UNFPAState of World Population 2002
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HOME: STATE OF WORLD POPULATION 2002: Overview
State of World Population
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Overview
Characterizing Poverty
Macro-economics, Poverty, Population and Development
Women and Gender Inequality
Health and Poverty
HIV/AIDS and Poverty
Poverty and Education
Population, Poverty and Global Development Goals: the Way Ahead
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Overview

Introduction
Population, Development and the Millennium Development Goals
Other Key Issues
How to Meet Poverty Eradication Goals

Other Key Issues

POVERTY AND GENDER Women are disproportionately represented among the poor. Most poor women are in households headed by a man, but some of the poorest women are in women-headed households. An increasing number are widows.

Reducing the "gender gap" in health and education reduces individual poverty and encourages economic growth. The effects are strongest in the poorest countries. Economic growth and rising incomes reduce gender inequality, but they do not break down all barriers to women's social participation and development. There must be specific action to recognize and remove gender bias based on human rights principles.

The most obvious impact of gender bias is in sexual violence, within and outside the home. One woman in three will experience violence at some time in her life (8).

Gender bias in the economic sphere can be hard to pin down, but its results are real and practical. For example, gender bias may stand in the way of interventions such as improving water and energy supply, which reduce the time women have to spend fetching water and gathering cooking fuel. Women use the time saved to earn additional income and participate in community affairs.

As incomes rise, poor families increase their spending on children's education, health care and nutrition. Girls generally benefit more than boys. Effects accumulate over generations as educated mothers invest more in their daughters' schooling.

Special information and service programmes can have greater impacts among poor women, because the better off already have several ways to find information and services. Studies in Bangladesh found that participation in programmes that combine maternal and child health and family planning with poverty alleviation produce greater reductions in child mortality, particularly among girls, in the poorest groups compared to the richest groups. Combining the two programmes improved their effectiveness (9).

GENDER DIFFERENCES IN THE USE OF RESORCES Women do a wide range of paid and unpaid work, in the home and outside of it. Much of this work is not included in national accounting systems. This invisibility translates into incapacity: what countries do not count, they do not support.

Measuring gender inequality is not easy. But by any measure, women in poverty fall well short of their male counterparts in resources available to them, and in control of joint resources. Redressing the balance will depend partly on the ability of women and men to build partnerships for increasing their joint resources. An important part of the partnership will be shared and informed decision-making about sex and reproduction, about family responsibilities and the upbringing of children, especially girls.

Poor women live with their poverty, but they are not passive. They must work hard merely to survive. Their capabilities are reduced by illiteracy, poor health and malnutrition. With whatever energy remains, they take every opportunity to escape their poverty.

Obstacles to their struggle are external and often institutionalized. Traditional practices do not allow for social mobility. Gender roles are prescribed and rigid. Those who feel their interests threatened by change, such as individuals or groups who wield power in traditional society, often oppose initiatives to empower poor women.

Change can create opportunity for women. New job opportunities created by development, for example, in textiles or electronic assembly, often fall to women rather than men. This can strengthen their position within the family and their ability to participate in family decision-making, but men who feel threatened by their partners' new-found capacity may respond with violence.

The urban setting is more flexible and offers more opportunity, but carries its own costs and obstacles for poor women. Removing traditional barriers opens opportunity, but also opens the possibility of economic and sexual exploitation. The traditional extended family protects women to some extent but also inhibits them. In the urban setting, protections as well as inhibitions may be removed.

Reducing gender inequality can accelerate economic growth and have a powerful impact on poverty. Comparing East Asia and South Asia between 1960 and 1992, South Asia started with wider gender gaps in health and education and closed them more slowly. If gender gaps had closed at the same rate in the two subregions, South Asia would have increased its real per capita annual growth in GDP by 0.7 to 1.0 per cent (10).

Gender issues are discussed in Chapter 4.

3 WIDOWS AND ELDERLY POOR

As life expectancies increase over the coming decades, hundreds of millions of women are expected to become widows-with important implications for the provision of social security, health care and housing.

In the richer countries, elderly people living alone are more likely than other groups to be in the bottom tenth of the income distribution, and most of the elderly living alone are women. In Australia, Chile and the nited States, elderly women are more likely than elderly men to qualify for means-based social assistance.

When economies of scale are considered, single widows, widows living with unmarried children, and female household heads (all of whom tend to live in relatively small households) are more likely to be poor. In some African and Asian countries widows without adult sons are especially vulnerable.

It is common to think of widows as elderly. But in many countries many widows are young, because of men's shorter life expectancy and a wide age difference between spouses. Wars tend to kill prime-age males. HIV/AIDS increases the risk that many young women will be widowed.

Widows already make up much of the world's older population. By the mid-1990s more than half of all women over 65 in Asia and Africa were widows, while only 10-20 per cent of men were widowers.

The number of people aged 60 and older is projected to more than triple in the next half century, from 593 million to 1.97 billion, increasing the share of older people in the population from 10 to 22 per cent.See Sources

COPING WITH CHANGE-HEALTH AND EDUCATION Social arrangements and practices reflect economic realities. Much of the current social tension and unease in developing countries reflects the struggle to adapt to economic change. The poor are often constrained by tradition in this struggle, since they do not have the power to make other choices.

Although all societies give high value to health and education as private goods, they tend to be valued less as public goods. This may be changing. If health and education and other means of empowering the poor to escape from poverty are seen as a matter of national security, they may be given more priority as public goods.

Providing universal high-quality education and health care to a large population at a cost all can afford is a challenge for all societies. Countries with a small tax base, a shortage of vital skills and an overburdened administration make progress against heavy odds. The relative success of many developing countries in extending life expectancy and reducing illiteracy is an indicator of their commitment.


POVERTY AND HEALTH Poverty kills. Life expectancy at birth in the least-developed countries is under 50 years, compared to 77 in richer countries. The poor are more exposed to environmental health risks and to infection, the result of inadequate and overcrowded housing without sanitation or clean water, often in unhealthy areas, both urban and rural. Hunger is a daily reality for the very poor. Malnutrition predisposes people to ill health and contributes to high maternal mortality among the very poor. Unwanted pregnancies put further strain on women's health. Infection and injury associated with pregnancy and childbirth decrease women's productivity and quality of life.

The poor see poor health as one aspect of their poverty. Ill health deepens poverty. Illness is most frequently cited by the newly poor as a cause of their slide into poverty (11). The poor have less access to health services than the better off and they are less likely to seek care when they need it. Poor people often do not use existing services because of their low quality. Even in publicly financed health systems more of the resources go to the better off. Poor health holds back economic growth. Productivity losses from ill health could amount to roughly $360 billion per year in developing countries within two decades (12).

WOMEN AND REPRODUCTIVE HEALTH Much of the burden of ill health, especially for women in their reproductive years, is related to sex and reproduction: more than 20 per cent in developing countries overall and 40 per cent in sub-Saharan Africa (13).

Worry about reproductive health is part of poor women's experience of poverty. Young women especially know little about family planning, and do not perceive that it is a choice available to them. The pressures are all in the opposite direction. There is a strong bias towards early marriage and childbearing among the poor, because children and a family are seen as elements of well-being. The ideas that smaller, healthier, better-educated families also contribute to well-being-and that there are choices to be made- come later in life, too late for many women.

Sex and reproduction are sensitive topics in any society, and it is particularly hard to open the discussion about contraception for young people, even more so for the unmarried, as an option along with abstinence. Yet the discussion is essential: unwanted adolescent pregnancy is a growing problem in many developing countries, and half of all new HIV infections are among people 15-24.

Early marriage does not protect young women's health: pregnancy before the age of 18 is several times more risky than for a woman over 20. Teenage mothers are more vulnerable to injuries such as obstetric fistula, which can blight the rest of their lives if not repaired. The male partners of young women tend to be older and more sexually experienced, and more likely to be infected with HIV. Teenage women, married or not, are more likely to be HIVpositive than young men their own age.

RICH-POOR GAP IN REPRODCTIVE HEALTH Health differentials between rich and poor are among the widest in any sphere of life. Health gaps between rich and poor are generally wider in poorer countries than richer ones, but this does not have to be so. Countries that design their health systems to promote equality can show a narrow range of difference, regardless of income.

One of the differences is that better-off people know about and can use health systems in general and reproductive, maternal and child health services in particular. A study of 44 developing countries showed that fertility is highest among the poorest and is successively lower in wealthier groups(14). The better off have fewer children than the poor, and they also have only the children they want. Poor women want more children, but they also have more children than they want.

Unwanted pregnancy can cost a woman her life: women in the poorest countries, and the poorest women within these countries, face a risk of death as a result of pregnancy up to 600 times higher than their better-off counterparts. More than half a million women die every year from causes related to pregnancy and childbirth, almost all of them in developing countries. Many times that number face illness or injury.

Poor women in poor countries desperately need antenatal care and safe delivery services, including emergency obstetric care. They also need family planning information and services to reduce unwanted pregnancy and avoid abortion, which is often illegal and unsafe.

For the young, early marriage, social pressure and reluctance to spend public money on protecting their reproductive health increase the dangers of being both young and poor. In Latin America, for example, 15- to 19-year-olds in the poorest families are four to ten times more likely to have a child as young people from the wealthiest households.

HEALTH SECTOR REFORM SHOULD SUPPORT REPRODUCTIVE HEALTH Health sector reform is intended to improve the reach and quality of services, but health depends on more than the health sector alone. Reform will be really effective only if other areas are reformed as well, notably education, gender relations and the overall quality of governance, including new resources and better use of available ones.

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