The gender gap in health is especially dramatic in the HIV/AIDS epidemic. In sub-Saharan Africa, 60 percent of all AIDS victims are women. “It is a shocking fact,” U.N. Secretary-General Kofi Annan said recently, “and one of which I, as an African man, feel ashamed, that a girl in some parts of sub-Saharan Africa is six times more likely to be affected than a boy.” Polygamy, sexual coercion and violence against women all contribute to this shameful fact. Girls are frequently pressured into sex with older men in exchange for food, clothing or school tuition–or forced into it for nothing.
Abstinence and monogamy make for fine rhetoric, but they are inadequate defenses for women who are married off young and deprived of education and social status. In Zambia, only 11 percent of women in a recent survey thought a woman had the right to ask her husband to use a condom–even though women are twice as likely as men to contract HIV from a single sex act. In Senegal, at least half the women living with HIV/AIDS have no risk factor other than living in a monogamous union. In India, where 90 percent of female infections occur within marriage, women who stand up to their husbands risk violence–and those who get infected by their husbands are often shunned by their families. Lacking other skills, they may survive by selling sex–which, of course, spreads the disease further. Any real solution to the AIDS pandemic will have to empower women through education, information and a guarantee of rights.
AIDS is not the only threat women face. Consider the current state of reproductive health. An estimated 350 million couples want effective contraception but are unable to get it. The result: approximately 80 million unintended pregnancies each year, some 19 million of which are terminated under unsafe conditions. Those unsafe abortions cause 13 percent of the 600,000 deaths women suffer annually during childbirth. Wealthy nations could prevent this tragedy for a fraction of what they spend on the military. Thoraya Ahmed Obaid, director of the United Nations Population Fund, noted recently that one day’s global military budget could “improve the lives of millions of women and families in developing countries.”
Sadly, the current U.S. administration is not providing the leadership in this critical area. Driven by ideology, it has withheld its annual $34 million contribution to the U.N. Population Fund, the world’s largest provider of family-planning services, since 2002. The Bush administration has also reimposed the so-called global gag rule, which effectively bars any organization that receives U.S. funds from discussing the full range of family-planning and reproductive-health services. At a recent regional meeting of 38 Latin American and Caribbean countries, the United States was the lone opponent of a declaration of support for women’s right to reproductive-health care and services.
When women lack reproductive-health services, they also miss opportunities to prevent and treat such killers as malaria and tuberculosis. Young children and pregnant women account for most of the world’s 1 million annual malaria deaths, 90 percent of which occur in Africa. And as HIV destroys women’s immune systems, they become ever more vulnerable to tuberculosis, the leading cause of death among people with HIV/AIDS. TB now causes half the AIDS-related deaths in Africa. This highly contagious disease can be cured with a $10 regimen of antibiotics, yet U.S. support for international treatment efforts is declining.
Equally preventable is cervical cancer, which kills 190,000 women each year, primarily in developing countries. This malignancy is caused by certain forms of human papilloma virus (HPV), or genital warts, a sexually transmitted infection whose complications are treatable at early stages. HPV is still common in developed nations, but routine Pap smears and early treatment reduced cervical cancer in the United States, for instance, by 74 percent between 1955 and 1992. The story is different in developing countries, where testing and treatment remain distant dreams for most women.
Disease isn’t the only threat to women’s health. Every year some 2 million girls and young women worldwide are subjected to genital mutilation, a brutal practice that can cause infertility and long-term ill health. And far more experience rape, assault and sexual coercion. Almost half of all girls from 10 to 25 say their first sexual encounter was forced, and the U.N. estimates that one in three girls will fall victim to violence in her lifetime. When women lack the right to property or inheritance, they often stay in abusive relationships for fear of losing their home or their children. Educated women with economic rights are far less likely to become victims. And when women aren’t victims, their whole societies benefit.
Last year during a trip to India I met with a group of adolescent girls in the slums of New Delhi. Some were as young as 12. Most of their friends were already married–their futures foreordained and severely circumscribed. But the girls I met still had their hopes and dreams. The question is whether they and their sisters will be able to protect themselves in a world where the balance still tilts heavily against them. The answer will be decided not only in the slums of South Asia but in the capitals of the world’s wealthiest nations and in the halls of great international institutions.
title: “A Worldwide Gender Gap” ShowToc: true date: “2023-01-05” author: “David Johns”
The gender gap in health is especially dramatic in the HIV/AIDS epidemic. In sub-Saharan Africa, 60 percent of people with AIDS are women. “It is a shocking fact,” U.N. Secretary-General Kofi Annan said recently, “and one of which I, as an African man, feel ashamed.” Polygamy, sexual coercion and violence against women all contribute to this distressing fact. Girls are frequently pressured into sex with older men in exchange for food, clothing or school tuition.
Abstinence and monogamy make for fine rhetoric, but they are inadequate defenses for women who are married off young and deprived of education and social status. In Zambia only 11 percent of women in a recent survey thought a woman had the right to ask her husband to use a condom–even though women are twice as likely as men to contract HIV from a single sex act. In India, where 90 percent of female infections occur within marriage, women who stand up to their husbands risk violence–and those who get infected by their husbands are often shunned by their families. Lacking other skills, they may survive by selling sex–which, of course, spreads the disease further. Any real solution to the AIDS pandemic will have to empower women through education and a guarantee of human and reproductive rights.
AIDS is not the only threat women face. Consider the current state of reproductive health. An estimated 350 million couples want safe and effective contraception but are unable to get it. The result: approximately 80 million unintended pregnancies each year, some 19 million of which are terminated under unsafe conditions. Those unsafe abortions cause 13 percent of the 529,000 deaths that women suffer annually during pregnancy and childbirth. Wealthy nations could prevent this tragedy for a fraction of what they spend on the military. Yet the neglect continues. Since 2002 the United States has withheld its annual $34 million contribution to the United Nations Population Fund, the world’s largest provider of family-planning services.
When women lack reproductive-health services, they also miss opportunities to prevent and treat such killers as malaria and tuberculosis. Young children and pregnant women account for most of the world’s 1 million annual malaria deaths, 90 percent of which occur in Africa. And as HIV destroys their immune systems, women become ever more vulnerable to tuberculosis. TB now causes half of the AIDS-related deaths in Africa. This highly contagious disease can be cured with a $10 regimen of antibiotics, yet U.S. support for international treatment efforts is declining.
Disease isn’t the only risk. Every year some 2 million girls and young women worldwide are subjected to genital mutilation, a barbaric practice that can cause infertility and long-term ill health. And far more experience rape, battering and sexual coercion. Almost half of all girls from 10 to 25 say their first sexual encounter was forced, and the United Nations estimates that one in three girls will fall victim to violence in her lifetime.
Last year, during a trip to India, I met with a group of adolescent girls in the slums of New Delhi. Some were as young as 12. Most of their friends were already married–their futures foreordained and severely circumscribed. But the girls I met still had their hopes and dreams. The question is whether they will be able to protect themselves in a world where the balance still tilts heavily against them. The answer will be decided not only in the slums of South Asia but in the capitals of the wealthiest nations. Leadership must come from the top–starting with Washington–or this injustice will never end.
