Women and Gender Inequality
Twenty years ago, early in the
HIV/AIDS epidemic, women were rarely infected. By 1997,
worldwide, 41 per cent of all HIV-positive adults were
women. By the end of 2001, the figure was nearly 50
per cent and in sub-Saharan Africa, 58 per cent (29).
Policy makers now acknowledge that women are being
infected because they are women. Mozambique's Prime Minister,
Dr. Pascoal Mocumbi, reported in 2001 that the overall rate of
infection among girls and young women in his country was twice
that of boys their age: "Not because the girls are promiscuous,
but because nearly three out of five are married by age 18, 40 per
cent of them to much older, sexually experienced men, who
may expose their wives to HIV/AIDS. Abstinence is not an option
for these child brides. Those who try to negotiate condom use
commonly face violence or rejection."
BIAS IN CHILD NUTRITION?
Is there gender inequality in
the feeding of children? The evidence is mixed. There is
bias against females in South Asia (and also some parts of
China) but it is diminishing. Demographic and Health Surveys
in 40 developing countries do not show significantly better
nutritional outcomes for boys, with the exception of
Bangladesh and Nepal.See Sources
PROMOTING HEALTH, NUTRITION, EDUCATION, SELFESTEEM
IPROGRESA (Programa Nacional de Educación,
Salud y Alimentación) has educated Mexican women on health
and nutrition issues, provided new spaces in which to communicate
with other woman, educated girls to improve their
position in the future, and increased their self-confidence and
self-esteem. The programme began in 1997 as a country-wide
effort to fight extreme poverty in Mexico's rural areas.
With a budget of $500 million, PROGRESA provides
monetary assistance, nutritional supplements, educational
grants, and a basic health package to poor families for at least
three consecutive years. One of its innovations is to provide
money directly to women, putting additional resources under
their control and giving them greater freedom in their
own movements.See Sources
Dr. Mocumbi believes that no effective
action against the pandemic is possible until leaders
in sub-Saharan Africa recognize that the primary means
by which AIDS is spread is risky heterosexual sex. This
goes beyond a health issue, he said, for "unlike the
communicable killer diseases we have encountered most
often in the past, HIV/AIDS is transmitted through the
most intimate and private human relationships, through
sexual violence and commercial sex; it proliferates
because of women's poverty and inequality."(30)
SOCIAL AND RISK FACTORS Gender inequality deprives women
of the ability to refuse risky practices, leads to coerced sex and
sexual violence, keeps women uninformed about prevention, puts
them last in line for care and life-saving treatment, and imposes
an overwhelming burden on them to care for the sick and dying.
"Women are truly the most vulnerable
in this pandemic…. Until there is a much greater degree
of gender equality, women will always constitute the
greater number of new infections," Stephen Lewis, UN
Secretary-General Kofi Annan's Special Envoy for HIV/AIDS,
in Africa told a reporter at the end of 2001 (31).
Socially defined gender roles determine differences between
women and men in access to productive resources and decisionmaking.
There are variations among societies, but whatever
the superstructure, according to Lewis, the foundations always
incorporate an unequal power balance in gender relations
that favours men. Thus, he says, it is still a worldwide reality
that millions of women are effectively sexually subjugated and
forced into risky sex, without condoms, "without the capacity to
say no, without the right to negotiate sexual relationships."
Biology also works against women: women's physiology is more
vulnerable to HIV and other sexually transmitted infections.
Reproductive tract infections, which predispose to HIV infection,
are more easily transmitted and less easy to diagnose in women.
Vaginal scrapes and cuts suffered during violent or coerced sex
increase the risks.
TARGETING CREDIT TO WOMEN IN BANGLADESH
A number of NGOs
in Bangladesh direct credit to women.
The Grameen Bank and Bangladesh
Rural Advancement Committee (BRAC)
have improved women's mobility,
economic security, control over income and
assets, political and legal awareness,
and participation in public protests and
The programmes increase demand for
contraception and help women overcome
obstacles to their use. Both Grameen Bank
and BRAC have family planning awareness
programmes, and having a small family
is one of the Grameen Bank's Sixteen
Decisions that every woman has to memorize.
Neither has offered family planning
services (though BRAC has recently
started providing contraceptives to some
members) but this seems to be less
important than the effect of economic
empowerment on women: where services
are available from other providers, empowerment
is linked with contraceptive use.
Women feel empowered by credit
despite the extra work it entails: they feel
more self-fulfilled and valued by other
household members and the community.
The effect on fertility seems to be in addition
to the impact of family planning programmes
and other health care interventions.
Microcredit programmes have a more
powerful impact if women are the borrowers:
female borrowing has a significant
effect on seven out of eight indicators:
boy's and girl's schooling; women's and
men's labour supply; total household
expenditure; contraceptive use; fertility;
and value of women's assets other than
land. By contrast, male borrowing was significant
in only three out of eight.
Household consumption increases by 18
taka for every 100 lent to a woman and by
11 for every 100 lent to a man.See Sources
IGNORANCE ABOUT SEX IS EXPECTED
In many societies, culture dictates that "good" women
are ignorant about sex and passive in sexual interactions.
This makes it difficult for women to inform themselves
about risk reduction, and even more difficult, even
if they are informed, for them to negotiate safer sex
or the use of condoms (32).
A study in Zambia revealed that only 11 per cent of
the women interviewed believed that a married woman
could ask her husband to use a condom, even if she knew
that he had been visiting prostitutes and was possibly
Young women are particularly vulnerable
and under-informed. In 17 African countries, surveys
indicated that over half of the girls did not know any
way of protecting themselves from HIV (33).
Yet there is much evidence that teenage girls are sexually
active before marriage, indicated by the numbers of
teenagers who drop out of school because they are pregnant.
The "sugar daddy" syndrome, though more talked about
than proved to be widespread, works against young women.
HIV infection rates among young African women aged 15-19
in some urban areas are said to be five to six times
higher than for young men (34).
The strong norms of virginity and fidelity applied to women
(but not to men), as well as the "shame" that prevents open discussion
of sexual matters, make it very difficult for women to seek
protection or treatment or even information about sexually transmitted
diseases, and especially HIV/AIDS.
STIGMA A husband's family
and the community at large may blame his widow for his
death, and may refuse the usual support to her and her
children. The law may allow the woman to inherit her
husband's land and property, but local and customary
rules often override it in practice. Stigma coupled
with fear has even spawned lynch mobs when women are
discovered to have the disease, or, as in the case of
young South African activist Gugu Dhlamini, courageously
reveal their HIV status (35).
The outcome has been tragic for many innocent women
and their children.
ECONOMIC DEPENDENCY Women's economic dependency
increases their vulnerability to HIV. Although women are the
primary producers of food across much of Africa, they may not
have any rights in the land they work or to the products of
their labour. Inheritance may depend on local practice and in
effect put them at the mercy of their husband's relatives.
This poverty and economic dependency make it impossible for
many women either to negotiate the terms of their relationships
or remove themselves if the relationship puts them at risk. It may
force them to endure routine domestic violence, which both
increases their chance of contracting HIV/AIDS and deters them
from seeking testing and treatment. With few opportunities to earn
livelihoods independent of men, many women are compelled to
use sex to gain resources, increasing the risks to themselves and the
men who use them.
DOBLE STANDARD The power
imbalance limits women's freedom in other ways. A 1999
Tanzanian study showed that while men sought voluntary
counselling and testing without consulting their wives,
women felt compelled to consult their husbands (36).
Initial Africa-based surveys are revealing that when anti-retroviral
therapies become available, health facilities discriminate in
favour of men.
Women are expected to be virtuous and faithful, to take care
of their sick partners and children, support their families and
comfort the dying. Yet they are denied support themselves or the
information or treatment that could save their lives: and when
their partner dies, they are held responsible.
Women's tragedy passes down the generations. Mothers often
discover that they are HIV-positive only when they visit prenatal
clinics. The risk of mother-to-child transmission is high, but
women have little support in reducing the risks-anti-retroviral
therapy, advice on the alternative dangers of breastfeeding and
of breast-milk substitutes, or continuing care or counselling.
Where treatment has been offered, it most frequently is for a
brief period, to prevent infant infection, leaving the mother to
face the prospect of her own death and worry about the fate of her
orphaned children. Young children whose mothers die from any
cause are at much higher risk of death themselves; their risks after
an AIDS-related death may be higher because of the stigma and
the possibility that they may themselves be infected.
Conflict situations, in which rape is used as a weapon of war
spread the pandemic, as the virus is spread through sexual violence.
In Rwanda today, many women who were raped in the genocide
are now dying of AIDS, so for them the genocide continues.
TAKING ACTION, EMPOWERING WOMEN Empowering
women is key to challenging the pandemic, preventing its further
spread and rolling back the incidence of new infections. It is
more urgent than ever to protect and improve women's health,
including their reproductive health, and provide the information
and services to do so; to decrease the gender gap in education
and make education universal; to improve women's access to economic
resources, increase their political participation, protect
them from violence and enable them to achieve their rights to sexual
and reproductive health and self-determination. The goals
include real and equal partnership with men. They are ambitious
but realistic, and more than ever necessary.
The global community has developed a serious set of
blueprints for addressing inequality. Their recommendations are
laid out in the Convention on the Elimination of All Forms
of Discrimination against Women, the ICPD Programme of Action
and the Platform for Action of the Fourth World Conference on
Women with their five-year reviews. Many of the recommendations
are included in the MDGs. Will countries accelerate their implementation
of these recommendations, and will the international
community provide additional resources to do so?