To decide whether it is poverty that leads to ill-health or poor heath that exacerbates poverty is like trying to solve the puzzle of what came first: chicken or egg. Regardless of what comes first, the link between health and poverty is deep-rooted and it has been firmly established that one leads to, or exacerbates, the other.
While the health of both men and women is adversely affected by poverty, higher proportion of women are affected by its effects because of increased poverty among women or what is termed as ‘feminisation of poverty’. But one of the factors of increased poverty in women is the immense or unique health problems they have to live with.
According to the World Health Organisation while health is one of the fundamental rights of every individual, many women across the world are being denied this basic right, and in many cases their health issues arise due to or are aggravated by their socio-economic condition. In most developed countries women lag behind men on virtually every social and economic indicator, and hence constitute a larger proportion of the poor.
Faced with gender bias from birth, especially when it comes to allocation of resources, due to their lower social status women have fewer opportunities to access healthcare. Since traditions relegate women and girls to the background, in many families, especially where food is limited, the choicest portions are given to men and boys and women eat last, often surviving on leftovers; because of this they suffer from anaemia and chronic malnutrition, which increases their susceptibility to infection which further compromises their health. According to the National Nutrition Survey of Pakistan over 35 per cent women are nutrient deficient.
Despite an extensive Expanded Programme on Immunisation, and immunisation against polio and Hepatitis B, outreach to all parts of the country has not been fully achieved. Lack of immunisation leads to disability, leaving the person unable to work, thus pushing him further down the poverty ladder. It is rightly said that while disability is crippling, if a woman is disabled it is a lethal combination; a disabled woman is sure to miss out all chances of improving her life and is forced to lead a miserable life.
Another factor that contributes to women’s ill-health is early marriage; despite the Child Marriage Restraint Act 1929 early marriages account for 25-30pc of all marriages in the country. Due to this, fertility rates especially in rural areas and among the poor are still quite high. Only 30pc of women use contraceptives while there is a 30pc unmet need. Repeated pregnancies, too early and too late, take a toll on women’s health. When they don’t need more children but have no access to family planning services they resort to unsafe abortion, which is often detrimental to their health.
The case of S.A. can be taken as an example: S.A. got married at the age of 14 and within a period of 10 years had eight children. She didn’t want any more children because she could barely feed them working in three homes, but she was not aware of family planning and didn’t know where to go. While trying to get an abortion when she got pregnant again she almost lost her life. Unable to work for months she and her children survived on charity and neighbours’ kindness, who like S.A. were not financially strong.
To add to this women in our country often are either not aware of its importance or do not have access to proper maternal health facilities; this further impacts their health. The mortality rate in Pakistan is about 260 per 100,000 live births, and is nearly twice as high in rural areas than in urban areas. Poor maternal health due to repeated pregnancies also hinders women from pursuing productive pursuits, thus they remain poor.
Due to social and cultural practices men are considered breadwinners and women unpaid caregivers. As a result of women’s child rearing and caregiving responsibilities they are hardly able to pursue a career and do not have an income of their own. Since she has to rely on her husband she often ignores her health needs and suffers silently.
Even when a woman enters the waged labour market it is mostly low-paying work and of lower status. Themselves suffering from poor health and burdened with caregiving responsibilities, it might be difficult for them to access healthcare for themselves or their children as they might have mobility issues and also because they can’t frequently stay away from work as in that case they are faced with loss of job, which pushes them further into the clutches of poverty.
Whatever may be the cause of ill-health, women who are suffering from poor health are more vulnerable to slide down the poverty ladder. Not only they themselves but their children also suffer from the consequences of poor health and poverty. If women enjoy better health status they can not only take better care of their children and families and make better use of available resources. They will also be able to take up some means of employment to supplement the family income, thus bringing themselves and their family out of poverty and misery.
In a nutshell it can be concluded safely that women’s health is central to poverty alleviation. If we want to reduce poverty taking care of women’s health needs is imperative.