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
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
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
Gender issues are discussed in Chapter 4.
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
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
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
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
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.