Women and Gender Issues
Introduction
Intense national efforts supported by a number of global partnerships have led to great progress over the past two decades in reducing maternal and newborn mortality and improving the health and well-being of women1 newborns and adolescents (1). But progress has been uneven and too many are still being left behind. Global estimates point to approximately 810 maternal deaths every day (2) one stillbirth every 16 seconds (3) and 2.4 million newborn deaths each year (4) while almost one in five women gives birth without assistance from a skilled health provider (5). An estimated 218 million women globally have unmet needs for modern contraception (6) and at least 10 million unintended pregnancies occur each year among 15–19-year-olds in low- and middle-income countries (7). Emerging data from 2020 are starting to reveal the devastating effects of Covid-19 across these and other key indicators of sexual reproductive maternal newborn and adolescent health (SRMNAH) (8). The response to and recovery from the pandemic must prioritize meeting the SRMNAH needs of women newborns children adolescents and families.
Foreword
Today our world grapples with deep and interlocking global challenges from the existential threat of climate change to pervasive poverty and growing inequality to shrinking democratic and civic spaces and most recently the COVID-19 pandemic. As we imagine and act upon sustainable and transformative responses to these challenges the World Survey 2019 affirms that attention to gender equality remains of paramount importance.
Enabling and empowering the srmnah workforce: Gender matters
The health workforce is on average 70% women although there are gender differences by occupation (125). Women account for 93% of midwives and 89% of nurses compared with 50% of SRMNAH doctors (see Chapter 5). The considerable gendered disparities in pay rates career pathways and decision-making power create systemic inefficiencies by limiting the productivity distribution motivation and retention of female health workers (126).
About The World Survey On The Role Of Women In Development
With growing global attention being paid to the idea of ‘leaving no one behind’ the time is ripe for gaining insight into the unique ways in which poverty shapes and constrains the lives of women as a means to inform policy action. Unpaid care and domestic work contribute to human well-being and feed into economic growth through the reproduction of a labour force that is fit productive and capable of learning and creativity. However women’s disproportionate responsibility for that work increases their vulnerability to poverty. Discriminatory social norms and gender stereotypes position women and girls as the default providers of care1 which means that women are less able to acquire access to decent paid work be financially independent and accumulate savings assets or retirement income for their later years.
Need for and availability of midwives and other srmnah workers
This chapter assesses the state of the world’s SRMNAH workforce in 2019 and uses modelling to predict how this might change by 2030. The composition of the SRMNAH workforces varies: different countries use different job titles to describe occupations and the roles and responsibilities of an occupation may differ between countries using the same job title. This variation in classification and nomenclature frustrates efforts to conduct national and global monitoring and analyses. For example not all countries or languages distinguish clearly between midwives and other occupation groups such as nurses obstetricians and traditional birth attendants and a midwife’s scope of practice is not the same in every country. A recent review found 102 unique names used in low- and middleincome countries to describe health workers who attend births (78). Similarly not all countries adhere to the 2018 definition of skilled health personnel providing care during childbirth (79).
Breaking The Cycle Of Income And Time Poverty Among Women: The Role Of Basic Infrastructure And Public Services
Across developing countries women who are income-poor and live in rural or remote areas are disproportionately excluded from access to time-saving infrastructure and high-quality public services such as health and education. As a result income and time poverty among those women increases and their capacities are depleted. The challenge is particularly acute in least developed countries and countries affected by crises. The physical distance from and the lack of affordability and poor quality of infrastructure and public services are among the most significant barriers to access for women who are both income-constrained and time-constrained. In addition service delivery models and investments in infrastructure often remain blind and unresponsive to the time-use and mobility patterns of women including women with young children limiting their potential to reduce poverty and mitigate depletion.
Conclusions And Recommendations
The present World Survey on the Role of Women in Development has contained an examination of the important links between gender equality income poverty and time poverty. The responsibility for unpaid care and domestic work which falls disproportionately on the shoulders of women and girls sustains people and households on a day-to-day basis and across generations. Unpaid care work is the foundation upon which all other economic activities rest. Rooted in discriminatory social norms and gender stereotypes women’s disproportionate responsibility for unpaid care and domestic work has significant consequences for both women and their families and is deeply connected to the high rate of poverty among women. The intersection of income poverty and time poverty among women is starkly evident in the fact that they are at greatest risk of poverty at the stage in their life course during which they form a family and raise children. At that stage families face the increased expenses associated with having children and the women in the family also have less time available for paid work. Women face a stark choice between forgoing income-generating opportunities or accepting insecure forms of employment while struggling to manage their heavy and intense burdens of unpaid care and domestic work responsibilities.
Equity of access to the srmnah workforce
The SoWMy need and demand calculations presented in Chapter 4 have limitations not least that they do not take into account within-country inequities in the availability of and access to SRMNAH workers. Unless the workforce is equitably available and accessible to all service users and able to provide the same quality of care for all it will not meet all the need for SRMNAH services regardless of the number of health workers.
Foreword
The Covid-19 crisis has prompted changes in how we think about health care and support: when and where it should be delivered who should be involved and what human and other resources should be prioritized. One important lesson is that even the most robust health systems can suddenly become fragile. We have seen during the crisis that women and girls have been affected in many ways including increased genderbased violence and reduced access to essential sexual and reproductive health services leading to increases in maternal mortality unintended pregnancies unsafe abortions and infant mortality.
Education and regulation of midwives to ensure high-quality care
High-quality midwifery education is essential to prepare midwives to provide high-quality SRMNAH care (50). Despite evidence of the benefits produced by investment in it midwifery education and training remain grossly underfunded in many countries. There are wide variations in the content quality and duration of education programmes and key challenges relating to resources and infrastructure which adversely affect students’ learning experience and limit opportunities for gaining “hands-on” experience (51-56). Research across Africa and South Asia has shown that inadequate education and training significantly jeopardize the professional identity competence and confidence of midwives as primary SRMNAH care providers (57). However there are indications that positive efforts to improve the quality of midwifery education are under way in a number of countries (58) including India (Box 3.1).
Preface
The 2017 edition of World Population Policies a report published biennially since 2001 provides an overview of the laws and policies relating to induced abortion. It includes consideration of the various legal grounds for abortion and selected requirements for induced abortion including gestational limits the number of personnel required to authorize an abortion mandatory third-party consent and compulsory counselling and waiting periods.