We’ve come a long way since 1995–and it is time to celebrate women and their achievements. But it is also time to take stock of how women’s rights are fulfilled in the world –especially the right to health. Twenty years after countries signed pledges in the 1995 Beijing Declaration and Platform of Action, women still face many health problems and we must re-commit to addressing them.
Here are ten of the main issues regarding women’s health that keep me awake at night:
Cancer: Two of the most common cancers affecting women are breast and cervical cancers. Detecting both these cancers early is key to keeping women alive and healthy. The latest global figures show that around half a million women die from cervical cancer and half a million from breast cancer each year. The vast majority of these deaths occur in low and middle income countries where screening, prevention and treatment are almost non-existent, and where vaccination against human papilloma virus needs to take hold.
Reproductive health: Sexual and reproductive health problems are responsible for one third of health issues for women between the ages of 15 and 44 years. Unsafe sex is a major risk factor – particularly among women and girls in developing countries. This is why it is so important to get services to the 222 million women who aren’t getting the contraception services they need.
Maternal health: Many women are now benefitting from massive improvements in care during pregnancy and childbirth introduced in the last century. But those benefits do not extend everywhere and in 2013, almost 300 000 women died from complications in pregnancy and childbirth. Most of these deaths could have been prevented, had access to family planning and to some quite basic services been in place.
HIV: Three decades into the AIDS epidemic, it is young women who bear the brunt of new HIV infections. Too many young women still struggle to protect themselves against sexual transmission of HIV and to get the treatment they require. This also leaves them particularly vulnerable to tuberculosis – one of the leading causes of death in low-income countries of women 20–59 years.
Sexually transmitted infections: I’ve already mentioned the importance of protecting against HIV and human papillomavirus (HPV) infection (the world’s most common STI). But it is also vital to do a better job of preventing and treating diseases like gonorrhoea, chlamydia and syphilis. Untreated syphilis is responsible for more than 200,000 stillbirths and early foetal deaths every year, and for the deaths of over 90 000 newborns.
Violence against women: Women can be subject to a range of different forms of violence, but physical and sexual violence – either by a partner or someone else – is particularly invidious. Today, one in three women under 50 has experienced physical and/or sexual violence by a partner, or non-partner sexual violence – violence which affects their physical and mental health in the short and long-term. It’s important for health workers to be alert to violence so they can help prevent it, as well as provide support to people who experience it.
Mental health: Evidence suggests that women are more prone than men to experience anxiety, depression, and somatic complaints – physical symptoms that cannot be explained medically. Depression is the most common mental health problem for women and suicide a leading cause of death for women under 60. Helping sensitise women to mental health issues, and giving them the confidence to seek assistance, is vital.
Noncommunicable diseases: In 2012, some 4.7 million women died from noncommunicable diseases before they reached the age of 70 —most of them in low- and middle-income countries. They died as a result of road traffic accidents, harmful use of tobacco, abuse of alcohol, drugs and substances, and obesity — more than 50% of women are overweight in Europe and the Americas. Helping girls and women adopt healthy lifestyles early on is key to a long and healthy life.
Being young: Adolescent girls face a number of sexual and reproductive health challenges: STIs, HIV, and pregnancy. About 13 million adolescent girls (under 20) give birth every year. Complications from those pregnancies and childbirth are a leading cause of death for those young mothers. Many suffer the consequences of unsafe abortion.
Getting older: Having often worked in the home, older women may have fewer pensions and benefits, less access to health care and social services than their male counterparts. Combine the greater risk of poverty with other conditions of old age, like dementia, and older women also have a higher risk of abuse and generally, poor health.
When I lie awake thinking of women and their health globally, I remind myself: the world has made a lot of progress in recent years. We know more, and we are getting better at applying our knowledge. At providing young girls a good start in life.
And there has been an upsurge in high-level political will – evidenced most recently in the United Nations Secretary-General’s Global Strategy for Women’s and Children’s Health. Use of services, especially those for sexual and reproductive health, has increased in some countries. Two important factors that influence women’s health – namely, school enrolment rates for girls and greater political participation of women – have risen in many parts of the world.
But we are not there yet. In 2015, in too many countries, “women’s empowerment” remains a pipedream – little more than a rhetorical flourish added to a politician’s speech. Too many women are still missing out on the opportunity to get educated, support themselves, and obtain the health services they need, when they need them.
That’s why WHO is working so hard to strengthen health systems and ensure that countries have robust financing systems and sufficient numbers of well-trained, motivated health workers. That’s why WHO, with UN and world partners, are coming together at the UN Commission on Status of Women from 9-20 March 2015 in New York. We will look again at pledges made in the 1995 Beijing Declaration and Platform of Action with a view to renewing the global effort to remove the inequalities that put decent health services beyond so many women’s reach.
And that is why WHO and its partners are developing a new global strategy for women’s, children’s and adolescents’ health, and working to enshrine the health of women in the post 2015 United Nations’ Sustainable Development Goals. This means not only setting targets and indicators, but catalysing commitments in terms of policy, financing and action, to ensure that the future will bring health to all women and girls – whoever they are, wherever they live.
Dr Flavia Bustreo, Assistant Director General for Family, Women’s and Children’s Health through the Life-course, World Health Organization,
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