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An Inequality Beyond Wealth: Gaps in Women’s Health

A mother and her child from West Point, a low-income neighbourhood of Monrovia, Liberia. The 10-worst countries to be a mother in are all in sub-Saharan Africa. Credit: IPS

UNITED NATIONS, Oct 18 2017 (IPS) - While many often focus on wealth disparities, economic inequality is often a symptom and cause of other inequalities including women’s access to sexual and reproductive health.

In a new report, the UN Population Fund (UNFPA) explores the persistent, if not widening, inequalities in sexual and reproductive health around the world, holding back women and girls from a productive and prosperous future.

“It’s not just about money,” Editor of UNFPA’s report Richard Kollodge told IPS.

“Economic inequality reinforces sexual and reproductive health inequality and vice versa,” he continued.

Despite its recognition as a right, access to sexual and reproductive health is far from universally realized and it is the poorest, less educated, and rural women that continue to bear the brunt of such inequalities.

Globally, women and girls in the poorest 20 percent of households have little or no access to contraception and skilled birth attendants, leading to more unintended pregnancies and higher risk of illness or death from pregnancy or child birth.

In the developing world, 43 percent of pregnancies are unplanned and this is more prevalent among rural, poor, and less educated women.

These inequalities are particularly prevalent in West and Central Africa.

In Cameroon, Guinea, Niger, and Nigeria, use of skilled birth care is at less than 20 percent among the poorest women compared to at least 70 percent among the wealthiest.

The lack of power to choose whether, when or how often to become pregnant can limit
girls’ education, delay their entry into the paid labour force, and reduce earnings, trapping women in poverty and marginalization.

“The absence of these services in these women’s lives leads them to be poor or makes them even poorer,” said Kollodge.

A woman with no access to family planning may be unable to join the labor force because she has more children than intended.

In high-fertility developing countries, women’s participation in the labor force remains low, from 20 percent in South Asia to 22 percent in sub-Saharan Africa.

Once in the paid labor force, underlying gender inequalities lead to women earning less than men for the same types of work.

Though the gender wage gap has decreased in recent year, women still earn 77 percent of what men earn globally.

At the current pace, it will take more than 70 years before the gender wage gap is closed.

Further gaps can be seen for women who have children—a “motherhood penalty,” Kollodge said—as well as for women of color and those with less education.

Illiterate people earn up to 42 percent less than their literate counterparts and a majority of the world’s estimated 758 million illiterate adults are women.

This can also be traced to harmful gender norms that keep girls from school, and creates a vicious cycle that keeps women in the bottom rung of the economic ladder and without access to sexual and reproductive health services.

If all girls stayed in and received secondary education, it’s estimated that child marriages would decrease by 64 percent, early births by 59 percent, and births per woman by 42 percent.

Among the countries that have made most progress is Rwanda, which has effectively closed the gap between poor and rich households in access to contraception.

Kollodge told IPS that Rwanda’s achievement shows that a low-income country can advance access to sexual and reproductive health.

“The policies that [countries] adopt really make a difference. There are things you can do, regardless of your GDP, to improve well-being and reduce inequality in sexual and reproductive health and rights,” he said.

Rwanda’s success is partly due to the expanded availability and integration of family planning services in each of the country’s villages and health centers.

But inequality in sexual and reproductive health is not just a developing country issue, Kollodge noted.

The United States has one of the highest maternal mortality rates in the developed world.

In Texas, maternal mortality rates jumped from 18.8 deaths per 100,000 live births in 2010 to 35.8 deaths in 2014, the majority of whom were Hispanic and African-American woman.

Meanwhile, the government is working to repeal health coverage which risks returning to a time where many insurance plans considered pregnancy a pre-existing condition, barring women from getting full or any coverage.

Already, the Donald Trump administration has rolled back access to contraception, affecting up to 60 million women.

Elsewhere, the U.S.’ decision to cut funding to UNFPA is affecting the health and lives of thousands of women.

In 2016, the government provided 69 million to UNFPA programs, helping avert almost one million unintended pregnancies and prevent 2,300 maternal deaths.

“Any reduction to UNFPA has a direct impact on women and adolescent girls in developing countries,” said Kollodge.

The report calls to make information and services more available and accessible and recommends a number of actions including increasing access to child care which can help women join the labor force and climb out of poverty.

This will lead to not only better reproductive health outcomes, but also a healthier economy and society as a whole.

“If you eliminate these inequalities in accessing sexual and reproductive health and thus give women control over their own lives, you are going to make a lot of headway in economic inequality,” Kollodge told IPS.

He said that though eliminating inequalities in sexual and reproductive health alone will not be enough, countries will never achieve economic inequality if half of the world’s population lacks access to health services and rights.

“And if you continue to have extreme economic inequality, it drags down whole economies and prohibits countries from rising out of poverty fast enough to achieve the Sustainable Development Goals (SDGs),” Kollodge continued, pointing to SDG 1 which aims to end poverty by 2030.

The internationally adopted SDGs also include a goal to reduce inequality within and among countries by accelerating income growth of the poorest 40 percent of the population at a rate higher than the national average.

“If you don’t do that, you are never going to achieve shared prosperity,” Kollodge said.

 
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