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Title: SAFE WOMANHOOD IN A CHALLENGING WORLD


1
SAFE WOMANHOOD IN A CHALLENGING WORLD
  • Afaf I. Meleis, PhD, FAAN
  • Professor and Margaret Bond Simon Dean
  • School of Nursing
  • University of Pennsylvania
  • Philadelphia, PA

Global Health SeminarUniversity of North
Carolina February 3, 2006
2
Is The World Unsafe?
  • Violence wars, terrorism
  • Infections new and reemerging
  • Environment accidents, pollution, lack of caring
    and support
  • Unhealthy life styles eating, sleeping,
    activity, smoking

3
Is the World Unsafe for Women for other reasons?
4
What Makes the World Unsafe for Women?
  • Violence
  • Infections
  • Lifestyles cardiovascular
  • Wars

I could easily discuss any of these, and I do
agree that these are compelling reasons that make
the world unsafe for women, but I believe there
are added risks for women that magnify each of
these to a higher proportion.
5
What Makes the World Unsafe for Women?
  • The Gender Divide
  • It makes women socially, culturally, and
    biologically at higher risk for morbidity and
    mortality

6
A Framework for Discussion an Unsafe World for
Women and Their Health
  • The context for my comments
  • Research to uncover the lived experiences of low-
    or no-income women

7
Women From
  • Brazil
  • Columbia
  • Egypt
  • Kuwait
  • Mexico
  • USA

8
We Studied(Total N of research
participants1161)
  • Per diem maids in Columbia
  • Per diem maids in Egypt
  • Fishermens wives in Brazil
  • Women in clerical jobs in Southern Brazil
  • Women in clerical jobs in the USA
  • Women in clerical jobs in Egypt
  • Farm workers in Egypt
  • Auxiliary nurses in Mexico

9
The Context for My Comments
  • In addition to the many years of researching
    womens situations, my practice as a nurse, my
    life experience as a woman, though privileged
    rich with educational opportunities, I will never
    claim to know through first-hand experience what
    it is like to be abused, harassed or violated, I
    can look at these experiences from an outsiders
    perspective and, somewhat, an insiders position
    and understand and relate to these experiences.

10
  • I am also an immigrant who lived in the center
    and on the margins, and know how different are
    the experiences and the responses at both the
    center and the margins

11
The context of my comments is profoundly
influenced by my own lived personal, academic,
and clinical experiences
  • A nurse
  • A medical sociologist
  • An immigrant
  • A feminist
  • A researcher

12
What Makes the World Unsafe for Women?
  • The burden of womens work

13
Womens work is veiled, voluminous, and devalued
14
In developing countries women produce 75 of food
15
In sub-Saharan Africa and the Caribbean, they
provide 80 of staple food
16
In Asia women carry 90 of the rice field
17
An African ProverbWithout Women We Would All
Go Hungry
18
Housework
At home women cook, clean, carry water, sew,
bake, and care for families
19
Nationally and Internationally
  • Womens work underreported and underestimated
  • However, there is a beginning recognition of how
    vital women are for the hunger and economic
    crises
  • Economic and labor statistics do not reflect
    womens work outside of the context of the formal
    labor force

20
Womens Work
  • Women are self-employed or in unpaid labor
  • Much of work is not remunerated and not factored
    into economic productivity as the gross national
    product
  • Women considered unproductive by economists and
    development experts

21
Women create and maintain community life and
provide emotional work and labor
22
  • I am a poor, nonworking person. I am just a
    housewife.

23
Crisis in Care-Giving
  • We are facing a crisis in care-giving in health
    care systems that is impacting national and
    global health policy
  • The crisis is reduced to
  • Shortages and numbers of nurses
  • Aging nursing population
  • Immigration of nurses
  • It is due to misinformed patriarchal policy
    makers that we do not yet have effective solutions

24
  • I grew up seeing my mother and the rest of the
    women in the family do a lot of work from sunrise
    to sunset

25
Womens WorkWhen womens work is unacknowledged
and devalued
  • Limited studies of employment, hazards, and
    health
  • Almost non-existent studies of work, risks, and
    health

26
Risks for Women
  • Nature and definition of work
  • Overload
  • Burden of double and triple shifts

27
Vicious Cycle
  • Even when women try to use their culture-imposed
    types of work to earn a better living, they
    become
  • Maids
  • Nannies to well-to-do families in high-income
    societies.
  • They are
  • Exploited
  • Abused
  • Driven to suicide (maybe!)

28
Women-Workers in Other Countries
  • Domestic workers who work in other countries,
    Filipinas in Hong Kong, Indians in Saudi Arabia,
    Thai in Korea are at a higher risk because of
  • Limited policies to protect them,
  • Lack of access to health care,
  • Demands of family in countries of origin,
  • Marginalization in host family,
  • Lack of support

29
Messias, D.K.H., Im, E., Page, A., Regev, H.,
Spiers, J., Yoder, L., Meleis, A.I. (1997).
Defining and redefining work Implications for
womens health. Gender and Society, 11 (3),
296-323. Messias, D.H., Regev, H., Im., E.,
Spiers, J., Van, P., Meleis, A.I., (1997).
Expanding the visibility of womens work Policy
implications. Nursing Outlook, 45,
258-264. Meleis, A.I., Lindgren, T. (2001) Show
Me a Woman Who Does Not Work! Journal of Nursing
Scholarship, Third quarter, 33 (3), 209-210.
30
Meleis, A.I. (2001). Womens Work, Health, and
Quality of Life It is Time We Redefine Womens
Work. Women and Health. 33, Numbers 1 / 2,
xvxviii (note preface to book printed as
article). Meleis, A.I., and Lindgren, T. (2002).
Man works from sun to sun, but womans work is
never done Insights on research and policy.
Health Care for Women International, 23 (6-7),
742753.
31
What Makes the World Unsafe for Women
  • The burden of work (producing)
  • Marriage

32
  • It is a worldwide phenomenon that women are
    defined by marriage and are always under enormous
    pressure to be found by a husband.

33
MARRIAGE A Risk Factor
  • Women are violated and killed because marriage
    brings
  • Bridal burning in India
  • Abuse and battering by
  • husband and in-laws
  • Burden of caring for
  • in-laws

34
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35
CHILD LABOR
36
CHILD LABOR
37
What Makes the World Unsafe for Women
  • The burden of work (producing)
  • Marriage
  • Violence

38
What Makes the World Unsafe for Women
  • Laws that condone and support domestic violence
    under the pretence that this is a family matter
  • Social pressure that forbids women from
    disclosing/reporting violence

39
  • Disclosing rape is
  • not accepted
  • It is newsworthy
  • when a father
  • allows a daughter
  • to disclose being
  • raped

40
Laws that violate women ? stoning for having a
baby out of wedlock
41
Let us look at what happened in the Soviet Union -
  • Some may say changes in political regimes may
    bring more safety for women. . .

42
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43
Issues Uzbek Women Face
  • Domestic Violence police underreporting, failure
    of state and families to correct the problem
  • Limited knowledge of the options available to
    women facing domestic violence
  • Forensic evidence centers are few and located in
    big cities, far from reach of rural women
  • Victims often hesitate to report violence to the
    police out of fear to shame the family and of
    futility of their attempts as well as economic
    impact of police fines and jail time on the
    family budget

44
Issues Uzbek Women Face
  • Families often do not support the victims
  • Beating is always a womans fault. Men never
    beat for nothing
  • Rape of married women
  • Limited access to higher education
  • Stigmatization of divorced women
  • Polygamy
  • Poverty and limited employment opportunities due
    to gender discrimination

45
Issues Facing Ukrainian Women
  • Domestic violence
  • Medical service to women, especially pregnant, is
    often inadequate
  • High rates of infant mortality, miscarriages, and
    STDs
  • High cost of contraceptives and lack of basic
    knowledge of family planning leading to high
    abortion rates

46
Issues Facing Ukrainian Women
  • Gender-based employment discrimination that is
    also based on age and appearance
  • Marital status-based employment discrimination
  • Women trafficking into forced labor and sex
    industry

47
Examples from Eastern Europe
  • Since the fall of the Soviet Union
  • Laws do not prohibit discrimination against women
  • Higher HIV infection rate for women
  • Prostitution to support drug habits or to feed
    family
  • Police detain prostitutes but rape them in lieu
    of money or release

48
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49
Violence
  • Wars
  • Terrorism
  • For women these mean
  • Rape
  • Trafficking
  • Sex industry
  • Infections
  • Burden of more work
  • Loss of work as men come back from war
  • Religious revival

50
Rape Violence and Children
51
How about Afghanistan and Iraq post-war
liberation?
52
Publications on the Issue
53
  • In times of economic turmoil, women suffer the
    most for their families
  • Women are fired first
  • When rations are given, usually to men, women may
    be forced to prostitute themselves to feed their
    families

54
There are hidden consequences of 9/11
55
Domestic violence is a taboo exacerbated by
terrorism
56
Different Types of Violence
  • Young women and girls are two and a half times
    more likely to be infected by HIV/AIDS than their
    male counterparts.
  • In Sub-Saharan Africa, women ages 15-24 account
    for 75 of all young people infected with
    HIV/AIDS.
  • In South and Southeast Asia, 30 of all those
    infected with HIV are women, and this percentage
    is rising rapidly.
  • Peter Bell, CARE 2005

57
What Makes the World Unsafe for Women
  • The burden of work (producing)
  • Marriage
  • Violence
  • Pregnancy, birthing, motherhood (reproducing)

58
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59
Reproductive Roles as Risks
  • 1 in 7 women in parts of Africa will die in child
    birth. (In Sweden 1 in 6000)
  • In Iraq, a woman is 3.5 times more likely to see
    her child die in 1st year than in Sweden
  • 200 million women become pregnant around the
    world, one third is unintended and unwanted
  • Nigerian women face 1 in 13 lifetime risk of
    maternal mortality
  • Women living in Sub-Saharan Africa face the
    greatest risk of mortality due to unsafe abortion
  • Gender-based violence is associated with higher
    mortality rates

60
  • A son gave her security in the marriage, and was
    going to be a man, a breadwinner

61
With increasing technology to determine the sex
of a baby
  • Women who choose to give birth to a daughter
    suffer prejudice

62
Another Kind of Violence Associated with
Reproductive Function
  • Female vaginal mutilation/female
    circumcision/female purification
  • Different types posing different risks
  • Increased risk of infections
  • Increased risks to reproductive system
  • Increased risks for psycho trauma

63
  • Another kind of violence is preventing women from
    having safe abortions

64
What Makes the World Unsafe for Women
  • Burden of Womens work (producing)
  • Marriage
  • Violence
  • Pregnancy, birthing, motherhood (reproducing)
  • Resources

65
Health Care is a Major Problem
  • Distance
  • Transportation
  • Length of wait
  • Availability of personnel
  • Cost of medicine
  • Cost of transportation
  • Many responsibilities

66
Their Health Care
  • A source of overload
  • Fragmented
  • Inaccessible economically
  • Relied more on illness care

67
What Makes the World Unsafe for Women
  • Burden of Womens work (producing)
  • Marriage
  • Violence
  • Pregnancy, birthing, motherhood (reproducing)
  • Resources
  • Theoretical and conceptual frameworks

68
Theoretical/Conceptual Frameworks
  • Biomedical Model
  • Reproductive Maternal Model
  • Morality Model

69
Theoretical/Conceptual Frameworks
  • Biomedical Model
  • Disease focus
  • Gender is not front and center
  • Sociopolitical/cultural context minimized
  • Fosters dependency
  • Reproductive and Maternal Model
  • Focus on pregnancy and birthing
  • Lacks context of womens life
  • Attention is on reproductive years

70
Theoretical/Conceptual Frameworks
  • Morality Model
  • Adherence to moral standards buys care
  • Commercial sex workers stigmatized
  • Preservation of virginity is paramount
  • Ritual killing goes unpunished
  • Bride burning ignored
  • Trafficked women stereotyped

71
What Makes the World Unsafe for Women
  • Burden of Womens work (producing)
  • Marriage
  • Violence
  • Pregnancy, birthing, motherhood (reproducing)
  • Resources
  • Theoretical and conceptual framework
  • Policies

72
An Example of Policy that Makes the World Unsafe
  • . . . any organization receiving
  • USAID assistance must declare
  • that it does not promote,
  • support, or advocate the
  • legalization of prostitution.
  • U.S. Senate

73
Reaction by Governments
  • The Government of Brazil rejected 40M from USAID
    because the United States wanted to impose
    controls on countries that receive the funds.

74
  • Our feeling was that the manner in which the
    USAID funds were consigned would bring harm to
    our program from the point of view of its
    scientific credibility, its ethical values, and
    its social commitment. We must remain faithful
    to the established principles of the scientific
    method and not allow the theological beliefs and
    dogma to interfere.

Pedro Chequer, DirectorBrazilian AIDS Program
75
Themes in the Lives of Women
  • Exploitation
  • Overload
  • Worry
  • Social insecurity
  • Economic insecurity
  • Inaccessible health care
  • Inaccessible education

76
Marginalization
  • Intermediacy
  • Differentiation
  • Power
  • Secrecy
  • Reflectiveness
  • Voice
  • Liminality

77
  • The single best predictor of perceived wellbeing
    was role integration, balance between stressors,
    and satisfaction in all combined roles.

78
Level of Education(2005 Carnegie Challenge)
  • Gain of 4 years of education fertility drops by
    one birth (Klasen 1999)
  • One additional year of education decreases infant
    mortality rate by 5-10 (Schultz 1993)
  • Primary and secondary education protects women
    and their children against HIV/AIDS and violence
    (Herz and Sperling 2004)
  • Womens education increases ability to resist
    violence in India (Sen, Amartya 2000)

79
Level of Education(2005 Carnegie Challenge)
  • Educated women are less likely to be circumcised
    and oppose it more often for their daughters and
    granddaughters in Africa (ORC Macro International
    1995)
  • Mothers education associated with less intent to
    circumcise daughters, less risks and greater use
    of medical personnel (when circumcized), in Egypt
    (Malhotra and others 2003)

80
  • Lack of education makes the world unsafe for women

81
Coping Strategies and Resources
  • Turning to self
  • Problem solving
  • Reaching out

82
Womens Health as a Foreign Policy
  • Change conceptual framework
  • Develop explicit policies
  • Redefine work

83
Change Conceptual Framework
  • Stereotyping, morality, reproductive, stigma, and
    exploitive
  • Vulnerable, gendered, equity and empowering

84
What Will Make the World Safe for Women?
  • Womens health on the agenda
  • Equity
  • Opportunities
  • Paradigm change - gender

85
Explicit Policies
  • Develop health programs that acknowledge womens
    perspectives, experiences, and context
  • The daily situations of women, need to be
    described and integrated in health programs
  • Identifying women who are most vulnerable to
    risks
  • Provide resources and structure to support and
    protect women

86
Messias, D.K.H., Regev, H., Im, E., Spiers, J.,
Van, P. Meleis, A.I. (1997). Expanding the
Visibility of Womens Work Policy Implications.
Nursing Outlook, 45, 258-264. Messias, D.K. H.,
Im., E., Page, A., Regev, H., Spiers, J., Yoder,
L., Meleis, A.I., (1997). Defining and
Redefining Work Implications for Womens Health.
Gender and Society, 11(3) 296-323.
87
Work Redefined
  • Energy expenditures
  • Activity
  • Space
  • Time
  • Resources
  • Results
  • Values
  • Meanings

Messias et al. 1997Meleis et al. 2001
88
Keeping Womens Health as a Top Priority on
National and International Agenda
  • Education
  • Development
  • Research
  • Services

89
Women in a Safe World
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