by Work the World

Nursing, Midwifery, All Destinations, Clinical Features

While it is clear that both men and women suffer in poverty, gender discrimination means that women have far fewer resources to cope. The United Nations says they are likely to be the last to eat and are routinely trapped in time-consuming, unpaid domestic tasks.

It’s unsurprising, therefore, that women are also the group least likely to access necessary healthcare. Because their voices are rarely heard in decisions on managing an economy or sharing benefits and costs, infrastructure simply doesn’t work for the vast majority of women in the developing world  (UN Women).

‘Women in developing nations lack basic health care and face life-debilitating and life-threatening health issues. Some health issues never existed in the West, whereas science eradicated others decades ago. Maternal mortality, female genital cutting, child marriage, human immunodeficiency virus (HIV)/AIDS, and cervical cancer are a few of the issues that plague developing nations.’ (Introduction to Global Women’s Health)

This article will explore the inequalities women face in the developing world, specifically in relation to healthcare. We’ll take a look at the top women’s health issues in a few of the destinations we travel to, and what is being done to combat this. 

Nepal: MATERNAL MORTALITY

Nepalese mother carrying her baby on the back near Kathmandu.

The maternal mortality rate in Nepal has historically been one of the highest in Asia. These deaths occur within a context of gender-based economic, political and cultural neglect of women’s right to equal status and access to medical services. (Roman Shrestha). In their article ‘Maternal mortality—a neglected tragedy’, Rosenfield and Maine suggest that ‘nearly all of these deaths are preventable because the majority of [them] are caused by hemorrhages, sepsis, hypertensive disorders, prolonged or obstructed labour, and unsafe abortions.’

So why do these preventable deaths still occur? There are many reasons for this. Perhaps the most prominent is the wide-spread lack of education on behalf of mothers-to-be, many of whom are unaware of the possible complications that can arise during pregnancy. This is due to low literacy rates – something women are subject to. However, there are ways in which women participate in cultural mythologies that perpetuate dangerous beliefs surrounding pregnancy, too.

Many Nepalese people, especially in rural areas believe that complications are created by the ‘evil eye’, and so seek help from traditional healers, or ‘shamans’, before seeking medical help. One study also unveiled that some groups of women in Nepal do not seek prenatal care because they think their unborn infant would be more likely to die if they do so (Roman Shrestha).

What’s more, delivering at home has long been part of Nepali culture, with generations of women relying on the help of their mothers and grandmothers, instead of professionals, to see them through. The 2006 Nepal Demographic Health Survey (NDHS) revealed that 82% of all women give birth at home and a skilled professional attends only 18% of those births.

Another factor for this high rate of Maternal Mortality is young marriage. This is because conceiving early has increased risk, and those who marry young are likely to conceive multiple times over their life, therefore repeating this life-threatening processes. Lastly, women in rural areas often have to travel long distances to reach their nearest hospital: an unfeasible option when heavily pregnant.

What’s being done?

It’s not all bad news. Governmental changes such as the introduction of ‘safe abortions’ (i.e. making them legal in 2002) have also been attributed to lower rates of maternal deaths, many of which were directly linked to self-induced abortion. Nepal has also seen a general decrease in fertility rate over the last few years, meaning more women are using contraception and thus avoiding pregnancy all-together. However, these factors don’t necessarily make the birthing journey any less risky for expectant mothers who plan on completing their pregnancy.   

When it comes to accessing maternal care of these women, individuals inside Nepali healthcare are aware that changes need to be made. One of these is gynaecologist Dr. Sangeeta Mishra, who says: "I plan to develop a major educational and awareness generation program for these women, where most of the deaths occur ... to [inform] them of the importance of delivering at the hospital or having a skilled helper at home.” (PRI). Improvements of this sort are already underway, and focus on an increased empowerment and education of women, aiming to grant them a greater awareness of how to mitigate pregnancy-related risks. 

However, an ODI report concludes that: ‘Despite these improvements, numerous systemic challenges remain. These include addressing inequalities, increasing community mobilisation to improve accountability, building more effectively on inter-sectoral synergies and, most importantly, maintaining a political and financial commitment to safer motherhood.’ (ODI)

TANZANIA: FGM  

Masai territory, Kenya.  August 10, 2011.  Two Masai women walk in their village.

Female Genital Mutilation or Cutting (FGM/C) can be defined as ‘all procedures that involve partial or total removal of the external female genitalia or other injuries to the female genital organs for non-medical reasons.’ (WHO). Approximately 7.9 million women and girls in Tanzania have undergone FGM, with percentages increasing in areas like Arusha (UNICEF, 2013) (28toomany).

FGM is commonly believed to be the necessary means to secure female virginity, reduce sexual desire subsequent promiscuity, and to improve fertility (Mwabalasa, 2006). Women who have not been cut are often subject to social stigma: often insulted by their peers and looked down upon by the families of potential suitors, who may prohibit their son from marrying into families which do not practice FGM. (Equality Now, 2001). If a man does choose to marry an ‘uncircumcised’ girl, the view is taken that this man has ‘done the girl a favour’. Within such a marriage, the girl is likely to be discriminated against by her in-laws. (28toomany)

Mary, a Maasai, had FGM when she was 14 years old:

“My mother told me that FGM was important for my family’s dignity, bringing glory and respect to my parents and that after FGM I would gain higher status and recognition in the community and be able to marry a rich, respected and caring husband.”

The reality of FGM was, however, very different to what her mother had told her. (28toomany). There’s no doubt that the prevalence is FGM is unaided by Tanzania’s (and to a wider extent, Africa’s) widespread sexual taboos. It’s been reported that sexual behaviour is a highly sensitive subject, and is rarely discussed between adults and young people (Mwambete and Mtaturu, 2006). It can be assumed this is only increased when it comes to issues of female sexuality, virginity, and pleasure.

What’s being done?

Despite the pervasiveness of this practice, there is hope for women and girls in Tanzania. The Tanzanian Government have put in place a number of measures to combat FGM; an example being an amendment passed by The Parliament of Tanzania which specifically prohibits FGM. However, this law only applies to minors, and is often ignored. Still, individuals across the country have taken matters into their own hands by providing ‘safe houses’ for girls fleeing their communities due to the threat of FGM. Rhobi Samwelly is one such woman, whose own experience of FGM led her to found a safe house where up to 154 girls stay at a time. Read her full story here: (Telegraph)

FGM is an incredibly complex issue; simple changes in law and health policy often seem to lack the ammunition needed to break historical, religious, and cultural norms. However, be assured that efforts are being made and slowly, change is happening.  You can help support this, too; charities like NAFGEM collaborate with Tanzanian communities and local governments to help prevent FGM, and are always happy to receive donations. 

PERU: CERVICAL CANCER  

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Cervical cancer is the third most common cancer worldwide. Certain countries are more susceptible to it than others, with 80% of all cases occurring in the developing world. (NCBI) When it comes to Peru, cervical cancer is the leading cause of cancer-related death amongst women and the top cancer diagnosis in 2012. (Read more about cancers and Oncology in Peru here).

One of the main factors for its prevalence in Peru is a general lack of effective screening programs.

These aim to detect signs of the HPV virus (one of the main causes of cervical cancer) and are often inaccessible to women living in poverty and isolation. ‘It has been estimated that only about 5% of women in developing countries have been screened for cervical dysplasia in the past 5 years, compared with 40% to 50% of women in developed countries’ (NCBI).

It’s also been suggested that the public Peruvian perception of government health services is largely negative, and that many people wait until symptoms were severe before seeking treatment in hospital. Preventative healthcare across all fields in Peru is somewhat lacking, despite efforts being made to change this.

What’s being done?

Attention to cervical cancer has been declared a national priority, and screening services have been in place for over 30 years. However, women are screened opportunistically, not systematically. This means those most at risk–women aged 35 to 50–remain at significant risk, and mortality rates are persistently high. Because of this, the responsibility to connect with screen services rests with the women most susceptible to cervical cancer. 

Furthermore, The Pan American Health Organisation (PAHO) state:

‘There have been challenges with the cytology tests such as a high proportion of inadequate samples, limited laboratory infrastructure and personnel to process the samples in a timely manner, and sub-standard quality control procedures. Furthermore, the follow-up care after abnormal cytology screening has been poor, as there have been unusually long delays in obtaining cytology test results, women may not have been informed of their screening test results and treatment has not been accessible’.  TATI demonstration project

There is certainly a lot of room for growth in this area of women’s health in Peru. If you choose to take your healthcare placement here, you’ll have to chance to gain experience with those who are striving to make the best with the limited resources they have and rotate through one of the largest Oncology departments in the country.

GHANA: SANITARY PADS

 African people on the vegetables market in Kumasi, Ghana

For most of us in the Western World, it’s the taxation of sanitary products that demonstrates a gender-bias infrastructure. In rural Ghana, it’s the absence of easily accessible sanitary products altogether. This lack of basic feminine hygiene products presents a range of problems for adolescent girls that stretches far beyond a few days per month.

Girls in remote areas have no access to pads, often using cloths that can leak.

Researcher Linda Scott told the BBC’s Focus on Africa Programme: "The cloth is so scarce that they only have two pieces of it, so they have to wash it at night and hope that it dries in the morning, which of course in a damp climate it doesn't, so they end up wearing damp and soiled cloths which is not hygienic." http://news.bbc.co.uk/1/hi/8488375.stm

This, paired with a long walk to school where there are no facilities to privately wash their cloth, leaves many girls staying at home during their period. (Source).

Fourteen-year-old Hawa from the outskirts of Dawia says:

“I want to be a nurse and that’s why I always want to go to school but there are times I just can’t. These rags leak all the time when I use it. I feel wet and when my school dress is soiled with blood, the boys laugh at me.”

To make matters more worrying, reports show that girls who miss school for a few days a month are far more likely to leave education early, phasing out as a result of being left behind.

Some argue that it’s not the lack of resources, but the problem with Ghana’s education system that is the heart of this issue. Joy News report that ‘infrastructural planning for schools in Ghana has always been done with little or no consideration for the sexual health of pupils at all, especially girls.’ On the other hand, Oxford University reports that cheaper sanitary pads could reduce female absenteeism in Ghana by up to fifty percent.  Whatever the crux of the issue, here’s what’s being done in response:

What’s being done?

Intervention from Western NGO’s likeBright Generation's Menstrual Pads for Dignity Initiative’ provides immediate aid to areas lacking any resources. Additionally, the initiative provides hygiene, reproductive, and financial education for the girls it serves. What’s reassuring about organisations like the latter is their long-term aim to produce sanitary pads domestically: ‘The creation of a factory in Ghana would not only make the pads less expensive, it would also provide jobs in local communities.’  Menstrual Pads for Dignity Initiative

It’s unsurprising that other developing countries such as India face similar problems. Many individuals across the globe have been inspired to take matters into their own hands, conceiving of ways to up-cycle common materials such as banana peels and waste packaging into absorbent pads for women and girls. This is usually done using new technologies that can be replicated with scrap metals in developing countries. It’s possible that machines like these could be made by local communities in Ghana, too.

Whatever your field of study or department you choose to spend time in, you’re bound to encounter issues of women’s health, limited resources, and gendered inequality on your overseas elective. You’ll meet women from all walks of life: from the local specialists who deploy incredible creativity to meet the needs of the public, to those who have walked miles to access medical help. One thing’s for sure: there will be an excess opportunity to increase your cultural sensitivity and develop an insight into differing healthcare models.

If you want to get to grips with these cultural and economic differences, our friendly team are on-hand to help you start the journey. To have a no-obligation conversation with one of our elective experts, fill out the short enquiry form at the bottom of the page, and we’ll be in touch. If you can’t wait and want to speak to us right now, call 01273 974634.

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