Health is the reflection of any society’s commitment to equality and justice. The Middle East and North Africa countries are characterized by a state of dramatic inequality and lack of gender justice resulting from cultural discrimination, wars, conflict, poverty, unemployment, and refuge, which gravely affects health hazards that women endure in their lives, as well as their self-confidence and access to assistance from social support systems to deal with health related problems. For example, the insufficient education made available for women leads to limited social and economic opportunities. Therefore, women are driven to poverty and lack spending power. Moreover, the restrictions imposed on the movement of women and girls, as well as impediments before their decision making abilities and their lack of self-confidence and inequality before the law pose obstacles before women and girls that prevent them from accessing healthcare services, including reproductive and sexual health care, efficiently and fairly.
Women and girls in the Middle East and North Africa face violations in all aspects of life, which in turn affect health:
· UN Women’s website asserts that one of three women in the world are subject to sexual violence at least once in their lives, mostly by their intimate partners. The percentage of women subject to physical or sexual violence in the world amounts to 35%, and in some countries 70%. The website also stresses that 37% of women in the Arab world have been subject to physical or sexual violence at least once in their lives.
· 52% of married women have the freedom to make their own decisions regarding sexual relations, the use of contraceptives and healthcare. The website adds that statistics indicate that the rates are higher in reality, however, the lack of statistics that can document all cases can change the result.
· According to the global Girls Not Brides organization, a child out of three children in the developing world gets married before the age of 18, which means that 700 million living women were married as children. If child marriage is not prevented, the number of girls married as children will become 1.2 billion by the year 2050. Early marriage in the region leads to pregnancy of teenagers with a higher rate of unwanted pregnancy results and miscarriages, not only in the first pregnancy, but also in following pregnancies. Researches indicate that early marriage during teenage years is accompanied with double the risk of miscarriage and four times the risk of losing the baby. Female teenagers are biologically and psychologically immature, therefore, pregnant teenagers are classified under the high risk category.
· According to the Arab Monetary Fund data, the unemployment rates amongst women reached 43% in the Arab world and 12% internationally. Yemen, Saudi Arabia and Palestine lead the Arab states where women face unemployment, which negatively impacts life.
· The Arab Women Organization states that illiteracy in the Arab world amounts to 30%, and is higher amongst women, as it reaches 50%. The highest illiteracy rates are in Iraq at 61%. The number of illiterate persons aged 15 and higher amounts to approximately 99.5 million people.
· Gender impacts the results of peoples’ health with relation to the actual health conditions and the understanding of healthy state and healthcare behaviors, as well as the position and response of healthcare providers and the society. Since women in different regions of the Middle East and North Africa play a key role in providing healthcare in the family, gender discrimination may also have consequences on the health of women, children, the family and the society as a whole.
· Gender standards affect institutions, including the health sector institutions. Such standards impact the chances of women and men being subject to health hazards, access to information and healthcare services, validated health results, and response to healthcare and the socioeconomic consequences of disease and illness. To address such gender discrimination phenomena, which impede women’s access to healthcare, it is important that healthcare systems provide excellent healthcare services that are not limited to maternity and childhood.
Access to Healthcare and Health Service
Access to and benefiting from health services is determined by physical access to or availability of services, economic access, cost of services, social access or the acceptability of such services. Freedom of movement, financial power and social status are important determinants for accessing healthcare, therefore, the lack of health services is considered a problem in many countries in the region, particularly those blighted by wars and constant conflicts, such as Palestine, Yemen, Syria, Libya and Iraq.
Social restrictions also impact women’s safe access to healthcare services. Women who are financially dependent on their husbands are mostly not capable of accessing such services without the husband’s approval. This is a difficult situation, particularly if the need for such services is connected to a stigma, such as seeking treatment for sexually transmitted diseases. Women’s options in selecting a healthcare provider are impacted by cultural and financial considerations.
As a result of the prevalent cultural considerations in the region, many women tend to ignore serious symptoms for long periods without any medical consultation. Women’s health is normally neglected or is not in the family’s priorities, which could lead to deterioration in medical conditions resulting from the delay in seeking treatment. Women’s lack of information and knowledge on health related issues, as well as their inability to distinguish symptoms of diseases also exacerbates the problem.
The low opportunities for receiving and using healthcare services result in some consequences on women’s and girls’ health with relation to discovering and diagnosing the disease properly, as well as delayed and non-commitment to treatment. This affects the chances of survival and recovery from disease for women, such as cancer diseases where early treatment is the preferable course of action.
The restriction imposed on women’s movement and the lack of female healthcare workers also lead to negative health results for women. On the other hand, men may also be affected by negative health results due to the fact that health centers mainly focus on pregnancy, maternal care and childhood, which constitutes another obstacle.
Women’s Decision Making Power in the Household
Women’s freedom in decision making is an important characteristic for self-independence, empowerment and personal freedom. It includes the ability to take decisions and act. Women have limited power and male members of the family normally have the final say in financial matters, issues relating to freedom of movement, children’s education, seeking healthcare and using contraceptives. In the region, it was found that women who have more decision making powers, for example, would give birth to their first child at an older age and the duration between pregnancies was longer. The ability to hold discussions and reach an agreement on family planning between spouses is an important result of giving females decision-making powers and self-independence in the family and society. The availability of good healthcare services impacts disease rates and fatality rates amongst mothers as well as physical and psychological stresses on newborns, complications relating to multiple births, unsafe abortion, low-birth-weight infants and malnutrition.
Peoples’ Health Movement – The Road to the Vision
The adoption of the Peoples’ Health Movement in Savar, Bangladesh after years of movement and mobilization through national and regional coalitions and the joining of 1400 health activists from 73 states around the world, after six years of the gathering held in Cape Town at the time to reaffirm peoples’ commitment to the struggle for health, a struggle described by Amit Sengubta as “a struggle for a more fair, just and caring world.” David Sander described the Peoples’ Health Movement’s struggle for the elimination of poverty rates and the reduction of discrepancy in wealth and income that resulted from liberal globalization, as well as strengthening public health, reforming the health sector and improving work conditions, food systems and living environments.
The vision that was included in the Peoples’ Charter for Health in 2000 and Cuenca Declaration in 2005 has now become more relevant than ever before, because the root causes for poor health and inequality are yet to be addressed and reversed. These causes are deeply rooted in the current development model that is characterized by individuality; human, capitalistic and neoliberal centralization; patriarchy; racism; religious zealousness; discrimination based on physical ability and homophobia.
Work on Gender and Health in the Middle East and North Africa
In the Middle East and North Africa states, the integration of gender responsiveness is part of the civil society organizations and social movements’ work that advocate the right to health for marginalized categories and struggle for fair gender standards. Such organizations and movements also strengthen the commitment of governments towards addressing the gender-based health system in patriarchal local communities. We at the Peoples’ Health Movement consider the investment in the education and health of women key for development. Policies must reflect the special conditions of inequality. The increased representation and involvement of women in public life is an essential element to change the existing traditional models and improve the health results of women in the region. This requires working on encouraging the participation of women, raising awareness, networking between organizations and reducing the stereotypes on women through social media, as well as encouraging community initiatives between women to face the restrictions and social and cultural bias against them.
Our goal is to increase knowledge and improve the responsiveness of the health sector by collecting data and developing rules and standards for integrating gender in health related laws, policies and programs; the participation in awareness raising activities aiming at addressing the existing gender differences in health; and encouraging the health sector policies, interventions and programs that systematically address gender related gaps.
· Research and documentation are key tools for advocacy for the Peoples’ Health Movement to document the gender gaps in health that need to be addressed. This in turn will assist the civil society organizations involved in the movement in identifying advocacy messages, policy papers and position papers that target communities and decision makers.
The Peoples’ Health Movement in the region will expand the base of allies in the Middle East and North Africa states. It will also call for the engagement of feminist, social and health organizations that struggle for the elimination of discrimination against women, combating GBV, pressure governments to ensure economic, social and cultural rights, and facilitate access to decision makers on the regional, national and local levels:
· Facilitate access to information and exchange of knowledge
· Reduce the risk of civil society organizations facing counter messages
· Support and advocate the legitimacy of the rights of inflicted categories
· Enable alliances to better access decision makers
3. Public Mobilization
· The organizations of the Peoples’ Health Movement and alliances will work on mobilizing and stirring public opinion through campaigns targeting decision makers and influencers. This aims at raising the Arab public awareness of the most important issues to address gender based discrimination and to convey the interests of the public to decision makers and hold them accountable.
· Mobilize and stir public opinion through different social and electronic media outlets. Social media has provided an important platform and opportunity to transform the public from recipients of information to (participants) activists in campaigns.