It is imperative that we improve gender equity in health
“There is no tool for development more effective than the empowerment of women” — Kofi Annan, 7th UN secretary general
In the 1970s, a small hospital just outside of Dhaka launched an experiment, dispersing a cadre of female community health workers who were to provide door-to-door family planning services to women in the local communities and within the locality.
At a time when the fertility rate was very high and female employment (especially in health care) was very low, this was unheard of — but it started a trend. As women became more involved in their reproductive choices, fewer succumbed to pregnancy-related deaths, child mortality declined, and their children enjoyed much healthier lives.
This program was scaled-up across the whole country, with the government training tens of thousands of female community health workers using what is known as the “Matlab model.”
It was instrumental in reducing the country’s fertility rate from 6.3 in 1975 to 2.14 in 2015.
Icddr,b piloted the successful female community health workers model and has continued innovating services to address the urgent needs of those most denied access to health care.
Today, at least half of the world’s population today do not have a basic pathway to essential health care services and the number of women and girls affected by this systematic failure is unknown.
Specifically, they face inequity surrounding their sexual and reproductive health care needs due to lack of adequate resources to bear the cost of care, or simply a lack of access and availability of proper care.
A low-cost, life-saving solution
Despite the tremendous success in lowering the maternal mortality ratio, the rate is still very high. The majority of pregnant women still give birth at home, making them susceptible to post-partum haemorrhage (PPH) characterised by excessive bleeding after delivery, a severe complication that accounts for a third of maternal deaths in Bangladesh.
To make identification of PPH effortless so that it can be recognised by even a non-medical person, icddr,b developed a low-cost solution, the “icddr,b Q-mat.” Ideal for home-births, it is placed under a woman immediately after birth to soak the flow of blood.
This provides a measurement of the amount of blood lost during delivery and can determine if referral to a nearby health care facility is needed.
Promoting breastfeeding in the workplace
There have been numerous initiatives to promote exclusive breastfeeding but the prevalence rate has remained low 55% for children under six months.
To put this into perspective, the World Health Organization recommends exclusive breastfeeding until at least six months.
The institute has been active in encouraging mothers to breastfeed their children, offering counselling services at the breastfeeding clinic at our Dhaka hospital. It is the only facility in the city to provide re-lactation therapy for mothers, through one-on-one sessions as well as group counselling.
This service is especially vital, as many children who are admitted to the hospital with diarrhoeal disease will cease to be breastfed by their mothers and the hospital endeavours to encourage these women to continue feeding.
Moreover, research conducted at icddr,b on breastfeeding was the impetus for the Bangladesh government’s drive to increase maternity leave to six months.
More recently, icddr,b has been focusing on supporting women in the ready-made garments sector to optimally breastfeed. A prototype breast milk pasteurisation machine was installed at a factory, allowing the mothers to pump and safely store their milk for up to eight hours at room temperature.
School during menstruation
Stigma surrounding menstruation is a very distinct form of discrimination which often normalises exclusion and ostracism. In Bangladesh, girls will miss an average of three days of school every month because they cannot afford sanitary products or there is a lack of appropriate facilities.
These perennial issues are currently being tackled by icddr,b, one step at a time. A sanitary pad fashioned from reusable cloth was specially designed by icddr,b and distributed to them along with underwear and disposable bags, so that they do not miss a day of school because of menstruation.
Moreover, both boys and girls are counselled on the many changes they will experience as they go through puberty. The results have already shown a 13%reduction in absenteeism and more understanding and positive attitudes from peers.
Taking their initiatives forward, icddr,b led the formation of a coalition, the “Menstrual Hygiene Management Working Group,” which brings together stake-holders from the government, NGOs, and hospitals to advocate for a more girl-friendly school environment.
When women are stronger and healthier, they are able to become active citizens in their communities
Engaging men in conversation
As many as 58% of women in Bangladesh have reported experiencing some form of physical and/or sexual violence from an intimate partner in their lifetime.
This creates a cycle of abuse where male children of couples in abusive relationships learn to accept violence towards women and become more likely to perpetrate this violence in adulthood.
To achieve long-lasting changes in society, it is also essential to work with men and boys for changing their violence-endorsing attitudes. They also need to be equipped with alternative ways of conflict resolution.
Understanding that behavioural patterns are formulated very early among children highlight the importance of preventive interventions targeting men in their early years, and icddr,b’s work in this area could reduce spousal violence against adolescent girls by 21%.
Violence and mental disorders in women
Violence perpetrated against women makes them more susceptible to a number of mental health problems, including anxiety, depression, acute and post-traumatic stress, and somatoform disorders.
Women often face extreme social and emotional duress to maintain a relationship (within the confines of marriage) even if they were physically, verbally, and emotionally abused, not just by their husbands, but in laws and other relations as well.
Icddr,b and its collaborators are one of the first institutions to conduct research to better understand and explore the experiences of women in Bangladesh who developed specific mental disorders and endured violence at some point in their lives.
One of the key reasons those with mental disorders endured more violence because they were often “othered,” and those around them either avoided associating with them or resorted to violence as a means to elicit more “normal” behaviour.
For female garment workers
Undoubtedly, those who work in such factories for 10-12 hours a day, 6-7 days a week, will bear enormous hazards to their health, the effects of which are likely to be long-term.
Pregnant women often developed hypertensive disorders due to the physical nature of the job, and most women are forced to hand over their meagre salaries to their husbands or mother-in-laws, limiting their mobility and undermining their economic empowerment.
Furthermore, women’s participation in the workforce made them more susceptible to violence, both at home and in the workplace.
Working in tandem with national and international experts, icddr,b is committed to developing effective interventions targeting both men and women. Research at icddr,b and elsewhere demonstrate that it is not enough to economically empower women. Gender sensitization and collectivization is essential for effectively reducing spousal violence against women.
The organisation has been championing the development of women and girls since its inception. Gender inequality is calamitous to the physical and mental well-being of millions of girls and women across the world.
It is imperative to take action to improve gender equity in health as a means to address women’s rights to accessible and affordable health care services.
When women are stronger and healthier, they are able to become active citizens in their communities, contributing to the betterment of society.
Farasha Bashir is a Communications Specialist at icddr,b.