat, especially if it occurs outside of marriage, and can result in additional shame and exclusion. Teenage mothers are also at a higher risk of maternal mortality and the likelihood of repeat early pregnancy further increases this danger. Adolescence also presents risks such as sexual abuse and exploitation, including exposure to sexually transmitted diseases, and the danger of contracting HIV from older sexual partners. Adolescent girls may also be particularly susceptible to abuse of drugs due to sexual exploitation, and are frequently targeted by advertisers of tobacco and alcohol products, putting them at risk for immediate and long-term health problems related to addiction. A combination of marriage, pregnancy, and care-giving responsibilities may prevent girls from attending school, leading to poor education and limited job opportunities, as well as physical strain from caring for sick and elderly relatives, and performing household and agricultural tasks.

Health Risks of Women at Work: Work performed at home, often considered "unemployment," can be just as hazardous to women's health as industrial work. Malnourished women may face long hours of heavy labour, exposure to smoke-generating fuels and household chemicals, and injury risks like burning and scalding. Women competing with men in the workplace may be at higher risk of physical harm, and women in traditionally "feminine" jobs often face low pay and long hours. Working women outside the home also face a double burden of domestic work and limited time for self-care, exacerbating health strains.

Reproductive Health: Reproductive health refers to a state of complete physical, mental, and social well-being in the reproductive process. It involves the ability to reproduce and regulate fertility, successful pregnancy and childbirth, and safe sexual relationships. Lack of basic obstetric services and reproductive health care results in high rates of maternal mortality and morbidity. Fear of unwanted pregnancy and social pressure can negatively impact women's sexual health. Women's health is further threatened by the spread of diseases like AIDS and HIV, where they are often seen only as vectors of transmission. Women may be disadvantaged in protecting themselves against HIV and may face judgement and lack of access to health services.

Violence Against Women: Domestic violence against women is a major issue that has often gone unrecognised and untreated due to societal stigma. In some cultures, physical force is accepted, and perpetrators are not held accountable. In industrialised nations, violence against women is a leading cause of injury, surpassing accidents, rape, and mugging combined. Elderly women are also at risk of abuse. The failure to acknowledge and address violence against women mirrors the failure to address child abuse. Women suffer from a range of assaults, both in and outside the home, that compromise their physical and emotional well-being, security, and self-esteem, leading to significant harm to their health.

Other Areas of Concern: Due to the diminished societal standing of women, the effect of numerous illnesses on them has been largely overlooked. Malaria, Leprosy, Onchocerciasis, Lymphatic Filariasis, Leishmaniasis, Schistosomiasis, and Tuberculosis are examples of such diseases that may not infect women more frequently than men, but tend to result in more severe outcomes due to societal stigmas, delayed reporting of symptoms, and guilt for not fulfilling traditional caregiving responsibilities. Historically, the distinction between genders in illnesses such as cancer and heart disease, which are the leading causes of death for women in industrialised nations, was ignored, as were the varying impacts of treatment drugs on men and women. In clinical trials, men have been used as the standard and it is only now that the inadequacy of this standard for women is being acknowledged. The health concerns of the elderly, particularly in industrialised countries, are also becoming increasingly important, with women on average living longer than men but experiencing a longer period of overall illness and with little attention paid to gender differences in quality of life or specific illnesses among the elderly.

Need for Health Research from Female Perspective: A growing recognition has arisen of the difficulties faced by women in both developing and developed nations when it comes to their health. Research shows that there are numerous reasons for these difficulties, including injustices that have been classified as violations of internationally protected human rights. For example, maternal deaths can be caused by a lack of access to maternity care, underlying issues like exhaustion and anemia linked to multiple births and short intervals between them, and systemic issues like poverty. The causes of morbidity and mortality vary greatly, depending on the country, disease, and socio-economic and ethnicity of populations. However, a significant variation is the difference between men and women, which has not been adequately addressed in research and practice. In terms of reproductive health, studies have typically not taken into account the differences between the sexes. This is partly due to the menstrual cycle being considered a confounding variable in data analysis, and partly due to concerns about exposing fetuses to unknown risks through experimentation. Women differ from men in far more ways than just reproductive function and hormonal status, which makes research and health interventions based solely on male or undifferentiated population less relevant. Women have different body shapes, organ sizes and distributions of body fat, which affects how they respond to drugs and therapies. For these reasons, health problems need to be approached from a female perspective. At all levels - national, regional, and international - there is a pressing need to improve the prevention, diagnosis, and treatment of illnesses in women and to expand research on conditions that affect them. Risk factors for poor health can be analysed based on a range of criteria, and women at risk can be classified based on factors like age, socio-economic status, literacy, educational status, family structure, and ethnicity. The following points, which is not exhaustive or comprehensive, provides a context in which human rights law can be invoked to provide relief, remedy, and preferably preventative interventions for women facing health difficulties

·         Human rights law acknowledges the state's responsibility to ensure access to obstetric services, a right protected by the Right to Healthcare. The Right to Education, among other rights, addresses the underlying cause of multiple births. When women and men have access to information and education on family planning, they are better able to understand the health benefits of spacing out their pregnancies. States may also be held responsible for poverty, which can be addressed by the Right to Development

·         Over the past many years, efforts have been made at different levels to enhance the health and well-being of women through the utilisation of human rights law. Healthcare associations are offering legal services to women to educate them on their legal rights and to promote the legal protection of their health. Internationally, medical associations are implementing programs aimed at promoting the significance of medical ethics in the realm of human rights protection and educating their members on the practical application of these ethics in both practice and research. Although these initiatives are commendable, they are also sporadic in nature. Hence, there is a pressing need for a more vigorous and sustained examination of the health status of women at the national, regional, and international levels.

·         The advancement of these efforts necessitates the allocation of various types of resources, including the education of health professionals in human rights law and the education of human rights advocates in the acquisition and interpretation of health data and the identification of legally significant elements. Health professionals and human rights advocates who are motivated by the goal of promoting and protecting women's health should use health data to inform their advocacy, utilising their knowledge of current and achievable practices and the objectives outlined in international human rights treaties.

The implementation of human rights principles for the promotion and protection of women's health would serve as a powerful catalyst for the above proposals. These principles should specifically address factors related to health status, health service provisions, and conditions affecting the health and well-being of women. Based on these principles, efforts can be made to develop specific guidelines for the legal promotion and protection of women's health. With the demonstration of sound practices and adherence to these principles, appropriate mechanisms at all levels can establish standards for the observance of women's rights to health, thereby addressing any instances of injustice and paving the way for necessary reforms.

(The author is a journalist and social activist with focus on women's rights and disaster risk reduction. She can be reached at mailmeatjyotitiwari@gmail.com)

Views expressed are personal.