Adarshna

Achieving Gender Equality in Education and Health – the expected role of the Medical Professionals

Addressing Poverty, Education, and Gender Equality to Improve the Health of Women Worldwide

The Millennium Development Goals (MDGs),developed by the United Nations in 2000, provided a framework for a new global partnership to improve the health well-being of the world population (United Nations, 2000).

Achieving the goals lies in the ability of the world to view fellowship, the interdependency, and mutuality of coexisting as a cornerstone to health and well-being.

The links among poverty, education, and gender equality to the health of women and children are undeniable.

A woman’s health and the multiple roles she plays as a mother, an individual, a family member, and a citizen in society are important to the economic development of a community.

Yet women and children face many barriers to achieving health and well-being.

Children living in poverty are hungry, and this a¡ects their ability to participate in primary education and become literate.

In many settings despite the presence of primary education, the girl child faces discrimination and is not allowed to attend school.

Women and children bear the burden of disease and poverty globally.

A woman’s status in society, her lack of empowerment, and the inequities that exist related to employment and pay create barriers to achieving health and well-being for herself and her family.

 For the last century, poverty and the consequence of it, hunger, have had a detrimental e¡ect on the well-being of women and children in the developing world  

women are segregated into work that pays them 23% to 30%less than men, especially in the hotel and con
struction industries

The gap is further widened because women continue in mostly unpaid positions, such as family businesses, where they freely give their time 

Although these jobs contribute to the well-being of the family unit, they place many women in a position of servitude with limited access to ¢nancially stability.

As the global economic crisis  slows, women will continue to feel the effects with a slower return to employment than men

 For women to achieve parity in labor, they need to be well represented within governments to affect  policy and decision making.

Worldwide, women are assuming a greater number of seats in government; however, they continue to hold less than 10% of elected seats in parliament in many countries and no seats in many governments

Women unevenly shoulder the burden of poverty and the consequences of it.

Globally, girls endure  conditions that make having goals beyond survival unthinkable.

Women have higher rates of death related to nutrition and communicable and noncommunicable diseases that are directly related to lack of resources 

The link between economics and health is visible

The outcome of the an economic downturn in developing regions will be a rise in infant mortality related to underemployment and food costs

In 2005, 13 million babies were born prematurely, with 85% of those births occurring in Africa and Asia and More than one million babies die annually due to prematurity (March of Dimes, 2009).

Many more may die when they are born prematurely to malnourished mothers. Moving forward, it is estimated that there will be 30,000 to 50,000 excess deaths related to the economic downturn, many of whom will be women and children (Freidman & Schady, 2009).

Food scarcity and food costs will result in an increase in the numbers of people who are malnourished (United Nations, 2008). Malnutrition of mothers is a known contributor to preterm birth (Gwatkin, Rustein, Johnson, Pande, & Wagsta¡, 2000).With the economic crisis spanning the globe and the rise in food prices, it is anticipated that more women will be malnourished and more children will be born prematurely.

Girls who are educated have better birth outcomes.

Independent of living conditions or socioeconomic status, when a women’s education level advances, her health and those of her daughters and other
household members improves (Govindasamy, 2000).

The longer a girl child stays in school, the longer she delays birthing and increases the possibility of better birth outcomes (Filippi et al., 2006).

Success in achieving education rests in children completing their studies.

Many children start school but inevitably drop out due to family circumstances.

In settings where education is available for girls and women, it is often substandard and at a lesserquality than what is available to boys. Therefore,  the quality of the education must also be improved.

The United Nations Education Science and Cultural Organization (UN-
ESCO) estimates that in sub-Saharan Africa alone, more than three million teachers will be needed for the population by 2015 (United Nations, 2009b).

Societies need to believe that education is a basic human right that should be made available to everyone (UNESCO, 2008).

Citizens of the world need to view this crisis as one that affects them, and they need to find ways to participate in the solution. 

With education parity achieved, advancement in employment should occur. Unemployed women remain more vulnerable, and they often work in non paying family run agricultural jobs in addition to spending 33 hours/week caring for their families. 

By comparison, men spend 6 hours/week caring for their families (United Nations Children’s Fund [UNICEF], 2007). According to UNICEF women earn 
only 57% of what men earn yet they produce almost 50% of the world’s food. During their reproductive years, women bear the burden of children and also contribute to society and country development despite the high cost of childcare throughout the world (Gill et al., 2007).

Yet women’s wages across all regions of the world are 20% lower than men and 70% lower in sub-Saharan Africa (UNICEF). The disparity in employment and compensation for equal work will continue the cycle of poverty for women. Addressing this injustice in small and large ways will improve a woman’s ability to care for herself and her children.

Economic survival is rooted in women’s empowerment. The discrepancy between women’s contributions to the economy and their income is directly related to their status. Elevating the status of women will have a profound impact on their distinct health issues (Sciarra, 2009). The human rights of women in low-resource countries are linked to their ability to improve their health status speci¢cally in the area of reproductive health (Shaw & Keith, 2006). Empowerment of women can only be achieved when the rights of women are seen as equal to those of men. Many inequalities are related
to cultural beliefs such as a woman cannot travel without a male family member. Therefore, access to health care is limited (Sen et al., 2007). Once at a health center, a woman can only be cared for by female health care providers. Because of these cultural beliefs, women cannot leave the home to
be educated, and thus many qualified health care providers are not women. More work is needed by health care providers to demonstrate that health 
care supports cultural and religious beliefs by ensuring that a person is in optimal health.

To fully understand the inequalities that exist in education, one must first examine the larger picture of
gender disparities that exist over the course of a woman’s life. It is the intersection of gender, race
and ethnicity, age, sociocultural, geopolitical, and environmental conditions that shape the trajectory
for health and empowerment of girls and women (Woods, 2009).

Gender inequality begins before birth and extends across the life span (Gill et al., 2007). With our
modern technologies and the ability to determine the sex of a fetus, many female fetuses are aborted
prior to birth because of the cultural and economic value of having sons (Oomman & Ganatra, 
2002).

In developed nations, women have a longer life expectancy at the time of birth, but in underde-
veloped and developing nations, this advantage is overridden by gender-based discrimination that
reversesthisstatistic(WorldHealthOrganization,2009).

Mehta (2006) stated that the burden of living with AIDS will fall to the women of society as 
they are the fastest growing group of HIV-positive persons worldwide. Many women do not have the
right or liberty to control their own bodies and have little influence in reproductive decision mak-
ing. Women often cannot seek health care for themselves or their children without permission,
but they are the primary caregivers for the sick and vulnerable. As the rate of disparities of
those infected and affected by HIV/AIDS grows, family structures and communities will collapse
leavingmorewomenandchildrenlivinginpoverty 

During childhood, the disempowerment of women is fueled by the perception that boys will be the
wage earners and thus need to be fed better, receive a higher level of education, and have access
to more comprehensive health care so they grow to be strong, healthy, productive adults bringing in-
come to the family. On the other hand, girls are viewed as a burden to their families, especially in
cultures where the families must provide dowries for their daughters when they reach the age of mar-
riage (Cesario, 2003). These childhood disparities result in the vulnerability of girls to more illnesses,
especially those related to nutritional disorders, infection, bone and muscle weakness, and com-
municable disease (Ehrhardt, Sawires, McGovern, Peacock, & Weston, 2009).

As girls enter adolescence, they face additional stressors. Oftentimes young women enter arranged
marriages at an early age and begin lives in which they are objecti¢ed by their families, spouses, and
communities (Ehrhardt et al., 2009). In many cultures, the male partner is responsible for
reproductive decisions, and the woman is viewed simply as a child bearer. This lack of decision-making power within the relationship results in multiple, closely spaced pregnancies, insu⁄cient access to contraception, acquisition of sexually transmitted diseases including HIV/AIDS, and forced abortions that are often carried out under unsanitary conditions by informally trained providers. It is estimated that unsafe abortion kills more than 70,000 women each year, mostly in underdeveloped nations (International Planned Parenthood Federation, 2008). In addition, the power structure of a relationship is evident in the high rate of domestic violence that is part of many cultures (Ellsberg, 2006). Women and young children live at risk daily with no tools or supports with which to stop physical and verbal abuse. As women age, they are also at higher risk for many chronic diseases, such as chronic obstructive pulmonary disease, cardiovascular disease, diabetes, blindness, cancer, and depression (Magnusson, 2009). In addition, they are less likely to receive care or curative therapies for chronic conditions and  may receive health care that is of a lesser quality  than that received by men ( Ehrhardt et al., 2009). The majority of suicides in Middle Eastern and African countries are attributed to the oppression of women (Sen et al., 2007). Although many matriarchal societies hold women in high regard, they continue to live in oppression and lack empowerment to sustain their health. Throughout the life span, the effects of gender inequity are visible. If women were empowered and valued from childhood, they would be a ble to seek equality to men. However, the goal is not to reach equity by sameness; services for women should be di¡erent than men (Sen et al., 2007). The goal is to ensure that access to health is free from bias. To achieve this development goal, every society must deconstruct years, and in some instances centuries, of how women are valued in their community and globally. 

Poverty occurs at many di¡erent levels in society. Je¡ery Sachs (2005a) described the degrees of poverty as extreme, moderate, or relative. People living in extreme poverty cannot meet the basic needs for survival: they are chronically hungry; have no access to health care, clean water, andsanitation; have no access to education; and lack shelter.These situations occur mostly in developing countries and a¡ect women (Thompson, 2007  People living in moderate poverty are just barely meeting their survival needs, and families living with relative poverty lack access to those material goods or situations such as advanced education that al low upward social mobility (Sachs, 2005a, 2005b) Women and children living in extreme poverty do not bene¢t from many programs targeted at alleviating poverty. Their energy is focused on everyday survival, and therefore, they bene¢t most from humanitarian aid (Sachs, 2005a, 2005b). Social programs that target people moving from a level of extreme poverty to moderate poverty have shown great success.

Organisations can create community-based initiatives focused on empowering poor rural women with the goal of long term financial sustainability. Women participate in collateral free micro credit programs. The programs provide women with small loans secured by their commitment to participate in a community education program. Repayment occurs over time while they attend the education programs and share stories of how they are using their funds. The focus of the education programs are health promotion and education for family planning, water and sanitation, immunization, nutrition, and basic curative services (BRAC, 2009).

It was envisioned that focusing on the fundamental determinants of health and  well being would improve the plight of women in a very traditional society (Rohde, 2006). BRAC programs have shown that encouraging women to participate in entrepreneurial and education programs has improved their health and status in society (Rohde, 2005). 

Education is seen as a means of alleviating poverty and gender inequality. For women and girls, education has rightly been identified as the roadmap to lift families out of poverty, to gain employment, and to empower women to become independent and con tributing members of society outside of the home For many young girls, the barriers created by society and culture regarding education begin at an early age. Girls are left behind from school to fetch water and gather wood for heat and cooking while boys are chosen to attend school with the promise that they will care for the women. In many circumstances this promise of often not kept due to distance and disease.

Various Campaigns for Female Education can be a means to ensure that girls are educated to create a multiplier effect to fight poverty and sexually transmitted diseases.

This model program supports primary and secondary education, educates girls on
economics, and supports empowerment of women to create leaders who initiate sustainable change.The outcomes of educating young girls and empowering young women is that they are 3 times less likely to become infected with HIV, earn 25% more income, and invest up to 90% of this
income in their families

Girls and young women who have been part of these programs have fewer children, and their children are healthier with 40% more living past age 5 (CAMFED).Through their alumni network, women are supported in achieving their educational goals which leads to empowerment and the ability to be self sustaining economically. The alumni then serve as role models for the next generation of young girls by demonstrating how education will affect their futures. OneNurseCanMakeaDifference

The Human Rights Declaration of 1948 states, ‘‘Everyone has a right to a standard of living adequate for the health and wellbeing of himself and of his family, including food, clothing, housing and necessary medical and social services’’ (United Nations,1948). On a global level, nurses work to ensure these human rights where they dissect with societal, economic, and public health issues. A nurse is often the only health care provider to thousands of people.The role of the nurse is perplexing: on one hand the nurse seeks to provide wellness for a community amidst numerous barriers and constraints. On the other hand, a nurse is a member of society that is seeking relief from poverty within a community. The International Council of Nurses (ICN) views the role of the nurse as vital to reducing the impact of poverty on health and well-being (ICN, 2009a). Nurses are positioned within society to strengthen the link between health and human rights that will assist with the prevention of disease and improve opportunities for access to health care (ICN, 2009b).

The role of the nurse in a community is to provide education, support, and guidance on achieving
health. Nurses are also members of the community and are often looked at as leaders. They can fight poverty at the community level by adopting a participatory approach of involving the community in problem solving; poor people should be viewed as mutual participants and not objects within nursing interventions. Nurses have direct knowledge of and experience with working with poor and vulnerable members of society. Nurses should use this knowledge to promote advocacy and partnerships to create anti poverty measures within communities and work with organizations that will provide income opportunities and health related education for women. At the same time nurses should work to  increase the visibility of those most vulnerable, often the women of a community. Nurses should use their infuence within these groups to relieve the sufering of women living in poverty.

The global partnership formed by the MDGs will improve the health and well-being of women and children globally. Nursing has tremendous capacity to work with women to eradicate poverty, to improve children’s access to primary education, to support girls in achieving equity with boys in completing their studies, and to elevate the status of women in our societies. Nurses have the ability to educate society on the links among poverty, inequality, and the empowerment of women by focusing on community initiatives that can provide women and girls with sustainable ways to change their circumstances. By focusing our efforts on relieving the sufferring associated with hunger, ensuring that children, specifically girls, are educated  in a safe environment, and creating opportunities for health either within nurse run health centers or small village clinics, nurses will have an impact on global health.

There needs to be a renewed call to awareness of the a¡ect of poverty, gender inequities in education
and employment and women’s empowerment, and their effect on overall well-being.Without represen-
tation in government, women’s status and their contributions to society will lag behind and be det-
rimental to their families’ well being.Nurses have the capacity to assist women in realizing their capacity
to a¡ect change within their families and communities. When nurses exercise their leadership in
advocating for vulnerable others at any level of society, they can make strides toward improving the
variables that a¡ect health: poverty, education,and empowerment.