Unsafe world for women - Sept 1504

SAFE WOMANHOOD IN A CHALLENGING WORLD Afaf I. Meleis, PhD Dean and Margaret Bond Simon Chair School of Nursing University of Pennsylvania Philadelphia, PA September 15, 2004

Why Is Our World Unsafe? ♀ Violence: wars, terrorism ♀ Infections: new and reemerging ♀ Environment: accidents, pollution, lack of caring and support

♀ Unhealthy life styles: eating, sleeping, activity, smoking

Why Is the World Unsafe for Women?

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.

A Framework for Discussion on Unsafe World for Women and Their Health

♀ The context for my comments: ď źResearch to uncover the lived experiences of low- or no income women

Women From: ♀ Brazil ♀ Columbia ♀ Egypt ♀ Kuwait ♀ Mexico

We Studied (Total N of research participants=1161): ♀ Per diem maids in Columbia ♀ Per diem maids in Egypt ♀ Fishermen’s 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

The Context for My Comments ♀ In addition to the many years of researching women’s 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 firsthand experience what it is like to be abused, harassed or violated, I can look at these experiences from an outsider’s perspective and, somewhat, an insider’s position and understand and relate to these experiences.

What Qualifies Me to Speak on the Subject of Women Globally?

♀ A nurse and medical sociologist ♀ 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

The Context of My Comments is Profoundly Influenced by • Being a nurse • A medical sociologist • An immigrant • A feminist • A researcher

What Makes the World Unsafe for Women ♀ The burden of women’s work

Women’s work is veiled, voluminous, and devalued

In developing countries women produce 75% of food

In sub-Saharan Africa and Caribbean, they provide 80% of staple food

An African Proverb: “Without Women We Would All Go Hungry”

In Asia women carry 90% of the rice field

Work At home women cook, clean, carry water, sew, bake, and care for families

Women’s Work ♀ Much of work is not remunerated and ♀ ♀ ♀ ♀

not factored into economic productivity as the gross national product; Women are self-employed or in unpaid labor; Women considered unproductive by economists and development experts; Women’s work underreported and underestimated; However, there is a beginning recognition of how women are vital for the hunger and economic crises

Nationally and Internationally ♀ Economic and labor statistics do not reflect women’s work outside of the context of the formal labor force

Women’s Work: ♀ When women’s work is

unacknowledged and devalued; ♀ Limited studies of employment and health; ♀ Almost non-existent studies of work and health; ♀ Occupational surveillance for risks and hazards and for prevention minimally addressed; ♀ Work risks not addressed.

Man works from sun to sun, but woman’s work is never done: Insights on research and policy Meleis, A.I., & Lindgren, T., Health Care for Women International (in Press)

Women create and maintain community life and provide emotional work

“I am a poor, nonworking person.

I am just a housewife.�

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

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

Vicious Circle ♀ Even when women try to use their

culture-imposed types of work to earn better living, they become: Maids Nannies to well-to-do families in high-income societies.

♀ They are

oExploited oAbused oDriven to suicides (may be!)

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

It is a worldwide phenomenon that women are defined by marriage and are always under enormous pressure to “be found� by a

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

CHILD LABOR

CHILD LABOR

What Makes the World Unsafe for Women: ♀ The burden of work (producing)

♀ Violence

♀ Laws that condone and support domestic violence under the pretence that this is a family matter

♀ Social pressure that forbids women from disclosing

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

Laws that violate women: stoning for having a baby out of wedlock

♀ Some may say changes in political regimes may bring more safety for women…

Let’s look at what happened in the Soviet Union -

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; Families often do not support the victims; “Beating is always a woman’s fault. Men never beat for nothing”; Rape in marriage; Limited access to higher education; Stigmatization of divorced women; Polygamy; Poverty and limited employment opportunities due to gender discrimination.

Issues Facing Ukrainian Women: ♀ Domestic violence ♀ Medical service to women, especially ♀ ♀ ♀ ♀ ♀

pregnant, is often inadequate High rates of infant mortality, miscarriages, and STD’s High cost of contraceptives and lack of basic knowledge of family planning leading to high abortion rates 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

Examples from Eastern Europe: ♀ Since 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

Violence oWars oTerrorism

♀ For women these mean:  Rape  Trafficking  Sex industry  Infections  Burden of more work  Loss of work as men come back from war  Religious revival

How about Afghanistan and Iraq post-war liberation?

Publications on the Issue

Rape: Violence and Children

♀ In times of economic turmoil, women suffer the most for their families: ď źWomen are fired first ď źWhen rations are given, usually to men, women may be forced to prostitute themselves to feed their families

There are hidden consequences to 9/11:

“Domestic Violence is a Taboo” exacerbated by terrorism

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

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 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

“A son gave her security in the marriage, and was going to be a man, a bread winner�

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

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

What Makes the World Unsafe for Women ♀ Burden of Women’s work (producing)

♀ Violence ♀ Pregnancy, birthing, motherhood (reproducing)

♀ Resources

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

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

Themes in the Lives of Women ♀ Felt exploited ♀ Overload ♀ Worry ♀ Social insecurity ♀ Economic insecurity ♀ Inaccessible health care system

Marginalization ♀ Intermediacy ♀ Differentiation ♀ Power ♀ Secrecy ♀ Reflectiveness ♀ Voice ♀ Liminality

Single best predictor of perceived wellbeing was role integration, balance between stressors, and satisfaction in all combines roles.

Coping Strategies and Resources ♀ Turning to self ♀ Problem solving ♀ Reaching out

Women’s Health as a Foreign Policy ♀ Change conceptual framework

♀ Explicit policies ♀ Redefine work

Change Conceptual Framework ♀ Stereotyping, morality, reproductive, stigma, and exploitive

♀ Vulnerable, gendered, equity and empowering

What Will Make the World Safe for Women? ♀ Women’s health on the agenda

♀ Equity ♀ Opportunities ♀ Paradigm Change - gender

Explicit Policies ♀ Develop health programs that

acknowledge women’s 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

Expanding the Visibility of Women’s Work: Policy Implications Messias, D.H, Regev, H., Im, E., Spiers, J., Van, P. & Meleis, A.I.(1997) Nursing Outlook, 45, 258-264

Defining and Redefining Work Implications for Women’s Health Messias,D.K.H., Im, E., Page, A., Regev, H., Spiers, J. Yoder, L., & Meleis, A.I. (1997), Gender and Society 11(3), 296-323.

Work Redefined ♀ Energy expenditures ♀ Activity ♀ Space ♀ Time ♀ Resources ♀ Results ♀ Values Messias et al 1997 ♀ Meanings Meleis et al 2001

Keeping Women’s Health as a Top Priority on National and International Agenda ♀ Education ♀ Development ♀ Research ♀ Services

Women in a Safe World