Globalization & Eating Disorder, Autism & Inclusion, Feminization of Poverty, Global Health Approaches to HIV/AIDS

Birth, old age, Sickness, and death:

From the beginning,

This is the way Things have always been.

Any thought Ofrelease from this life Will wrap you only more tightly

In its snares. The sleeping person

Looks for a Buddha, The troubled person Turns toward meditation.

But the one who knows That there's nothing to seek Knows too that the1'e's notbing to say. She keeps her mouth closed.

-Ly Ngoc Kieu, Vietnam, I041-II131

TVhere, after all, do universal human rights begin? In small

places, close to home-so close and so small that they cannot be seen on any maps ofthe world. ... Such are the places where every man, woman, and child seeks equaljustice, equaloppor-

tunity, and equal dignity, without discri1nination.

-Eleanor Roosevelt, U.S.A., 19582

I

Women's Health, Poverty, and Rights

EVERY TWO SECONDS, somewhere in the world, eight babies are born, about half of them girls.) Some 81% will live in poor countries. As we shall see in

this and the next chapter, their births are all too often something more to be endured than to be celebrated.

Let us put a human face on the numbers. Think of Hope, the mother of

Mary, a baby girl born in western Kenya. Hope was in her mid-thirties and already had five children when I visited the area in 2004 and heard about her from a traditional birth attendant at the local health clinic. Hope was disappointed to produce yet another girl, another mouth to feed, and she was feeling weak and very tired. Her other five children-three girls and two boys-were all under age twelve. To try to pay for the daily costs of her family, her husband searched for work in a nearby town even though he had

been feeling very sick, while Hope sold vegetables in a local market. She struggled up after giving birth, thanked the village midwife who had helped her at the birth, and gave the new baby a breast to be shared with a sibling.

Several thousand miles north and east, in a rural village near Lucknow,

India, baby Kamla was born in a small house made of clay and palm fronds. Kamla's young mother, Laxmi, age seventeen and already the mother ofanother little girl, was unhappy. Because she had not borne a son, she had failed as a wife.

I

2 OUTRAGE TO COURAGE WOMEN'S HEALTH AND HUMAN RIGHTS 3

Her one-year-old and the new baby were weak because the family she had

married into was poor and she had not had sufficient good food to nurture

a growing fetus and provide enough milk for her baby. Laxmi had gone to school for a year, not quite enough time for her to learn to read. Her parents

arranged her marriage when she was twelve, and she went to the home of her

husband when she was fourteen. Her in-laws were mistreating her and resented

her for giving birth only to girls. When Laxmi's husband judged that she had not been working hard or keeping the house in order, he sometimes struck

her. And here she was with Kamla, another girl, another burden. .My companion on this trip was a woman from BETI (Better Education

through Innovation), a women's group working in the Lucknow area. She explained that not all stories of girls' births in India and other poorer coun-

tries are sad; many girls are welcomed into the world. But the hard truths are that most women in the world who are giving birth today are poor and

illiterate, with little access to health care; that most girls in our world will

face discrimination, poverty, unequal access to education and health care,

and unequal pay for equal work. And about a third of women giving birth

today will face violence at the hands of a partner, a violation of human rights

that all too often happens in "small places, close to home, so small and so

close that they cannot be seen on the maps of the world." Women's health cannot be understood or improved without understand-

ing the contextual relationship-the subordination of women, poverty, and violence, resulting in unequal access to education, food, health care, and

paid employment.

VVOmen and Poverty

What does poverty mean? The \Norld Bank, in its 2000-2001 report on

poverty, offered this description:

Poor people live without fundamental freedoms of action and choice that

the better-off take for granted. They often lack adequate food and shelter,

education and health, deprivations that keep them from leading the kind of

life that everyone values. They also face extreme vulnerability to ill health,

economic dislocation, and natural disasters. And they are often exposed to

ill treatment by institutions of the state and society and are powerless to

influence key decisions affecting their lives.

In an attempt to document the extent of poverty, the report continues: The world has deep poverty amid plenty. Of the world's 6 billion people,

2.8 billion-almost half-live on less than $1 a day, with 44% living in

South Asia. In rich countries, fewer than one child in one hundred does

not reach its fifth birthday, while in the poorest countries, as many as one

in five children do not. And while in rich countries fewer than 5% of all

children under five are malnourished, in poor countries as many as 50%

are.... The average income in the richest twenty countries is 37 times the

average in the poorest twenty-a gap that has doubled in the past forty

years.... In East Asia the number of people living on less that $1 a day

fell from around 420 million to around 280 million between 1987 and

1998.... Yet in Latin America, South Asia, and Sub-Saharan Africa, the

numbers of poor people have been rising. And in the countries of Europe

and Central Asia in transition to market economies, the number of people

living on less than $1 a day rose more than twenty fold during that period. 4

The World Bank report notes further that experiences of poverty are very

different at sub-national levels in countries and for minorities and women.

Based on measures of school enrollment and infant mortality rates women. , face more severe disadvantages than do men. s vVorldwide, women's wages, when women have access to the formal economy, are about two-thirds of men's. The majority of women are in low-wage situations or work informally

for part-time wages with little or no benefits. In this age of globalization,

which touts the spread of democracy and equality through market forces,

the wage gap between men and women persists and is so prevalent that it is

now commonly referred to as "the feminization of poverty." Rural women,

in particular, have suffered; over the past two decades, the number of rural

women worldwide living in absolute poverty rose by nearly 50 %.6

The Human Poverty Index (HPI), introduced in the 1997 Human Devel-

opment Report from the United Nations Development Programme (UNDP),

attempts to quantify poverty in the world today by accounting for and try- ing to measure aspects of poverty beyond income, including lack of access to opportunities and resources.! The report suggests that the HPI provides a better, though still incomplete, measure of women's experience of poverty. Though the practice of measuring by entire households makes it difficult to

4 OUTRAGE TO COURAGE

WOMEN'S HEALTH AND HUMAN RIGHTS 5

WOMEN'S COURAGE: BEIJING, CHINA. The Beijing Cultural Development Cen-

ter for Rural Women, also known as Rural Women Knowing All (RWKA) was

formed to address the reality that rural women in China have little access to

health services, independent income, and even education. RWKA works across

China to improve women's literacy and expand educational opportunities for

poor women. It does this through various media projects, including RWKA's

magazine-the only magazine for rural women in China-which reaches mil-

lions of women using an appropriate level of written language for people with

minimal reading skills. RWKA's television and film projects include a documentary film series

which deals with rural women's economic and social rights, environmental

protection in China, education, and the construction of the legal system in

China. The organization's reach has grown tremendously in recent years and

now includes micro-credit programs, migrant women's clubs, literacy educa-

tion, and reproductive health examinations. RWKA's vision is to inspire Chinese

women by introducing them to positive role models and programs forfinancial

and social empowerment.

discern bias and different levels of poverty within the home, "it is clear that

poverty strikes women particularly harshly."8 Poverty's greater burden on women has been known for years. It was

described in the Platform for Action of the UN Fourth World Conference on Women, r995: "In the past decade the number of women living in pov- erty has increased disproportionately to the number of men, particularly in

the developing countries. In addition to economic factors, the rigidity of socially ascribed gender roles and women's limited access to power, educa- tion, training and productive resources ... are also responsible."9 It is clear

that poverty affects households in general, but because men and women do different work and have different responsibilities for the household, women bear a greater burden as they manage consumption, some production, and scarce resources.

Many conditions of women's lives set them up to have fewer financial resources than their male counterparts, and poverty in turn can influence these conditions. For example, level of school enrollment, one measure of

WOMEN'S COURAGE: PHNOM PENH, CAMBODIA. Urban Poor Women

Development (UPWD) initiates projects to help poor women in urban regions

of Cambodia improve their economic situations. Many unskilled rural women

migrate to Phnom Penh in search of jobs, where they endure poor living con-

ditions in the slums of the city.

Formed in 1997, UPWD offers training to female workers in the city to increase their employability and their rights awareness. Working atthe community level,

the group gives funds to start small women's businesses, provides workshops

on leadership skills, and offers training sessions for non-governmental orga-

nizations. UPWD hopes to lift Cambodian women out of poverty and increase

their economic and social status.

poverty, reveals that more women than men are denied the education and skills to support themselves. Worldwide, 69% of females over the age offifteen are literate, compared with 83% of males. In less developed countries the percentages are 66% and 81% respectively.lO lVlore examples of challenging conditions for women are addressed in more detail in later chapters.

Unsurprisingly, the percentages of women in the paid labor force in vir-

tually all countries are consistently lower than the percentages of men. For example, 37% of women are in the labor force in North Africa compared with 82% of men; 45% in Latin America and the Caribbean, compared with 86% of men. II

If a mother is undernourished, often because she is poor, her baby is likely to be underweight and may even be born with a smaller brain. Mater-

nal mortality, another measure of women's poverty, persists: complications of pregnancy and childbirth, when met with inadequate medical care at the time of delivery, can be deadly. Quality care saves lives, and it doesn't have

to be done in a very wealthy country, as Malaysia and Chile have demon- strated. Skilled personnel attended 96% and IOO% of births in those coun- tries, respectively, resulting in the deaths of thirty-nine and thirty-three women per roo,ooo live births. In Niger, by comparison, where only r8% of births are attended by skilled personnel, 920 women died per IOO,OOO live births in 2004. In Indonesia, 56% of births were attended by skilled person- nel, and 580 women died per roo,ooo live births.

6 OUTRAGE TO COURAGE WOMEN'S HEALTH AND HUMAN RIGHTS 7

Discrepancies in infant death rates illustrate women's disadvantaged status in

poorer countries, as is discussed in the next chapter. Their disadvantaged status

is also expressed in the situation ofyoung women with regard to HIV/AIDS,

discussed in a subsequent chapter, where it is noted that the HIV/AIDS epidemic

has had a profound impact on the lives of women, especially those whose

economic dependence on men and low social status leave them powerless to

avoid risky sexual behaviors. Access to money matters. Poverty is directly correlated with poor health.

In a study of socioeconomic status and health, Nancy Adler et al. state:

"Throughout history, socioeconomic status (SES) has been linked to health.

Individuals higher in the social hierarchy typically enjoy better health than

do those below.... The effects of severe poverty on health may seem obvi-

ous through the impact of poor nutrition, crowded and unsanitary living

conditions, and inadequate medical care.... There is evidence that the

association of SES and health occurs at every level of the SES hierarchy....

Not only do those in poverty have poorer health than those in more favored

circumstances, but those at the highest level enjoy better health than do

those just below."12

Health Defined Now it becomes clear why a narrow definition of health that would refer only

to physical fitness and/or an absence of illness would not help much with

understanding the situation of women and their health and taking action to

improve it. In contrast, the concept and ideal of health defined by the World

Health Organization (\VHO) as "a state of complete physical, mental and

social well being and not merely the absence of disease or infirmity" makes a

lot of sense. Indeed, it is the definition used in this book as not only illnesses

(e.g., HIVIAIDS) but also other conditions affecting health (e.g., education

and work) are discussed.

Using the WHO definition of health raises the challenge of lneClsuring

healtb status across societies and groups that are very different one from another in terms of culture, economy, history, demography, and medical

history.13 Nevertheless, the United Nations and other multinational agencies

have attempted to measure health status; in combination they provide the best

statistics and information currently available on the subject. Drawing from

many sources, including as careful work as possible by various multinational,

governmental, and nongovernmental agencies, researchers and officials have

no doubt that in no society today, including our own, do women enjoy the

same opportunities as men. As a 1997 UN Development Programme report

notes: "This unequal status leaves considerable disparities between how

much women contribute to human development and how little they share its

benefits." 14 Three years later, another UN report, Tbe TIVOdd's TIVOmen 2000:

Trends and Statistics, showed some gains but still found persistent disparities

between women and men worldwide in six areas: health, human rights and

political decision-making, work, education and communication, population,

and families. IS

The extent of poverty and ill health discussed above contrasts with a

genuine revolution in human health and well being in the world as a whole.

People are living longer-average life expectancy at birth in many developed

countries nearly has doubled, from about 45 in 1900 to about 78 in 2003, and

poorer countries have also experienced dramatic improvements in terms of

declines in mortality-although this positive trend has reversed in some Afri-

can countries as a result of the HIV/AIDS pandemic. 16 There have been great

improvements in health in general and success at controlling such diseases as

smallpox and cholera. At the same time, however, the health of people around

the world has been threatened by illness-causing substances, including some,

like smoking and high-fat diets, that encourage unhealthy behavior. HIV/

AIDS and TB have become scourges in more and more countries, threaten-

ing whole populations and weakening societal structures.

vVe live in a paradoxical world: while there have been tremendous health

gains in some parts of the world and among some populations, these are

counterbalanced by stagnation and decline in others. Health improvements

have been unevenly distributed. I? Gro Brundtland, former head of the World

Health Organization, in a 1998 press release, was quoted as follows: "Never

have so many had such broad and advanced access to healthcare. But never

have so many been denied access to healthcare. The developing world carries

9 0% of the disease burden, yet poorer countries have access to only 10% of

the resources that go to health." 18 Had Brundtland been highlighting women's

health, she might have added that women carry the majority of the ill health

burden but have access to a minority of resources to lighten it.

8 OUTRAGE TO COURAGE WOMEN'S HEALTH AND HUMAN RIGHTS 9

VVOmen and Human Rights: A SI07.v Dawning

The reports mentioned above hint at but do not explicitly indicate the dire

consequences that the persistent discrimination against women has for their

health status. Jonathan Mann, who spent his life as a champion of human rights

and health, made the link clear: "Discrimination against ethnic, religious,

and racial minorities, as well as on account of gender, political opinion, or

immigration status, compromises or threatens the health and well-being

and, all toO often, the very lives of millions.... Discriminatory practices

threaten physical and mental health and result in the denial of access to care,

inappropriate therapies, or inferior care."19 Being born female is a health

hazard, at times a fatal one. Mann is, to be sure, talking more broadly about human rights, a concept

that first became a worldwide preoccupation after the Second World War,

when representatives of the newly formed United Nations tried to identify

and agree upon what governments should not do to people and what they

should assure to all. Out of these discussions came the Universal Declara-

tion of Human Rights, promulgated on December 10, 1948.20 But as sig-

nificant as this achievement was, the Universal Declaration was a product of

its time. The concept of "universal" human rights was, after all, developed

by a particular set of people, people who were in positions of power at that

time. For the most part, they were male, with the notable and inspiring

exception of Eleanor Roosevelt. In subsequent decades, as individual people

and groups-previously marginalized and certainly not party to the earlier

discussions-began demanding their "rights," the UN had to rethink its

definitions, broadening them to include the needs of people whose special

vulnerabilities were not taken into consideration in the past-women, chil-

dren, indigenous people, the disabled, and so on.

Despite progress, the process was slow. These days, the idea that "women's

rights are human rights" seems obvious, but it was not until 1993, when the

UN held a conference on human rights in Vienna, that the member states

began to talk about abuses such as rape and domestic violence as "human

rights" violations. It took even longer and prodding by women's and human

rights organizations for the UN Security Council to recognize the par-

ticular violations of women's human rights in situations of war and armed

conflict, including systematic rape as a policy of war and sexual slavery for

the "comfort" of soldiers. As Human Rights vVatch noted, "Combatants

and their sympathizers in conflicts, such as those in Sierra Leone, Kosovo,

the Democratic Republic of Congo, Afghanistan, and Rwanda, have raped

women as a weapon of war with near complete impunity."21

The problem, though, was much deeper and broader than had been rec-

ognized. As Human Rights Watch put it:

Millions of women throughout the world live in conditions of abject depri-

vation of, and attacks against, their fundamental human rights for no other

reason than that they are women.... Nlen in Pakistan, South Africa, Peru,

Russia, and Uzbekistan beat women in the home at astounding rates, while

these governments alternatively refuse to intervene to protect women and

punish their batterers or do so haphazardly and in ways that make women

feel culpable for the violence. As a direct result of inequalities found in

their countries of origin, women from Ukraine, Moldova, Nigeria, the

Dominican Republic, Burma, and Thailand are bought and sold, traf-

ficked to work in forced prostitution, with insufficient government atten-

tion to protect their rights and punish the traffickers. In Guatemala, South

Africa, and Mexico, women's ability to enter and remain in the work force

is obstructed by private employers ,vho use women's reproductive status

to exclude them from work and by discriminatory employment laws or

discriminatory enforcement of the law. In the U.S., students discriminate

against and attack girls in school who are lesbian, bisexual, or trans-gen-

dered, or do not conform to male standards of female behavior. ~Nomen in

Morocco,]ordan, Kuwait, and Saudi Arabia face government-sponsored

discrimination that renders them unequal before the law-including dis-

criminatory family codes that take away women's legal authority and place

it in the hands of male family members-and restricts women's participa-

tion in public life.... Abuses against women are relentless, systematic, and

widely tolerated, if not explicitly condoned. Violence and discrimination

against women are global social epidemics, notwithstanding the very real

progress of the international women's human rights movement in iden-

tifying, raising awareness about, and challenging impunity for women's

human rights [and health] violations. 22

In response to ever-louder criticisms and complaints, the UN promulgated

two conventions of particular importance to women and girls: the Convention

on the Elimination ofAll Forms of Discrimination Against Women (known

10 OUTRAGE TO COURAGE WOMEN'S HEALTH AND HUMAN RIGHTS II

as CEDAvV or the women's convention, adopted in 1979 by the UN General Assembly)2J and the Convention on the Rights of the Child (adopted in

November 1989 and entered into force in September 1990).24 Both of these

conventions laid out guidelines to protect the rights of women and children,

but like many such documents, they lack enforcement mechanisms that are

indispensable to creating meaningful change. The Universal Declaration and other UN documents spelling out human

rights are not as far removed from the everyday health concerns of women as they may seem. After all, as Mann wrote, "Human rights and public health are

two complementary approaches, and languages, to address and advance human well-being."25 Invoking international agreements like these lends strength to

women's groups and others who try to encourage governments to improve conditions that affect women's health. In 1992, for example, at a Global Fund for Women meeting of a women's circle working to eliminate trafficking in

~ ~

women, some American participants asked activists from South and South-

east Asia what they (the Americans) could do to help the most. Expecting

the activists to say that they needed more money for their work, the eager donors were awakened by the answer: "The most important thing that you and other Americans can do to help is to get the U.S. Government to ratify

the women's convention [CEDAW] and the Convention on the Rights of the Child, both of which address the issue of trafficking in women and girls."

The activists explained that without U.S. ratification of such conventions, it was difficult, if not impossible, for them to lobby their governments for legal

change in such countries as Nepal, the Philippines, and Thailand.

The UN may seem distant to many of us, and its ways are often bureau-

cratic, but women's groups around the world have used the UN system to

lobby for change in their own countries. These activists were saying that around the world, caring women and men must join together to demand

full human rights for all women. (As of 2007, the U.S. Government has not

ratified CEDAWor the Convention on the Rights of the Child. For infor-

mation, see section on "Some Useful Resources," pp. 277-283.) For decades, women's health issues have been approached as purely

"development" issues (i.e., improving economic and social development). This focus is an instrumental one (i.e., improving women's health in order to increase productivity or providing family planning in order to reduce population levels). Why now complicate things by shifting to a human rights

framework? The answer highlights a critical difference: The human rights

approach moves the intention away from a broad instrumental approach to

an individual, human approach-to improving women's health and/or pro- viding family planning simply for the sake of justice.

The stories of Kamla and Mary, the little girls born in India and Kenya,

would not have been relevant if we were to take a strictly deve10pmentalist

approach to their situations without addressing their rights as human beings.

Recall that both were born into poor families, that one of the mothers had suffered violence, and that just because they were born female, both were

destined to have problems gaining access to education and other services.

Arguing a development rather than a human rights approach would result

in the idea that the poor will always be with us, that governments should try to educate girls in order to increase national productivity, and that domes-

tic violence is a private rather than a public matter and need be considered primarily to calculate a society's health costs.

A human rights perspective demands that we recognize that providing education for girls, for example, is not only a good development decision but

also a question of justice, of individual rights. It leads us to see that tolerating

sexual abuse is not just a bad economic choice, in terms of health costs, but also

a violation of a woman's right to bodily integrity. A human rights view reveals that maternal mortality is not only a tragedy because it deprives children of a caregiver but an abrogation of the right of a woman to basic health care.

The rights to "life, liberty, and security of person" and to freedom from

"slavery or servitude" and "cruel, inhuman, or degrading treatment or pun-

ishment" in articles 3,4, and 5 of the Universal Declaration were to be guar- anteed to every person. Who could take issue with that? The problem is the

context: these words referred to civil and political prisoners, not to people

who were subjected to "slavery," "torture," or "cruel, inhuman, or degrading

treatment" in their homes or places of work. It was the human rights advocates

who highlighted the importance of equality and freedom from bodily harm for individual people whose circumstances were not recognized in early international conventions on human rights. It was women's advocacy groups who proclaimed at the 1993 UN Conference on Human Rights in Vienna: "Women's rights are human rights." This is an idea that Eleanor Roosevelt would surely have fully understood, but it is an idea that did not make its way into public consciousness until the 1990S.

I2 OUTRAGE TO COURAGE WOMEN'S HEALTH AND HUMAN RIGHTS

Why Focus on VVOnzen?

The discrepancies in opportunity and access for women already highlighted

here may be reason enough to focus a discussion on women. But there are

other reasons to learn more about the experiences of women and their health.

Women, whether healthy or not, are at the heart of family and society.

A woman's health affects every area of her life and therefore of her family and

community. Today, for a variety of reasons, women often end up as the sole

supporters of their children. \Vhile percentages vary around the world, in

many countries more than 30% of households are headed by single females. 26

Women are not just productive members of a family; often they are its safety

net. If the truth of women's lives, in all their complexity, is hidden from us, change is unlikely.

The subordination of women as well as the persistence of poverty, the

proliferation of violence, and continuing gaps in access to food, health care,

education, and living wages are in their breadth and depth like a war on

women. These inequalities-these violations of the human rights ofwomen-

stem from a basic dislocation in society that distorts the lives of both men

and women. This dislocation has to do with the way we conceive of ourselves

in relation to others. Focusing on and learning more about the situation of

women may help us transform our "either/or" way of thinking and change the way that we view and treat each other in this world.

At the moment, we are caught in a paradigm of behavior that is unhealthy.

It is an either/or paradigm that leads us to categorize people and then assign

values to the various categories-black versus white, male versus female,

strong versus weak, educated versus uneducated, rich versus poor. Instead

of appreciating and welcoming such differences, we use these dichotomies

to separate ourselves and even pit ourselves against one another. Although

there is nothing inherently unequal or even negative about assigning

categories-perhaps a natural human tendency-it is the destructive value

judgments that follow that need to be eliminated. This paradigm of see-

ing people who are different from ourselves as the "other" and possibly of lesser value has resulted in the marginalization and subordination of certain

groups over the years (groups such as people of color, indigenous people,

differently abled people, and women). The result has been the development of hierarchical social structures, structures that have subordinated more

than half of the world's population-·-women and groups of marginalized

men as well. \Ve need to understand and work to change the paradigm of "either/or" to "both/and."

The "either/or" paradigm is perfectly illustrated by the si anificant state- . b

ments: "It's a girl!" or "It's a boy!" Society's different and value-laden reac-

tions to these two statements will determine the course and health of a person's life.

The subordination ofwomen is deeply ingrained in the lives of both men

and women. Sometimes it is explained in terms of biological differences. 2i

Over time, culture, religion, and most social systems, including educational,

legal, and medical systems, which in both traditional and modern forms tend

to be hierarchical in structure, have assigned less status and power to women

and other marginalized groups. 28 The subordination ofwomen and girls takes

many forms. At the moment of birth, celebrations may differ according to

the sex of the baby. In childhood, girls' and boys' access to food, health care,

and education often differs. Later in life, women's subordination is illustrated

in the objectification of women's bodies, the gendered division of labor, and persistent abuse of women and girls.

As the realities of women's lives demonstrate, the state of women's health

is critically connected to the subordination of women. Throughout this

book, many examples of this subordination will be cited and described. How-

ever, it is important to remember, as Gerda Lerner argues in The Creation ofPatriarchy, that:

vVhile women have been victimized by ... many other aspects of their

long subordination to men, it is a fundamental error to try to conceptual-

ize women primarily as victims. To do so at once obscures what must be

assumed as a given of women's historical situation: vVomen are essential

and central to creating society; they are and always have been actors and

agents in history. "Vomen have "made history," yet they have been kept from knowing their history and from interpreting history, either their own

or that of men.... The tension between women's actual historical experi-

ence and their exclusion from interpreting that experience I have called

"the dialectic of women's history".... [which] has been a dynamic force,

causing women to struggle against their condition.... This coming-into-

consciousness of women becomes the dialectical force moving them into action to change their condition and to enter a new relationship to male- dominated society.29

OUTRAGE TO COURAGE WOMEN'S HEALTH AND HUMAN RIGHTS IS

WOMEN'S COURAGE: ACCRA, GHANA. The African Women's Development

Fund (AWDF) raises money and gives grants to projects initiated by African

women for African women. Founded in 2000, the Fund is one of about twenty

women's funds around the world that have formed in the last ten years to

provide support to women's human rights organizations in their countries or

regions. AWDF gives grants ranging in size from about $lOpOO to $25,000 to

strengthen and link smaller women's groups throughout Africa. The Fund also

provides technical assistance in organizational management and assistance in

communications and networking.

The Fund helps women's groups defend and improve women's rights in

areas such as reproductive health, political participation, access to healthcare,

and employment. Between 2000 and 2007, AWDF provided grants to groups

in more than thirty-two African nations.

The examples of women's groups inserted throughout the text in this book represent this "coming-into-consciousness" of women, that force that is moving them into action to change their condition.

A final and important reason to understand the complex health situa- tion of poorer women is to better appreciate our global interconnectedness. William Budd, a physician, writing about typhoid in I 93 I, noted: "This disease

not seldom attacks the rich, but it thrives among the poor. But by reason of

our common humanity we are all, whether rich or poor, more nearly related

here than we are apt to think. The members of the great human family are,

in fact, bound together by a thousand secret ties, of whose existence the world in general little dreams. And he that was never connected with his poorer neighbor, by deeds of charity or love, may one day find, when it is

too late, that he is connected with him by a bond which may bring them both, at once, to a common grave."30 Adding SARS, avian flu, or BIV/AIDS

along with one or two politically correct changes in pronouns makes this quote timely today.

\Nomen in poorer countries are much more vulnerable to the kinds of

infectious diseases alluded to in the previous paragraph than are people in richer countries. Still, women around the world deeply feel their shared struggles around such health issues as domestic violence, reproductive rights, and equal access to paid employment.

But the clarion call in Dr. Bud's statement, to me, is the phrase "by reason

ofour C07nJtzon humanity [my emphasis] we are all, whether rich or poor, more nearly related here than we are apt to think." Though women and men may

share vulnerabilities and struggles relating to issues of health and human rights, our true bond of interconnectedness is in our common humanity.

We can choose to live by universal standards of justice, and we can choose to create change to make that justice possible for all.

To improve women's health we must treat specific health problems, but the conditions of women's lives must also change so that we women can gain

more power over our lives and our health. At the base of such social change

is extending women's capacity to be in charge of our own lives, to exercise our human rights.

\Ve focus on women, therefore, because women's experiences are dif- ferent and under-studied, because societies need women to be healthy and

fully engaged, because it is only fair that women have full equality in their

societies. And we focus on women because understanding their unique chal- lenges is a prerequisite to justice.

"Anne Firth Murray's book gives us a moving and insightful perspective on the chal- lenges and triumphs of women working across the globe to ensure that most basic of human rights-good health. Her stories of women's creativity and courage in mobilizing to ensure equal access to healthcare are inspiring and hopefuL This is a book about one of the most critical subjects of our time. Read it."

-Kavita N. Ramdas, President and CEO The Global Fund For Women

"Anne Firth Murray is an inspiration. As Stanford's foremost authority on international women's health and human rights issues, she has inspired a generation of students to "think big" and take action for a brighter future for women globally. This book is a must-read for every future leader of our time."

-Lee Trope, founder and director of the thinkBIG conference on International Women's Health and Human Rights

"Anne Firth Murray provides a broad, comprehensive survey of global women's health that is grounded in local and personal stories. While detailed accounts of the devaluing of women at every stage in the life cycle provoke outrage, the efforts to redress underlying economic, educational, and medical inequalities inspire courage. This book clearly documents why human rights movements must always address women's rights."

-Estelle B. Freedman, Professor, Stanford University; author, No TU17Iing Btlck: The Risto1Y ofFe1llini.w1t tlnd the Future ofVVOllle11

From Outrage

to Courage W071zen Taking Action for Health and Justice

(J.C) Q 8) ANNE FIRTH MURRAY

COMMON COURAGE PRESS

MONROE, MAINE