Report of the Secretary-General
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to the Commission on the Status of Women, 39th Session, 27 Feb. 1995
II. CRITICAL AREAS OF CONCERN
C. Inequality in access to health and related services
Item 3 (b) of the provisional agenda E/CN.6/1995/1.
PREPARATIONS FOR THE FOURTH WORLD CONFERENCE ON WOMEN:
ACTION FOR EQUALITY, DEVELOPMENT AND PEACE: REVIEW AND APPRAISAL OF THE IMPLEMENTATION
OF THE NAIROBI FORWARD-LOOKING STRATEGIES FOR THE ADVANCEMENT OF WOMEN
II. CRITICAL AREAS OF CONCERN
C. Inequality in access to health and related services
1. In the Nairobi Forward-looking Strategies for the Advancement of Women, health is
one of the three sub-themes, along with employment and education, of the three goals -
equality, development and peace - of the United Nations Decade for Women. In designing
measures for the implementation of the basic Strategies at the national level, a number of
areas for specific action were identified.
2. With the recognition of the vital role of women as providers of health care and the
need for strengthening basic services for the delivery of health care came the need both
to promote the positive health of women at all stages of life and to recognise the
importance of women's participation in the achievement of Health for All by the Year 2000.
The Strategies stressed the need to increase the participation of women in managerial and
higher professional positions, through appropriate legislation, training and supportive
action and to change the attitudes and composition of health personnel.
3. They also emphasized the necessity for providing health education to the entire
family and the need to combine promotional, preventive and curative health, and access to
water and sanitary facilities that involved women in all stages of planning and
implementation. They stressed as well the need to comply with the International Code of
Marketing of Breast Milk Substitutes, forbidding any commercial pressures that interfered
with the priority of breast-feeding, the application of vaccination programmes for
children and pregnant women and the elimination of any differences in coverage between
boys and girls, as well as the eradication of the marketing of unsafe drugs and of
practices detrimental to health and the provision of access to essential drugs.
4. The Strategies called for the provision of adequate nutrition for women and children
and the promotion of interventions to reduce the prevalence of nutritional diseases such
as anaemia in women of all ages, particularly young women.
5. They also stressed recognition of the fact that the ability of women to control
their own fertility was an important basis for the enjoyment of other rights. The
Strategies called for the provision of appropriate health facilities, adapted to women's
specific needs, and the reduction of the unacceptably high levels of maternal mortality.
The need was also expressed to strengthen maternal and child health and the
family-planning components of primary health care, and to produce family-planning
information and create services, pursuant to the basic human right of all couples and
individuals to decide freely and informedly the number and spacing of their children. The
urgency of developing policies to encourage delay in the commencement of child-bearing was
indicated, since pregnancy in adolescent girls had adverse effects on morbidity and
mortality, as well as the need to change discriminatory attitudes towards women and girls
through health education. There was a need for providing adequate fertility-control
methods, consistent with internationally recognised human rights, as well as with changing
individual and cultural values.
6. The need to encourage participation of local women's organizations in
primary-health-care activities was part of the focus of the Strategies, as were the
application of gender-specific indicators for monitoring women's health and the necessity
of enhancing the concerns with occupational health and the harmonisation of work and
7. The Economic and Social Council, in its resolution 1990/15 (adopted by the Council
upon the recommendation of the Commission on the Status of Women, at its thirty-fourth
session), adopted the recommendations and conclusions arising from the first review and
appraisal of the implementation of the Nairobi Forward-looking Strategies, contained in
the annex to that resolution. The following constitute the most detailed recommendations
arising out of the review process.
"15. Since the beginning of the 1980s, there has been a decline in the standard of
health and nutrition of women in parts of every developing region due, inter alia, to a
decline in per capita expenditure on health. This is a particularly alarming situation
since maternal and neonatal health are crucial to infant survival. Infant and child
mortality rates have been rising in a number of countries after having declined for
"Recommendation XIII. Governments, international organizations, non-governmental
organizations and the public in general should be aware of the decline in women's health
in developing countries. Improvement of women's health by the provision of appropriate and
accessible health services should be a priority within the goal of health for all by the
"Women constitute the majority of health-care workers in most countries. They
should be enabled to play a much larger role in decision-making for health. Governments,
international non-governmental organizations and women's organizations should undertake
programmes aimed at improving women's health by ensuring access to adequate maternal and
child health care, family planning, safe motherhood programmes, nutrition, programmes for
female-specific diseases and other primary health care services in relation to the goal of
health for all by the year 2000.
"The World Health Organisation and other organizations of the United Nations
system should further develop emergency programmes to cope with the deteriorating
conditions of women's health mainly in developing countries, with particular attention to
nutrition, maternal health care and sanitation.
"16. Women's access to information and services relating to population and family
planning are improving only slowly in most countries. A woman's ability to control her own
fertility continues to be a major factor enabling her to protect her health, achieve her
personal objectives and ensure the strength of her family. All women should be in a
position to plan and organise their lives.
"Recommendation XIV. Governments, non-governmental organizations and women's
movements should develop programmes to enable women to implement their decisions on the
timing and spacing of their children. These programmes should include population education
programmes linked to women's rights and the role of women in development, as well as the
sharing of family responsibilities by men and boys. Social services should be provided to
help women reconcile family and employment requirements.
"Family planning programmes should be developed or extended to enable women to
implement their decisions on the timing and spacing of their children and for safe
"The United Nations Secretariat, the United Nations Population Fund, the World
Health Organisation and other organizations of the United Nations system should develop
collaborative programmes to link the role of women in development to questions related to
"17. During the past five years, women's health, both physical and psychological,
has been increasingly affected in many countries by the consumption and abuse of alcohol,
narcotic drugs and psychotropic substances.
"Recommendation XV. Governments and other competent national authorities should
establish national policies and programmes on women's health with respect to the
consumption and abuse of alcohol, narcotic drugs and psychotropic substances. Strong
preventive as well as rehabilitative measures should be taken.
"In addition, efforts should be intensified to reduce occupational health hazards
faced by women and to discourage illicit drug use.
"18. The emergence, since the Nairobi Conference, of new threats to the health and
status of women, such as the alarming increase in sexually transmitted diseases and the
acquired immunodeficiency syndrome (AIDS) pandemic, requires urgent action from both
medical and social institutions.
"Recommendation XVI. Greater attention is also needed with respect to the issue of
women and AIDS. Efforts in this regard should be an integral part of the World Health
Organisation Global Programme on AIDS. Urgent action and action-oriented research are also
required by social institutions at all levels, in particular the United Nations system,
national AIDS committees and non-governmental organizations, to inform women of the threat
of AIDS to their health and status."
1. Women's health: an overall view
8. In the 1991 progress report on women, health and development of the Director-General
of the World Health Organisation (WHO), 1/ presented to the Forty-fourth World Health
Assembly, it was recognised that women's health was influenced by biological,
environmental, social, economic and cultural factors. 2/ It was further recognised that
women's health, their status and their multiple contributions were pivotal links between
the health of a population and its prospects of sustainable development - prospects which,
despite the remarkable progress of the 1960s and 1970s, had been dimming in the 1980s. 3/
9. Setting an agenda for women's health must begin with a recognition of the fact not
only that the health situation of women is different from that of men, but also that the
systems identifying and determining that health situation are fashioned according to
gender-biased models. Gender discrimination has tended to be hidden within the general
issue of poverty and underdevelopment. In practice, women and girls suffer
disproportionately because of their low status in society.
10. While most of the world's poor suffer from poor health and nutrition, in many
countries, particularly those of South Asia, rates of malnutrition are generally higher
among females than among males of the same age group. In many countries, food is
distributed within the household according to a member's status rather than according to
11. Low health status is the outcome of biological as well as social, political and
economic factors acting together. Many women suffering from poor health status are found
to lack knowledge, information, skills, purchasing power, income-earning capacity and
access to essential health services. Health must be considered in a holistic manner.
12. Reliable and high-quality health services promote sustainable development. The
greatest reduction in fertility rates have resulted from a combination of women's improved
economic and social status, education and access to reproductive-health-care services.
13. Despite the fact that in households and sometimes in the community, women are the
primary providers of health care, they often lack access to outside health care for
themselves. For example, data show that in many countries there are fewer women than men
who are treated in hospitals, receive prescriptions for medication, receive timely
treatment from qualified practitioners and survive common diseases. Restricted access to
health services leaves women less capable of taking care not only of their own health, but
also of that of their children, thereby perpetuating a trend of high child mortality.
14. Ensuring women equal access to the benefits of public health care is critically
dependent upon gender-specific health strategies. This is true because men and women tend
to suffer from different illnesses. Women are far more likely to suffer from reproductive
role-related illnesses such as sexually transmitted diseases, anaemia, and the
complications resulting from child-bearing. Targeting these health problems clearly
involves different strategies for men and women.
15. Under increasing economic pressure in the past four years, 37 of the poorest
countries have cut health-related spending by 50 per cent. Some countries report on the
implementation of social compensation programmes to offset the impact of structural
16. A major factor mentioned by many countries is the focus on primary health care,
promoted by most developing countries. To provide equal care to both rural and urban
women, many countries have adopted the system of primary health care including family
planning, maternal and child care, vaccination and reinforcement for the curing of
diseases, including prevention of sexually transmitted diseases and human immunodeficiency
17. In Asia and the Pacific, the focus of policy in the area of women's health has
generally been within the context of reproductive health. Fertility control and family
planning have been the major set of issues around which health policies and programmes
have generally evolved in the past.
18. Some countries report that the fact that women have come to dominate the teaching
and health professions has resulted in the feminization of those professions, and a
consequent lowering within them of prestige and pay. Several national reports
acknowledge the skills of women in the areas of birth attendance and traditional medicine
practices, and various areas of self-healing, although these practices have not yet been
duly incorporated in the medical system.
19. In many countries, there is not yet a policy for women's health, except for
reproductive health. The reports often link improvements in the overall situation of
women's health to demographic trends and improvement in infrastructure. Health is
considered an outcome of combined factors promoting quality of life.
20. Many countries note the contribution of specific health programmes, like the
expanded programme of immunization, to women's health, and the contribution of local
non-governmental organizations in health campaigns.
21. Rural health centres are in general on the decline, and in much poorer condition
than urban ones. For instance, one country reports that a person in the rural areas
consults the health centre about twice a year, versus four times a year in the urban
2. Environmental health
22. Sustaining the global cycles and systems upon which all life depends is a first
requisite of health. The combination of population and production growth and unsustainable
consumption patterns has, however, heavily depleted natural resources, threatening the
environmental base upon which health and survival depend.
23. In developing countries, where populations are still expanding, pressure on scarce
resources has made it very difficult to improve living conditions. In 1990, an estimated
1.5 billion people did not have access to safe water, and almost 2 billion people lacked
sanitary means for disposing of excreta.
24. Many countries have subscribed to the goal of universal access to safe water for
the year 2000. Some reports indicate that improvements have been made in sanitary
education and in the application of low-cost technologies. One country refers to an
initiative to save on wood energy, for example, through cheaper production of charcoal and
improved charcoal stoves.
3. The life-cycle perspective
25. In the case of women's health, the using of a lifelong perspective that takes into
account the whole life-span is of paramount importance, since health conditions in one
phase of a woman's life affect not only its subsequent phases but also future generations.
It is also useful to look at common issues or themes so as to identify a useful framework
from which a feasible agenda for action can be elaborated.
26. For every 100 females delivered into the world, there are 105 males born. The
female human being is biologically more resistant, and the surplus of male infants is
nature's way of balancing the sex ratio in the population.Ordinarily, the number of
surviving girls soon surpasses that of boys. However, there are parts of the world where
this male-to-female imbalance is never overcome.
27. Human intervention, in the form of neglect of girls, favours the survival of males.
In several countries in the Asian and Pacific region, the preference for sons over
daughters has resulted in a differential treatment of infants by sex. The data show that
there is a higher risk that girls, as compared with boys, will die before age 5, in spite
of the natural biological advantage of girls. In Bangladesh, the under-five mortality rate
for girls was recorded as 175 per 1,000 live births, as against 160 for boys, and in
Nepal, 187 for girls as against 173 for boys. The pattern is much more alarming in regions
within large countries like India and China, known for their strong preference for sons.
In India, there are 957 females aged four years or under for every 1,000 males in the
28. Preference for sons is most marked in South Asia and the Middle East, but is not
confined to those regions alone. In Colombia, the number of deaths of boys between the
ages of one and two is 75 as against a figure of 100 for girls in the same age group.
Recent empirical evidence suggests that excess female mortality during childhood also
occurs in Latin America and the Caribbean, particularly in the less developed countries
with low life expectancy.
29. Globally, at least 2 million girls per year are at risk of having to submit to
genital mutilation. WHO estimates that 90 million women in the world today have - at some
time between the ages of 2 and 15, depending on local custom, and most commonly between
the ages of 4 and 8 - undergone one of the procedures that fall under this category. Most
live in Africa, a few in Asia, and, increasingly, due to migration processes, some in
Europe and North America.
30. Many Governments have publicly denounced the practice. Some have translated their
concerns into laws prohibiting female genital mutilation or into programmes to persuade
people to abandon the practice. Several countries report on the existence of harmful
traditional practices and their impact on women's health. One report, on the other hand,
highlights coexisting cultural practices that are beneficial, including respect for and
assistance to elders, mutual assistance networks and breast-feeding.
31. More than 50 per cent of the world population is under age 25, and 80 per cent of
the 1.5 billion young people between the ages of 10 and 24 live in developing countries.
Although fertility levels have been decreasing in many regions, the fertility rates of
adolescents are very high and in some cases increasing. At present, it is estimated that
close to 15 million infants per year (10 per cent of total births) are born to adolescent
32. Adolescents girls are more vulnerable to reproductive health problems than young
men. The age of the first sexual encounter is declining everywhere. For example, a survey
in Nigeria found that 43 per cent of schoolgirls in the age group 14-19 were sexually
active. During the 1980s, 30.2 per cent of female adolescents in Jamaica and 12.7 per cent
in Mexico were sexually active before they were 15 years of age. The proportion of females
under 20 years of age who used contraceptives at first coitus was 40 per cent in Jamaica,
21 per cent in Mexico and 8.5 per cent in Guatemala.
33. The rate of pregnancy among girls in the age group 15-19 is 18 per cent in Africa,
8 per cent in Latin America, 5 per cent in North American and 3 per cent in Europe. In
Venezuela, the number of births to girls under age 15 rose by 32 per cent between 1980 and
1988. In the Caribbean, 60 per cent of first births are to teenagers, most of whom are
34. One quarter of the 500,000 women who die every year from
pregnancy-and-childbirth-related causes are teenagers. A survey in Bangladesh found that
maternal mortality in age group 10-14 was five times higher than in age group 20-24.
35. The sense of urgency in addressing the situation is justified by the sheer numbers
of girls involved. In 1990, girls aged 15 or under constituted 40 per cent of the female
population in Egypt and Morocco, 44 per cent in Algeria and Mauritania, 45 per cent in
Ethiopia and Mali, 46 per cent in Djibouti and Somalia, 48 per cent in Nigeria, Uganda and
the United Republic of Tanzania, 50 per cent in Co^te d'Ivoire, and 52 per cent in Kenya.
Increasing concern for the status of women and girls prompted the South Asian Association
for Regional Cooperation (SAARC) to declare 1990 the Year of the Girl Child.
36. Some countries report an increase in the life expectancy of girls over that of
boys. One country reports that owing to the availability of medical facilities and health
units in all villages, life expectancy at birth for girls increased from 2 to 66 per cent,
or at a rate of 127 per cent, from 1981-1982 to 1992-1993.
37. Many countries indicate strong policies of readmitting teenage mothers into
secondary schools. Many have included courses on family-life education at school. One
country reports a peer approach counselling programme at the Young Women's Christian
5. Reproductive health
38. The health of women in the years 15-45 is influenced predominantly by their
reproductive and maternal roles. Despite progress in a number of key areas, the morbidity
and mortality rates of women due to reproduction remain unnecessarily high in many areas
of the globe. Maternal mortality is the indicator that exhibits the widest disparity among
countries. Of the 150-200 million pregnancies that occur world wide each year, about 23
million lead to serious complications such as post-partum haemorrhage, hypertensive
disorders, eclampsia, puerperal sepsis and abortion. Half a million of these end with the
loss of the mother.
39. Ninety-nine per cent of these deaths take place in developing countries. The
incidence of maternal death ranges from almost non-existent to very high (the rates in
some poor countries reach as high as 1,600 times those in industrialized countries).
Scattered information suggests that in some countries, one fourth to one half of all
deaths of women of child-bearing age result from pregnancy and its complications.
40. Maternal mortality rates in central and eastern Europe, apart from Romania and
Albania, are about twice as high as the average for Europe as a whole. In Romania and
Albania, maternal mortality has fallen dramatically since the legalization of abortion, as
previous rates were largely due to unsafe abortions. Unsafe abortions are among the top
causes of maternal mortality in all countries except Azerbaijan. Azerbaijan's exceptional
status might be due to the way it defines such practices. In the Russian Federation,
nearly 200 abortions are reported for every 100 births.
41. Comparing new information on maternal mortality with that available five years ago
suggests that pregnancy and childbirth have become safer for women in most of Asia and in
parts of Latin America. Nevertheless, data are still too scattered and more needs to be
done to have a more complete picture. However, frequent child-bearing, which can seriously
compromise the health and nutrition of a woman's children, continues to be characteristic
of large numbers in many areas of the world.
42. One reason for the lack of progress is the tendency to look for rapid solutions to
deep-seated problems. It has been found that safer motherhood requires a massive and
simultaneous attack on all the elements contributing to the problem, including those under
the headings of legislation, social services, rights of women. As regards the health
sector alone, the system's entire infrastructure - including community mobilization, pre-
and post-natal care, clean and safe delivery with trained assistance and above all timely
referral for management of complications - needs strengthening in most countries where
maternal mortality is high.
43. International commitments setting goals for reduction of maternal mortality by 50
per cent for the year 2000 have been endorsed by most countries. Many countries mention
the Safe Motherhood Initiative, adopted by WHO, the United Nations Development Programme
(UNDP), the United Nations Population Fund (UNFPA), and the United Nations Children's Fund
(UNICEF) in 1987. Many countries report that the increased provision and improvement of
existing maternity services at all levels of the health system is the most effective means
of reducing maternal mortality. In addition, quality reproductive-health-care services,
including family planning, together with good primary health care represent important
interventions. Many countries report increments in health care to address the matter of
maternal mortality. Several reports mention a national programme for maternal health, with
campaigns on reproductive health and family planning. Several countries report the
inclusion in their expanded programmes of immunization of antitetanus campaigns.
44. Fertility levels, measured by the total fertility rate, have continued their
tendency to decline in all regions. World fertility fell by 10.5 per cent, from 3.8 to 3.4
births per woman, between the periods 1975-1980 and 1985-1990. The total fertility rate
varied from 8.5 (the highest) in Rwanda, to 1.27 (the lowest), in Italy.
45. Sub-Saharan Africa is the only region of the developing world that has not yet
undergone a widespread decline in fertility. A decline has started in three countries of
the area: Botswana, Kenya and Zimbabwe. Ethiopia reports a fertility rate of 7.5 births
per woman in 1992.
46. The total fertility rate continued to decline in all subregions of Asia and the
Pacific throughout the post-Nairobi Conference era. Between 1985 and 1992, it dropped from
2.42 to 2.19 in developing East Asia and from 3.69 to 3.37 in South-East Asia. In South
Asia, it fell from 4.71 to 4.36 and in the Pacific Islands, from 4.92 to 4.61. The
developed countries of the region, namely, Australia, Japan and New Zealand, which had
already achieved a total fertility rate of 1.71 by 1985, experienced a further decline to
1.56, by 1992.
47. In the Caribbean, many countries have experienced nearly a 50 per cent drop, from
about 6.0 to 3.0, in total fertility rate levels within the last 30 years, and the rate is
expected to decline further in the next decade. 48. Although fertility rates have gone
down world wide, many women still lack access to information and services, or cannot make
use of them because of economic limitations or cultural norms. Only 27 per cent of couples
use contraception; 140 million women in developing countries become pregnant although they
did not want a child. Every year, over 20 million women terminate unwanted pregnancies
through unsafe abortions, as a result of lack of access to relevant care and services such
as family planning, costly contraceptive methods, lack of information, and restrictive
legislative practices. Of these, 15 million survive, but with a wide range of long-term
disabilities. Some 60,000-100,000 die.
49. One country reports that in 1992, for the first time since the introduction of
family planning, the gender-differential participation ratio became 55 to 45 in favour of
men, owing to a broader public awareness of the relative seriousness of the side-effects
of contraceptive measures taken by women. Some countries consider that with respect to
utilization of contraceptives, universal coverage has been reached: only 4 per cent of
sexually active women are without any such coverage. The protection and monitoring of
maternity programmes have been further reinforced in the last years. One country reports
the establishment of family counselling services, with a counsellor-to-woman ratio of
7. Cervical cancer and sexually transmitted diseases
50. Cancers of all types among women are increasing. Those affecting women more
frequently in both developed and developing countries are stomach cancer, breast cancer,
cervical cancer and colorectal cancer.
51. Cervical cancer is the most common form of cancer in women in most developing
countries and the second most common form of cancer in women in the world as a whole.
There are an estimated 450,000 new cases (a realistic figure including undiagnosed early
cases would go as high as 900,000), and a death toll of 300,000, each year.
52. Breast cancer is one of the major causes of female mortality in developed
countries. The number of women developing breast cancer and dying from the disease is
growing steadily every year. As in cervical cancer, early detection plays a major role in
reduction of mortality.
53. Prevalence rates of sexually transmitted diseases are higher among females than
among males in those aged 20 years or under. In one industrialized country, 6 million
women, half of whom are teenagers, acquire a sexually transmitted disease.
54. A number of countries report the launching of national awareness-raising campaigns.
Several countries report the establishment of national programmes of early detection of
55. AIDS emerged as a major health problem in the mid-1980s, in both the developed and
the developing countries, threatening to undermine major gains in the reduction of
morbidity and mortality. A decade ago, women seemed to be on the periphery of the AIDS
epidemic, but today almost half of newly infected adults are women. Women are more
susceptible to contracting the disease for biological reasons and because of their lower
56. WHO estimates that well over 14 million adults and children have been infected with
HIV since the start of the pandemic, and projects that this cumulative figure may reach
30-40 million by the year 2000. It is estimated that over half a million children have
been infected with HIV from their infected mothers. The epidemic incapacitates people at
the ages when they are needed most for the support of the young and the elderly. WHO
estimates that by the year 2000, 13 million women will have been infected with AIDS.
57. The AIDS pandemic is most devastating in sub-Saharan Africa. WHO had estimated that
by 1992, 1.5 million adults in the region would develop AIDS, and more than 7 million
would be infected with HIV. In this region, HIV transmission is predominantly through
heterosexual relations, and among the infected population, almost the same proportions of
men and women are represented. In the 15 countries in Eastern, Central and Western Africa
where by 1990 above 1 per cent of the adult population was infected, the already low level
of life expectancy at birth (about 50 years in 1985-1990) is projected to remain unchanged
through the year 2000. Because as many women as men carry the virus, WHO estimates that
child mortality may increase by as much as 50 per cent through mother-to-child
transmission in much of sub-Saharan Africa during the 1990s. In Ethiopia, the trend
between 1987 and 1993 (2.4:1 compared with 1.4:1) indicates that the male-to-female ratio
58. At the beginning, transmission of HIV in North America, Europe and Australia
occurred basically through homosexual contact, but increasingly heterosexuals and
drug-users are becoming the agents of transmission, especially in North America. According
to WHO estimates, 1.6 million cases of HIV and close to 350,000 cases of AIDS might occur
by 1992. In Latin America, the Caribbean and the urban sections of Brazil are the areas
most affected. It is estimated that currently about 1 million people in the region may be
affected by HIV.
59. Asia and the Pacific has exhibited the highest growth rate in HIV/AIDS among women,
many of whom are married women with a single partner. India and Thailand are the countries
worst affected. There are no estimates available for the region as a whole, but the
estimate for India is up to about 1 million, and for Thailand about 400,000.
60. A Global Programme on AIDS was established by WHO in 1987. By 1990, more than 150
countries had established national AIDS committees to coordinate national control
programmes. Part of the problem that has to be faced concerns the reluctance of national
authorities to acknowledge the existence of HIV infection, and its real magnitude. Another
challenge is the discrimination against people with HIV/AIDS, a response often connected
with the stigma attached to sexually transmitted diseases, and the mistaken belief that
HIV can be transmitted through casual social contacts.
61. The Global Programme on AIDS strategy stresses a gender-specific approach,
emphasizing women's social, physical and economic vulnerability. In most countries where
HIV/AIDS has become a serious threat or is expected to become one, national AIDS
committees have been established to formulate prevention programmes. Several countries are
devoting resources to research, guidance, educational material and technical assistance.
National campaigns of education and prevention have been developed in many countries.
Several have included prevention components in school curricula. A few countries report
close collaboration with non-governmental organizations in training peer leaders as a way
of improving service delivery.
9. Health consequences of violence
62. Although grossly underreported, violence against women has assumed alarming
proportions, as can be seen in section D below. Only recently have domestic violence and
rape been viewed as a public health problem, yet they are a significant cause of female
mortality and morbidity. Violence against women leads to psychological trauma and
depression, injuries, sexually transmitted diseases and HIV, suicide and murder.
63. Accurate figures on the prevalence of domestic violence and rape are not available,
but from existing data it is known that rape and domestic violence account for about 5 per
cent of the total disease burden among women aged 15-44 in developing countries. In
industrialized countries, where the total disease burden is much smaller, this share rises
to 19 per cent. In these countries, assaults have been reported to cause more injuries to
women than vehicle accidents, rape and mugging combined.
64. In Asia, non-governmental organizations have played a pivotal role in publicizing
the situation. They have collaborated with Governments in many countries in efforts
involving the provision of legal aid and legal counselling to victims of violence, and the
running of trauma centres and shelters for abused women.
10. Health issues related to ageing
65. Life expectancy for women has risen by eight years since 1970 in the low- and
middle-income countries, and by five years world wide, though this gain has been less than
that enjoyed by men.
66. In the years to come the number of women over age 65, in both industrialized and
developing countries, will increase; and the total number of these women will rise from
330 million in 1990 to 600 million in 2015. Women over age 50 constitute more than one
third of the entire female population of the United States of America. In addition, women
constitute about 59 per cent of the United States population aged 65 or over, and 72 per
cent of the population over age 85. In contrast, in Lithuania, female life expectancy
decreased, as it did in Poland and some of the newly independent States.
67. Of these elderly women, many will suffer from the chronic diseases associated with
ageing such as osteoporosis and dementia, or from the consequences of neglect such as
malnutrition, alienation and loneliness. Reporting on health conditions of the elderly
female population is still scanty, especially in the developing countries. Osteoporosis
affects 10 per cent of women world wide above age 60. In one industrialized country,
osteoporosis is responsible for 1.3 million bone fractures per year. Most of the women
affected become totally dependent as a result of the illness.
68. When women do seek care for their health problems, the result is often
overprescription of tranquillizers - especially to older women - instead of further
investigation. A North American study found that physicians prescribed psychoactive drugs
2.5 times more often to women over age 60 than to men in the same age group.
69. Many industrialized countries are concerned with the rising demand for health-care
services on the part of their growing population of elderly people. Some developing
countries are restating the importance of the traditional family and community networks in
caring for the elderly.
70. Adequate nutritional intake is particularly important for girls and women.
Discriminatory feeding practices in childhood sometimes lead to protein-energy
malnutrition, anaemia and other micronutrient deficiencies in young girls. Higher rates of
malnutrition generally exist among females than among males in the same age group. In many
developing countries, food is distributed within the household according to a member's
status rather than according to nutritional needs.
71. Problems caused by malnutrition in girls are responsible for subsequent problems
during childbirth, like obstructed labour, fistulas and birth asphyxia. Because women need
more iron than men, and because they tend to receive a lower share in the distribution of
food, globally 43 per cent of women and 51 per cent of pregnant women suffer from anaemia.
A third of women of reproductive age who are not pregnant have anaemia. In developing
countries, 56 per cent of pregnant women are anaemic and up to 7 per cent suffer from
severe anaemia. Virtually all adolescent girls in developing countries suffer from iron
72. Because their mothers lack iodine, 30,000 babies are stillborn every year, and over
120,000 are born cretins. Iodine deficiency is the most common and preventable cause of
mental retardation. At least 25 per cent of adolescent girls are affected. This deficiency
leads not only to goitre but to brain damage as well, and also affects women's
reproductive function. In developing countries, stunting caused by energy-protein
malnutrition in girls affects 43 per cent of all women aged 15 or over.
73. Many countries mention the adoption at the World Summit for Social Development of
the goal of a one-third reduction in iron-deficiency anaemia by the year 2000. Some
countries have improved their nutrition surveillance system. Many report a direct impact
of structural adjustment programmes on the nutritional situation.
12. Mental health
74. Community-based studies and treatment studies indicate that women are
disproportionately affected by mental health problems and that their vulnerability is
closely associated with their marital status, their work and their roles in society.
Epidemiologic evidence is accumulating that links mental disorders with alienation,
powerlessness and poverty, conditions most frequently experienced by women.
75. Several reports indicate a tendency in health services to shift their emphasis from
the provision of curative services to the prevention of ill health. Although most health
measures still focus on physical ill health, well-being-related measures are becoming
13. Substance abuse
76. Over the next 30 years, tobacco-related deaths will more than double, so that
starting from the year 2020 well over 1 million adult women will die from tobacco-related
illnesses annually. Women are smoking in increasing numbers in developing countries and
are a special target of cigarette advertising world wide. In France, a recent survey among
students showed that girls today smoke more than boys. There is also a rapidly growing
trend among girls towards the use of other drugs.
77. Some 30 million women have contracted diseases due to alcohol intake.
Alcoholic cirrhosis is the cause of 300,000 deaths among women each year. The
ill-treatment of 50 per cent of battered wives is alcohol-related.
78. Illicit drug-abuse problems among females have been underestimated, as statistics
in many countries are not gender-disaggregated. A few countries report a new
bio-psycho-social approach in health services, distinct from the focus only on maternal
and child health.
1/ Document WHO/FHE/WHD/92.5.
2/ Ibid., para. 16.
3/ Ibid., para. 10.
(This documents has been made available in electronic format
by the United Nations. )