Stumbling Over Reproductive Health
Resolve instead never to put a stumbling block or hindrance in the way of another. - Romans 14:13
In many developing countries, significant obstacles have been put in the way of a woman, especially when it comes to her reproductive rights. A woman’s reproductive health in these countries is affected by the social, cultural and economic conditions in which she lives. Unequal access to information, care and basic health practices increase the health risks for women.
Every woman has a right to complete health care throughout her life. This includes the right to plan pregnancies, space child births and the right to have control over her body. According to the United Nations, reproductive health is described as “a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity in all matters that relate to the reproductive system.”
Women’s reproductive health therefore implies that women should be able to have a satisfying safe sex life, the capability to reproduce and the freedom to decide if, when and how often to do so.
However, women in developing countries usually have less power, fewer resources and lower status in the family and community. Where men traditionally control household finances, women’s health expenses are often not a priority. This basic inequality means that more women than men lack access to important health information and services. Also, more women than men lack control over their basic health care decisions. Women are often not in a position to decide if, when and with whom to become pregnant or to determine the number, spacing and timing of their children’s births.
Cultural practices like early marriages, female genital mutilation, wife inheritance and too many childbirths signal the violation of a woman’s right to make decisions about her body. For example, in some parts of East Africa there is a cultural practice that dictates that when a man dies, his wife must be “inherited” by one of the man’s relatives. This means having sex with this male relative, and, more often than not, it is unprotected sex. There is a belief that until this is done, the dead man’s spirit will haunt the wife. In some cases men with some degree of mental problems are hired to carry out this “inheritance.” Women usually have no voice in these decisions.
Many women prefer to see female health care providers. However, women health care providers are few in the developing world, which presents yet another cultural obstacle to women seeking health services. Also, more often than not, pregnant women are not the ones who decide whether or where to seek health care. This decision is made by the husband sometimes with the mother-in-law’s input.
Often families value boys more than girls. In some cultures, it is the male members of the family who perform ceremonies after the death of the parents. They also carry the family name. As a result, girls are often discriminated against. They are breast-fed for a shorter time, given less food and medical care, and receive little or no education.
HIV and AIDS
Discrimination against women leads to many health hazards including HIV and AIDS and other sexually transmitted diseases. Women often cannot refuse unsafe sex because of unequal gender power dynamics in their societies and institutions, including marriage. They cannot control decisions or negotiate safer sexual practices. In some African settings, the topic of sex is a taboo. It must not be talked about, and women are expected to succumb to the wishes and whims of their partners without asking questions. They are often at the mercy of their partners’ demands. As a result, statistics show that 165 million women get sexually transmitted diseases every year, and the majority of them are in the developing countries.
In the developing world, especially sub-Saharan Africa, women continue to suffer disproportionately from the global HIV and AIDS epidemic. Young women are particularly vulnerable to HIV and AIDS. They have higher infection rates than men due to their physiological vulnerability, the exchange of sex for gifts or money between young women and older men and their low status in society. It is estimated that more than 17 million women are already infected with HIV worldwide and that most of them live in sub-Saharan Africa.
Frequent pregnancies pose another health obstacle for women in developing countries. Almost half of all young women in developing countries become mothers before the age of 20. This puts a woman at risk of poor health and complications of pregnancy and childbirth. Frequent childbirths means that the woman is less able to control her own life, to get an education and to learn skills to support herself.
According to the United Nations Population Fund State of the World Population reports, children who are born into large, closely spaced families have to compete with brothers and sisters for food, clothing and parental affection. If these children survive their vulnerable childhood years, their intellectual development may be impaired, and their growth is more likely to be stunted than their counterparts in more advantaged homes.
UNICEF reports that every minute a woman dies from a problem related to pregnancy — about 529,000 a year — and the vast majority of these cases occur in developing nations. While nearly all women in industrialized countries receive prenatal care, many pregnant women in developing countries seek prenatal care only when they have a complaint. In a study in Morocco, 50 percent of women said they had not sought care during their pregnancies because they had not experienced a problem. Others do not seek medical care because such services were not available.
Unsafe abortion is also a health obstacle for many women in the developing countries. Women often cannot negotiate sexual activity because of cultural or religious mores and societal gender inequality, and so they become pregnant. Although trying to terminate the unwanted pregnancies puts their lives at risk, many resort to doctor impostors. Complications from unsafe abortions are a major factor of maternal death and disability. In the developing world, 16 percent of all maternal deaths are attributed to unsafe abortions.
Female genital mutilation, a cultural practice in parts of Africa, the Middle East and Asia can cause serious health problems. Generally practiced in unsanitary conditions, acute hemorrhage and infection can occur. Girls below the age of 10 who cannot make informed decisions are subjected to this practice.
Poverty is a key cause of maternal mortality. When we are talking about the poorest of the poor, we are talking about women. This means that the poorer the household, the greater the risk of maternal deaths and morbidity.
Gender-based violence is a worldwide problem that is rampant in developing countries yet often overlooked as a health problem. Many girls are sexually abused by family members and friends, and many women are forced to have sex or are physically abused by their partners.
The way forward
Much needs to be done to improve the reproductive health of women in developing countries. Investing in women’s reproductive health not only advances human rights but also improves the health and well-being of women and their families.
Jesus broke tradition and treated women in a much more egalitarian way than was normal in the society of that time. The early Christian churches followed Jesus’ lead and gave women much higher status and more privileges than was common in the rest of the world. Reducing cultural, financial and physical obstacles to reproductive health is necessary for improving maternal health. Work on women’s reproductive health and rights calls for culturally sensitive approaches because the issues go to the heart of culture.
Churches, governments and advocates for women can help remove these obstacles to good health care for women in developing countries by:
- Providing information and counseling to women, especially poor and underprivileged women, about their sexual and reproductive rights.
- Prioritizing child spacing and maternal mortality.
- Involving men in all health initiatives to promote good reproductive health. Men must also be involved in addressing gender-based violence.
- Sustaining support from community members and policymakers to keep girls in school, including vocational training for women.
- Providing women and couples access to a wide range of contraceptive methods so they can have the number of children they want, when they want them.
- Implementing effective health policies that support youths’ reproductive health, including increased access to reproductive health services and HIV prevention programs.
- Banning female genital mutilation and reducing early marriage and childbearing.
- Empowering women to participate in all levels of decision-making in their communities.
- These steps can enable women to make informed decisions and help them enjoy their reproductive rights, a necessary right for women to be full members of God’s kin-dom.
Elmira Sellu is a United Methodist Women regional missionary based in Sierra Leone.