THE STATE OF WORLD POPULATION 2000
Lives Together, Worlds Apart
Men and Women in a Time of Change

Inequality between women and men limits the potential of individuals, families, communities and nations. Ending gender discrimination is an urgent human rights and development priority, says The State of World Population 2000 report from the United Nations Population Fund (UNFPA).

Despite the tremendous changes of the 20th century, discrimination and violence against women and girls remain firmly rooted in cultures around the world. Passed down from one generation to the next, ideas about "real men" and "a woman’s place" are instilled at an early age and are difficult to change.

These restrictions take a heavy toll. Girls and women the world over are denied access to education and health care. Millions are subjected to abuse and violence. Women’s legal rights are not protected. Their medical concerns are given less attention than men’s are. They are denied opportunities in the workplace and receive less pay than men for the same work.

Men, and societies, also pay a price. Yet, until recent years, gender discrimination was considered either unimportant or non-existent, either accepted or ignored, without even the statistics to describe it. While many countries have started taking steps to protect women’s rights and promote equality, actual progress has been slow.

Gender discrimination will not end until all eyes are open to its inherent contradictions, and countries, communities and families act to end it.

Gender and Health

Gender inequality harms women’s health and prevents many women from participating fully in society. Unequal power relations between men and women often limit women’s control over sexual activity and their ability to protect themselves against unwanted pregnancy and sexually transmitted diseases (STDs), including HIV/AIDS. Teenage girls are particularly vulnerable.

Inadequate reproductive health care for women also results in high rates of unwanted pregnancy, unsafe abortion and preventable death and injury as a result of pregnancy and childbirth. Gender-based violence — including rape, wife beating and female genital mutilation — hurts women’s health, well-being and social participation.

Universal access to sexual and reproductive health care, including family planning services, was a central objective of the 1994 International Conference on Population and Development (ICPD) in Cairo. Countries agreed that empowering women and meeting people’s needs for education and health were necessary for individual advancement and balanced development. At the 1999 fifth-year review of the Conference (ICPD+5), governments agreed on these new bench-marks, among others: to halve the 1990 illiteracy rate for women and girls by 2005; to halve unmet need for family planning by 2005 and to eliminate it altogether by 2015; to reduce HIV infection in youth by one quarter by the year 2010, by providing information and services to reduce their risk; and to ensure that by 2015, 90 per cent of all births are assisted by skilled attendants. They also agreed that where abortion is legal, it should be safe and accessible.

Providing family planning to everyone who wants it is a significant challenge. Today about one third of all pregnancies — 80 million a year — are believed to be unwanted or mistimed. If women could have the number of children they wanted, the average family size in many countries would fall by nearly one child.

Over the next 15 years — assuming services can be provided — the number of contraceptive users in developing countries is expected to increase by more than 40 per cent to 742 million due to population growth and increased demand for contraception. Providing women with safe options for pregnancy and childbirth is another priority. Today, some 500,000 maternal deaths occur each year in developing countries, where only 53 per cent of all births are professionally attended. This lack of care translates into the neglect of 52.4 million women annually. Nearly 30 per cent of women who give birth in developing countries, some 38 million each year, receive no antenatal care.

Quality care before, during and after birth is essential to safe motherhood. The best way to prevent maternal deaths, however, is to provide emergency obstetric care. Rapid transport to a medical facility is crucial to saving mothers who are facing complications.

Each year, women undergo an estimated 50 million abortions, 20 million of which are unsafe, resulting in the deaths of 78,000 women and the suffering of millions more. At least one fourth of all unsafe abortions are to girls aged 15-19. Increased access to family planning is clearly the best way to reduce abortion. Care for women who have undergone abortion is also an important way to reduce maternal mortality.

At the end of 1999, 34.3 million men, women and children were living with HIV or AIDS, and 18.8 million had already died from the disease. HIV/AIDS is now the leading cause of death in Africa and the fourth most common cause of death worldwide. In 1999, there were 5.4 million new infections, 4.0 million of them in sub-Saharan Africa. In Africa, HIV-positive women outnumber men by 2 million. Programmes that address gender inequality and engage men as partners in fighting AIDS can help slow the spread of the disease. 

Another health, and human rights, concern is female genital mutilation (FGM), which affects over 100 million women and girls, mostly in Africa and Western Asia. Since it is nearly always carried out in unsanitary conditions without anaesthetic, FGM can result in severe infection, shock or even death, and there are lifetime health consequences including an increased risk of experiencing a difficult delivery and dying in childbirth.

Gender-sensitive reproductive health programmes are essential to counter inequality and protect women’s health. Programmes are beginning to address the dynamics of knowledge, power and decision-making in sexual relationships, between providers and clients, and between community leaders and citizens. Non-governmental organizations (NGOs) are increasingly playing important roles in providing services, for instance to address sensitive topics such as adolescents’ needs.

Young men and women face different social pressures and expectations which may work against responsible sexual behaviour. Many girls are forced into early and unsafe sexual activity by abuse, child marriage or poverty. Both married and unmarried youth lack access to reproductive health information and services. Training young people as peer educators encourages responsible behaviour. Parents and other adults can learn to be sources of information and counselling. 

Men also face reproductive health problems including sexually transmitted infections, impotence and infertility. Many men also say they want to limit or space their children, but neither they nor their wives are using contraception. Reproductive health services for men have concentrated on STDs. The proportion of contraceptive use attributable to men has fallen in recent years. Good programmes can increase men’s knowledge of and use of contraception. 

Gender-based Violence 

At least one in three women has been beaten, coerced into sex, or abused in some way — most often by someone she knows. One woman in four is abused during pregnancy. At least 60 million girls are "missing", mostly in Asia, as a result of sex-selective abortion, infanticide or neglect. 

Two million girls between ages 5 and 15 are introduced into the commercial sex market each year. Perhaps as many as 5,000 women and girls are murdered each year in so-called "honour" killings by members of their own families. Rape, battery and other forms of gender-based violence are widespread worldwide. 

Many cultures condone or tolerate a certain amount of violence against women. In parts of the world, men are seen as having a right to discipline their wives as they see fit. Even women often view physical abuse as justified under certain conditions. 

Justification for violence stems from distorted views about the roles and responsibilities of men and women in relationships. Events that may trigger violent responses include not obeying the husband, talking back, refusing sex, not having food ready on time, failing to care for the children or home, questioning the man about money or girl-friends or going somewhere without his permission. 

Violence can cause immense damage to women’s reproductive health and well-being, resulting in unwanted pregnancies; unsafe abortion; persistent gynaecological problems; sexually transmitted diseases, including HIV/AIDS; and psychological and emotional problems that can be more difficult to bear than physical pain. 

NGOs are actively countering violence against women. African NGOs have led the increasingly successful fight against FGM. In Colombia, women’s groups provide training and support for rape survivors. A Bosnian group has counselled 20,000 women and children who have suffered from sexual violence. 

Men, Reproductive Rights and Equality 

Discrimination against women and girls will never stop without the support and understanding of men, especially in the family. Men’s attitudes and behaviours are strongly influenced by stereotypical definitions of masculinity and what it means to be a "real man". These stereotypes, however, are unrealistic and set men up for failure, stress and difficulty in relationships. Men unable to live up to expectations that they should be powerful and competent may retreat into passivity, escape through drugs or alcohol, or resort to violence or exaggerated bravado and risk-taking. 

Helping women and men to communicate about their family roles and responsibilities can strengthen families, protect reproductive health, and reduce gender inequality and gender-based violence. One study in the Philippines showed that domestic violence was least prevalent when the husband and wife communicated and shared responsibility for decisions. 

Men’s behaviour can change. In India, male health workers have motivated other men to take an interest in women’s health and help with house-work. In Mali, men’s involvement in reproductive health has led to support for women’s employment. And in Nicaragua, courses on gender and power have reduced gender-based violence and increased sexual responsibility. 

Counting the Cost of Inequality 

Just as substantial as the human suffering caused by gender discrimination are the social and economic costs. Inequality rewards men, and some women, blinding them to more productive alternatives. It obstructs social and economic participation and closes off possible partnerships. And it reduces women’s effectiveness by failing to support their responsibilities, challenges and burdens. 

Women’s economic activity is undercounted because it is often in the informal sector. Better accounting could encourage investment and promote productivity. A study in Kenya found that giving women farmers the same support as men could increase yields by more than 20 per cent. In Latin America, eliminating gender inequality in the labour market could increase women’s wages by half and national output by a full 5 per cent. 

Girls in poor households are more likely to die than boys before age 5, even though globally girls have a better chance of surviving childhood. Inadequate health care in poor populations has a greater impact on women than men; in particular, poor women are more likely than other women to die as a result of pregnancy. The costs of the death of a mother include her lost contribution to the family and its survival, and increased mortality for her children. 

High rates of HIV/AIDS infection, due in part to gender inequality and a failure to invest in prevention, have taken a tremendous toll in many nations. In some countries, it is estimated that the pandemic has reduced per capita GDP growth by 0.5 per cent annually. The impacts on the health system and on the poor are severe. In some of the most affected countries, infected persons occupy more than half the available hospital beds. 

The global costs of gender violence and abuse include the direct costs of health care, missed work, law enforcement and protection, shelter and divorce. The World Bank estimates that in industrial countries sexual assault and violence take away almost one in five healthy years of life for women aged 15-44. 

Denying education to girls slows social and economic development; investing in education pays off. One study concluded that, other factors being equal, countries having three female students or fewer for every four male students could expect 25 per cent less GNP per capita than countries with greater parity in education. The economic advances in some Asian countries from the 1960s through the 1980s hinged in part on smaller family sizes and increased investment in girls’ education and health. Educated women with increased income invest more in their children’s health and education. 

The gender gap in schooling is closing in most of the world, but it remains large in South Asia and sub-Saharan Africa, where fewer than 40 per cent of secondary students are female. 

Another cost, one that will rise in coming years as the number of older persons increases, is caring for the elderly. Everywhere, older women live longer than men do. But despite their longer life spans, public pension systems offer women less support because of women’s lower formal labour force participation. 

Women’s Rights 

A series of human rights treaties, starting with the United Nations Charter and the Universal Declaration of Human Rights, affirm the rights of girls and women. Forged over several decades by governments and influenced by the global women’s movement, these agreements provide a legal foundation for ending gender discrimination and gender-based rights violations, and oblige governments to take action. 

The 1979 Convention on the Elimination of All Forms of Discrimination against Women has 165 states parties. An Optional Protocol to the Convention was opened for signature in December 1999 and will enter into force with 10 ratifications. The Protocol will enable individuals and groups of women to submit discrimination complaints to the treaty monitoring body. It will also enable the Committee on the Elimination of Discrimination against Women to initiate inquiries into situations of grave or systematic violations of women’s rights. 

The Vienna Declaration and Programme of Action for human rights (1993), the Programme of Action adopted by the ICPD, and the Platform for Action adopted by the Fourth World Conference on Women (Beijing, 1995) also strongly support gender equality and women’s empowerment. These agreements, while not legally binding, are powerful instruments for promoting change. 

The agreements from the ICPD and the Beijing women’s conference clearly spell out the components of reproductive rights. These include the right to sexual and reproductive health; voluntary choice in marriage, sexual relations and childbearing; freedom from sexual violence and coercion; and the right to privacy. All of these rights are essential to gender equality. 

However, for women’s rights to become a reality, they need to be taken seriously, especially by men. This requires education and awareness raising. Women’s rights also need to be incorporated into national policies, laws and programmes. 

In the past few years, many legal victories have been registered. Mexico and Peru, for example, have passed laws to increase access to reproductive health services. Portugal has amended its constitution to specify that the Government has to guarantee family planning. Botswana, China, Colombia, the United Kingdom and Viet Nam have increased penalties for various sexual offences. Bolivia no longer requires that a woman be found "honest" to be considered the victim of a sexual offence. Germany has criminalized rape by a husband against a wife. Several have outlawed female genital mutilation. But much more remains to be done. 

Working Towards a Better Future 

Governments have a key role to play in creating conditions for gender equality, by removing legal barriers and changing laws, policies and programmes. Political leaders can advocate and promote gender equality and encourage others to do so. Women’s increased political participation is another important way to advance. 

Governments have agreed that everyone should have access to reproductive health care by 2015. The key elements — family planning, services for safe motherhood and protection from sexually transmitted disease — are essential to the quality of life of both men and women. 

Programmes are also needed to address men’s reproductive health needs and foster their active support for women’s health. Men should be engaged in dialogues on gender inequality and its costs to men, women and society at large. 

Systematic gender analysis and monitoring can show what is needed to respond to the needs of both women and men and promote gender equality. Women’s groups need to be involved in designing, implementing and monitoring programmes. Further improvements are needed in the quality of sexual and reproductive health care. Service providers need training and support to provide sensitive care to both women and men. 

Needed action against gender-based violence includes advocacy, gender-sensitivity training, legal changes, improved enforcement, safe alternatives for victims, reporting systems, mediation and counselling services, and support for groups providing counselling and help. 

Elimination of gender inequality in hiring, wages, benefits and job security should include ending requirements that women prove that they are using contraceptives or are not pregnant. Human rights and health education campaigns should take into account the different perspectives of men and women. 

The long-term approach to ending gender discrimination requires efforts at all levels, including training children to see and avoid gender bias. Media, including film, radio, TV and the Internet, can encourage positive images and role models. 

Stronger partnerships among governments, NGOs and local communities to monitor and promote compliance with human rights standards are also needed, as are stronger efforts to achieve universal primary education. The international development community, including UN agencies and the World Bank, needs to continue efforts to mainstream gender analysis into policies and programmes. Better collaboration among donors is needed to reduce duplication and share expertise. 

Of the $5.7 billion per year that countries have agreed is needed from international sources for reproductive health and population programmes, only about $2.1 billion has been made available. Funding for education and women’s empowerment is also inadequate. While international donors, including foundations, have strongly supported efforts to promote gender equality, sufficient resources do not yet back this commitment. 

The last several decades have seen greater attention and some progress towards the empowerment of women. There has also been a growing recognition of how the rules governing men’s and women’s opportunities, social endowments and behaviours affect prospects for accelerated development and justice. But social change is often difficult, particularly when the basic relations between men and women are involved. 

The changes in these relationships, and the systems of power and belief that support them, are no less sweeping than other changes already under way in urbanization, globalization and governance. In the end, societies need their own solutions to provide a better life for both women and men, consistent with their cultures and conditions, grounded in a vision of justice and gender equality. 

—Word count: 3,002

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