Gender inequality holds back the growth of individuals, the development
of countries and the evolution of societies, to the disadvantage
of both women and men.
Indian girl at work. Lack of support for girls' education limits their future choices.
facts of gender inequalitythe restrictions placed on women's
choices, opportunities and participationhave direct and often
malign consequences for women's health and education, and for their
social and economic participation. Yet until recent years, these
restrictions have been considered either unimportant or non-existent,
either accepted or ignored. The reality of women's lives has been
invisible to men. This invisibility persists at all levels, from
the family to the nation. Though they share the same space, women
and men live in different worlds.
The first steps have been taken to end this invisibility. In 1979,
by adopting the Convention on the Elimination of All Forms of Discrimination
against Women, the global community agreed to eliminate gender discrimination.
The Convention, which has the force of international law, has now
been ratified by 165 of the 188 member states of the United Nations.
Health care and education for girls and women have been the subject
of international agreements, notably those reached at a series of
world conferences on women beginning in 1975, the World Conference
on Education for All in 1990 and the International Conference on
Population and Development (ICPD) in 1994.
A rapidly growing number of countries have adopted population and
development policies that include measures to meet the health care
and education needs of girls and women, including their reproductive
health needs. Education and health, including reproductive health,
are human rights. Meeting education and health needs and working
towards gender equality will also contribute to balanced population
growth and economic development.
Most countries have some measures in place to protect women's personal
security and their rights in marriage, property, inheritance, political
representation and the workplace. Those measures are being expanded
and increasingly enforced.
The impact of women's empowerment on the rights and roles of men
is being considered. Efforts to bring women into the mainstream
of development now emphasize partnership between women and men.
"Gender issues" are not the same as "women's issues":
understanding gender means understanding opportunities, constraints
and the impact of change as they affect both women and men. It is
increasingly understood that partnership between women and men is
the basis for strong families and viable societies in a rapidly
Equal partnership is also the aim of women's organizations, which
are rapidly growing in number and strength in many countries of
Asia, Africa and Latin America. The advantages of partnerships between
official organizations and women's groups are increasingly recognized.
Yet gender inequality remains pervasive. It is a public concern,
but it also relates to private behaviour, and therefore has not
yet been fully discussed, especially where male dominance is the
basis of family life. Elsewhere, though unequal restrictions on
women may be outlawed or condemned, they persist in forms that have
been rendered more socially acceptable.
This year's State of World Population report makes the case for
bringing gender inequality fully into the light and treating it
as a matter of urgency affecting both human rights and development
priorities. Gender discrimination will not end until all eyes are
opened to its inherent contradictions, and countries, communities
and families take action to end it.
Box 1: Discrimination
and Poverty Go Hand in Hand
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More equal power relations between men and women, combined with
increased access to good reproductive health care, would save the
lives of hundreds of thousands of women, including many of those
who die from pregnancy-related causes. If women had the power to
make decisions about sexual activity and its consequences, they
could avoid many of the 80 million unwanted pregnancies each year,
20 million unsafe abortions, some 500,000 maternal deaths (including
78,000 as a result of unsafe abortion), and many times that number
of infections and injuries. They could also avoid many of the 333
million new sexually transmitted infections contracted each year.
Adolescent girls are particularly vulnerable (Chapter 2).
Violence against women also takes a steep toll on women's health,
well-being and social participation (Chapter 3). Men must involve
themselves in protecting women's reproductive health as a matter
of self-interest and to protect their families, as well as for its
own sake (Chapter 4).
The equality of women and men is integral to development (Chapter
5). It is also a human right (Chapter 6). Governments must take
the fundamental decisions. Donor countries have agreed to support
these priorities, but donors in the 1990s have not met even half
of the agreed resource targets in the area of population and reproductive
health (Chapter 7).
Gender and Health (Chapter 2)
Quality reproductive health services enable women to balance safe
childbearing with other aspects of their lives. The International
Conference on Population and Development and the United Nations'
"ICPD+5" five-year review recognized the important relationship
between gender and reproductive health. Gender-sensitive programmes
listen to clients and involve them in programme and service design.
Components of reproductive health
About one third of pregnanciesabout 80 million a yearare
believed to be unwanted or mistimed. The number of users of family
planning services in developing countriesassuming services
can be providedis expected to increase by more than 40 per
cent by 2015: 742 million compared with 525 million in 2000. Just
over half of the increase will be due to rising numbers of women
of reproductive age (15-49) in these countries. This group will
grow by more than one fifth in the next 15 years, to 1.55 billion.
The rest of the increase in users will result from increased demand
as the proportion of people using contraception rises.
Good family planning programmes share several characteristics:1
- Government support is strong;
- Providers are well trained, sensitive to cultural conditions,
listen to clients' needs, and are friendly and sympathetic;
- Services are affordable and a choice of contraceptive methods
- Counselling ensures informed consent;
- Privacy and confidentiality are ensured;
- Facilities are comfortable and clean;
- Service is prompt.
Figure 1: Family
Planning Needs Will Grow as Both Population and Demand Increase
Universal access to sexual and reproductive health care is a central
objective of the ICPD Programme of Action. Since the ICPD, many
countries have expanded services beyond family planning to care
for women's and men's broader reproductive health needs.
One woman a minute dies of pregnancy-related causes. Maternal mortality
is preventable by:
- Helping women avoid unwanted pregnancy;
- Ensuring the presence of trained attendants at every birth;
- Providing emergency obstetric care;
- Providing post-natal care61 per cent of maternal deaths
occur after delivery;
- Providing effective post-abortion care78,000 maternal
deaths are due to unsafe abortions, 95 per cent of which take
place in developing countries.
Box 2: Most Maternal
Deaths Could be Prevented
Some 20 million of the estimated 50 million abortions each year
are unsafe; 78,000 women die and millions suffer injuries and illness
as a result. Expanded access to family planning would prevent many
unwanted pregnancies and many unsafe abortions. In many low-income
countries effective post-abortion care would reduce maternal mortality
by as much as one fifth.
Sexually transmitted diseases (STDs) afflict five times more women
than men. There are an estimated 333 million new cases every year.
These diseases cause infertility, pregnancy-related complications,
post-partum illness and cervical cancer.
Human immunodeficiency virus/acquired immune deficiency syndrome
(HIV/AIDS) is now the leading cause of death in Africa and the fourth
most common cause of death worldwide. At the end of 1999, 34.3 million
men, women and children were living with HIV or AIDS, 5.4 millions
were newly infected that year, and 18.8 million had already died
from the disease. More than 95 per cent of all HIV-infected people
live in the developing world.
Women are more vulnerable to infection than men and are becoming
infected at a faster rate. In Africa, HIV-positive women outnumber
infected men by 2 million. The ICPD+5 review agreed that women need
information, education, skills, services and social support to reduce
their vulnerability. There should be wider access to male and female
condoms, and retro-viral drugs where possible. Information and counselling
are needed on sexuality, gender roles and power imbalances, gender-based
violence and other issues. Family planning and services for STDs
and HIV/AIDS should be integrated within reproductive health services.
Women tend to become infected far younger than men. In several
African populations, girls aged 15-19 are five or six times more
likely to be HIV-positive than boys their own age. Clearly, older
males are infecting teenage girls. Good-quality sex education helps
adolescents delay sexual intercourse and increase safe sexual practices.
Worldwide, some 130 million girls and young women have undergone
female genital mutilation (FGM). Genital mutilation is extremely
painful and may result in severe infection, shock or even death.
Survivors experience painful sexual intercourse and may be at greater
risk during and after childbirth. FGM can lead to repeated infections
Gender biases can also lead to a variety of restrictions on carefor
example, restricting certain procedures to doctors, or providing
public clinics only for maternal and child health, so men and childless
or unmarried women feel uncomfortable going to them for reproductive
Reproductive health services are increasingly recognizing that
reproductive health is a matter for men as well as women, including
the effect of women's reproductive health on men and men's support
for their partners' reproductive health.
Young people's reproductive health
Young men and women face different social pressures and expectations
which may work against responsible sexual behaviour. Training young
people as peer educators encourages discussion and responsible behaviour.
Sometimes, simply calling attention to double standards can lead
Many girls and boys, however, are forced into early and unsafe
intercourse by sexual abuse, child marriage or poverty. Adults also
prevent young people from acting responsibly by limiting their access
to information and health services. Parents can learn to be sources
of information and counselling to their children. Many other adults
in and out of the family can also play a part, especially political
and religious leaders, who have a great deal of influence on changing
Men's reproductive health needs
Men are subject to sexually transmitted infections and have other
reproductive health problems such as impotence and infertility.
Men also want to space their childrenand in some developing
countries between one quarter and two thirds of men say they want
no more children, but neither they nor their wives are using contraception.
Reproductive health services for men have concentrated on treatment
and control of STDs. The proportion of contraception attributable
to men has fallen in recent years. Information on avoiding pregnancy
and preventing infection is still limited among unmarried men. Good
programmes can increase men's interest in and their use of contraception.
Migrants and refugees
Migrants and refugees have special reproductive health needs.
UNFPA has provided timely emergency assistance in a number of developing
Partnerships for reproductive health
Non-governmental organizations (NGOs) have helped to bring about
major shifts in population and development programmes, and have
brought gender concerns to the centre of these programmes. NGOs
are working for gender equality and engaging in advocacy and policy
formulation covering such sensitive topics as unwanted pregnancy,
STDs and HIV/AIDS, and adolescent reproductive health, among others.
NGOs' work on violence against women is one of the most important
contributions to ending gender-based abuse. National NGOs are promoting
reproductive health and women's well-being, providing health care
and social services, and participating actively in health reforms.
One of the great strengths of NGOs is their ability to form partnerships
and alliances among themselves and with governments. International
networks validate and strengthen national groups and raise the NGO
profile in international discussion.
Civil society/government partnerships can be highly productive.
In Bangladesh, for example, 25 per cent of reproductive health activities
are carried out by NGOs. Effective partnerships are especially important
where public-sector investments are most limited.
Violence against Women (Chapter 3)
Girls and women worldwide, across lines of income, class and culture,
are subjected to physical, sexual and psychological abuse. Violence
against women includes rape, genital mutilation and sexual assault;
forced pregnancy, sterilization or abortion; forced use or non-use
of contraceptives; "honour" crimes; sexual trafficking;
and dowry-related violence.
Around the world, at least one in every three women has been beaten,
coerced into sex, or abused in some other waymost often by
someone she knows, including her husband or another male family
member. One woman in four has been abused during pregnancy.
Each year rape and domestic violence cost women worldwide the equivalent
of millions of lost years of healthy life. Physical violence is
nearly always accompanied by psychological abuse, which can be just
as demeaning and degrading.
Many cultures condone or at least tolerate a certain amount of
violence against women. Even women often view a certain amount of
physical abuse as justified under certain conditions. As many as
5,000 women and girls are killed annually in so-called "honour"
killings, many of them for the "dishonour" of having been
The reproductive health consequences of violence include unwanted
pregnancies, complications of pregnancy, unsafe abortion and sexually
An estimated 4 million women and girls are bought and sold worldwide
each year, either into marriage, prostitution or slavery. Although
the greatest volume of trafficking occurs in Asia, Eastern European
women are increasingly vulnerable.
Recognizing the growing use of violence against women as a weapon
of war, a conference of the International Criminal Court in 1998
added to its definition of war crimes a statute on gender justice
stating that rape, sexual slavery, enforced prostitution, forced
pregnancy, enforced sterilization and other forms of sexual violence
are "grave breaches" of the Geneva Conventions against
Men, Reproductive Rights and Gender Equality (Chapter 4)
Gender considerations involve men as well as women, so understanding
gender means understanding opportunities and constraints as they
affect both women and men. Definitions of gender roles are often
rigidly stereotypical, and increasingly fail to correspond to external
change. These anomalous expectations are at the root of continuing
Men develop an interest in women's reproductive health when they
learn more about how they can help ensure safe pregnancy and delivery.
Shared beliefs about marriage and proper behaviour improve the reproductive
health of both partners.
The Cost of Inequality (Chapter 5)
Empowerment and equality for women are important human rights aims
in themselves, but they are also integral to development. It is
more than a matter of economics: in the words of UNFPA's Executive
Director, Dr. Nafis Sadik, "Better health and education, and
freedom to plan their families' future, will widen women's economic
choices, but it will also liberate their minds and spirits."
Much of women's work, paid and unpaid, has an economic impact,
though their contribution is rarely noticed or fully quantified.
If it were recognized for what it is and supported accordingly,
its value would be even greater. Giving women farmers in Kenya the
same support as men, for example, would increase their yields by
more than 20 per cent; raising Latin American women's wages to men's
levels would increase national output by 5 per cent.
One of the keys to sustainable development will be recognizing
the costs of gender discrimination and the advantages of equality,
making them visible to policy makers and families, and agreeing
Health care and education
The absence of health care has economic as well as personal costs.
As much as 30 per cent of economic growth may be attributed to better
health and nutrition. On the other hand, life expectancy is shorter
in poor nations and among poor people. Cuts in health services such
as those imposed after the Asian financial crisis affect the poor
most acutely, and poor women in particular, as the heaviest users
of public services. Where funding cuts led to fees being imposed,
more recovery time was needed after illness, and labour force participation
dropped. Poor women were among those most seriously affected.
Limited access to health care among the poor has a greater relative
impact on women than on men. In particular, poor women are more
likely to die as a result of pregnancy. A mother's death represents
more than a personal tragedy: the economic and social costs include
the impact on children's health and education, and on the father's
ability to hold the family together.
Like maternal death and disability, HIV/AIDS has a heavy economic
and social cost, in part because deaths are concentrated in the
early to mid-adult years, when family responsibilities are greatest
and earning power highest. Partly as a result of gender inequality,
women are now more likely than men to contract HIV infection. Economic
costs may amount to a loss of 0.5 percentage points in annual gross
domestic product (GDP) growth, a considerable burden where growth
is already slow.
Gender violence also imposes costs, from the cost of caring for
the injured to the cost of family dissolution; indirect costs include
missed opportunities for women and their children. Inequality also
has psychological costs, notably from reduced self-esteem and depression
among women, and frustration among men due to unrealistic expectations.
Studies repeatedly show that educating girls and women raises every
index of development. Denying education to women has slowed social
and economic development. An estimated two thirds of the 300 million
children without access to education are girls, and two thirds of
the some 880 million illiterate adults are women.
Economic returns on investment in women's education, on the other
hand, exceed those for men. Differences in fertility levels between
regions are strongly related to differences in levels of health
and women's education. A recent study attributed one third of the
increase in male and female life expectancy between 1960 and 1990
to gains in the educational attainment of women.
Family planning and reproductive health programmes in general improve
women's health. They tend to result in lower total fertility and
slower population growth. The ageing of populations will also have
social and economic consequences; old age poses different challenges
for women and men. Gender factors strongly influence these trends
and demand fresh attention from policy makers.
Economic benefits from declining fertility include a one-time "demographic
bonus" as the workforce increases relative to the dependent
population. Improving education for girls and meeting their special
health needs will help make the most of the demographic bonus.
Box 3: Beyond 6 Billion
Measuring gender bias
Several composite measures are used to assess gender bias. Variation
is considerable, and for many countries, the indicators differ on
what areas need most attention; but all agree to a large extent
on the relative standing of countries and localities.
Working to End Gender Inequality (Chapter 6)
Equality is a human right
The equality of women and men has been accepted as a fundamental
principle of human rights since the adoption of the United Nations
Charter in 1945. Several international treaty agreements, such as
the Convention on the Elimination of All Forms of Discrimination
against Women, oblige signatory states to take action against discriminatory
As expressions of the world's conscience, the consensus decisions
of international conferences are powerful instruments for promoting
the right to equality. The 1994 ICPD and the Fourth World Conference
on Women in 1995 and their respective five-year reviews agreed on
specific goals towards achieving it.
Box 4: ICPD+5 Review
Action Taken, Action Needed (Chapter 7)
Governments must take the fundamental decisions to move ahead on
gender equality. Legal changes are a matter for sovereign decision;
also, in many developing countries civil society is relatively small
and powerless. Governments are also major employers, and their rules
and practices have a powerful influence on social change. Governments
are the major suppliers of services such as health and education,
and public policy in these areas will determine the pace of change.
Parliamentarians are the interface between people and governments,
though non-governmental organizations are playing a growing part
in defining and promoting gender equality and equity. Parliamentarians
are often the channel through which responses to policy, and news
of changing needs and practices, reach governments.
Social change cannot be brought about merely through legislation;
it must be encouraged by leadership and example. It can also be
encouraged by international action to put into effect the agreements
reached in legally binding instruments such as the Convention on
the Elimination of All Forms of Discrimination against Women and
the morally binding consensus of international discussions such
as the ICPD. Major initiatives such as the global campaign for girls'
education have been launched to re-energize the discussion and mobilize
the promised support.
Donor countries are called upon to support these priorities, and
have agreed to do so. But donors in the 1990s have not met even
half of the agreed resource targets in the area of population and
reproductive health; international assistance for education and
women's empowerment is also woefully inadequate. The shortage of
funding to help countries advance gender equality harms the interests
of women and men, their countries and the global future.
Box 5: "Beijing+5"
Review Reaffirms Commitment to 1995 Platform for Action
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